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We describe a novel, rapid midline retroperitoneal operative technique in a patient, with multi-level degenerative scoliosis, who underwent an extensive L2-S1 anterior lumbar interbody fusion in addition to posterior instrumentation. Uniquely, our approach enables an essentially midline approach to the rectus muscle and uses the diminution of the transversalis fascia-to-peritoneum transition in the pelvis to provide expedited exposure—making it particularly helpful for ALIF exposure, retraction and intraoperative radiography. We minimize morbidity around the rectus sheath by dissecting only the medial rectus muscle and then gently, bluntly mobilizing the retroperitoneum from the deep pelvis cranially.

Although hypertonic saline (HTS) decreases intracranial pressure (ICP) with traumatic brain injury (TBI), its effects on survival and post-discharge neurologic function are less certain. We assessed the impact of HTS administration on TBI outcomes and hypothesized that favorable outcomes would be associated with larger amounts of 3% saline. This is a retrospective study of consecutive-patients with the following criteria: blunt trauma, age 18-70 years, intracranial hemorrhage, Glasgow Coma Scale score (GCS) 3-12, and mechanical ventilation ≥ 5 days. The need for craniotomy or craniectomy denoted surgical decompression patients. Amounts of HTS were during the first-5 trauma center days. Traits for the 112 patients during 2012-2016 were as follows: GCS, 6.8 ± 3.2; subdural hematoma, 71.4%; cerebral contusion, 31.3%, ICP device, 47.3%; surgical decompression, 51.8%; ventilator days, 14.8 ± 6.7; trauma center mortality, 13.4%; and no commands at 3 months 35.5%. In surgically decompressed patients, trauma center mortality was greater with ≤ 8.0 mEq/kg sodium (38.9%) than with > 8.0 mEq/kg (7.5%; P = 0.0037). In surgically decompressed patients, following commands at 3 months was greater with ≥ 1400 mEq sodium (76.9%) than with < 1400 mEq (50.0%; P = 0.0489). For trauma center surviving non-decompression patients with no ICP device, those following commands at 3 months received more sodium (513 ± 784 mEq) than individuals not following commands (82 ± 144 mEq; P = 0.0142). For patients with a GCS 5-8, following commands at 3 months was greater with ≥ 1350 mEq sodium (92.3%) than with < 1350 mEq (60.0%; P = 0.0214). In patients with subdural hematoma or cerebral contusion, following commands at 3 months was greater with ≥ 1400 mEq sodium (84.2%) than with < 1400 mEq (61.8%; P = 0.0333). Patients with ICP > 20 mmHg for ≤ 10 hours (mean hours 2.0) received more sodium (16.5 ± 11.5 mEq/kg) when compared to ICP elevation for ≥ 11 hours (mean hours 34) (9.4 ± 6.3 mEq/kg; P = 0.0139). These observations demonstrate that hypertonic saline administration in patients with complex traumatic brain injury is associated with 1) mitigation of intracranial hypertension, 2) trauma center survival, and 3) following commands at 3 months post-injury.

Deliberation on how deaf patients might experience auditory hallucinations remains a topic of interest for psychopathological exploration. Deaf patients often report u201cconversationsu201d, u201cloud voicesu201d and other subjective narratives to describe important fonts of information during psychotic outbreaks.Objectives:The aim is to clarify the territory of auditory hallucinations in deaf patients from a phenomenological frame set.Methods:A literature review was conducted using the PubMed and the ResearchGate search databases.Results:Deaf patients often experience language disfluency, borrowing expressions from the u201chearing cultureu201d that compromise the examination. Despite the contradicting information, the state of the art literature supports the hypothesis that pre-linguistic deaf psychotic patients do not experience true auditory hallucinations. The remainder deaf psychotic patients might experience auditory hallucinations correlated directly to the array of experiences concerning language and the level of hearing loss. The psychotic experiences lived by this patients are vast and not fully grasped, sometimes assuming the form of a delusion of hearing.Conclusions:To assess for auditory hallucinations in deaf patients an understanding of the deaf culture should be intertwined with a broaden concept of a psychotic experience in this population. Expert assessment and deaf-oriented mental status exam are strongly advised. The further knowledge necessary to enlighten the deaf internal psychotic experiences entails bigger sampled studies, functional MRI studying and a re-evaluation of the concept of auditory hallucination in pre-linguistic deaf patients. Clinicians should adopt a mutational attitude in the continuing debate between professionalsu2019 expectations, the deaf phenomenological frames of reference for a psychotic experience and the unknowable.

Background and Aims:Fibromyalgia is a chronic pain condition presented in at least 2% of the population. Fibromyalgia is characterized by widespread pain with similarities to neuropathic pain and is often accompanied by fatigue, sleep compromise, memory impairment, irritable bowel syndrome and mood disorders. The diagnosis of fibromyalgia should not be an exclusion diagnosis and often appears in patients with other conditions. No clear pathophysiology mechanism has been established in this condition but an abnormality in central pain processing is suggested by evidence. This condition is responsible for a great decrease in quality of life of patients. The aim is to do a review of management strategies.Methods:A literature review was conducted using the PubMed search database.Results:Successful management of this condition should blend education, patient support, physical therapy, exercise, nutrition, cognitive behavioral therapy and pharmacological therapy. Patient self-handling is of extreme importance in aiming for a good management. Pharmacological therapies with high quality evidence include triciclics, serotonin norepinephrine reuptake inhibitors, and gabapentinoids. More controversial is the use of various opioids, dopamine agonists and cannabinoids.Conclusions:Fibromyalgia is a complex condition that requires a multidisciplinary approach from clinicians. Further evidence-based knowledge is needed to better comprehend the mechanisms of this condition as well as to give more and better pharmacological options in the treatment of this patients and improve their quality of life.

Amphibian genomes differ greatly in DNA content and chromosome size, morphology, and number. Investigations of this diversity are needed to identify mechanisms that have shaped the evolution of vertebrate genomes. We used comparative mapping to investigate the organization of genes in the Mexican axolotl (Ambystoma mexicanum), a species that presents relatively few chromosomes (n = 14) and a gigantic genome (>20 pg/N). We show extensive conservation of synteny between Ambystoma, chicken, and human, and a positive correlation between the length of conserved segments and genome size. Ambystoma segments are estimated to be four to 51 times longer than homologous human and chicken segments. Strikingly, genes demarking the structures of 28 chicken chromosomes are ordered among linkage groups defining the Ambystoma genome, and we show that these same chromosomal segments are also conserved in a distantly related anuran amphibian (Xenopus tropicalis). Using linkage relationships from the amphibian maps, we predict that three chicken chromosomes originated by fusion, nine to 14 originated by fission, and 12–17 evolved directly from ancestral tetrapod chromosomes. We further show that some ancestral segments were fused prior to the divergence of salamanders and anurans, while others fused independently and randomly as chromosome numbers were reduced in lineages leading to Ambystoma and Xenopus. The maintenance of gene order relationships between chromosomal segments that have greatly expanded and contracted in salamander and chicken genomes, respectively, suggests selection to maintain synteny relationships and/or extremely low rates of chromosomal rearrangement. Overall, the results demonstrate the value of data from diverse, amphibian genomes in studies of vertebrate genome evolution.

Multiple studies have addressed deep vein thrombosis chemoprophylaxis timing in traumatic brain injuries. However, a precise time for safe and effective chemoprophylaxis is uncertain according to experts. A comprehensive literature review on brain injuries was performed to delineate temporal proportions for 1) spontaneous intracranial hemorrhage (ICH) progression, 2) post-chemoprophylaxis ICH expansion, and 3) post-chemoprophylaxis deep vein thrombosis. Twenty-three publications were found including more than 5,000 patients. Spontaneous ICH expansion at 24 hours was 14.8% in 1,437 patients from chemoprophylaxis studies and 29.9% in 1,257 patients not in chemoprophylaxis studies (P