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STUDY DESIGN.: Systematic review. OBJECTIVE.: To perform a systematic review, evaluating the best available evidence regarding the treatment of lumbar adjacent segment pathology (ASP) to facilitate clinical recommendations for treatment. SUMMARY OF BACKGROUND DATA.: It is unclear how nonoperative treatment of lumbar clinical ASP (CASP) compares with operative treatment, and it is also unclear if 1 type of operative treatment is superior to another in the treatment of lumbar CASP. Given that ASP occurs with a known frequency after fusion, it is important to understand outcomes for treatment based on the best available evidence. METHODS.: We conducted a systematic search in PubMed and the Cochrane Library for literature published through February 2012 for lumbar ASP. Our first goal was to identify studies comparing operative with nonoperative management of lumbar ASP. Our second goal was to identify studies comparing operative with operative management of lumbar CASP. Our third goal was to identify case series evaluating outcomes after the treatment of lumbar CASP. The overall body of evidence with respect to each clinical question was determined on the basis of precepts outlined by the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) working group and recommendations made by the Agency for Healthcare Research and Quality. RESULTS.: No studies comparing operative with nonoperative management or comparing operative with operative management of CASP were identified in the literature. Eight case series were identified for the treatment of CASP with decompression alone, decompression and fusion, or decompression and disc arthroplasty. CONCLUSION.: The strength of evidence supporting these clinical questions was insufficient based on GRADE criteria; therefore, conclusions are based on the best available evidence and clinical experience. Operative management for lumbar CASP should be considered after failure of nonoperative management. When considering the type of operative treatment for lumbar CASP, clinical judgment, radiographical appearance, and patient preference should guide operative intervention. If a patient's disability secondary to lumbar CASP is high enough, consideration should be given to operative treatment. All these recommendations are weak based on GRADE. CONSENSUS STATEMENT: [ABSTRACT FROM AUTHOR]

Study Design: Systematic review.Objective: To systematically search for critically appraise and summarize studies that (1) evaluated the association between degenerative magnetic resonance imaging (MRI) changes and chronic low back pain (CLBP) and (2) compared surgical and nonsurgical treatment of these degenerative MRI changes.Summary Of Background Data: The role of routine MRI in patients with CLBP is unclear. It is also uncertain whether or not surgical treatment of degenerative MRI changes results in alleviation of back pain.Methods: Systematic literature searches were conducted in PubMed for studies published through March 1, 2011. To evaluate whether MRI degenerative changes are associated with CLBP, studies that were designed to compare the prevalence of MRI changes among subjects with and without CLBP were sought. The prevalence odds ratio was used to compare the odds of degenerative MRI findings in subjects with CLBP to the odds of such findings among those without CLBP. To evaluate whether surgical treatment of degenerative MRI changes is associated with different outcomes compared with nonsurgical treatment, comparative studies were sought. The GRADE system as applied to describe the strength of the overall body of evidence.Results: Regarding the association of degenerative changes on MRI and CLBP, five studies were included, all of which were cross-sectional in design. On the basis of these studies, a statistically significant association was found in all but one study regarding the presence of disc degeneration and CLBP (odds ratio range: 1.8-2.8). The overall strength of evidence across studies was considered to be insufficient, however. No comparative studies of surgical versus nonsurgical treatment of degenerative MRI changes were identified.Conclusion: Although there may be an association between degenerative MRI changes and CLBP, it is unknown if these estimates accurately represent the association given the quality of included studies, lack of a direct link between degenerative MRI changes and CLBP, and heterogeneity across studies. Thus, a strong recommendation against the routine use of MRI for CLBP evaluation is made. Since there are no data evaluating the efficacy of the surgical treatment of degenerative MRI changes, a strong recommendation is made against the surgical treatment of CLBP based solely upon degenerative MRI changes.Clinical Recommendations: Recommendation1: There is insuffi cient evidence to support the routine use of MRI in patients with CLBP.Recommendation: StrongRecommendation2: Surgical treatment of CLBP based exclusively on MRI fi ndings of degenerative changes is not recommended.Recommendation: Strong. [ABSTRACT FROM AUTHOR]

The article presents an abstract on the role of sulfoglucuronyl (HNK-I) carbohydrate and its binding protein in the development of rat cerebellum. Developmental expression of sulioglucuronyl carbohydrate and its binding protein SBP-1 is useful to understand the function of SBP- I. During early posnatal development, SBP-l expresses in the granule neurons of the external and internal granule cell layers.

The article presents an abstract of the research paper "Role of Sulfoglucuronyl (HNK-1) Carbohydrate and its Binding Protein,SBP-1 in Developing Rat Cerebrum." It will be presented in the joint meeting of the International Society for Neurochemistry and the European Society for Neurochemistry that will be held in Berlin, Germany from August 8-14, 1999. Potential mechanism for guidance in neuronal migration is provided by the SBP1 -sulfoglucuronyl carbohydrate interactions.

Aims: Fractures of the pelvis and acetabulum are often the consequence of high energy trauma in young individuals or fragility fractures in osteoporotic bone. They can be life-threatening or life changing injuries. No published data exists comparing body mass index (BMI) and mortality for this patient group. The aim of this study was to identify if low BMI (<18.5) was a predictor of morbidity and mortality for patients with these injuries.Patients and Methods: Of the 1033 patients with pelvic or acetabular fractures referred to a single level 1 major trauma centre (MTC) over a 4.5-year period (August 2015 - January 2020); we retrospectively analysed data for all admitted patients. Data was collected on demographics, injury pattern, operative intervention and complications. Comparison was made between patients that were underweight (BMI<18.5) and patients that were not. Both in-hospital and post discharge complications were recorded including pulmonary embolus (PE), deep venous thrombosis (DVT), ileus, infection, loss of reduction and mortality at 6 months.Results: 569 patients admitted to the MTC with a pelvic or acetabular fracture were included in our analysis. Underweight patients had a statistically significant increase in mortality both in-hospital (p = 0.019) and at 6 months post injury (p = 0.039) when compared to other BMI groups. No statistical significance was found between these BMI groups comparing morbidity: DVT (p = 0.712), PE (p = 0.736) nor ileus (p = 0.149). Covariate analysis showed that a low BMI was associated with triple the in-hospital mortality after correction for age and energy of injury (adjusted OR 3.028, 95% CI 1.059-8.659).Conclusion: This is the first published study that demonstrates a statistically significant increase in mortality in patients with pelvic or acetabular fractures who are underweight. Surgeons should carefully consider appropriate peri-operative optimisation for these patients. Further investigation into the effects of low BMI and response to trauma is required. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between ovarian immobility and presence of endometriomas and assess the diagnostic accuracy of transvaginal sonographic (TVS) ovarian immobility in the detection of deep infiltrating endometriosis (DIE).Methods: This was a multicenter prospective observational study of women presenting with chronic pelvic pain from January 2009 to March 2015. Women with or without history of endometriosis who were scheduled to undergo laparoscopic surgery for endometriosis gave a detailed history and underwent specialized TVS in a tertiary referral unit prior to laparoscopy. During TVS, ovarian mobility and the presence of endometriomas were assessed. The relationship between TVS ovarian mobility, with or without endometriomas, and DIE was correlated with the gold standard, diagnosis of endometriosis at laparoscopy.Results: Included in the analysis were 265 women with preoperative TVS and laparoscopic outcomes. Ovarian immobility on TVS was significantly associated with presence of endometriomas at surgery, with a prevalence of 12.2%, 10.8% and 52.7% for fixation of the left ovary only, the right ovary only and bilateral ovaries, respectively, compared with 4.2%, 3.7% and 7.3% for normal ovaries. The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and positive and negative likelihood ratios of TVS ovarian immobility for diagnosis at surgery of immobility of ovaries with endometriomas in the left ovary only were 44.4%, 92.3%, 44.4%, 92.3%, 5.8, 0.6, in the right ovary only were 50.0%, 98.5%, 80.0%, 94.2%, 33.0, 0.5 and bilaterally were 74.4%, 68.6%, 72.5%, 70.6%, 2.4, 0.4, while those for diagnosis of immobility of normal ovaries were 25.0%, 87.9%, 8.3%, 96.4%, 2.1, 0.9 for left ovary only, 14.3%, 92.9%, 7.1%, 96.6%, 2.0, 0.9 for right ovary only and 35.7%, 97.2%, 50.0%, 95.0%, 12.6, 0.7 bilaterally, respectively (P < 0.05 except for normal left and right ovaries with P = 0.2 and 0.4, respectively). The sensitivity, specificity, PPV and NPV for performance of ovarian immobility in the prediction of DIE for all women were 58.3%, 74.1%, 60.6%, 72.2% and in the prediction of need for bowel surgery were 78.2%, 71.1%, 41.3%, 92.6%, respectively.Conclusions: There is a significant association between ovarian immobility and the presence of endometriomas. Ovarian immobility as a sonographic 'soft marker' of DIE performs better in the presence of endometriomas compared with in normal ovaries. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Objective: Laparoscopic sacrocolpopexy is becoming an increasingly popular surgical approach for repair of apical vaginal prolapse. The aim of this study was to document the postoperative anterior mesh position after laparoscopic sacrocolpopexy and to investigate the relationship between mesh location and anterior compartment support.Methods: This was an external audit of patients who underwent laparoscopic sacrocolpopexy for apical prolapse ≥ Stage 2 or advanced prolapse ≥ Stage 3, between January 2005 and June 2012. All patients were assessed with a standardized interview, clinical assessment using the International Continence Society Pelvic Organ Prolapse quantification and four-dimensional transperineal ultrasound to evaluate pelvic organ support and mesh location. Mesh position was assessed with respect to the symphysis pubis whilst distal mesh mobility was assessed using the formula √[(XValsalva - Xrest )2 + (YValsalva - Yrest )2 ], where X is the horizontal distance and Y is the vertical distance between the mesh and the inferior symphyseal margin, measured at rest and on Valsalva.Results: Ninety-seven women were assessed at a mean follow-up of 3.01 (range, 0.13-6.87) years after laparoscopic sacrocolpopexy, 88% (85/97) of whom considered themselves to be cured or improved, and none had required reoperation. On clinical examination, prolapse recurrence in the apical compartment was not diagnosed in any patient; however, 60 (62%) had recurrence in the anterior compartment and 43 (44%) in the posterior compartment. On ultrasound examination, mesh was visualized in the anterior compartment in 60 patients. Both mesh position and mobility on Valsalva were significantly associated with recurrent cystocele on clinical and on ultrasound assessment (all P < 0.01). For every mm that the mesh was located further from the bladder neck on Valsalva, the likelihood of cystocele recurrence increased by 6-7%.Conclusion: At an average follow-up of 3 years, laparoscopic sacrocolpopexy was highly effective for apical support; however, cystocele recurrence was common despite an emphasis on anterior mesh extension. Prolapse recurrence seemed to be related to mesh position and mobility, suggesting that the lower the mesh is from the bladder neck, the lower the likelihood of anterior compartment prolapse recurrence. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

The article discusses the ICD-PM perinatal period deaths classification being developed by the World Health Organization based on existing International Classification of Diseases-10 (ICD-10) codes. Topics include reference to unrecognized stillbirths or neonatal deaths, unifying perinatal death classification system with the contributing maternal factors as well as convened groups of experts such as obstetricians and neonatologists. Also mentioned are ICD-MM codes and the epidemiologists.

Objective: To apply the World Health Organization (WHO) Application of the International Classification of Diseases, tenth revision (ICD-10) to deaths during the perinatal period: ICD-Perinatal Mortality (ICD-PM) to existing perinatal death databases.Design: Retrospective application of ICD-PM.Setting: South Africa, UK.Population: Perinatal death databases.Methods: Deaths were grouped according to timing of death and then by the ICD-PM cause of death. The main maternal condition at the time of perinatal death was assigned to each case.Main Outcome Measures: Causes of perinatal mortality, associated maternal conditions.Results: In South Africa 344/689 (50%) deaths occurred antepartum, 11% (n = 74) intrapartum and 39% (n = 271) in the early neonatal period. In the UK 4377/9067 (48.3%) deaths occurred antepartum, with 457 (5%) intrapartum and 4233 (46.7%) in the neonatal period. Antepartum deaths were due to unspecified causes (59%), chromosomal abnormalities (21%) or problems related to fetal growth (14%). Intrapartum deaths followed acute intrapartum events (69%); neonatal deaths followed consequences of low birthweight/ prematurity (31%), chromosomal abnormalities (26%), or unspecified causes in healthy mothers (25%). Mothers were often healthy; 53%, 38% and 45% in the antepartum, intrapartum and neonatal death groups, respectively. Where there was a maternal condition, it was most often maternal medical conditions, and complications of placenta, cord and membranes.Conclusions: The ICD-PM can be a globally applicable perinatal death classification system that emphasises the need for a focus on the mother-baby dyad as we move beyond 2015.Tweetable Abstract: ICD-PM is a global system that classifies perinatal deaths and links them to maternal conditions. [ABSTRACT FROM AUTHOR]

Objective: We explore preterm-related neonatal deaths using the WHO application of the International Classification of Disease (ICD-10) to deaths during the perinatal period: ICD-PM as an informative case study, where ICD-PM can improve data use to guide clinical practice and programmatic decision-making.Design: Retrospective application of ICD-PM.Setting: South Africa, and the UK.Population: Perinatal death databases.Methods: Descriptive analysis of neonatal deaths and maternal conditions present.Main Outcome Measures: Causes of preterm neonatal mortality and associated maternal conditions.Results: We included 98 term and 173 preterm early neonatal deaths from South Africa, and 956 term and 3248 preterm neonatal deaths from the UK. In the South African data set, the main causes of death were respiratory/cardiovascular disorders (34.7%), low birthweight/prematurity (29.2%), and disorders of cerebral status (25.5%). Amongst preterm deaths, low birthweight/prematurity (43.9%) and respiratory/cardiovascular disorders (32.4%) were the leading causes. In the data set from the UK, the leading causes of death were low birthweight/prematurity (31.6%), congenital abnormalities (27.4%), and deaths of unspecified cause (26.1%). In the preterm deaths, the leading causes were low birthweight/prematurity (40.9%) and deaths of unspecified cause (29.6%). In South Africa, 61% of preterm deaths resulted from the maternal condition of preterm spontaneous labour. Among the preterm deaths in the data set from the UK, no maternal condition was present in 36%, followed by complications of placenta, cord, and membranes (23%), and other complications of labour and delivery (22%).Conclusions: ICD-PM can be used to appraise the maternal and newborn conditions contributing to preterm deaths, and can inform practice.Tweetable Abstract: ICD-PM can be used to appraise maternal and newborn contributors to preterm deaths to improve quality of care. [ABSTRACT FROM AUTHOR]

Objective: The WHO application of the tenth edition of the International Classification of Diseases (ICD-10) to deaths during the perinatal period (ICD Perinatal Mortality, ICD-PM) captures the essential characteristics of the mother-baby dyad that contribute to perinatal deaths. We compare the capture of maternal conditions in the existing ICD-PM with the maternal codes from the WHO application of ICD-10 to deaths during pregnancy, childbirth, and the puerperium (ICD Maternal Mortality, ICD-MM) to explore potential benefits in the quality of data received.Design: Retrospective application of ICD-PM.Setting: South Africa and the UK.Population: Perinatal death databases.Methods: The maternal conditions were classified using the ICD-PM groupings for maternal condition in perinatal death, and then mapped to the ICD-MM groupings of maternal conditions.Main Outcome Measures: Main maternal conditions in perinatal deaths.Results: We reviewed 9661 perinatal deaths. The largest group (4766 cases, 49.3%) in both classifications captures deaths where there was no contributing maternal condition. Each of the other ICD-PM groups map to between three and six ICD-MM groups. If the cases in each ICD-PM group are re-coded using ICD-MM, each group becomes multiple, more specific groups. For example, the 712 cases in group M4 in ICD-PM become 14 different and more specific main disease categories when the ICD-MM is applied instead.Conclusions: As we move towards ICD-11, the use of the more specific, applicable, and relevant codes outlined in ICD-MM for both maternal deaths and the maternal condition at the time of a perinatal death would be preferable, and would provide important additional information about perinatal deaths.Tweetable Abstract: Improving the capture of maternal conditions in perinatal deaths provides important actionable information. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To use office gel sonovaginography ( SVG) to predict posterior deep infiltrating endometriosis ( DIE) in women undergoing laparoscopy. Methods This was a multicenter prospective observational study carried out between January 2009 and February 2013. All women were of reproductive age, had a history of chronic pelvic pain and underwent office gel SVG assessment for the prediction of posterior compartment DIE prior to laparoscopic endometriosis surgery. Gel SVG findings were compared with laparoscopic findings to determine the diagnostic accuracy of office gel SVG for the prediction of posterior compartment DIE. Results In total, 189 women underwent preoperative gel SVG and laparoscopy for endometriosis. At laparoscopy, 57 (30%) women had posterior DIE and 43 (23%) had rectosigmoid/anterior rectal DIE. For the prediction of rectosigmoid/anterior rectal (i.e. bowel) DIE, gel SVG had an accuracy of 92%, sensitivity of 88%, specificity of 93%, positive predictive value ( PPV) of 79%, negative predictive value ( NPV) of 97%, positive likelihood ratio ( LR+) of 12.9 and negative likelihood ratio ( LR-) of 0.12 ( P = 3. 98E-25); for posterior vaginal wall and rectovaginal septum ( RVS) DIE, respectively, the accuracy was 95% and 95%, sensitivity was 18% and 18%, specificity was 99% and 100%, PPV was 67% and 100%, NPV was 95% and 95%, LR+ was 32.4 and infinity and LR- was 0.82 and 0.82 ( P = 0.009 and P = 0.003). Conclusions Office gel SVG appears to be an effective outpatient imaging technique for the prediction of bowel DIE, with a higher accuracy for the prediction of rectosigmoid compared with anterior rectal DIE. Although the sensitivity for vaginal and RVS DIE was limited, gel SVG had a high specificity and NPV for all forms of posterior DIE, indicating that a negative gel SVG examination is highly suggestive of the absence of DIE at laparoscopy. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To evaluate preoperative real-time dynamic transvaginal sonography ( TVS) in the prediction of pouch of Douglas ( POD) obliteration in women undergoing laparoscopy for suspected endometriosis. METHODS This was a multicenter prospective observational study undertaken from January 2009 to November 2011. All women with symptoms suggestive of endometriosis who were scheduled for laparoscopy underwent detailed preoperative TVS, in particular to ascertain whether the POD was obliterated. POD obliteration was assessed using a real-time TVS technique called the 'sliding sign'. Preoperative TVS sliding sign findings were then compared to gold standard laparoscopic POD findings. Results One hundred consecutive women with preoperative TVS and laparoscopic outcomes were included in the final analysis. Mean age was 32.8 years and mean age at diagnosis of endometriosis was 27.4 years. At laparoscopy, 84/100 (84%) were found to have some form of endometriosis (73% peritoneal endometriosis, 35% ovarian endometrioma(s), 33% deep infiltrating endometriosis). At laparoscopy, 30/100 (30%) had an obliterated POD and 19/30 (63.3%) of these women also had evidence of bowel endometriosis. The sonographic sliding sign technique had an accuracy of 93.0%, sensitivity of 83.3%, specificity of 97.1%, positive predictive value of 92.6%, negative predictive value of 93.2%, positive likelihood ratio of 29.2 and negative likelihood ratio of 0.17 in the prediction of POD obliteration ( P = 1. 8E−16). Conclusions Preoperative real-time dynamic TVS evaluation using the sliding sign seems to establish with a high degree of certainty whether the POD is obliterated. Given the increased risk of deep infiltrating endometriosis in women with POD obliteration, the TVS sliding sign technique may also be useful in the identification of women who may be at a higher risk for bowel endometriosis. Copyright © 2012 ISUOG. Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Tunçalp Ö, Hindin MJ, Souza JP, Chou D, Say L. The prevalence of maternal near miss: a systematic review. BJOG 2012;119:653-661. Background Severe maternal morbidity or 'near miss' is a promising indicator to improve quality of obstetric care. Objectives To systematically review all available studies on 'near miss'. Search strategy Following a pre-defined protocol, our review covered articles between January 2004 and December 2010. We used a combination of the following terms: near miss morbidity, severe maternal morbidity, severe acute maternal morbidity, obstetric near-miss, maternal near miss, obstetric near miss, emergency hysterectomy, emergency obstetric hysterectomy, maternal complications, pregnancy complications, intensive care unit. Selection criteria Nearly 4000 articles were screened by title and abstract, and 153 articles were retrieved for full text evaluation. There were no language restrictions. Data collection and analysis Data extraction was performed using an instrument that included sections on study characteristics, quality of reporting, prevalence/incidence and the definition and identification criteria. Univariate analysis and meta-analysis for sub-groups were performed. Main results A total of 82 studies from 46 countries were included. Criteria for identification of cases varied widely. Prevalence rates varied between 0.6 and 14.98% for disease-specific criteria, between 0.04 and 4.54% for management-based criteria and between 0.14 and 0.92% for organ-based dysfunction based on Mantel criteria. The rates are higher in low-income and middle-income countries of Asia and Africa. Based on meta-analysis, the estimate of near miss was 0.42% (95% CI 0.40-0.44%) for the Mantel (organ dysfunction) criteria and 0.039% (95% CI 0.037-0.042%) for emergency hysterectomy. Our meta-regression results indicate that emergency hysterectomy rates have been increasing by about 8% per year. Authors' conclusions There is growing interest in the application of the maternal near-miss concept as an adjunct to maternal mortality. However, in the literature published before 2011 there was still important variation in the criteria used to identify maternal near-miss cases. The World Health Organization recently published criteria based on markers of management and of clinical and organ dysfunction which would enable systematic data collection on near miss and development of summary estimates. Comparing the rates over time and across regions, it is clear that different approaches are needed to lower the rates of near miss and that interventions must be developed with the local context in mind. [ABSTRACT FROM AUTHOR]

We use the method of time – distance analysis to measure lifetimes of solar p modes in the range ℓ=100 − 600 and ν=3.0 − 4.5 mHz with data taken with the Taiwan Oscillation Network (TON). The lifetimes of p modes are determined by the changes in the amplitude and width of the cross-correlation function of a wave packet with the number of skips. The amplitude of the cross-correlation function decreases exponentially with the number of skips as in previous work. This decrease has been interpreted as the effect of the finite p-mode lifetime. In this study, we find that the width of the cross-correlation function increases with the number of skips. We interpret this phenomenon as the effect of the dispersion of the wave packet. We include this effect in the determination of the lifetime of the wave packet. The lifetime increases after the dispersion is taken into account. We also study the change in lifetime between solar minimum and maximum. [ABSTRACT FROM AUTHOR]

Accumulation of immune cell populations and their cytokine products within tracheobronchial airways contributes to the pathogenesis of allergic asthma. It has been postulated that peripheral regions of the lung play a more significant role than proximal airways with regard to inflammatory events and airflow obstruction. To determine whether immune cell populations and associated cytokines are uniformly distributed throughout the conducting airway tree in a non-human primate model of allergic asthma. We used a stereologic approach with a stratified sampling scheme to measure the volume density of immune cells within the epithelium and interstitium of trachea and 4–5 intrapulmonary airway generations from house dust mite (HDM) (Dermatophagoides farinae)-challenged adult monkeys. In conjunction with immune cell distribution profiles, mRNA levels for 21 cytokines/chemokines and three chemokine receptors were evaluated at four different airway generations from microdissected lungs. In HDM-challenged monkeys, the volume of CD1a+ dendritic cells, CD4+ T helper lymphocytes, CD25+ cells, IgE+ cells, eosinophils, and proliferating cells were significantly increased within airways. All five immune cell types accumulated within airways in unique patterns of distribution, suggesting compartmentalized responses with regard to trafficking. Although cytokine mRNA levels were elevated throughout the conducting airway tree of HDM-challenged animals, the distal airways (terminal and respiratory bronchioles) exhibited the most pronounced up-regulation. These findings demonstrate that key effector immune cell populations and cytokines associated with asthma differentially accumulate within distinct regions and compartments of tracheobronchial airways from allergen-challenged primates. [ABSTRACT FROM AUTHOR]

Background: A review of the literature pertaining to percutaneous transhepatic cholangioscopic lithotomy (PTCSL) showed that more than 50% of reported patients had undergone earlier biliary surgery.Methods: A retrospective study investigated 74 patients undergoing initial PTCSL for hepatolithiasis who had undergone no prior biliary surgery or manipulation. The patients were followed for 1 to 23 years after PTCSL for effective evaluation of the procedure outcome.Results: Complete clearance of hepatolithiasis was achieved for 61 (82%) patients. The incomplete clearance rate was higher for patients with intrahepatic duct stricture (11/37 [30%] vs 2/37 [5%]; p < 0.05), although it showed no relation to the actual lobar distribution of hepatolithiasis (left: 7/41 [17%] vs right: 2/11 [18%] vs bilateral: 4/22 [18%]; p < 0.05). The recurrence rate for hepatolithiasis also was higher for patients with intrahepatic duct stricture (18/26 [69%] vs 13/35 [37%]; p < 0.05), but the recurrence rate showed no relation to the lobar distribution of hepatolithiasis (left: 18/34 [53%] vs right: 4/9 [44%] vs bilateral: 9/18 [50%] p > 0.05) or the presence of gallbladder stones (5/12 [42%] vs 26/49 [53%]; p > 0.05). Patients showing the coexistence of retained or recurrent hepatolithiasis demonstrated a higher incidence of recurrent cholangitis (57% [13/23] vs 14% [7/51]; p < 0.01) or cholangiocarcinoma (17% [4/23]) vs 0% [0/51]; p < 0.01).Conclusions: The findings show that PTCSL is effective for treating primary hepatolithiasis, and that complete stone clearance is mandatory to diminish the sequelae of hepatolithiasis. Intrahepatic duct stricture was the main factor contributing to incomplete clearance and stone recurrence. [ABSTRACT FROM AUTHOR]

Business process integration and management (BPIM) is a critical element in enterprise business transformation. Small and medium-sized businesses have their own requirements for BPIM solutions: The engagement methodology should be fast and efficient; a reusable and robust framework is required to reduce cost; and the whole platform should be lightweight so that one can easily revise, develop, and execute solutions. We believe that model-driven technologies are the key to solving all of the challenges mentioned above. Model Blue, a set of model-driven business integration and management methods, frameworks, supporting tools, and a runtime environment, was developed by the IBM China Research Laboratory (CRL) in Beijing to study the efficacy of model-driven BPIM. To verify the technology and methodology, Model Blue was deployed with Bank SinoPac, a mid-sized bank headquartered in Taiwan. A lightweight BPIM solution platform was delivered for Bank SinoPac to design, develop, and deploy its business logic and processes. During the eight-month life span of the project, IBM teams developed four major solutions for Bank SinoPac, which also developed one solution independently. In spite of the remote working environment and the outbreak of the Severe Acute Respiratory Syndrome illness, the project was completed successfully on schedule and within budget, with up to 30% efficiency improvement compared with similar projects. Bank SinoPac was satisfied with the technology and methodology, and awarded IBM other projects. In this paper, we illustrate how each key business process integration and solution development phase was carried out and guided by business process modeling, together with major experiences gained. The following technical aspects are discussed in detail: a two-dimensional business process modeling view to integrate flow modeling and data modeling; a lightweight processing logic automation environment with tooling support; and the end-to- end BPIM... [ABSTRACT FROM AUTHOR]

Based on the HLH and TON ground-based helioseismological projects and the SOHO/MDI spaceborne project, we obtained acoustic power maps of active regions averaged over 1 mHz intervals. These maps allowed the spatial and frequency distributions of acoustic power in an active region and its surroundings to be studied. The time step of the HLH data is 42 s, which makes it possible to investigate the acoustic power up to 11.9 mHz. Data in the Ca II K and Ni I lines, which originate in the middle chromosphere and the photosphere, respectively, give an idea of the height distribution of acoustic oscillation energy in the solar atmosphere. The acoustic halo produced by excess acoustic power around sunspots clearly shows up on acoustic maps in the Ca II K line and, to a lesser degree, in the Doppler Ni I line shifts. Ground-based observations also reveal a large enhancement of acoustic power inside sunspots. Our tests show that this effect results from the combination of a high intensity gradient in the data and atmospheric seeing. The latter was reduced by referencing each image to the sunspot. The spatial distribution of power inside the sunspot due to atmospheric seeing was found to depend on the exposure time of the data used. Excluding the nonsolar effects, a common property of all acoustic maps is the suppression of the solaroscillation acoustic power in active regions. [ABSTRACT FROM AUTHOR]

A phase I dose-escalation study of multicyclic, ifosfamide, carboplatin, and etoposide (ICE) with sequential reinfusion of peripheral blood stem cells (PBSCs) was conducted to determine the maximum-tolerated dose (MTD) of ICE. Twenty-four patients with SCLC (LD: 6, ED: 18) were treated with ifosfamide (3000–9000 mg/m2, 24-h infusion), carboplatin (300–400 mg/m2), and etoposide (300 mg/m2) followed by subcutaneous filgrastim (75 μg/day) from day 4 to the day of PBSC collection. PBSC were harvested when the WBC count reached 5 × 109/l. The leukapheresis product was cryopreserved and reinfused on day 4 of the next cycle, which was started 48 h after the last PBSC collection. The ifosfamide dose was escalated as follows: 3000 mg/m2 (level 1), 5000 mg/m2 (level 2), 7000 mg/m2 (level 3), 9000 mg/m2 (level 4). Patients with LD were treated with concurrent radiotherapy at 1.5 Gy twice daily for the initial 3 weeks to a total dose of 45 Gy and MTD, defined separately. Patients were evaluated for hematologic and non-hematologic toxicity, actual dose intensities, as well as response to therapy. The maximum-tolerated dose (MTD) was defined as the dose level at which more than 5 days of grade 4 myelo- suppression or non-hematologic toxicity greater than grade 3 developed in two thirds of the patients. For ED cases, MTD was level 4 and the recommended dose of ifosfamide was 7000 mg/m2. For LD cases, the recommended dose of ifosfamide was 5000 mg/m2. The dose limiting toxicity of multicyclic ICE was hemato- logic toxicity and CNS toxicity which manifested as ataxia. Tumor responses were seen in all patients, with 14 patients showing a complete response. The actual total dose-intensity at the recommended dose level was 2.2 and 1.74, for ED and LD, respectively, compared with previously reported ICE regimens. PBSC support for... [ABSTRACT FROM AUTHOR]

Background and Objectives: The authors report current 3-year and 5-year institutional bibliometric profiles and investigate the correlations between objective metrics of neurosurgical residency programs and social media presence, including residency program size, faculty count, Doximity rankings, and measures of research output., Methods: A list of neurosurgery residency programs was obtained through the Doximity Residency Navigator. Publication history of faculty members was compiled using Scopus and analyzed to create institutional bibliometric profiles from 2018-2022 to 2020-2022. Mann-Whitney U tests were used to compare departmental metrics for institutions with and without social media accounts. Spearman rank correlations were used to examine the relationship between social media following and metrics, and between Twitter following and methods of Twitter use., Results: 74% (n = 86) of neurosurgery programs have a Twitter account, 47% (n = 55) have a Facebook account, 63% (n = 73) have Instagram accounts, and 16% (n = 19) have LinkedIn accounts. The most notable differences were found when comparing departments with and without Twitter accounts, where a difference was found in all metrics except the average H-index. Residency program size, faculty count, average H-index, 3-year and 5-year publication and citation counts per faculty, and institutional H-indices were significantly correlated with Twitter following. Higher Doximity rankings were correlated with Twitter following and Facebook likes. There is a greater increase in 5-year citations per publication from 2009-2013 to 2018-2022 for institutions that created departmental Twitter accounts after 2013. Articles that were tweeted about had higher 3-year citations per publication than the institution's overall 3-year citations per publication., Conclusion: Our findings provide updated insight into the relationship between social media presence and objective academic metrics of neurosurgery departments. We identify and quantify correlations between social media platforms and program characteristics, with a focus on research output. These metrics can be used to guide programs in their development of social media., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Study Design: Retrospective cohort., Objective: To evaluate factors associated with the long-term durability of cost-effectiveness (CE) in ASD patients., Background: A substantial increase in costs associated with the surgical treatment for adult spinal deformity (ASD) has given precedence to scrutinize the value and utility it provides., Methods: We included 327 operative ASD patients with five-year (5 yr) follow-up. Published methods were used to determine costs based on CMS.gov definitions and were based on the average DRG reimbursement rates. The utility was calculated using quality-adjusted life-years (QALY) utilizing the Oswestry Disability Index (ODI) converted to Short-Form Six-Dimension (SF-6D), with a 3% discount applied for its decline in life expectancy. The CE threshold of $150,000 was used for primary analysis., Results: Major and minor complication rates were 11% and 47%, respectively, with 26% undergoing reoperation by five years. The mean cost associated with surgery was $91,095±$47,003, with a utility gain of 0.091±0.086 at one years, QALY gained at 2 years of 0.171±0.183, and at five years of 0.42±0.43. The cost per QALY at two years was $414,885, which decreased to $142,058 at five years.With the threshold of $150,000 for CE, 19% met CE at two years and 56% at five years. In those in which revision was avoided, 87% met cumulative CE till life expectancy. Controlling analysis depicted higher baseline CCI and pelvic tilt (PT) to be the strongest predictors for not maintaining durable CE to five years [CCI OR: 1.821 (1.159-2.862), P =0.009] [PT OR: 1.079 (1.007-1.155), P =0.030]., Conclusions: Most patients achieved cost-effectiveness after four years postoperatively, with 56% meeting at five years postoperatively. When revision was avoided, 87% of patients met cumulative cost-effectiveness till life expectancy. Mechanical complications were predictive of failure to achieve cost-effectiveness at two years, while comorbidity burden and medical complications were at five years., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Some patients treated surgically for grade 1 spondylolisthesis require revision surgery. Outcomes after revision surgery are not well studied. The objective of this study was to determine how revision surgery impacts patient-reported outcomes (PROs) in patients undergoing decompression only or decompression and fusion (D+F) for grade 1 spondylolisthesis within 5 years of the index surgery., Methods: Patients in the 12 highest Quality Outcomes Database (QOD) enrolling sites with a diagnosis of grade 1 spondylolisthesis were identified and the incidence of revision surgery between the decompression-only and D+F patients were compared. PROs were compared between cohorts requiring revision surgery versus a single index procedure., Results: Of 608 patients enrolled, 409 had complete 5-year data available for this study. Eleven (13.3%) of 83 patients underwent revision in the decompression-only group as well as 32 (9.8%) of 326 in the D+F group. For the entire cohort, patients requiring revision had significantly worse PROs at 5 years: Oswestry Disability Index (ODI) 27.4 versus 19.4, p = 0.008; numeric rating scale for back pain (NRS-BP) 4.1 versus 3.0, p = 0.013; and NRS for leg pain (NRS-LP) 3.4 versus 2.1, p = 0.029. In the decompression-only group, the change in 5-year PROs was not impacted by revision status: ODI 31.9 versus 24.2, p = 0.287; NRS-BP 1.9 versus 2.9, p = 0.325; and NRS-LP 6.2 versus 3.7, p = 0.011. In the D+F group, the change in 5-year PROs was diminished if patients required revision: ODI 19.1 versus 29.1, p = 0.001; NRS-BP 3.0 versus 4.0, p = 0.170; and NRS-LP 2.3 versus 4.6, p = 0.001., Conclusions: The most common reasons for reoperation within 5 years in the decompression-only group were repeat decompression and instability, whereas in the D+F group the most common reason was adjacent-segment disease. The need for revision resulted in modestly diminished benefit compared with patients with no revisions. These differences were greater in the fusion cohort compared with the decompression-only cohort. The mean PRO improvement still far exceeded minimal clinically important difference thresholds for all measures for patients who underwent a revision surgery.

Background Context: Use of an anterior cervical dynamic implant (ACDI) is generally considered a nonfusion technique for treating cervical degenerative disorders. However, there is limited research focused on evaluating the long-term clinical and radiographic outcomes of ACDI., Purpose: To analyze the long-term clinical and radiographic outcomes of ACDI in the treatment of degenerative cervical disorders., Study Design: A retrospective cohort study., Patients Sample: Patients with degenerative cervical disorders who underwent anterior cervical discectomy and dynamic cervical implant (DCI) implantation between May 2012 and August 2020 at our institution were included in this study., Outcome Measures: Clinical outcomes were assessed using the modified Japanese Orthopedic Association (mJOA), visual analog scale (VAS) scores and patient reported satisfaction rate. Imaging assessment parameters included intervertebral height (IH), intervertebral disc height (IDH), C2-7 range of motion (ROM), segmental ROM, the degree of DCI subsidence and anterior migration, heterotopic ossification (HO) as well as adjacent segment degeneration (ASD)., Methods: JOA and VAS scores were obtained through questionnaire. The patient reported satisfaction was rated as very satisfied, satisfied, less satisfied and dissatisfied at the final follow-up. The position of the implants, IDH and IH were evaluated on lateral radiographs. ROM at C2-7, ROM at operated level were measured on dynamic radiographs. Cervical 3 -dimensional computer tomography (CT) and magnetic resonance image (MRI) images were used to assess the presence of HO and ASD. The clinical and radiologic variables between the preoperative period and different follow-up time point were statistically analyzed by unpaired t-tests or chi-square tests. Statistical significance was defined as p<.05., Results: A total of 92 patients (51 males and 41 females) were included in this study. Among them, there were 36 cases of cervical spondylotic myelopathy, 26 cases of cervical radiculopathy, and 30 cases of myeloradiculopathy. The mean age was 55.1±12.6 years. The number of operated levels was single level in 57 patients, 2 levels in 31 patients, and 3 levels in 4 patients. The average follow-up period was 81.3 months (range: 35-135 months). The mean JOA scores showed a gradual increase at 1 month, 1 year, and the final follow-up (12.0±0.7,13.5±0.8, and14.4±1.1 respectively) compared to the preoperative score (9.1±0.9, p<.01). VAS scores significantly decreased at 1 month, 1 year, and the final follow-up (4.1±0.7, 2.3±0.9, and 2.0±0.8 respectively) compared to the preoperative score (7.2±l .2, p<.01). At the final follow-up, the patient reported satisfaction was rated as very satisfied, satisfied, less satisfied and dissatisfied (79%, 10%, 10%, 1% respectively). Revision surgery was not required for any of the patients during the follow-up period, either due to instrumentation failure or adjacent segmental diseases. In the radiographic assessment, there was a notable increase in IH and IDH after surgery compared to preoperative values (33.0±4.0 mm vs. 30.7±3.0 mm, p<.01 and 6.7±2.4 mm vs. 4.6±0.9 mm, p<.01 respectively), which gradually decreased at 1 year and the final follow-up (IH: 32.1±2.5 vs. 30.9±3.5 p=.024; IDH: 5.3±1.5 mm vs. 4.3±0.6 mm, p=.043 respectively). At the 1-month postoperative follow-up, the segmental ROM exhibited a decrease compared with preoperative values (6.2±1.8° vs. 7.5±2.0° p=.044), followed by an increase at the 1-year follow-up (6.2±1.8° vs. 6.4±1.5° p=.078), but ultimately decreased at the final follow-up (6.4±1.5° vs. 2.9±0.6°, p<.01). HO was observed in approximately 81.5% of cases (75/92), while a great proportion (41.3%) of patients experienced varying degrees of prosthesis subsidence and anterior migration during the follow-up., Conclusion: At the long-term follow-up, a high incidence of HO, along with varying degrees of subsidence and migration of the prosthesis, were observed in most patients. As the motion preservation capability of the ACDI gradually diminishes, delayed intervertebral autofusion becomes a more likely outcome compared to motion sparing., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We share our experience with the Hugo™ Robotic-Assisted Surgery system in benign gynecological surgeries. We retrospectively analyzed patients who underwent elective robotic surgeries for benign gynecological conditions at our surgical center from February 2023 to February 2024. Data collected included patient demographics, surgery indications, and outcomes. Perioperative data on port-placement time, arm configurations, docking, and console time were documented. Procedural outcome data including troubleshooting and overall satisfaction were also recorded. The primary outcome was perioperative data on port placement, docking time, arm configuration, and console time. The secondary outcome was defined as team satisfaction, system troubleshooting, arm repositioning, and complications graded 3-4 on the Clavien-Dindo Scale. A total of 60 patients underwent procedures for benign gynecological conditions using the Hugo™ RAS over the 12-month study period, primarily for pelvic endometriosis (53%), hysterectomies (27%), and adnexal surgery (10%). The mean port-placement time was 13 min and 41 s. In 31% of cases, low-port placement was used, with arm positioning being asymmetrical in 63% and symmetrical in 37%, demonstrating the system's flexibility in customizing port configurations while optimizing cosmetic outcomes. Docking time averaged 5 min and 51 s, and console time was 1 h and 5 min. Operational challenges included arm tremors and limited workspace for the assistant. This study details our knowledge using the Hugo™ RAS. Learning curves of port placement, arm positioning, docking, and procedure time can be rapidly adapted in a well-trained team. Our experience suggests the technology is still in its learning curve period., (© 2024. Crown.)

Nerve injury can induce aberrant changes in the spine; these changes are due to, or at least partly governed by, transcription factors that contribute to the genesis of neuropathic allodynia. Here, we showed that spinal nerve ligation (SNL, a clinical neuropathic allodynia model) increased the expression of the transcription factor Tbx5 in the injured dorsal horn in male Sprague Dawley rats. In contrast, blocking this upregulation alleviated SNL-induced mechanical allodynia, and there was no apparent effect on locomotor function. Moreover, SNL-induced Tbx5 upregulation promoted the recruitment and interaction of GATA4 and Brd4 by enhancing its binding activity to H3K9Ac, which was enriched at the Trpv1 promotor, leading to an increase in TRPV1 transcription and the development of neuropathic allodynia. In addition, nerve injury-induced expression of Fbxo3, which abates Fbxl2-dependent Tbx5 ubiquitination, promoted the subsequent Tbx5-dependent epigenetic modification of TRPV1 expression during SNL-induced neuropathic allodynia. Collectively, our findings indicated that spinal Tbx5-dependent TRPV1 transcription signaling contributes to the development of neuropathic allodynia via Fbxo3-dependent Fbxl2 ubiquitination and degradation. Thus, we propose a potential medical treatment strategy for neuropathic allodynia by targeting Tbx5., Competing Interests: The authors declare no competing financial interests., (Copyright © 2024 the authors.)

Background Context: In cases of basilar invagination-atlantoaxial dislocation (BI-AAD) complicated by atlas occipitalization (AOZ), the approach to cranial end fixation has consistently sparked debate, generally falling into two categories: C1-C2 fixation and occipitocervical fixation. Several authors believe that C1-C2 fixation carries a lower risk of fixation failure than occipitocervical fixation., Purpose: To study the biomechanical differences among 3 different cranial end fixation methods for BI-AAD with AOZ., Study Design: This was a finite element analysis., Patient Sample: A 35-year-old female patient diagnosed with congenital BI-AAD and AOZ., Outcome Measures: range of motion (ROM), peak von Mise stress (PVMS), cage micro-subsidence, cage micro-slippage METHOD: Four finite element models were constructed, including unstable group (BI-AAD with AOZ), C1 lateral mass screw group, occipital plate group, occipitocervical rod group. The flexion and extension (FE), lateral bending (LB) as well as axial rotation (AR) were simulated under a torque of 1.5 Nm. Parameters include C1-C2 ROM, PVMS on screw-rod construct, cage micro-subsidence, cage micro-slippage., Results: The ROM of the C1 lateral mass screw group was smaller than that of the other fixation groups in LB and AR, but not FE. Compared with the occipitocervical rod group, the ROM in LB and AR of the occipital plate group was higher, but not in FE. The PVMS of C1 lateral mass screw group was significantly higher than that of the other groups. The ROM and PVMS of the occipitocervical rod group were in between the other 2 groups. Regarding the screws at the cranial end, the PVMS of the 4-screw occipitocervical rod group was significantly lower than that of the other groups. In general, the cage micro-motion follows the ascending order: C1 lateral mass group < occipitocervical rod group < occipital plate group., Conclusion: In cases of BI-AAD with AOZ, the C1 lateral mass screw group provided the least ROM and cage micro-motion, but the screw-rod PVMS was the largest. The advantage of occipital plate fixation lies in the lowest screw-rod PVMS, but the ROM and cage micro-motion is the highest. Four-screw fixation at the cranial end of occipitocervical rod group helps to reduce the PVMS and may prevent screw failure at the cranial end., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: The long-term effects of increased body mass index (BMI) on surgical outcomes are unknown for patients who undergo surgery for low-grade lumbar spondylolisthesis. The goal of this study was to assess long-term outcomes in obese versus nonobese patients after surgery for grade 1 spondylolisthesis., Methods: Patients who underwent surgery for grade 1 spondylolisthesis at the Quality Outcomes Database's 12 highest enrolling sites (SpineCORe group) were identified. Long-term (5-year) outcomes were compared for patients with BMI ≥ 35 versus BMI < 35., Results: In total, 608 patients (57.6% female) were included. Follow-up was 81% (excluding patients who had died) at 5 years. The BMI ≥ 35 cohort (130 patients, 21.4%) was compared to the BMI < 35 cohort (478 patients, 78.6%). At baseline, patients with BMI ≥ 35 were more likely to be younger (58.5 ± 11.4 vs 63.2 ± 12.0 years old, p < 0.001), to present with both back and leg pain (53.8% vs 37.0%, p = 0.002), and to require ambulation assistance (20.8% vs 9.2%, p < 0.001). Furthermore, the cohort with BMI ≥ 35 had worse baseline patient-reported outcomes including visual analog scale (VAS) back (7.6 ± 2.3 vs 6.5 ± 2.8, p < 0.001) and leg (7.1 ± 2.6 vs 6.4 ± 2.9, p = 0.031) pain, disability measured by the Oswestry Disability Index (ODI) (53.7 ± 15.7 vs 44.8 ± 17.0, p < 0.001), and quality of life on EuroQol-5D (EQ-5D) questionnaire (0.47 ± 0.22 vs 0.56 ± 0.22, p < 0.001). Patients with BMI ≥ 35 were more likely to undergo fusion (85.4% vs 74.7%, p = 0.01). There were no significant differences in 30- and 90-day readmission rates (p > 0.05). Five years postoperatively, there were no differences in reoperation rates or the development of adjacent-segment disease for patients in either BMI < 35 or ≥ 35 cohorts who underwent fusion (p > 0.05). On multivariate analysis, BMI ≥ 35 was a significant risk factor for not achieving minimal clinically important differences (MCIDs) for VAS leg pain (OR 0.429, 95% CI 0.209-0.876, p = 0.020), but BMI ≥ 35 was not a predictor for achieving MCID for VAS back pain, ODI, or EQ-5D at 5 years postoperatively., Conclusions: Both obese and nonobese patients benefit from surgery for grade 1 spondylolisthesis. At the 5-year time point, patients with BMI ≥ 35 have similarly low reoperation rates and achieve rates of satisfaction and MCID for back pain (but not leg pain), disability (ODI), and quality of life (EQ-5D) that are similar to those in patients with a BMI < 35.

Objective: The aim of this study was to compare the rate of achievement of the minimal clinically important difference (MCID) in patient-reported outcomes (PROs) and satisfaction between cervical spondylotic myelopathy (CSM) patients with and without class III obesity who underwent surgery., Methods: The authors analyzed patients from the 14 highest-enrolling sites in the prospective Quality Outcomes Database CSM cohort. Patients were dichotomized based on whether or not they were obese (class III, BMI ≥ 35 kg/m2). PROs including visual analog scale (VAS) neck and arm pain, Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA), EQ-5D, and North American Spine Society patient satisfaction scores were collected at baseline and 24 months after cervical spine surgery., Results: Of the 1141 patients with CSM who underwent surgery, 230 (20.2%) were obese and 911 (79.8%) were not. The 24-month follow-up rate was 87.4% for PROs. Patients who were obese were younger (58.1 ± 12.1 years vs 61.2 ± 11.6 years, p = 0.001), more frequently female (57.4% vs 44.9%, p = 0.001), and African American (22.6% vs 13.4%, p = 0.002) and had a lower education level (high school or less: 49.1% vs 40.8%, p = 0.002) and a higher American Society of Anesthesiologists grade (2.7 ± 0.5 vs 2.5 ± 0.6, p < 0.001). Clinically at baseline, the obese group had worse neck pain (VAS score: 5.7 ± 3.2 vs 5.1 ± 3.3), arm pain (VAS score: 5.4 ± 3.5 vs 4.8 ± 3.5), disability (NDI score: 42.7 ± 20.4 vs 37.4 ± 20.7), quality of life (EQ-5D score: 0.54 ± 0.22 vs 0.56 ± 0.22), and function (mJOA score: 11.6 ± 2.8 vs 12.2 ± 2.8) (all p < 0.05). At the 24-month follow-up, however, there was no difference in the change in PROs between the two groups. Even after accounting for relevant covariates, no significant difference in achievement of MCID and satisfaction was observed between the two groups at 24 months., Conclusions: Despite the class III obese group having worse baseline clinical presentations, the two cohorts achieved similar rates of satisfaction and MCID in PROs. Class III obesity should not preclude and/or delay surgical management for patients who would otherwise benefit from surgery for CSM.

Objective: Depression and anxiety are associated with poor outcomes following spine surgery. However, the influence of these conditions on achieving a minimal clinically important difference (MCID) following lumbar spine surgery, as well as the potential compounding effects of comorbid depression and anxiety, is not well understood. This study explores the impact of comorbid depression and anxiety on long-term clinical outcomes following surgical treatment for degenerative lumbar spondylolisthesis., Methods: This study was a retrospective analysis of the multicenter, prospectively collected Quality Outcomes Database (QOD). Patients with surgically treated grade 1 lumbar spondylolisthesis from 12 centers were included. Preoperative baseline characteristics and comorbidities were recorded, including self-reported depression and/or anxiety. Pre- and postoperative patient-reported outcomes (PROs) were recorded: the numeric rating scale (NRS) score for back pain (NRS-BP), NRS score for leg pain (NRS-LP), Oswestry Disability Index (ODI), and EQ-5D. Patients were grouped into 3 cohorts: no self-reported depression or anxiety (non-SRD/A), self-reported depression or anxiety (SRD/A), or presence of both comorbidities (SRD+A). Changes in PROs over time, satisfaction rates, and rates of MCID were compared. A multivariable regression analysis was performed to establish independent associations., Results: Of the 608 patients, there were 452 (74.3%) with non-SRD/A, 81 (13.3%) with SRD/A, and 75 (12.3%) with SRD+A. Overall, 91.8% and 80.4% of patients had ≥ 24 and ≥ 60 months of follow-up, respectively. Baseline PROs were universally inferior for the SRD+A cohort. However, at 60-month follow-up, changes in all PROs were greatest for the SRD+A cohort, resulting in nonsignificant differences in absolute NRS-BP, NRS-LP, ODI, and EQ-5D across the 3 groups. MCID was achieved for the SRD+A cohort at similar rates to the non-SRD/A cohort. All groups achieved > 80% satisfaction rates with surgery without significant differences across the cohorts (p = 0.79). On multivariable regression, comorbid depression and anxiety were associated with worse baseline PROs, but they had no impact on 60-month PROs or 60-month achievement of MCIDs., Conclusions: Despite lower baseline PROs, patients with comorbid depression and anxiety achieved comparable rates of MCID and satisfaction after surgery for lumbar spondylolisthesis to those without either condition. This quality-of-life benefit was durable at 5-year follow-up. These data suggest that patients with self-reported comorbid depression and anxiety should not be excluded from consideration of surgical intervention and often substantially benefit from surgery.

Study Objective: Although mean/static compliance of bladder filling can be readily assayed via cystometry, a protocol measuring compliance dynamics at a specific stage of bladder filling has not been established in human patients. For patients with pelvic organ prolapse (POP), the objective benefits of robotic-assisted sacrocolpopexy (RSCP) surgical intervention for restoring bladder functions, primarily urine storage, have yet to be established. Also, bladder compliance is a viscoelastic parameter that crucially defines the storage function. Therefore, we aimed to investigate the impact of RSCP on bladder compliance of POP patients using a pressure-volume analysis (PVA), which graphically illustrates bladder compliance., Design: A retrospective pre and postoperative study., Setting: Multiple hospitals in Taiwan., Patients: Twenty seven female POP patients (stage ≥ II)., Intervention: RSCP for POP repair., Measurements and Main Results: We retrospectively reviewed the pre- and postoperative PVAs for women with POP who underwent RSCP. The mean compliance of the entire (Cm), the early half (C1/2), and the late half (C2/2) of bladder filling were analyzed as primary outcomes. Changes in intravesical volume (ΔVive) and detrusor pressure (ΔPdet) of bladder filling, ΔPdet in the early (ΔPdet1/2) and late (ΔPdet2/2) filling, and postvoiding residual volume (Vres) were analyzed as secondary outcomes. Compared with the preoperative control, RSCP increased Cm (p = .010, N = 27) and C2/2 (p <.001, N = 27) but negligibly affected C1/2 (p = .457, N = 27). Mechanistically, RSCP decreased ΔPdet (p = .0001, N = 27) without significantly affecting ΔVive (p = .863, N = 27). Furthermore, RSCP decreased the ΔPdet2/2 (p <.001, N = 27) but not ΔPdet1/2 (p = .295, N = 27)., Conclusions: This is the first report on applying PVA in assaying dynamics of bladder compliance in patients with POP. Our results suggest that RSCP improved bladder storage in women with POP since it increased bladder compliance, particularly in the late filling, possibly by restoring the anatomical location and geometric conformation for bladder expansion., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Nerve-sparing (NS) surgery was first introduced for the treatment of deep endometriosis (DE) 20 years ago, drawing on established neuroanatomy and success from oncological applications. It aims to identify and preserve autonomic nerve fibres, reduce iatrogenic nerve injury, and minimize postoperative visceral dysfunction, without compromising the therapeutic effectiveness against endometriosis. The evolution of NS surgical techniques over the past two decades has been supported by an expanding body of literature on anatomical details, dissection techniques, and functional outcomes. Recent evidence suggests that NS surgery results in reduced postoperative voiding dysfunction (POVD). Transient POVD may be influenced by preoperative dysfunction, with parametrial infiltration being a strong predictive factor for POVD. While the benefits in bowel and sexual functions are less pronounced and consistent, NS surgery potentially prevents de novo dysfunctions in these areas. Furthermore, perioperative complication rates, effectiveness in pain relief, and fertility outcomes are reportedly on par with conventional surgery., Competing Interests: Declaration of competing interest The authors have no conflicts of interest., (Copyright © 2024. Published by Elsevier Ltd.)

Objective: Lumbar decompression and/or fusion surgery is a common operation for symptomatic lumbar spondylolisthesis refractory to conservative management. Multiyear follow-up of patient outcomes can be difficult to obtain but allows for identification of preoperative patient characteristics associated with durable pain relief, improved functional outcome, and higher patient satisfaction., Methods: A query of the Quality Outcomes Database (QOD) low-grade spondylolisthesis module for patients who underwent surgery for grade 1 lumbar spondylolisthesis (from July 2014 to June 2016 at the 12 highest-enrolling sites) was used to identify patient satisfaction, as measured with the North American Spine Society (NASS) questionnaire, which uses a scale of 1-4. Patients were considered satisfied if they had a score ≤ 2. Multivariable logistic regression was performed to identify baseline demographic and clinical predictors of long-term satisfaction 5 years after surgery., Results: Of 573 eligible patients from a cohort of 608, patient satisfaction data were available for 81.2%. Satisfaction (NASS score of 1 or 2) was reported by 389 patients (83.7%) at 5-year follow-up. Satisfied patients were predominantly White and ambulation independent and had lower baseline BMI, lower back pain levels, lower Oswestry Disability Index (ODI) scores, and greater EQ-5D index scores at baseline when compared to the unsatisfied group. No significant differences in reoperation rates between groups were reported at 5 years. On multivariate analysis, patients who were independently ambulating at baseline had greater odds of long-term satisfaction (OR 1.12, p = 0.04). Patients who had higher 5-year ODI scores (OR 0.99, p < 0.01) and were uninsured (OR 0.43, p = 0.01) were less likely to report long-term satisfaction., Conclusions: Lumbar surgery for the treatment of grade 1 spondylolisthesis can provide lasting pain relief with high patient satisfaction. Baseline independent ambulation is associated with a higher long-term satisfaction rate after surgery. Higher ODI scores at 5-year follow-up and uninsured status are associated with lower postoperative long-term satisfaction.

Objective: The objective was to evaluate factors associated with the long-term durability of outcomes in adult spinal deformity (ASD) patients., Methods: Operative ASD patients fused from at least L1 to the sacrum with baseline (BL) to 5-year (5Y) follow-up were included. Substantial clinical benefit (SCB) in Oswestry Disability Index (ODI), numeric rating scale (NRS)-back, NRS-leg, and Scoliosis Research Society (SRS)-22r scores and physical component score were assessed on the basis of previously published values. Factors were evaluated on the basis of meeting optimal outcomes (OO) at 2 years (2+) and 5 years (5+). Furthermore, 2+ patients were isolated and evaluated on the basis of meeting OO at 5 years (2+5+) or not at 5 years (2+5-). OO were defined as follows: no reoperation, major mechanical failure, proximal junctional failure, and meeting either 1) SCB in terms of ODI score (decrease > 18.8) or 2) ODI < 15 and SRS-22r total > 4.5., Results: In total, 330 ASD patients met the inclusion criteria, with 45.5% meeting SCB for ODI at 2 years, while 46.0% met SCB at 5 years; 79% of those who achieved 2-year (2Y) SCB went on to achieve 5Y SCB. This rate was lower for OO, with 41% achieving 2Y OO (2+), while 37% met 5Y OO (5+) and 80% of 2+ patients had durable outcomes until 5+ (32% of the total cohort). Of the patient factors, frailty was significantly different among groups at 2 years, while comorbidity burden was significantly different at 5 years and the combination thereof differed in those with durable outcomes. Those who regained their level of activity postoperatively had 4 times higher odds of maintaining OO from 2 years to 5 years (p < 0.05). Osteoporosis rates, although equivocal at BL, were higher at the last follow-up in those who met 2Y OO but failed to meet 5Y OO. The odds of achieving OO at 5 years in 2+ patients decreased by 47% for each additional comorbidity and decreased by 74% in those who had lower-extremity paresthesias at BL (both p < 0.05). Controlling for patient factors and BL disability found fewer levels fused, decreased correction of sagittal vertical axis, and increased correction of pelvic incidence-lumbar lordosis mismatch to be predictive of maintaining 2Y OO until 5 years (p < 0.05)., Conclusions: SCB was met in 46% of ASD patients at 5 years. The durability of OO was seen in a third of patients until 5 years postoperatively. Higher rates of medical complications were seen in those who failed to achieve and maintain OO until 5 years. Frailty and comorbidity burden were significant factors associated with the achievement and durability of OO until 5 years.