Whittakerbyrne2556

Podocytes showed homogenous cytoplasmatic stain both in positive and negative cases and in external negative controls. We found PLA2R IHC and serum PLA2R-Ab positivity in early-middle stage MGN compared with advanced stage more frequently. Correct stratification of patients with MGN needs PLA2R-Ab detection in serum and renal tissue. PLA2R IHC test, although a challenging stain, can be an easy diagnostic tool but requires reliable interpretation keys for a standard approach to the assessment of immunostaining.The new ASCO/CAP guidelines on hormone receptor testing in breast cancer recommends standard operating procedures (SOPs) established to confirm or adjudicate estrogen receptor (ER) results with weak or ≤10% staining, and the status of internal controls (ICs) reported for cases with 0% to 10% staining. The aim of this study is to determine the frequency of ER testing with weak or ≤10% staining that may require additional steps following SOPs and to identify any correlation between hormone receptor status of the tumor and the likelihood of finding IC. Breast cancer cases between January 2014 and April 2019 were included to identify negative, low-positive and weak-positive cases. The presence/absence of IC was correlated to tumor type. Following ASCO/CAP guidelines, 29.8% of cases (374/1261) will need additional steps to confirm/adjudicate results due to negative, low, or weak positive ER status. The probability of finding IC is ~50% lower in cases of ER and progesterone receptor (PgR) negative tumors. Repeat testing may be warranted in 13.1% (92/700) of all cases due to lack of IC. In conclusion, the new ASCO/CAP guidelines recommend laboratories to establish and follow SOP to confirm or adjudicate ER results for about 30% of the cases before reporting hormone receptors status. Over 40% of cases with less then 10% tumor ER positivity lacked IC that may need a comment per the guidelines indicating a repeat testing may be warranted. However, the presence/absence of IC may be related to the subtype of breast cancer and should not necessarily bring into question the validity of the test.

Prospective observational cohort study.

To prospectively examine dysphagia after subaxial cervical spine surgery.

Although dysphagia after anterior cervical spine surgery is common and well-studied, it has rarely been examined in posterior subaxial cervical spine surgery.

This study analyzed 191 consecutive patients (132 male, 59 female; mean age, 64.9 yrs) who underwent subaxial cervical spine surgery for degenerative disease and completed 1 year of follow-up. Anterior decompression with fusion (ADF) was performed in 87 patients, posterior decompression with fusion (PDF) in 21, and laminoplasty (LAMP) in 83. Dysphagia was evaluated by a self-administered questionnaire using the Bazaz dysphagia scale before, 6 months, and 1 year after surgery. Diagnosis, levels and number of operative segments, C2-7 lordotic angle (CL), O-C2 angle (OC2A), C2-7 range of motion (ROM), Japanese Orthopedic Association for cervical myelopathy (C-JOA) score, and neck pain visual analog scale (VAS) were examined.

Thirty-twvical alignment change due to anterior and posterior fusion surgery can cause postoperative dysphagia.Level of Evidence 3.

A retrospective cohort study with chart review.

The aim of this study was to compare the reoperation rates for symptomatic nonunions (operative nonunion rates) between posterolateral fusions with pedicle screws (PLFs) and posterior interbody fusion with pedicle screws (PLIFs).

Although radiographic nonunions in PLFs and PLIFs are well documented in the literature, there is no consensus on which technique has lower nonunions. Since some radiographic nonunions may be asymptomatic, a more clinically useful measure is operative nonunions, of which there is minimal research.

A retrospective cohort study, using data from the Kaiser Permanente Spine Registry, identified adult patients (≥18 years' old) who had elective single and multilevel PLFs and PLIFs. Descriptive statistics and 2-year incidence rates for operative nonunions were calculated by fusion-level (1-3), fusion type (PLF vs. PLIF), and levels fused (L3 to S1). Time-dependent multivariable Cox-Proportional Hazards regression was used to evaluate n Evidence 3.

4 years of follow-up, we found no difference in operative nonunions between PLF and PLIF except for constructs that included L5-S1 in which the risk of nonunion was limited to PLF patients.Level of Evidence 3.

Retrospective cohort study.

The aim of the study was to assess which factors increase risk of readmission within 30 days of surgery or prolonged length of stay (LOS) (≥2 days) after cervical disc arthroplasty (CDA).

Several studies have shown noninferiority at mid- and long-term outcomes after cervical disc arthroplasty (CDA) compared to anterior cervical discectomy and fusion ACDF, but few have evaluated short-term outcomes regarding risk of readmission or prolonged LOS after surgery.

Demographics, comorbidities, operative details, postoperative complications, and perioperative outcomes were collected for patients undergoing single level CDA in the National Surgical Quality Improvement Program (NSQIP) database. Patients with prolonged LOS, defined as >2 days, and readmission within 30 days following CDA were identified. Univariable and multivariable logistic regression models were used to identify risk factors for prolonged LOS and readmission.

A total of 3221 patients underwent single level CDAbase analysis of 3221 patients, wound complications are predictors of both prolonged LOS and readmission. Patient comorbidities, including diabetes, higher ASA classification, female sex, and higher BMI also increased risk of prolonged LOS or readmission.Level of Evidence 3.

Retrospective, case-control.

The aim of this study was to use predictive modeling and machine learning to develop novel tools for identifying patients who may be appropriate for single-level outpatient anterior cervical fusion and discectomy (ACDF), and to compare these to legacy metrics.

ACDF performed in an ambulatory surgical setting has started to gain popularity in recent years. Currently there are no standardized risk-stratification tools for determining which patients may be safe candidates for outpatient ACDF.

Adult patients with American Society of Anesthesiologists (ASA) Class 1, 2, or 3 undergoing one-level ACDF in inpatient or outpatient settings were identified in the National Surgical Quality Improvement Program database. Patients were deemed as "unsafe" for outpatient surgery if they suffered any complication within a week of the index operation. Two different methodologies were used to identify unsafe candidates a novel predictive model derived from multivariable logistic regression ofnd CCI (all, P < 0.05), and comparable to that of the predictive model (P > 0.05).

Predictive analytics and machine learning can be leveraged to aid in identification of patients who may be safe candidates for single-level outpatient ACDF. Surgeons and perioperative teams may find these tools useful to augment clinical decision-making.Level of Evidence 3.

Predictive analytics and machine learning can be leveraged to aid in identification of patients who may be safe candidates for single-level outpatient ACDF. Surgeons and perioperative teams may find these tools useful to augment clinical decision-making.Level of Evidence 3.

Retrospective review.

We aim to create a comprehensive narrative of all wrong-level spinal surgeries (WLSS) and subsequent prevention strategies employed at our institution and provide a roadmap for developing a rigorous prevention protocol.

There is currently no published evidence-based protocol to prevent WLSS. Selleckchem COTI-2 Previous studies are limited to multi-institution surgeon surveys and opinion pieces; the impact of serial interventions to eliminate WLSS is lacking. No studies have longitudinally analyzed a single institution's serial root cause analyses (RCA) of individual WLSS cases and the stepwise impact of targeted interventions to reduce WLSS occurrence.

We reviewed all wrong-site spine surgeries and prevention strategies employed at our institution between 2008 and 2019, and corresponding WLSS-related RCAs were collected from institutional records. We conducted a longitudinal analysis of these reports and tracked policy implementations that resulted along with the incidence of WLSS following each poprovements in WLSS rates. By focusing on lessons learned from RCAs using this methodology, institutions can iteratively improve rates of WLSS.

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4.

Consecutive case series.

Our aim was to evaluate the outcomes of patients who underwent supraclavicular scalenotomy followed by external neurolysis without rib resection for post-traumatic neurogenic thoracic outlet syndrome (NTOS).

NTOS comprises >95% of all thoracic outlet syndrome patients, and most patients with NTOS have a history of trauma before the onset of their symptoms.

Patients treated with supraclavicular scalenotomy and neurolysis without rib resection from September 2014 to December 2019 were retrospectively reviewed by using the medical records and operative notes. Patient's characteristics, clinical symptoms before treatment, operative findings, and short- and long-term outcomes were assessed. To assess clinical outcomes at 2 months after surgery (short-term outcomes) and 12 months later (long-term outcomes), we used a four-grade categorization of patients' subjective evaluations after surgery.

Ninety-six supraclavicular scalenotomies without rib resection were performed on patients with post-traumatic NTOS. The most common intraoperative observation was the fibrous bands within the anterior scalene muscle in 86 cases (89.6%). The short-term outcome with patients' subjective evaluation in 96 operations at 2 months after surgery showed a 96.9% success rate (excellent + good). In 85 cases followed for >12 months after surgery, the success rate based on patients' subjective evaluation at the last clinic follow-up appointment as a long-term outcome was 74.1%.

In post-traumatic NTOS, it has been reported the arm and hand symptoms are due to pressure on the brachial plexus, which can stem from the swollen muscle following injuries and later from tightness of the scarred muscle. Considering this mechanism and our results, we concluded that supraclavicular scalenotomy and external neurolysis without rib resection made sense, as they were very effective and adequate to improve symptoms of NTOS.

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5.

Biomechanical spine model. Comparison of stress in the implant and the adjacent cranial segment was done with conventional rigid versus dynamic stabilization system (DS) fixation.

The aim of this study was to study stress at the proximal end of spinal fixation with a novel DS.

High stress at the implant bone junction may cause proximal junctional failure (PJF) in adult deformity surgery.

Five life-size spine models were instrumented with pedicle screws and a 5.5-mm Titanium rod from T8-S1. The same models were subsequently instrumented with a similar rod and DS between T8-9 pedicle screws. The spine model was loaded with 25 Nm static load cranial to the proximal fixation in six directions. Strains were measured from the proximal screws. Disc pressure was measured from the proximal instrumented segment (T8-9) and cranial adjacent segment (T7-8).

Rigid fixation produced highest strain at T8, followed by T10 then T9. In contrast, DS fixation produced highest strain at T10, followed by T9 then T8. Strain at T8 was significantly less with DS fixation than rigid fixation (P = 0.