Comparison of inpatient vs. outpatient anterior cervical discectomy and fusion: a retrospective case series

<p>Abstract</p> <p>Background</p> <p>Spinal surgery is increasingly being done in the outpatient setting. We reviewed our experience with inpatient and outpatient single-level anterior cervical discectomy and fusion with plating (ACDF+P).</p> <p>Methods</p> <p>All patients undergoing single-level anterior cervical discectomy and fusion with plating between August 2005 and May 2007 by two surgeons (RPB or JAF) were retrospectively reviewed. All patients underwent anterior cervical microdiscectomy, arthrodesis using structural allograft, and titanium plating. A planned change from doing ACDF+P on an inpatient basis to doing ACDF+P on an outpatient basis was instituted at the midpoint of the study. There were no other changes in technique, patient selection, instrumentation, facility, or other factors. All procedures were done in full-service hospitals accommodating outpatient and inpatient care.</p> <p>Results</p> <p>64 patients underwent ACDF+P as inpatients, while 45 underwent ACDF+P as outpatients. When outpatient surgery was planned, 17 patients were treated as inpatients due to medical comorbidities (14), older age (1), and patient preference (2). At a mean follow-up of 62.4 days, 90 patients had an excellent outcome, 19 patients had a good outcome, and no patients had a fair or poor outcome. There was no significant difference in outcome between inpatients and outpatients. There were 4 complications, all occurring in inpatients: a hematoma one week post-operatively requiring drainage, a cerebrospinal fluid leak treated with lumbar drainage, syncope of unknown etiology, and moderate dysphagia.</p> <p>Conclusion</p> <p>In this series, outpatient ACDF+P was safe and was not associated with a significant difference in outcome compared with inpatient ACDF+P.</p

Integrative Gene Regulatory Network Analysis Reveals Light-Induced Regional Gene Expression Phase Shift Programs in the Mouse Suprachiasmatic Nucleus

We use the multigenic pattern of gene expression across suprachiasmatic nuclei (SCN) regions and time to understand the dynamics within the SCN in response to a circadian phase-resetting light pulse. Global gene expression studies of the SCN indicate that circadian functions like phase resetting are complex multigenic processes. While the molecular dynamics of phase resetting are not well understood, it is clear they involve a “functional gene expression program”, e.g., the coordinated behavior of functionally related genes in space and time. In the present study we selected a set of 89 of these functionally related genes in order to further understand this multigenic program. By use of high-throughput qPCR we studied 52 small samples taken by anatomically precise laser capture from within the core and shell SCN regions, and taken at time points with and without phase resetting light exposure. The results show striking regional differences in light response to be present in the mouse SCN. By using network-based analyses, we are able to establish a highly specific multigenic correlation between genes expressed in response to light at night and genes normally activated during the day. The light pulse triggers a complex and highly coordinated network of gene regulation. The largest differences marking neuroanatomical location are in transmitter receptors, and the largest time-dependent differences occur in clock-related genes. Nighttime phase resetting appears to recruit transcriptional regulatory processes normally active in the day. This program, or mechanism, causes the pattern of core region gene expression to transiently shift to become more like that of the shell region

Allergic sensitization: screening methods

Experimental in silico, in vitro, and rodent models for screening and predicting protein sensitizing potential are discussed, including whether there is evidence of new sensitizations and allergies since the introduction of genetically modified crops in 1996, the importance of linear versus conformational epitopes, and protein families that become allergens. Some common challenges for predicting protein sensitization are addressed: (a) exposure routes; (b) frequency and dose of exposure; (c) dose-response relationships; (d) role of digestion, food processing, and the food matrix; (e) role of infection; (f) role of the gut microbiota; (g) influence of the structure and physicochemical properties of the protein; and (h) the genetic background and physiology of consumers. The consensus view is that sensitization screening models are not yet validated to definitively predict the de novo sensitizing potential of a novel protein. However, they would be extremely useful in the discovery and research phases of understanding the mechanisms of food allergy development, and may prove fruitful to provide information regarding potential allergenicity risk assessment of future products on a case by case basis. These data and findings were presented at a 2012 international symposium in Prague organized by the Protein Allergenicity Technical Committee of the International Life Sciences Institute’s Health and Environmental Sciences Institute

Evidence-based Kernels: Fundamental Units of Behavioral Influence

This paper describes evidence-based kernels, fundamental units of behavioral influence that appear to underlie effective prevention and treatment for children, adults, and families. A kernel is a behavior–influence procedure shown through experimental analysis to affect a specific behavior and that is indivisible in the sense that removing any of its components would render it inert. Existing evidence shows that a variety of kernels can influence behavior in context, and some evidence suggests that frequent use or sufficient use of some kernels may produce longer lasting behavioral shifts. The analysis of kernels could contribute to an empirically based theory of behavioral influence, augment existing prevention or treatment efforts, facilitate the dissemination of effective prevention and treatment practices, clarify the active ingredients in existing interventions, and contribute to efficiently developing interventions that are more effective. Kernels involve one or more of the following mechanisms of behavior influence: reinforcement, altering antecedents, changing verbal relational responding, or changing physiological states directly. The paper describes 52 of these kernels, and details practical, theoretical, and research implications, including calling for a national database of kernels that influence human behavior

Variable IgE cross-reactivity between peanut 2S-albumins: The case for measuring IgE to both Ara h 2 and Ara h 6.

BACKGROUND:2S-albumins Ara h 2 and Ara h 6 are the most potent peanut allergens and levels of specific immunoglobulin E (IgE) towards these proteins are good predictors of clinical reactivity. Because of structural homologies, Ara h 6 is generally considered to cross-react extensively with Ara h 2.OBJECTIVE:We aimed to quantify the IgE cross-reactivity between Ara h 2 and Ara h 6.METHODS:Peanut 2S-albumins were purified from raw peanuts. The IgE cross-reactivity between Ara h 2 and Ara h 6 was evaluated with 32 sera from French and US peanut-allergic patients by measuring the residual IgE-binding to one 2S-albumin after depletion of IgE antibodies recognizing the other 2S-albumin. The IgE cross-reactivity between Ara h 2 and Ara h 6 was further investigated by competitive inhibition of IgE-binding and by a model of mast cell degranulation.RESULTS:A highly variable level of IgE cross-reactivity was revealed among the patients. The mean fraction of cross-reactive IgE antibodies represented only 17.1% of 2S-albumins-specific IgE antibodies and was lower than the mean fraction of IgE specific to Ara h 2 (57.4%) or to Ara h 6 (25.5%). The higher level of Ara h 2-specific IgE was principally due to the IgE-binding capacity of an insertion containing the repeated immunodominant linear epitope DPYSPOH S. The impact of IgE cross-reactivity on diagnostic testing was illustrated with a serum displaying an Ara h 6-specific IgE response of 26 UI/mL that was not associated with the capacity of Ara h 6 to trigger mast cell degranulation.CONCLUSIONS & CLINICAL RELEVANCE:Immunoglobulin E antibodies specific to peanut 2S-albumins are mainly non-cross-reactive, but low-affinity cross-reactivity can affect diagnostic accuracy. Testing IgE-binding to a mixture of 2S-albumins rather than to each separately may enhance diagnostic performance

Cultivating safeness from the inside out: understanding the processes and developing a compassion-based intervention for psychosis

Tese de Doutoramento em Psicologia, na especialidade de Psicologia Clínica, apresentada à Faculdade de Psicologia e de Ciências da Educação da Universidade de CoimbraGiven the challenging and often distressing characteristics of experiences occurring before, during and after a psychotic episode, emotional dysfunction after psychosis is a widely common reality. Although overlooked for a long time, psychological interventions have important benefits in coping with psychotic symptoms or loss of functions, reducing the burden of the disease and enhancing patients’ lives. From the recovery model’s perspective, psychological interventions should promote richer and more positive self-experiences across several dimensions, thus shifting from a symptom-focused approach to a more person-based approach. This paradigm shift entails clinical and research implications regarding assessment, research on psychological mechanisms and intervention methods and outcomes. Contextual behavioural approaches, emphasizing the importance of mechanisms such as compassion, mindfulness and acceptance, have the potential to be key interventions for people with psychosis. Thus, this projects’ aims were: 1) to contribute to the development and validation of adequate assessment tools, through a) the development and validation of a clinical interview for psychotic disorders based on the recovery model and b) the development and/or validation of self-report measures; 2) to extend the understanding on processes underlying the development and maintenance of psychotic symptoms and their impact; and 3) to develop, implement and evaluate a new compassion-based group intervention for people with psychosis. Methods: The present project comprises one descriptive study, two review studies and ten empirical studies. Empirical studies were conducted in adult, clinical samples of people with experience of psychosis. Methods to assess participants included self-report measures, clinician-reported measures (clinical interviews and rating scales) and instruments filled in by a significant-other of each participant. Three empirical studies were clinical, interventional studies and followed a longitudinal design, while the others assessed participants cross-sectionally (either for evaluating psychometric properties of instruments or associations between process and outcome variables). Results: Regarding the studies focused on assessment, overall our results highlight the adequate psychometric properties, clinical utility and pertinence of a new clinical interview and self-report measures designed to measure experiential acceptance towards delusions and voices, and to assess antipsychotic medication adherence. In what concerns processes underlying psychotic experiences and recovery, results highlighted the pervasive role of shame, self-criticism and fears of compassion in difficulties experienced by people with psychosis, on one hand, and the impact of mindfulness and positive affect on social safeness, on the other. Clinical studies further emphasized the safety, adequacy, acceptability and usefulness of compassion, acceptance and mindfulness-based interventions in this population. Furthermore, the COMPASS intervention showed benefits regarding self-to-self and self-to-others relationships, functioning and symptoms. Conclusions: Overall the studies presented in the research project emphasize the importance of social rank and contextual variables in the maintenance versus recovery from psychosis, from the assessment phase to the intervention planning and implementation. This entails important clinical and research implications, namely regarding the need to foster accepting and compassionate therapeutic environments rooted on care-giving social mentalities.Tendo em conta que as experiências que ocorrem antes, durante e após um episódio psicótico são desafiadoras e muitas vezes angustiantes, a disfunção emocional após a psicose é uma realidade amplamente comum. Embora negligenciadas durante muito tempo, as intervenções psicológicas têm benefícios importantes na capacidade de lidar com os sintomas psicóticos ou perda de funcionalidade, na redução da sobrecarga da doença e na melhoria da vida dos pacientes. Do ponto de vista do modelo recovery, as intervenções psicológicas devem promover experiências de autoconhecimento mais ricas e positivas em várias dimensões, havendo assim uma mudança de uma abordagem focada nos sintomas para uma abordagem mais baseada na pessoa. Esta mudança de paradigma tem importantes implicações clínicas e de investigação nos campos da avaliação psicológica, do estudo dos mecanismos psicológicos, e da intervenção. As abordagens comportamentais contextuais, enfatizando a importância de mecanismos como compaixão, atenção plena e aceitação, têm o potencial de serem intervenções-chave para pessoas com psicose. Assim, os objetivos deste projeto prenderam-se com: 1) contribuir para o desenvolvimento e validação de instrumentos de avaliação adequados, através a) do desenvolvimento e validação de uma entrevista clínica para perturbações psicóticas com base no modelo de recuperação, e b) do desenvolvimento e/ou validação de medidas de autorresposta; 2) ampliar a compreensão em relação aos processos subjacentes ao desenvolvimento e manutenção de sintomas psicóticos e seu impacto; e 3) desenvolver, implementar e avaliar uma nova intervenção em grupo baseada na compaixão para pessoas com psicose. Método: O presente projeto compreende um estudo descritivo, dois estudos de revisão e dez estudos empíricos. Os estudos empíricos foram realizados com amostras clínicas de adultos com experiência de psicose. Os métodos para avaliar os participantes incluíram medidas de autorrelato, medidas preenchidas pelo clínico (entrevistas clínicas e escalas de avaliação cotadas pelo clínico) e instrumentos preenchidos por uma pessoa significativa do participante. Três dos estudos empíricos foram estudos clínicos, intervencionais e seguiram um desenho longitudinal. Os restantes avaliaram transversalmente os participantes (seja para avaliar propriedades psicométricas de instrumentos ou para perceber as associações entre variáveis de processo e de resultado). Resultados: Em relação aos estudos focados na avaliação, os nossos resultados destacam as propriedades psicométricas adequadas, utilidade clínica e pertinência de uma nova entrevista clínica e de medidas de autorrelato desenhadas para medir a aceitação experiencial em relação a delírios e vozes, e para avaliar a adesão à medicação anti-psicótica. No que diz respeito aos estudos que exploraram os processos subjacentes às experiências psicóticas e à recuperação, os resultados destacaram o papel nefasto da vergonha, autocrítica e medos de compaixão nas dificuldades experimentadas pelas pessoas com psicose, por um lado, e o impacto da atenção plena e do afeto positivo no sentimento de segurança em contextos sociais, por outro. Os estudos clínicos enfatizaram a segurança, adequação, aceitabilidade e utilidade das intervenções baseadas na compaixão, aceitação e atenção plena nesta população. Além disso, a intervenção COMPASS mostrou benefícios no que concerne as relações dos participantes consigo próprios e com os outros, o seu funcionamento e sintomas. Conclusões: De maneira geral, os estudos apresentados neste projeto enfatizam a importância de variáveis contextuais na manutenção versus recuperação da psicose, desde a fase da avaliação ao planeamento e implementação da intervenção. Isto acarreta importantes implicações clínicas e de investigação, nomeadamente no que diz respeito à necessidade de promover ambientes terapêuticos de aceitação e compaixão baseados na mentalidade social de prestação de cuidados