Winkeltaylor3051

Next-generation sequencing (NGS) has revolutionized the scale and depth of biomedical sciences. Because of its unique ability for the detection of sub-clonal variants within genetically diverse populations, NGS has been successfully applied to analyze and quantify the exceptionally-high diversity within viral quasispecies, and many low-frequency drug- or vaccine-resistant mutations of therapeutic importance have been discovered. Although many works have intensively discussed the latest NGS approaches and applications in general, none of them has focused on applying NGS in viral quasispecies studies, mostly due to the limited ability of current NGS technologies to accurately detect and quantify rare viral variants. Here, we summarize several error-correction strategies that have been developed to enhance the detection accuracy of minority variants. We also discuss critical considerations for preparing a sequencing library from viral RNAs and for analyzing NGS data to unravel the mutational landscape. BACKGROUND We previously reported inpatient and 30-day postoperative patient-reported outcomes (PROs) of a controlled, non-crossover pilot study utilizing preoperative mindfulness-based stress reduction (MBSR) training for lumbar spine surgery. Our goal here was to assess 3- and 12-month postoperative PROs of preoperative MBSR in lumbar spine surgery for degenerative disease. METHODS Intervention group participants were prospectively enrolled in a preoperative online MBSR course. A comparison standard care-only group was one-to-one matched retrospectively by age, sex, surgery type, and prescription opioid use. Three- and 12-month postoperative PROs for pain, disability, quality of life, and opioid use were compared within and between groups. Regression models were used to assess whether MBSR use predicted outcomes. RESULTS Twenty-four participants were included in each group. At 3 months, follow-up was 87.5% and 95.8% in the comparison and intervention groups, respectively. In the intervention group, mean PROMIS-PF was significantly higher while mean PROMIS-PI and ODI were significantly lower. The change from baseline in mean PROMIS-PF and PROMIS-PI were significantly greater than in the comparison group. At 12 months, follow-up was 58.3% and 83.3% in the comparison and intervention groups, respectively. In the intervention group, mean PROMIS-PI was significantly lower and change in mean PROMIS-PI from baseline was significantly greater. MBSR use was a significant predictor of change in PROMIS-PF at 3 months and in PROMIS-PI at 12 months. No adverse events were reported. CONCLUSIONS Three- and 12-month results suggest preoperative MBSR may have pain-control benefits in lumbar spine surgery. BACKGROUND and Importance Awake craniotomy (AC) with brain mapping has been successfully utilized for the resection of lesions located in or near eloquent areas of the brain. The selection process includes a thorough pre-surgical evaluation to determine candidates suitable for the procedure. Psychiatric disorders including post-traumatic stress disorder (PTSD) are considered potential contraindications for this type of surgery, as these patients may be less cooperative to tolerate AC. click here Here we present the management of a patient with PTSD who underwent an awake craniotomy using a multidisciplinary team for removal of a dominant hemisphere low-grade insular glioma with speech, motor, and cognitive mapping. CLINICAL PRESENTATION A 34-year-old right-handed male military veteran, with a previous history of PTSD was scheduled for a left awake craniotomy for resection of a low-grade insular glioma. He underwent preoperative neurocognitive assessment with a neuropsychologist and clinic visit with a neurosurgeon in order to characterize his PTSD and potential triggers, explain the procedure in a stepwise fashion, and address any concerns. The intraoperative environment was modified in order to minimize triggering stimuli, and an asleep-awake-asleep anesthetic protocol was followed. The patient tolerated the procedure well without any postoperative neurological deficits including cognitive deficits. At 1-month follow-up, he denied any worsening of his PTSD symptoms and recalls the craniotomy as a positive experience. CONCLUSION With a multidisciplinary team, adequate preoperative education, detailed clinical interview to identify triggers, and a controlled intraoperative environment; awake surgery can be carried out safely in a patient with PTSD. BACKGROUND No formalized surgical treatment strategy exists for a thoracic epidural abscess. While endoscopic approaches have been described for the treatment of spinal infections, this is the first report of an endoscopic transforaminal approach for the drainage of a thoracic/lumbar epidural abscess with placement of indwelling abscess drain. OBJECTIVE The authors present a novel use of a known endoscopic approach and describe a minimally invasive surgical option for ventrally located thoracic epidural abscesses. METHODS A patient with ventrally located thoracic five to lumbar five epidural abscess with cord compression was taken for an endoscopic transforaminal drainage at the right thoracic nine to thoracic ten level. A drain was left in the abscess cavity and tunneled subcutaneously for continued postoperative drainage. RESULTS Immediate postoperative radiographic results showed significant reduction in the abscess size. The patient tolerated the procedure well with return to her neurologic baseline. CONCLUSION Endoscopic transforaminal drainage of ventrally located thoracic epidural abscess is a safe procedure that may be an option for patients with a purulent filled abscess. This procedure should be considered an option so as to avoid more invasive procedures that would require decompression and possibly instrumented fusion. Published by Elsevier Inc.OBJECTIVE We systematically reviewed the literature to compare risk factors for postoperative complications at the surgical wound site in primary and metastatic tumor operations. METHODS We screened English-language publications on the outcomes of primary and metastatic spinal tumor operations. Pooled analyses and meta-analyses with random effects modeling were performed comparing patients with and without wound complications, which were defined as surgical site infection or sterile wound dehiscence. RESULTS Our query identified 5,471 unique citations, from which we included 23 studies describing 5,104 patients. 1,936 patients underwent surgery for primary tumors with a wound complication rate of 8.1%. Subgroup analysis of benign and malignant primary tumors yielded significantly different wound complication rates of 7.8% and 26.9% respectively. The metastatic tumor cohort included 3,168 patients and a complication rate of 6.6%. In a pooled analysis of primary tumors, higher wound complication rates were associated with sacral operations and the use of instrumentation.