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Results Data from 34 patients with PD who were treated with GPi-targeted DBS were evaluated. Age was found to exhibit statistically significant positive correlations with all three measures of subcortical atrophy (P ≤ 0.002). None of the measures correlated with disease duration. Only Evans index and third ventricular width correlated with preoperative medication response (P 0.05). Conclusion Perioperative age and subcortical atrophy as measured in this study correlated with motor responsiveness at 6 months postoperatively among patients receiving bilateral GPi-targeted DBS stimulation for PD.Background Liposomal bupivacaine (LB) is FDA-approved for administration into surgical sites for postsurgical analgesia. The liposomal formulation allows for sustained effects up to 72 hours. Methods A retrospective study assessed patients undergoing lumbar interbody surgery. Visual analog scale (VAS) pain scores and amount of opioids consumed were recorded at 12-hour intervals for 72 hours post-operatively, as were patterns of discharge and hospital length of stay (LOS). Results A total of 122 patients (97 LB versus 25 control group) were reviewed. Median LOS was shorter in the LB cohort compared to controls (1.94 versus 3.08 days, respectively; p=0.0043). When assessing the percentage of discharges between groups at 12-hour intervals, there were significantly more discharges in the LB cohort at 36-48 hours (p=0.0226), and no differences elsewhere. There was a decrease in intravenous opioids consumed at 48-60 hours in the LB cohort compared to controls (p=0.0494), a difference not detected at other time points or with oral or total opioids. Mean VAS scores were significantly higher in LB cohort compared to controls at 0-12 hours (5.2 versus 3.9, respectively; p=0.0079), but insignificantly different subsequently up to 72 hours. The LB cohort and controls were not significantly different in total amount of opioids consumed, overall pain scores, or with regards to how the opioid amount consumed or pain scores changed over time. Conclusions The use of LB in lumbar interbody fusion decreases patients' LOS but has little effect on reducing overall pain scores or opioid usage in the 72-hour post-operative hospital time period.Background Superior petrosal sinus dural arteriovenous fistulas (SPS-DAVFs) are a common subtype of tentorial DAVFs that often require microsurgical treatment. In our experience, we have noted a rare condition involving the presence of a coexisting normal superior petrosal vein (SPV) during surgery for SPS-DAVFs; this condition has not been reported in the literature. The identification and preservation of coexisting normal veins are crucial to prevent venous complications. Methods We reviewed the data of 12 patients with SPS-DAVFs who underwent microsurgical treatment. Intraoperative indocyanine green video angiography (ICG-VA) was used to confirm the location of the fistula and identify the normal SPV. Postoperative radiological examination was performed, and the clinical outcome was evaluated with the modified Rankin Scale (mRS). Results A coexisting normal functional SPV was found in 6 cases. Analysis of the tributaries of SPV showed the vein of the cerebellopontine fissure was the most frequent arterialized drainage vein (66.7%), while the pontotrigeminal vein was the most frequent normal drainage vein (45.5%). The DAVFs were easily identified and disrupted using intraoperative ICG-VA. The normal SPV was also successfully preserved. All 6 patients experienced good clinical and radiological outcomes. Conclusion An SPS-DAVF can coexist with a normal functional SPV, which should be preserved. The ICG-VA technique is an efficient way to identify the normal SPV.Objective Distraction based systems are the most common systems used in the treatment of early onset scoliosis (EOS). In addition to its corrective and deformity progression preventive properties, its vertebral growth stimulation effect has been proved. Recently popularized magnetically controlled growing rods (MCGR) showed superior results in terms of outcomes and decreased complication rate. Its vertebral growth stimulation effect has not been studied. The aim of the study is to evaluate vertebral growth stimulation effect in patients treated with MCGR. Method Patient with progressive scoliosis treated by dual MCGR, who had no obvious lumbar vertebral deformity and had regular three month interval spinal lengthening for at least 30 months; were subdivided into two groups according to the inclusion of L3 vertebra within instrumentation segments. The L3 vertebral vertical and horizontal lengths were measured in postoperative and in last follow up, and their differences were analyzed statistically in both groups. Results Twenty four patients were included, 18 patient had L3 vertebra outside instrumentation segments, while the other 6 had spanned by MCGR. Uninstrumented L3 were followed up for an average of 36 months, the height difference between initial post-op and last follow up was 3.55 ± 0.63 mm and width difference was 3.85 ± 0.75mm. Conversely, Instrumented L3 were followed up for a mean of 38.9 months, their initial post-op and last follow up differences in height and width, were 6.91 ± 1.11 mm and 3.66 ± 0.92 mm, respectively. click here Conclusion Frequent distractions stimulate longitudinal vertebral growth in vertebra spanned by MCGR LEVEL OF EVIDENCE Level 3, Retrospective comparative study.Aims Higher mean lung dose (MLD) in breast cancer patients has been associated with pneumonitis, pulmonary fibrosis and secondary lung cancer primaries. This study examined MLD in a single institution from 2014 to 18 to assess trends in median MLD (Gy) over time and factors associated with higher MLD to determine best practices for limiting lung toxicity. Materials and methods General linear regressions were analysed to determine significant change in median MLD over time in patients receiving conventional or hypofractionated schedules for whole breast/chest wall (WB) radiotherapy with or without sequential boost or simultaneous integrated boost, WB tangential radiotherapy only and WB locoregional radiotherapy. Univariate and multivariable linear regression analysed identified factors associated with MLD. Results In total, 3894 patients were included in the analysis. The total median MLD across all years was 6.8 Gy in patients treated with conventional fractionation and 3.4 Gy in patients treated with hypofractionation. A significant increase in MLD was observed between 2014 and 2018 in patients receiving conventional or hypofractionation, conventional WB treatment with locoregional radiotherapy, conventional WB radiotherapy with simultaneous integrated boost and hypofractionated WB radiotherapy with sequential boost. Increased MLD was significantly correlated with lower lung volume and larger treatment volume due to locoregional radiotherapy, inclusion of a boost, chest wall treatment and reverse decubitus or supine positioning (P less then 0.0001). Conclusion A significant increase in MLD was observed over the years in patients receiving conventional and hypofractionated radiotherapy. Techniques such as prone positioning should be considered to lower MLD, particularly for patients with predisposing pulmonary risk.Daphnia pulex is a nutrient-rich freshwater crustacean with two different reproduction methods. Akt is a serine/threonine protein kinase that plays an important role in cell growth, survival, and lifespan regulation. To explore the function of Akt in the growth and aging process of Daphnia pulex, we cloned the cDNA sequence of the open reading frame (ORF) of the akt gene based on the bioinformatic analysis of the transcriptome data of D. pulex, and analyzed the structural features of the Akt protein. Gene silencing was performed using RNA interference (RNAi), and the expression of the Akt gene and protein before and after interference were analyzed using qPCR and western blotting. The results showed that the expression of akt in D. pulex at different ages showed a "W" pattern, being significantly higher at 20 days than at 10 days and 15 days (P less then .05). The expression trend of Akt protein and mRNA were similar, with lower expression at a younger age (1-5 day), after which expression gradually increased from 10 days age, and showed no significant change after 25 days, which might be caused by a lag of protein translation. RNAi reduced the expression of the Akt gene and protein by at least 76%, and the survival rate and reproductive capacity of D. pulex were significantly lower in the RNAi group compared with those in the control group. This study provides a better understanding of the function of the akt gene in D. pulex.Although the chronic presence of microorganisms in the airways of patients with stable chronic obstructive pulmonary disease (COPD) confers a poor outcome, no recommendations have been established in disease management guidelines on how to diagnose and treat these cases. In order to guide professionals, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) has prepared a document which aims to answer questions on the clinical management of COPD patients in whom microorganisms are occasionally or habitually isolated. Since the available scientific evidence is too heterogeneous to use in the creation of a clinical practice guideline, we have drawn up a document based on existing scientific literature and clinical experience, addressing the definition of different clinical situations and their diagnosis and management. The text was drawn up by consensus and approved by a large group of respiratory medicine experts with extensive clinical and scientific experience in the field, and has been endorsed by the SEPAR Scientific Committee.Cancer stem cells (CSCs) accounts for recurrence and resistance to chemotherapy in various tumors. Efficacy of chemotherapeutic drugs is limited by tumor stromal barriers, which hinder their penetration into deep tumor sites. We have earlier shown telmisartan (Tel) pretreatment prior to Docetaxel (DTX) administration enhances anti-cancer effects in non-small cell lung cancer (NSCLC). Herein, we demonstrated for the first time the efficacy of Docetaxel liposomes (DTXPL) in combination with Tel in 3D cultures of H460 cells by using polysaccharide-based hydrogels (TheWell Biosciences) and also in xenograft model of DTX resistant H460 derived CD133+ lung tumors. DTXPL and Tel combination showed enhanced cytotoxicity in H460 WT 3D cultures by two folds. In H460 3D cultures, Tel pretreatment showed increased liposomal uptake. DTXPL and Tel combination treated tumors showed reduction in tumor volume (p less then .001), increased apoptosis and downregulation of CSC markers (p less then .01) in H460 WT and DTX resistant CD133+ xenograft models.Mental disorders with physical symptoms, e.g. somatic symptom disorder, are characterized by altered interoceptive accuracy (IAc), which can be explained by individual differences in interoceptive learning (IL). We investigated if stress facilitates IL. Seventy-three healthy participants performed a heartbeat counting task (HCT T1) and a heartbeat perception training (HBPT). After exposure to a socially-evaluated cold pressor stress test (SECPT; n = 48) or a control condition (n = 25), two more HCTs were performed (T2 30 min after SECPT; T3 24 h later). After the HBPT, all participants showed an increase in IAc. We separated the stress group into high vs. low systolic blood pressures (SBP) responders (n = 24 each), with high SBP responders showing the largest IAc increases. Only SBP, but not cortisol responsiveness significantly predicted IAc increase from T1 to T2. Our results indicate that post-learning autonomic stress response facilitates IL, whereas the HPA axis response may be less important for this effect.