Multivariable Analysis of Factors Affecting Length of Stay and Hospital Charges After Single-level Corpectomy

Anterior cervical corpectomy and fusion (ACCF) is commonly employed for treating myelopathy, deformity, and a variety of other cervical pathologies. Limited data are available on factors associated with longer hospitalization and higher hospital charges following ACCF. The purpose of this study was to evaluate the pre-, intra-, and postoperative variables that are associated with length of hospital stay and hospital charges for patients undergoing single-level anterior cervical corpectomy and fusion in a retrospective case series. We retrospectively identified from a clinical database 69 patients who underwent single-level ACCF at a single institution from 2010 through 2014. Demographic variables, clinical information, and intraoperative data were analyzed with respect to length of hospitalization and hospital charges. T-test and Chi-squared testing as well as univariate and multivariable analysis were performed with p \u3c 0.05 considered significant. On multivariable analysis, polytrauma, postoperative complications, lower postoperative hematocrit, and two-staged procedures were significantly associated with longer lengths of stay. Length of stay, postoperative complications, and two-staged procedures were significantly associated with higher hospital charges. Patients undergoing a two-staged procedure and those having postoperative complications experience a longer postoperative length of stay and incur higher hospital charges. Avoidance of postoperative anemia may help to reduce length of stay following ACCF

Extraspinal Type I Dural Arteriovenous Fistula with a Lumbosacral Lipomyelomeningocele: A Case Report and Review of the Literature

Seven cases of adult spinal vascular malformations presenting in conjunction with spinal dysraphism have been reported in the literature. Two of these involved male patients with a combined dural arteriovenous fistula (DAVF) and lipomyelomeningocele. The authors present the third case of a patient with an extraspinal DAVF and associated lipomyelomeningocele in a lumbosacral location. A 58-year-old woman with rapid decline in bilateral motor function 10 years after a prior L4-5 laminectomy and cord detethering for diagnosed tethered cord underwent magnetic resonance imaging showing evidence of persistent cord tethering and a lipomyelomeningocele. Diagnostic spinal angiogram showed a DAVF with arterial feeders from bilateral sacral and the right internal iliac arteries. The patient underwent Onyx embolization of both feeding right and left lateral sacral arteries. At 6-month follow-up, MRI revealed decreased flow voids and new collateralized supply to the DAVF. The patient underwent successful lipomyelomeningocele exploration, resection, AV fistula ligation, and cord detethering. This report discusses management of this patient as well as the importance of endovascular embolization followed by microsurgery for the treatment of cases with combined vascular and dysraphic anomalies

An advanced PdNPs@MoS2 nanocomposite for efficient oxygen evolution reaction in alkaline media

In response to the increasing availability of hydrogen energy and renewable energy sources, molybdenum disulfide (MoS2)-based electrocatalysts are becoming increasingly important for efficient electrochemical water splitting. This study involves the incorporation of palladium nanoparticles (PdNPs) into hydrothermally grown MoS2via a UV light assisted process to afford PdNPs@MoS2 as an alternative electrocatalyst for efficient energy storage and conversion. Various analytical techniques, including scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and energy dispersive spectroscopy (EDS), were used to investigate the morphology, crystal quality, and chemical composition of the samples. Although PdNPs did not alter the MoS2 morphology, oxygen evolution reaction (OER) activity was driven at considerable overpotential. When electrochemical water splitting was performed in 1.0 M KOH aqueous solution with PdNPs@MoS2 (sample-2), an overpotential of 253 mV was observed. Furthermore, OER performance was highly favorable through rapid reaction kinetics and a low Tafel slope of 59 mV dec−1, as well as high durability and stability. In accordance with the electrochemical results, sample-2 showed also a lower charge transfer resistance, which again provided evidence of OER activity. The enhanced OER activity was attributed to a number of factors, including structural, surface chemical compositions, and synergistic effects between MoS2 and PdNPs