Efficiency of spinal anesthesia versus general anesthesia for lumbar spinal surgery: a retrospective analysis of 544 patients.

BACKGROUND: Previous studies have shown varying results in selected outcomes when directly comparing spinal anesthesia to general in lumbar surgery. Some studies have shown reduced surgical time, postoperative pain, time in the postanesthesia care unit (PACU), incidence of urinary retention, postoperative nausea, and more favorable cost-effectiveness with spinal anesthesia. Despite these results, the current literature has also shown contradictory results in between-group comparisons. MATERIALS AND METHODS: A retrospective analysis was performed by querying the electronic medical record database for surgeries performed by a single surgeon between 2007 and 2011 using procedural codes 63030 for diskectomy and 63047 for laminectomy: 544 lumbar laminectomy and diskectomy surgeries were identified, with 183 undergoing general anesthesia and 361 undergoing spinal anesthesia (SA). Linear and multivariate regression analyses were performed to identify differences in blood loss, operative time, time from entering the operating room (OR) until incision, time from bandage placement to exiting the OR, total anesthesia time, PACU time, and total hospital stay. Secondary outcomes of interest included incidence of postoperative spinal hematoma and death, incidence of paraparesis, plegia, post-dural puncture headache, and paresthesia, among the SA patients. RESULTS: SA was associated with significantly lower operative time, blood loss, total anesthesia time, time from entering the OR until incision, time from bandage placement until exiting the OR, and total duration of hospital stay, but a longer stay in the PACU. The SA group experienced one spinal hematoma, which was evacuated without any long-term neurological deficits, and neither group experienced a death. The SA group had no episodes of paraparesis or plegia, post-dural puncture headaches, or episodes of persistent postoperative paresthesia or weakness. CONCLUSION: SA is effective for use in patients undergoing elective lumbar laminectomy and/or diskectomy spinal surgery, and was shown to be the more expedient anesthetic choice in the perioperative setting

Post Point Wastewater Treatment Plant: environmental impact assessment

The Post Point Wastewater Treatment Plant is approaching capacity and must be expanded to meet current and future needs, as the City of Bellingham continues to grow. The plant presently has a peak capacity of 72 million gallons a day and services 83,000 customers over approximately 30 square miles

Single-neuron dynamics in human focal epilepsy

Epileptic seizures are traditionally characterized as the ultimate expression of monolithic, hypersynchronous neuronal activity arising from unbalanced runaway excitation. Here we report the first examination of spike train patterns in large ensembles of single neurons during seizures in persons with epilepsy. Contrary to the traditional view, neuronal spiking activity during seizure initiation and spread was highly heterogeneous, not hypersynchronous, suggesting complex interactions among different neuronal groups even at the spatial scale of small cortical patches. In contrast to earlier stages, seizure termination is a nearly homogenous phenomenon followed by an almost complete cessation of spiking across recorded neuronal ensembles. Notably, even neurons outside the region of seizure onset showed significant changes in activity minutes before the seizure. These findings suggest a revision of current thinking about seizure mechanisms and point to the possibility of seizure prevention based on spiking activity in neocortical neurons

Sistema de pronóstico geolocalizado de atenciones de urgencia

l objetivo de la investigación fue determinar a través de un nuevo modelo predictivo con la ayuda de la minería de datos y la técnica de predicción de minería de datos de regresión lineal, a través de un sistema de geolocalización para medir los impactos y cambios de atención de urgencia en los hospitales. Mediante una comparación de metodología, herramientas de minería de datos y software de modelos de proyección, se optará la mejor opción en base de su funcionalidad, escalabilidad, características, entre otros. Además, se recolectó datos en el período 2010 - 2019 del área de atención de urgencias. En un estudio transversal, las variables se identifican en un momento dado y se determinan las relaciones entre ellas. Se concluyó las enfermedades respiratorias son las de mayor impacto las que generan más atenciones de urgencia en los hospitales de acuerdo a los modelos de regresión lineal múltiple y regresión logística ordinal. También se concluyó que la mejor técnica de series de tiempo el Holt-Winter’s el cual nos arroja una precisión de 97.3% mostrando las cantidades que se esperan en las atenciones de urgencia del año 2020 en los hospitales. Se recomienda que se realicen de vuelta con una cantidad de datos mayor para ver el comportamiento de la cantidad de atenciones de urgencia en los hospitales y ver cuál es la enfermedad que es la que más atenciones obtenidas en los siguientes años. Esto agregando más variables tomando otras normativas de clasificación de enfermedades otras técnicas para ver el impacto y saber cuál es la enfermedad más frecuente en los hospitales de cada localidad geográfica también tomar otras técnicas de series de tiempo para encontrar nuevos porcentajes de pronóstico de atenciones de urgencia

Evidence that nicotinic 7 receptors are not involved in the hyperlocomotor and rewarding effects of nicotine.

ABSTRACT Neuronal nicotinic receptors are comprised of combinations of ␣ 2-9 and ␤ 2-4 subunits arranged to form a pentameric receptor. Currently, the principal central nervous system (CNS) subtypes are believed to be ␣ 4 ␤ 2 and a homomeric ␣ 7 receptor, although other combinations almost certainly exist. The identity of the nicotinic receptor subtype(s) involved in the rewarding effects of nicotine are unknown. In the present study, using some recently described subtype selective nicotinic agonists and antagonists, we investigated the role of the ␣ 7 nicotinic receptor in the mediation of nicotine-induced hyperactivity and selfadministration in rats. The ␣ 7 receptor agonists AR-R 17779 and DMAC failed to stimulate locomotor activity in both nicotine-nontolerant and -sensitized rats. In contrast, nicotine and the putative ␣ 4 ␤ 2 subtype selective agonist SIB1765F increased activity in both experimental conditions. In nicotinesensitized rats, the high affinity (including the ␣ 4 ␤ 2 subtype) nicotinic antagonist dihydro-␤-erythroidine (DH␤E), but not the selective ␣ 7 antagonist methyllycaconitine (MLA), antagonized a nicotine-induced hyperactivity. Similarly, DH␤E, but not MLA, pretreatment reduced nicotine self-administration. Electrophysiology experiments using Xenopus oocytes expressing the human ␣ 7 receptor confirmed AR-R 17779 and DMAC to be potent agonists at this site, and further studies demonstrated the ability of systemically administered AR-R 17779 to penetrate into the CNS. Taken together, these results indicate a negligible role of ␣ 7 receptors in nicotine-induced hyperlocomotion and reward in the rat, and support the view for an involvement of a member from the high-affinity nicotinic receptor subclass, possibly ␣ 4 ␤ 2 . Issues such as drug potency, CNS penetration, and desensitization of the ␣ 7 receptor are discussed