Salmonella Infection After Craniotomy.

Salmonella is an uncommon cause of meningitis, especially after neurosurgery. Here, we present a case of Salmonella meningitis after craniotomy, likely due to physical contact with a snake after surgery, with contiguous spread from the patient's hand to her wound. The purpose of this report is to serve as a reminder that patients undergoing neurosurgery should avoid contact with pets, including snakes and other reptiles, in the postoperative period and practice good hand hygiene

Occipitocervical fixation: general considerations and surgical technique

To review and present details on the occipitocervical fixation (OCF) technique as well as considerations for planning the procedure. Methods: We present the surgical technique of OCF in a step-by-step didactic and practical manner with surgical tips and tricks, including C1 and C2 screw fixation techniques. Additionally, we discuss complications, the extension of fusion, types of OCF, and how to avoid common side effects associated with OCF. The complex and mobile anatomy of the craniocervical junction, when requiring fixation and fusion, warrants rigid instrumentation that can be achieve using a modern screw-plate-rod construct. Indications for OCF are craniocervical instability, and atlantoaxial instability when selective atlantoaxial fusion is not feasible. OCF generally involves occiput-C2 fusion. C1 fixation is generally unnecessary, since it increases the surgical time and is associated with the risk of vascular complications. Selective occiput-C2 fusion is recommended when there is no need for including the cervical subaxial region (eg, when stenosis or fractures coexist in the subaxial spine), and good fixation is achieved at C2. Most instrumentation systems now have occipital plates that are not pre-integrated to rods, making fixation much simpler. Surgical steps, from position to wound closure, are presented in detail, with pearls for practice and discussion of cervical alignment. OCF is a challenging procedure, with potential risk of severe adverse effects. Understanding the surgical indications, as well as the nuances of the surgical technique, is required to improve patient outcomes and avoid complications

Freehand Juxtapedicular Screws Placed in the Apical Concavity of Adult Idiopathic Scoliosis Patients: Technique, Computed Tomography Confirmation, and Radiographic Results

Objective The purpose of this study is to highlight our technique for freehand placement of juxtapedicular screws along with intraoperative computed tomography (CT) and radiographic results. Methods Consecutive patients with adult idiopathic scoliosis undergoing primary surgery by the senior author were identified. All type D (absent/slit like channel) pedicles were identified on preoperative CT. Three-dimensional visualization software was used to measure screw angulation and purchase. Radiographs were measured by a fellowship trained spine surgeon. The freehand technique was used to place all screws in a juxtapedicular fashion without any fluoroscopic, radiographic, navigational or robotic assistance. Results Seventy-three juxtapedicular screws were analyzed. The most common level was T7 (9 screws) on the left and T5 (12 screws) on the right. The average medial angulation was 20.7° (range, 7.1°–36.3°), lateral vertebral body purchase was 13.4 mm (range, 0–28.9 mm), and medial vertebral body purchase was 21.1 mm (range, 8.9–31.8 mm). More than half (53.4%) of the screws had bicortical purchase. Two screws were lateral on CT scan, defined by the screw axis lateral to the lateral vertebral body cortex. No screws were medial. There was a difference in medial angulation between screws with (n = 58) and without (n = 15) lateral body purchase (22.0±4.9 vs. 15.5±4.5, p < 0.001). Three of 73 screws were repositioned after intraoperative CT. There were no neurovascular complications. The mean coronal cobb corrections for main thoracic and lumbar curves were 83.0% and 80.5%, respectively, at an average of 17.5 months postoperative. Conclusion Freehand juxtapedicular screw placement is a safe technique for type D pedicles in adult idiopathic scoliosis patients

Vibrational Excitations in Weakly Coupled Single-Molecule Junctions: A Computational Analysis

In bulk systems, molecules are routinely identified by their vibrational spectrum using Raman or infrared spectroscopy. In recent years, vibrational excitation lines have been observed in low-temperature conductance measurements on single molecule junctions and they can provide a similar means of identification. We present a method to efficiently calculate these excitation lines in weakly coupled, gateable single-molecule junctions, using a combination of ab initio density functional theory and rate equations. Our method takes transitions from excited to excited vibrational state into account by evaluating the Franck-Condon factors for an arbitrary number of vibrational quanta, and is therefore able to predict qualitatively different behaviour from calculations limited to transitions from ground state to excited vibrational state. We find that the vibrational spectrum is sensitive to the molecular contact geometry and the charge state, and that it is generally necessary to take more than one vibrational quantum into account. Quantitative comparison to previously reported measurements on pi-conjugated molecules reveals that our method is able to characterize the vibrational excitations and can be used to identify single molecules in a junction. The method is computationally feasible on commodity hardware.Comment: 9 pages, 7 figure

The Mass and Structure of the Pleiades Star Cluster from 2MASS

We present the results of a large scale search for new members of the Pleiades star cluster using 2MASS near-infrared photometry and proper motions derived from POSS plates digitized by the USNO PMM program. The search extends to a 10 degree radius around the cluster, well beyond the presumed tidal radius, to a limiting magnitude of R ~ 20, corresponding to ~ 0.07 M_sun at the distance and age of the Pleiades. Multi-object spectroscopy for 528 candidates verifies that the search was extremely effective at detecting cluster stars in the 1 - 0.1 M_sun mass range using the distribution of H_alpha emission strengths as an estimate of sample contamination by field stars. When combined with previously identified, higher mass stars, this search provides a sensitive measurement of the stellar mass function and dynamical structure of the Pleiades. The degree of tidal elongation of the halo agrees well with current N body simulation results. Tidal truncation affects masses below ~ 1 M_sun. The cluster contains a total mass ~ 800 M_sun. Evidence for a flatter mass function in the core than in the halo indicates the depletion of stars in the core with mass less than ~ 0.5 M_sun, relative to stars with mass \~1 - 0.5 M_sun, and implies a preference for very low mass objects to populate the halo or escape. The overall mass function is best fitted with a lognormal form that becomes flat at ~ 0.1 M_sun. Whether sufficient dynamical evaporation has occurred to detectably flatten the initial mass function, via preferential escape of very low mass stars and brown dwarfs, is undetermined, pending better membership information for stars at large radial distances.Comment: 19 pages, 14 figures, 2 tables, accepted by AJ, to appear April 200

The Herschel Orion Protostar Survey: Luminosity and Envelope Evolution

The Herschel Orion Protostar Survey obtained well-sampled 1.2–870 μm spectral energy distributions (SEDs) of over 300 protostars in the Orion molecular clouds, home to most of the young stellar objects (YSOs) in the nearest 500 pc. We plot the bolometric luminosities and temperatures for 330 Orion YSOs, 315 of which have bolometric temperatures characteristic of protostars. The histogram of the bolometric temperature is roughly flat; 29% of the protostars are in Class 0. The median luminosity decreases by a factor of four with increasing bolometric temperature; consequently, the Class 0 protostars are systematically brighter than the Class I protostars, with a median luminosity of 2.3 L_☉ as opposed to 0.87 L_☉. At a given bolometric temperature, the scatter in luminosities is three orders of magnitude. Using fits to the SEDs, we analyze how the luminosities corrected for inclination and foreground reddening relate to the mass in the inner 2500 au of the best-fit model envelopes. The histogram of the envelope mass is roughly flat, while the median-corrected luminosity peaks at 15 L_☉ for young envelopes and falls to 1.7 L_☉ for late-stage protostars with remnant envelopes. The spread in luminosity at each envelope mass is three orders of magnitude. Envelope masses that decline exponentially with time explain the flat mass histogram and the decrease in luminosity, while the formation of a range of stellar masses explains the dispersion in luminosity

Centralized, Stepped, Patient Preference–Based Treatment for Patients With Post–Acute Coronary Syndrome Depression

IMPORTANCE: Controversy remains about whether depression can be successfully managed after acute coronary syndrome (ACS) and the costs and benefits of doing so. OBJECTIVE: To determine the effects of providing post-ACS depression care on depressive symptoms and health care costs. DESIGN: Multicenter randomized controlled trial. SETTING: Patients were recruited from 2 private and 5 academic ambulatory centers across the United States. PARTICIPANTS: A total of 150 patients with elevated depressive symptoms (Beck Depression Inventory [BDI] score ≥10) 2 to 6 months after an ACS, recruited between March 18, 2010, and January 9, 2012. INTERVENTIONS: Patients were randomized to 6 months of centralized depression care (patient preference for problem-solving treatment given via telephone or the Internet, pharmacotherapy, both, or neither), stepped every 6 to 8 weeks (active treatment group; n = 73), or to locally determined depression care after physician notification about the patient's depressive symptoms (usual care group; n = 77). MAIN OUTCOME MEASURES: Change in depressive symptoms during 6 months and total health care costs. RESULTS: Depressive symptoms decreased significantly more in the active treatment group than in the usual care group (differential change between groups, -3.5 BDI points; 95% CI, -6.1 to -0.7; P = .01). Although mental health care estimated costs were higher for active treatment than for usual care, overall health care estimated costs were not significantly different (difference adjusting for confounding, -$325; 95$2639 to $1989; P = .78). CONCLUSIONS: For patients with post-ACS depression, active treatment had a substantial beneficial effect on depressive symptoms. This kind of depression care is feasible, effective, and may be cost-neutral within 6 months; therefore, it should be tested in a large phase 3 pragmatic trial. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01032018

Predictors of Patient Satisfaction in Spine Surgery: A Systematic Review

Background: Recently, there has been increased interest in patient satisfaction measures such as Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. In this systematic review, the spine surgery literature is analyzed to evaluate factors predictive of patient satisfaction as measured by these surveys. Methods: A thorough literature search was performed in PubMed/MEDLINE, Google Scholar, and Cochrane databases. All English-language articles from database inception to July 2020 were screened for study inclusion according to PRISMA guidelines. Results: Twenty-four of the 1899 published studies were included for qualitative analysis. There has been a statistically significant increase in the number of publications across years (P = 0.04). Overall, the studies evaluated the relationship between patient satisfaction and patient demographics (71%), preoperative and intraoperative clinical factors (21%), and postoperative factors (33%). Top positive predictors of patient satisfaction were patient and nursing/medical staff relationship (n = 4; 17%), physician–patient relationship (n = 4; 17%), managerial oversight of received care (n = 3; 13%), same sex/ethnicity between patient and physician (n = 2; 8%), and older age (n = 2; 8%). Top negative predictors of patient satisfaction were high Charlson Comorbidity Index/high disability/worse overall health functioning (n = 7; 29%), increased length of hospital stay (n = 4; 17%), high rating for pain/complications/readmissions (n = 4; 17%), and psychosocial factors (n = 3; 13%). Conclusions: There is heterogeneity in terms of different factors, both clinical and nonclinically related, that affect patient satisfaction ratings. More research is warranted to investigate the role of hospital consumer surveys in the spine surgical patient population

Evaluation of polygenic risk scores for breast and ovarian cancer risk prediction in BRCA1 and BRCA2 mutation carriers

Background: Genome-wide association studies (GWAS) have identified 94 common single-nucleotide polymorphisms (SNPs) associated with breast cancer (BC) risk and 18 associated with ovarian cancer (OC) risk. Several of these are also associated with risk of BC or OC for women who carry a pathogenic mutation in the high-risk BC and OC genes BRCA1 or BRCA2. The combined effects of these variants on BC or OC risk for BRCA1 and BRCA2 mutation carriers have not yet been assessed while their clinical management could benefit from improved personalized risk estimates. Methods: We constructed polygenic risk scores (PRS) using BC and OC susceptibility SNPs identified through population-based GWAS: for BC (overall, estrogen receptor [ER]-positive, and ER-negative) and for OC. Using data from 15 252 female BRCA1 and 8211 BRCA2 carriers, the association of each PRS with BC or OC risk was evaluated using a weighted cohort approach, with time to diagnosis as the outcome and estimation of the hazard ratios (HRs) per standard deviation increase in the PRS. Results: The PRS for ER-negative BC displayed the strongest association with BC risk in BRCA1 carriers (HR = 1.27, 95% confidence interval [CI] = 1.23 to 1.31, P = 8.2 x 10(53)). In BRCA2 carriers, the strongest association with BC risk was seen for the overall BC PRS (HR = 1.22, 95% CI = 1.17 to 1.28, P = 7.2 x 10(-20)). The OC PRS was strongly associated with OC risk for both BRCA1 and BRCA2 carriers. These translate to differences in absolute risks (more than 10% in each case) between the top and bottom deciles of the PRS distribution; for example, the OC risk was 6% by age 80 years for BRCA2 carriers at the 10th percentile of the OC PRS compared with 19% risk for those at the 90th percentile of PRS. Conclusions: BC and OC PRS are predictive of cancer risk in BRCA1 and BRCA2 carriers. Incorporation of the PRS into risk prediction models has promise to better inform decisions on cancer risk management

Diabetes mellitus en pacientes con enfermedad de Alzheimer: descripción clínica y correlación con el genotipo APOE en una muestra de población del departamento de Antioquia, Colombia

Introduction. Alzheimer’s disease is a multifactorial disease affecting approximately twenty million people worldwide. Numerous variables are associated with increased risk of developing this severe neurological disorder. Among the risk factors, diabetes mellitus, and the ε4 isoform of the APOE gene have been amply demonstrated as increasing the risk of developing this disease.Objective. To determine if a correlation exists between APOE genotype, diabetes mellitus and Alzheimer’s disease.Materials and methods. Clinical studies were carried out by surveying the clinical histories in a group of patients in the province of Antioquia, Colombia. Forty-three Alzheimer’s patients were compared with 43 control subjects, paired by age and gender. Commercially available methods were used to determine whether the patients had diabetes, and restriction enzyme-based genotyping was used to determine the APOE genotypes.Results. The most common non-neurological comorbidities were: arterial hypertension, acute myocardial infarction, chronic obstructive pulmonary disease and hypothyroidism. From the many variables investigated, two were conclusive: (1) the presence of Alzheimer’s disease was higher in patients with diabetes mellitus, and (2) no correlation between late-onset sporadic Alzheimer’s disease and APOE was found in the target population.Conclusions. To detect any association with the APOE genotype, a study involving much a larger population samples must be undertaken.Introducción. La enfermedad de Alzheimer es compleja y afecta, aproximadamente, a 20 millones de personas en todo el mundo. Muchas variables parecen aumentar el riesgo de desarrollar esta alteración neurológica. Entre los factores de riesgo, se ha demostrado ampliamente que la diabetes mellitus y la isoforma ε4 del gen APOE tienen incidencia positiva en el desarrollo de la enfermedad. Se reporta un estudio en el cual se investigó la posible correlación entre APOE, diabetes mellitus yla enfermedad de Alzheimer, en un grupo específico de pacientes del departamento de Antioquia, Colombia.Objetivo. Determinar si existe una correlación entre APOE, diabetes mellitus y la enfermedad de Alzheimer, en un grupo de pacientes de Antioquia, Colombia.Materiales y métodos. Se buscaron y analizaron las historias clínicas de los pacientes con diagnóstico de enfermedad de Alzheimer. Se seleccionaron aquellos que cumplían los criterios de inclusión. Se utilizaron métodos comercialmente disponibles para confirmar la presencia de diabetes mellitus. La genotipificación de APOE se hizo con un método basado en la PCR y la digestión con enzimas de restricción, en muestras de todos los participantes en el estudio.Resultados. En este estudio se analizan 43 casos de enfermedad de Alzheimer y 43 individuos sanos controles, pareados por edad y sexo. Las enfermedades concomitantes no neurológicas más comunes fueron: hipertensión arterial, infarto agudo del miocardio, enfermedad pulmonar obstructiva crónica e hipotiroidismo.Conclusiones. De las diferentes variables investigadas, dos arrojaron resultados concluyentes: i) la presencia de la enfermedad de Alzheimer es más frecuente en pacientes con diabetes mellitus, y 2) no se encontró correlación entre la enfermedad de Alzheimer de inicio tardío esporádico y el genotipo de APOE. Es importante indicar que debe llevarse a cabo un estudio con un tamaño de población mayor, para determinar cualquier posible correlación o inferencia con el genotipo de APOE. doi: http://dx.doi.org/10.7705/biomedica.v32i2.579