Citations

Abstract BACKGROUND Surgical site infections (SSIs) after spine and brain surgery present a major burden to patients and hospitals by increasing morbidity, mortality, and healthcare costs. OBJECTIVE To review available literature investigating the role of intrawound powdered vancomycin against SSIs after neurosurgical operations. METHODS All randomized and observational English language studies of intrawound powdered vancomycin use in spinal and cranial surgery were included and analyzed using random-effects modeling. RESULTS In spine surgery (25 studies with 16 369 patients), patients in the vancomycin group had a significantly lower risk for any SSI (odds ratio [OR]: 0.41; 95% confidence interval [CI]: 0.30-0.57; P < .001; I 2 = 47%). However, when separate analyses were conducted for superficial and deep SSIs, a significant difference was found only for deep (OR: 0.31; 95% CI: 0.22-0.45; P < .001; I 2 = 29%). Subgroup analyses for different vancomycin powder dosages (1 g vs 2 g vs composite dose) did not point to any dose-related effect of vancomycin. In cranial surgery (6 studies with 1777 patients), use of vancomycin was associated with a significantly lower risk for SSIs (OR: 0.33; 95% CI: 0.18-0.60; P = .0003; I 2 = 45%). In meta-regression analysis, trial-level variability of diabetes had no influence on the association of vancomycin powder use with SSIs. CONCLUSION Use of vancomycin powder in spinal and cranial surgery might be protective against SSIs, especially against deep SSIs. No dose-related effect of vancomycin powder was identified. However, caution is needed in the clinical interpretation of these results, owing to the observational design of the included studies in this meta-analysis.

Abstract Dural membrane is an important anatomic structure that surrounds and protects the entire central nervous system. Physical properties of the dura have many pathophysiological and therapeutic implications in cranial surgery, especially skull base disorders. The aim of this study is to investigate variation in skull base dural thickness and correlation with different demographic parameters. At the time of autopsy, the petrous apex dura with the underlying bone of 20 cadavers was harvested. Dural thickness was independently measured by two pathologists at the thinnest and thickest segments in the specimen. Correlational analyses were then performed to compare dural thickness with gender, age, neck circumference, height, weight, and body mass index (BMI). Mean, minimum, and maximum skull base dural thickness in our study was 0.36, 0.27, and 0.46 mm, respectively. Age demonstrated a negative correlation with dural thickness with significantly thinner dura in the older subjects, p = 0.01. There was a trend toward thinner dura in females that approached statistical significance, p = 0.06. No strong correlation could be found with body weight, height, neck circumference, or BMI. Our findings show a considerable intersubject and intrasubject variability in skull base dural thickness. Some demographic parameters also seem to impact dural thickness. Additional histological studies are needed for better understanding of the pathophysiological mechanisms pertaining to the tensile properties of the dural membrane.

ABSTRACT The QuantiFERON-TB Gold Plus (QFT-Plus; Qiagen, Germantown, MD) interferon gamma release assay (IGRA) received FDA clearance in 2017 and will replace the prior version of the assay, the QFT-Gold In-Tube (QFT-GIT). Here, we compared performances of the QFT-Plus assay and the QFT-GIT version in a diverse patient population, including patients undergoing evaluation for or follow-up of latent tuberculosis infection (LTBI; n = 39) or active TB infection ( n = 3), and in health care workers (HCWs; n = 119) at Mayo Clinic (Rochester, MN). Compared to the QFT-GIT, the QFT-Plus assay showed 91.2% (31/34) positive, 98.4% (124/126) negative, and 96.6% (156/161) overall qualitative agreement among the 161 enrolled subjects, with a Cohen's kappa value of 0.91 (excellent interrater agreement). Among the 28 patients diagnosed with LTBI at the time of enrollment, the QFT-GIT and QFT-Plus assays agreed in 24 (85.7%) patients; in all four discordant patients, the positivity of the QFT-GIT or QFT-Plus IGRA was associated with low-level interferon gamma (IFN-γ) reactivity, ranging from 0.36 IU/ml to 0.66 IU/ml. Additionally, we document a high degree of correlation between IFN-γ levels in the QFT-GIT TB antigen tube and each of the two QFT-Plus TB antigen tubes, as well as between the QFT-Plus TB1 and TB2 tubes (Pearson's correlation coefficients [ R ] > 0.95). Overall, we show comparable results between the QFT-GIT and QFT-Plus assays in our study population composed of subjects presenting with a diverse spectrum of TB infections. Our findings suggest that the necessary transition to the QFT-Plus assay will be associated with a minimal difference in assay performance characteristics.

Background: The use of a collaborative care management (CCM) model can dramatically improve short- and long-term treatment outcomes for patients with major depressive disorder (MDD). Patients with comorbid personality disorder (PD) may experience poorer treatment outcomes for MDD. Our study seeks to examine the differences in MDD treatment outcomes for patients with comorbid PD when using a CCM approach rather than usual care (UC). Methods: In our retrospective cohort study, we reviewed the records of 9614 adult patients enrolled in our depression registry with the clinical diagnosis MDD and the diagnosis of PD (Yes/No). Clinical outcomes for depression were measured with Patient Health Questionnaire–9 (PHQ-9) scores at 6 months. Results: In our study cohort, 59.4% of patients (7.1% of which had comorbid PD) were treated with CCM, as compared with 40.6% (6.8% with PD) treated with UC. We found that the presence of a PD adversely affected clinical outcomes of remission within both groups, however, at 6 months patients with PD had significantly lower MDD remission rates when treated with UC as compared with those treated with CCM (11.5% vs 25.2%, P = .002). Patients with PD in the UC group were also noted to have an increased rate of persistent depressive symptoms (PHQ-9 score ≥10) at 6 months as compared with those in the CCM group (67.7% vs 51.7%, P = .004). Conclusions: In patients with comorbid MDD and PD, clinical outcomes at 6 months were significantly improved when treated with CCM compared with UC. This finding is encouraging and supports the idea that CCM is an effective model for caring for patients with behavioral concerns, and it may be of even greater benefit for those patients being treated for comorbid behavioral health conditions.

Difficulty in identifying the susprascapular nerve (SSN) limits the success of US‐guided regional anesthetic injections. A proximal SSN block could be an effective and reliable approach. The primary objective was to validate the feasibility of the US‐guided proximal SSN block. The secondary objective was to quantify the spread of the colored local anesthetic to the phrenic nerve (PN). Fourteen brachial plexuses from seven cadavers were included. Characterization of the proximal SSN was performed using US to determine the diameter and depth of the origin of the SSN (orSSN). Ten mL of methylene blue‐infused ropivacaine 0.2% were then injected to the proximal portion of the SSN. After dissection, the distances between the tip of the needle and the orSSN and the PN were anatomically determined. The PN was also judged to be colored or not by the methylene blue. The mean diameter and depth of the orSSN were 0.2 cm (range, 0.1‐0.3 cm) and 1.5 cm (range, 0.6‐2 cm) respectively. The orSSN was successfully targeted in 14 of 14 specimens with US; the tip of the needle was a mean of 1.6 cm (range, 0.2‐2.5 cm) and 5.1 cm (range, 4‐6.5 cm) from the orSSN and PN respectively. The orSSN and PN were marked in 14 and 3 cases respectively. US‐guided proximal SSN block is effective and reliable. The origin of the SSN is an easily identifiable landmark. This regional anesthesia could also reduce the risk of phrenic nerve palsy following interscalene brachial plexus block. Clin. Anat. 31:824–829, 2018. © 2018 Wiley Periodicals, Inc.

We hypothesize that pattern of microvasculature in the thyroid nodules can be a biomarker of thyroid cancer. In this study, morphological features of microvasculature networks are assessed as potential biomarkers for differentiation of benign, suspicious and malignant thyroid nodules. This prospective study included n = 81 patients, with a total of 61 benign, 12 suspicious and 8 malignant nodules verfied by pathology and cytology findings. Thyroid nodules were first identified using conventional B-mode ultrasound. A sequence of raw ultrasound data were acquired from each nodule site in two perpendicular planes at ~600 frames/sec. Power Doppler image of the microvasculature was formed using singular value decomposition clutter removal filtering. Gross images were further processed using a combination of morphology and Hessian-based vessel enhancement filtering. Background-free images of the microvasculature networks were segmented (vessels segment length &gt;385μm and diameter &gt;90μm) for morphological analysis. Using a Bayesian framework, measures of vessels density, diameter and tortuosity were tested for significant differences in the three groups. Among all measures, the probability of vessel diameter &gt;600μm in benign cases was significantly higher than that in malignant cases with the p-value &lt;0.01 using Wilcoxon-Rank-Sum test, suggesting reliable cancer detection performance of the proposed method. [Acknowledgment: NIH Grant EB17213.]

Early detection of osteopenia and osteoporosis is critical in identifying at-risk groups and manage necessary therapy. In this paper, a new noninvasive and quantitative vibro-acoustic method is proposed for detection of osteoporosis and osteopenia. In this method, we excite the bone by an ultrasound radiation force (URF) pulse. The URF pulse induces a vibration in the bone, resulting an acoustic wave that is received by a hydrophone placed on the skin. This prospective study included n = 23 volunteers. The number of volunteers with osteopenia and osteoporosis were 7, 6, respectively, and the number of volunteers with normal bone was 10. URF excitations were applied at four equi-distance points on the bone. The resulting acoustic signals were used for wave velocity estimation based on cross-correlation technique. In general, the hydrophone signal may be modeled as a superposition of different modes of bone vibration. Based on this model, we used variational mode decomposition (VMD) as an efficient technique to decompose the received signal into an ensemble of band-limited intrinsic mode functions. Statistical analysis demonstrates that osteopenia and osteoporosis bones can be differentiated from normal bone with p&lt; 0.001 using Wilcoxon rank-sum test on estimated velocity of the modes with maximum power.

Abstract Sialic acid-binding immunoglobulin-like lectin (Siglec)-8 is a human cell surface protein expressed exclusively on eosinophils, mast cells, and basophils that, when engaged, induces eosinophil apoptosis and inhibits mast cell mediator release. This makes Siglec-8 a promising therapeutic target to treat diseases involving these cell types. However, preclinical studies of Siglec-8 targeting in vivo are lacking because this protein is only found in humans, apes, and some monkeys. Therefore, we have developed a mouse strain in which SIGLEC8 transcription is activated by Cre recombinase and have crossed this mouse with the eoCre mouse to achieve eosinophil-specific expression. We confirmed that Siglec-8 is expressed exclusively on the surface of mature eosinophils in multiple tissues at levels comparable to those on human blood eosinophils. Following ovalbumin sensitization and airway challenge, Siglec-8 knock-in mice generated a pattern of allergic lung inflammation indistinguishable from that of littermate controls, suggesting that Siglec-8 expression within the eosinophil compartment does not alter allergic eosinophilic inflammation. Using bone marrow from these mice, we demonstrated that, during maturation, Siglec-8 expression occurs well before the late eosinophil developmental marker C-C motif chemokine receptor 3, consistent with eoCre expression. Antibody ligation of the receptor induces Siglec-8 endocytosis and alters the phosphotyrosine profile of these cells, indicative of productive signaling. Finally, we demonstrated that mouse eosinophils expressing Siglec-8 undergo cell death when the receptor is engaged, further evidence that Siglec-8 is functional on these cells. These mice should prove useful to investigate Siglec-8 biology and targeting in vivo in a variety of eosinophilic disease models. We have developed a novel eosinophil-specific Siglec-8 knock-in mouse strain that facilitates the in vivo study of Siglec-8 targeting and biology.