The effect of concurrent cervical spine degenerative disease on the outcome of rotator cuff repair: a national database study

BACKGROUND

Cervical spine degenerative disease (CSD) can cause shoulder pain, potentially confounding the management of patients with rotator cuff tears. This study aimed to investigate the relationships between CSD and rotator cuff repair (RCR).

METHODS

A national administrative database (PearlDiver) was used to study 4 patient cohorts: (1) RCR only (RCRo), (2) RCR with concurrent CSD (RCRC), (3) RCR after a cervical spine procedure (RCRA), and (4) RCR before a cervical spine procedure (RCRB). The outcomes of RCR were compared using multivariable logistic regression, controlling for age, sex, and Elixhauser Comorbidity Index, as well as preoperative opioid utilization in the analysis of opioid use.

RESULTS

Between 2010 and 2021, a total of 889,977 patients underwent RCR. Of these patients, 784,230 (88%) underwent RCRo whereas 105,747 (12%) underwent RCRC, of whom 21,585 (2.4%) underwent cervical spine procedures (RCRA in 9670 [1.1%] and RCRB in 11,915 [1.3%]). At 2 years after RCR, compared with RCRo patients, RCRC patients had an increased risk of surgical-site infection (adjusted odds ratio [aOR] = 1.25, P = .0004), deep vein thrombosis (aOR = 1.17, P = .0002), respiratory complications (aOR = 1.19, P = .0164), and ipsilateral shoulder reoperations (débridement [aOR = 1.66, P < .0001], manipulation under anesthesia or arthroscopic lysis of adhesions [aOR = 1.23, P < .0001], distal clavicle excision [aOR = 1.78, P < .0001], subacromial decompression [aOR = 1.72, P < .0001], biceps tenodesis [aOR = 1.76, P < .0001], incision and drainage [aOR = 1.34, P = .0020], synovectomy [aOR = 1.48, P = .0136], conversion to shoulder arthroplasty [aOR = 1.62, P < .0001], revision RCR [aOR = 1.77, P < .0001], and subsequent contralateral RCR [aOR = 1.71, P < .0001]). At 2 years, compared with RCRC patients who did not undergo cervical spine procedures, RCRC patients who underwent cervical spine procedures had an increased risk of incision and drainage (aOR = 1.50, P = .0255), conversion to arthroplasty (aOR = 1.40, P < .0001), and revision RCR (aOR = 1.11, P = .0374), as well as a lower risk of contralateral RCR (aOR = 0.89, P = .0469). The sequence of cervical spine procedures did not affect the risk of shoulder reoperations. At 1 year, the risk of opioid use after RCR was less for RCRA patients compared with RCRB patients (aOR = 1.71 [95% confidence interval, 1.61-1.80; P < .0001] vs. aOR = 2.01 [95% confidence interval, 1.92-2.12; P < .0001]).

CONCLUSION

Concurrent CSD has significant detrimental effects on RCR outcomes. Patients with concurrent CSD undergoing cervical spine procedures have a greater risk of ipsilateral shoulder reoperations but a decreased risk of contralateral RCR. The risk of prolonged opioid use was lower if RCR followed a cervical spine procedure. Concurrent CSD must be considered and possibly treated to optimize the outcomes of RCR.

Long-term outcomes in patients treated with tissue-sparing posterior cervical fusion to revise a 1-level pseudarthrosis following ACDF

STUDY DESIGN

Observational Study BACKGROUND: Symptomatic pseudarthrosis is one long-term complication in patients treated with anterior discectomy and fusion (ACDF). When revising a pseudarthrosis, a surgeon must decide to intervene posteriorly and/or anteriorly. Open posterior cervical fusion (PCF) is attractive for high rates of arthrodesis, however this technique introduces risks of added complications resulting from extensive soft tissue dissection. The purpose of this study was to assess long-term outcomes in patients undergoing tissue-sparing PCF with facet instrumentation to treat a single level pseudarthrosis.

METHODS

Forty-five subjects were recruited from six participating sites. All subjects had a history of ACDF that was subsequently revised with tissue-sparing PCF to treat symptomatic pseudarthrosis at one level. Long-term radiographic assessments included flexion and extension X-ray and multi-planar CT. Subjects additionally completed a patient satisfaction questionnaire. Radiographs were assessed by investigators and an independent core imaging lab to diagnose implant integrity and arthrodesis at the revised levels.

RESULTS

The revision procedure required a median 49 min to complete with an estimated blood loss of 10 cc. Subjects were discharged a median 1 day following treatment. There were no instances of hospital re-admission nor subsequent surgical interventions. Study follow-up assessments were performed a median 39 months from revision. Surgeons diagnosed complete fusion in 91 % of cases. The core imaging lab identified bridging bone across the revised segment in 80 % of cases. Range of motion was < 2° in 93 % of cases. Seventy-four percent of subjects reported being satisfied with their outcomes.

CONCLUSIONS

This study summarizes long-term radiographic outcomes in a cohort of patients receiving tissue-sparing PCF for the treatment of pseudarthrosis. Assessed years after revision, patients achieved rates of arthrodesis similar to open PCF without the soft tissue dissection responsible for perioperative morbidity and long-term soft tissue pain.

Study on the relationship between vertebrobasilar dolichoectasia and posterior cranial fossa space

Objective

To investigate the correlation between vertebrobasilar dolichoectasia (VBD) and posterior cranial fossa (PCF) space.

Methods

The medical records and imaging data of patients with VBD and control group were collected from June 2021 to June 2022 in the Third People's Hospital of Hubei Province. All patients with VBD were graded by head and neck CTA. The grading index was divided into two parts, including vertebral artery bifurcation height and offset degree. Taking the healthy adult subjects of matched age as the control group. The linear volume of posterior cranial fossa was measured by median sagittal CTA images. Middle clivus length, transverse diameter of occipital foramen, supraoccipital length, sagittal diameter of posterior cranial fossa and height diameter of posterior cranial fossa was measured. The volume of the PCF was calculated by 3Dslice software. The relationship between VBD and the volume of PCF was analyzed by SPSS23.0.

Results

The height diameter of posterior cranial fossa, sagittal diameter of posterior cranial fossa, transverse diameter of occipital foramen, clival length, supraoccipital length and space volume of PCF were 34.78 ± 3.67 mm, 85.49 ± 4.15 mm, 30.89 ± 3.94 mm, 44.53 ± 5.36 mm, 45.21 ± 6.45 mm, 171.08 ± 15.81 cm3 in the case group. The linear volume of PCF and space volume of PCF were significantly lower than those in the control group (P < 0.05). Binary logistic regression analysis showed that the independent risk factors of VBD were height diameter of PCF, sagittal diameter of PCF, transverse diameter of occipital foramen, clival length, supraoccipital length and space volume of posterior cranial fossa. According to the classification, the height and diameter of PCF in grade 1 was significantly smaller than that in grade 2 VBD (P < 0.05). Under the standard of BA bifurcation degree, there were significant differences between different grades of VBD patients and age (P < 0.05).

Conclusion

The smaller volume of PCF may leading the greater possibility of VBD. Under the classification of VBD, the older, the longer the course of disease is, the higher degree of VBD classification is.

Wheel structured Zeonex-based photonic crystal fiber sensor in THz regime for sensing milk

In this paper, a wheel structured Zeonex-based hexagonal packing photonic crystal fiber (PCF) sensor has been proposed for sensing camel milk with a refractive index of 1.3423 and cow milk with a refractive index of 1.3459. This sensor has been investigated for porosities of 85%, 90%, and 98% within a terahertz (THz) region ranging from 0.2 to 2.0 THz. At an operating frequency of 2 THz, this sensor has shown a maximum sensitivity of 81.16% and 81.32% for camel and cow milk, respectively. EML of 0.033013 cm^-1 and 0.03284 cm^-1 has been found for camel and cow milk, respectively, at the same operating conditions with negligible confinement losses of 8.675  ×  10^-18 cm^-1 1.435  ×  10^-18 cm^-1. Several other parameters, such as the effective area, flattened dispersion, and numerical aperture, have also been obtained during the investigation. Since considerable attention has not been given yet in detecting various types of dairy products using PCF terahertz sensors, this design will pave a whole new path in further implementing THz sensing in the dairy industry.

Highly Sensitive Twin Resonance Coupling Refractive Index Sensor Based on Gold- and MgF2-Coated Nano Metal Films

A plasmonic material-coated circular-shaped photonic crystal fiber (C-PCF) sensor based on surface plasmon resonance (SPR) is proposed to explore the optical guiding performance of the refractive index (RI) sensing at 1.7–3.7 μm. A twin resonance coupling profile is observed by selectively infiltrating liquid using finite element method (FEM). A nano-ring gold layer with a magnesium fluoride (MgF2) coating and fused silica are used as plasmonic and base material, respectively, that help to achieve maximum sensing performance. RI analytes are highly sensitive to SPR and are injected into the outmost air holes of the cladding. The highest sensitivity of 27,958.49 nm/RIU, birefringence of 3.9 × 10−4, resolution of 3.70094 × 10−5 RIU, and transmittance dip of −34 dB are achieved. The proposed work is a purely numerical simulation with proper optimization. The value of optimization has been referred to with an experimental tolerance value, but at the same time it has been ensured that it is not fabricated and tested. In summary, the explored C-PCF can widely be eligible for RI-based sensing applications for its excellent performance, which makes it a solid candidate for next generation biosensing applications.

To study the impact of active case finding (ACF) among the TB patients detected in South Delhi

BACKGROUND

TB is one of the top 10 causes of death worldwide. The WHO adopted the End TB Strategy with ambitious goal of ending the global TB epidemic by 2030. The targets for this were 95% reduction in number of TB deaths, 90% reduction in TB incidence rate between 2015 and 2035 and to ensure that no family is burdened with catastrophic expenditure due to TB. Enhanced case detection is one of the components of End TB strategy adopted by WHO and within this Active Case Finding has an important place. However, its role in the Indian context needs to be assessed.

AIMS AND OBJECTIVES

To study the impact of Active Case Finding (ACF) in National Tuberculosis Elimination Program (NTEP) implementing area of National Institute of TB and Respiratory Diseases New Delhi in terms of case detection and treatment outcome.

MATERIALS AND METHODS

The TB patients detected during ACF through house to house survey in vulnerable population were identified, evaluated and followed up. Data from ACF records and TB treatment cards were filled in a pretested proforma and compared with passive case detection in the previous month from same area.

RESULTS

In December 2017 a total 8600 vulnerable population (living in slums, camps and night shelters) were screened over two weeks of whom 85 were found to have symptoms suggestive of TB of whom 19 were PTB that gives a case detection rate of 220 per lakh population. PTB case detection rate by passive case finding (PCF) in November 2017 from the same area of our study was found to be 63 per lakh population. This difference between the detection rate in ACF and passive case findings was statistically significant with Z proportion test and p value <0.00001. Treatment success rate was 75% and lost to follow up rate was 25% patients among the PTB patients detected in ACF. In passive case detection from the same area in November 2017 treatment success rate was 81.8% and lost to follow up rate (LTFU) was 18% in PTB patients. Even though LTFU rate was slightly higher but was not statistically significant.

CONCLUSION

ACF is an effective way to find additional cases of TB. ACF is more labour intensive than PCF but if judiciously used under national programme to target specific vulnerable population of society it can produce additional number of TB cases which otherwise would have gone undiagnosed. However, treatment outcome for these patients is below the target and hence to get the maximum impact of ACF there is a need to enhance the adherence to treatment through different methodologies. Poor treatment adherence will lead to increase transmission risk in communities and greater chance of developing drug resistance. Further studies with larger representative population should be undertaken in order to get more conclusive.

A Novel Ultra-Low Loss Rectangle-Based Porous-Core PCF for Efficient THz Waveguidance: Design and Numerical Analysis

A novel, rectangle-based, porous-core photonic crystal fiber (PCF) has been modeled for the efficient propagation of a THz wave. The performance of the anticipated model has been assessed using the finite element method (FEM) in the range of 0.5-1.5 THz. Both the fiber core and cladding are modeled with rectangular air holes. Numerical analysis for this model reveals that the model has a lower amount of dispersion of about 0.3251 ps/THz/cm at 1.3 THz. Compared to the other THz waveguides, the model offers an ultra-lower effective material loss of 0.0039 cm^-1 at the same frequency. The confinement loss is also lower for this model. Moreover, this model has a high-power fraction of about 64.90% at the core in the x-polarization mode. However, the effective area, birefringence, and numerical aperture have also been evaluated for this model. Maintenance of standard values for all the optical parameters suggests that the proposed PCF can efficiently be applied in multichannel communication and several domains of the THz technology.

A Controllable Plasmonic Resonance in a SiC-Loaded Single-Polarization Single-Mode Photonic Crystal Fiber Enables Its Application as a Compact LWIR Environmental Sensor

Near-perfect resonant absorption is attained in a single-polarization single-mode photonic crystal fiber (SPSM PCF) within the long-wave infrared (LWIR) range from 10 to 11 μm. The basic PCF design is a triangular lattice-based cladding of circular air holes and a core region augmented with rectangular slots. A particular set of air holes surrounding the core is partially filled with SiC, which exhibits epsilon near-zero (ENZ) and epsilon negative (ENG) properties within the wavelength range of interest. By tuning the configuration to have the fields of the unwanted fundamental and all higher order modes significantly overlap with the very lossy ENG rings, while the wanted fundamental propagating mode is concentrated in the core, the SPSM outcome is realized. Moreover, a strong plasmonic resonance is attained by adjusting the radii of the resulting cylindrical core-shell structures. The cause of the resonance is carefully investigated and confirmed. The resonance wavelength is shown to finely shift, depending on the relative permittivity of any material introduced into the PCF’s air holes, e.g., by flowing a liquid or gas in them. The potential of this plasmonic-based PCF structure as a very sensitive, short length LWIR spectrometer is demonstrated with an environmental monitoring application.

Impact of Alignment between Social Media and Business Processes on SMEs' Business Process Performance: A Conceptual Model

The development of information technology highly affects various business sectors including Small and Medium Enterprises (SMEs). Social media implementation, as one of the most widely used IT application, is expected to support SMEs’ performances. Many types of research in social media have focused on the impact of its implementation on the performance of an organization at a macro level. Research that investigates the linkage between social media and how the company performs its business process is lacking in the literature to date. This study aims to fill this gap by conducting a literature review on social media implementation particularly in SMEs. The result of this study is a conceptual model that follows the proposition of Task-Technology Fit in exploring the impact of social media on SMEs business process performances. As a technology, social media functionality must fit the tasks that SMEs must perform. The model proposed social media alignment with business process domain based on the Process Classification Framework (PCF). The performances are measured at a business process level using four indicators i.e. cost, time, quality and flexibility of the business process.

Comparison of clinical outcomes in anterior cervical discectomy versus foraminotomy for brachialgia

AIM

The choice between anterior cervical discectomy & fusion (ACD) or posterior cervical foraminotomy (PCF) for the treatment of cervical brachialgia is controversial. This study aimes to compare clinical outcomes between these two operative inteventions for brachialgia.

METHODS

Retrospective review of prospectively collected data was performed. Patients receiving a primary ACD or PCF to treat brachialgia, in a single tertiary neurosurgical unit were included. Surgical details, and patient reported outcomes (COMI-Neck questionnaire) were extracted from a prospectively maintained spinal procedure database. Minimum clinically important difference (MCID) was defined as a change in COMI score of -2 at 12 months. The student t-test, Chi-square test, and linear regression were used to compare groups.

RESULTS

Between June 2011 ad February 2016 there were 634 ACD procedures (Median age 49; 321 Male), and 54 PCF procedures (Median age 50; 37 Male) perfomed for brachialgia. Age, ASA and pre-operative COMI were similar between the groups (p > .05). Complete outcome data was recorded at twelve months in 312 ACD and 36 PCF patients. Both ACD and PCF were associated with an improvement in COMI at 3 and 12 months (all p < .01). Mean change in COMI at 3 months was -2.38 for ACD, versus -2.31 for PCF (p = .88); at twelve months it was -2.94 for ACD, versus -2.67 for PCF (p = .55). MCID was seen in 59% of ACD cases, versus 58% of PCF cases at twelve months (p = .91).

CONCLUSION

There was no significant difference between outcomes in the ACD and PCF groups. This is supportive of published literature. The proposed multicenter RCTs may inform further.

Effect of mental health on postoperative infection rates following cervical spine fusion procedures

PURPOSE

The aim of this study was to determine whether having an existing psychiatric disorder is a risk factor for developing post-operative infection following anterior cervical discectomy with fusion (ACDF) and posterior cervical fusion (PCF).

RESULTS

A total of 34,007 patients within Humana database was included in this study. Patients with mental disorders had post-operative infection rates of 3.2% and 4.4% within 1 and 3months, compared to 2.5% and 3.5% in patients without a psychiatric disorder (p < 0.05).

CONCLUSIONS

Patients with mental disorders had significantly higher rates of post-operative infection compared to patients who were never diagnosed with a psychiatric disorder.

Trends and Cost of Posterior Cervical Fusions With and Without Recombinant Human Bone Morphogenetic Protein-2 in the US Medicare Population

STUDY DESIGN

Retrospective database review.

OBJECTIVE

To analyze and report the trends and cost of posterior cervical fusions (PCFs) with and without off-label recombinant human bone morphogenetic protein-2 (rhBMP-2) in the Medicare population.

METHODS

Patient records from the PearlDiver database were retrospectively reviewed from January 1, 2005, to December 31, 2012, to distinguish individuals who underwent a PCF with or without rhBMP-2. Total numbers, incidence, age, gender, geographic region, reimbursement, and length of stay were analyzed and summarized.

RESULTS

The combined total of non-rhBMP-2 (n = 39 479; 85.51%) and rhBMP-2 PCF (n = 6692; 14.49%) procedures performed between 2005 and 2012 was 46 171. In general, the number of PCFs without rhBMP-2 consistently increased over time, while the number of PCFs with rhBMP-2 had only a slight increase from 2005 to 2012. On average, PCFs without rhBMP-2 were associated with $1197 higher cost than those with rhBMP-2, but the average length of stay was similar (6 days). From 2005 to 2012, the average cost for procedures with and without rhBMP-2 increased by $12 605 and $7291, respectively. The percentage of rhBMP-2 use peaked in 2007 and dwindled until 2010, and declined an additional 2.84% from 2011 to 2012. Multiple age, region, and gender tendencies were observed.

CONCLUSIONS

To our knowledge, this was the first study to use the PearlDiver database to report incidence and cost trends of PCF procedures. This article provides meaningful trend data on PCFs to surgeons and clinicians, researchers, and patients, as well as functions as a beacon for future research questions.

The impact of preoperative depression on quality of life outcomes after posterior cervical fusion

BACKGROUND CONTEXT

Posterior cervical fusion (PCF) has been shown to be an effective treatment for cervical spondylosis, but is associated with a 9% complication rate and high costs. To limit such complications and costs, it is imperative that proper selection of surgical candidates occur for those most likely to do well with the surgery. Affective disorders, such as depression, are associated with worsened outcomes after lumbar surgery; however, this effect has not been evaluated in patients undergoing cervical spine surgery.

PURPOSE

To assess the predictive value of preoperative depression and the health state on 1-year quality of life (QOL) outcomes after PCF.

STUDY DESIGN

A retrospective cohort analysis.

PATIENT SAMPLE

Eighty-eight patients who underwent PCF for cervical spondylosis were reviewed.

OUTCOME MEASURES

Preoperative and 1-year postoperative health outcomes were assessed based on the Pain Disability Questionnaire (PDQ), the Patient Health Questionnaire-9 (PHQ-9), and the EuroQol five-dimensions (EQ-5D) questionnaire.

METHODS

Univariable and multivariable regression analyses were performed to assess for preoperative predictors of 1-year change in health status.

RESULTS

Compared with preoperative health states, the PCF cohort showed statistically significant improved PDQ (87.8 vs. 73.6), PHQ-9 (7.7 vs. 6.6), and EQ-5D (0.50 vs. 0.60) scores at 1 year postoperatively. Only 10/88 (11%) patients achieved or surpassed the minimum clinically important difference for the PHQ-9 (5). Multiple linear and logistic regression analyses showed that increasing PHQ-9 and EQ-5D preoperative scores were associated with reduced 1-year postoperative improvement in health status (EQ-5D index).

CONCLUSIONS

Of patients who undergo PCF, those with a greater degree of preoperative depression have lower improvements in postoperative QOL compared with those with less depression. Additionally, patients with better preoperative health states also attain lower 1-year QOL improvements.

Establishment and characterization of a piscean PCF cell line for toxicity and gene expression studies as in vitro model

A new piscean fibroblastic cell line termed as PCF derived from the caudal fin tissue of dark mahseer, Puntius (Tor) chelynoides was established and characterized in the present study which was found to be suitable for toxicity and gene expression studies as in vitro model. The cell line grew well in Leibovitz's L-15 medium supplemented with 10% fetal bovine serum (FBS). The cells were able to grow at a temperature ranging from 20 to 28 °C with an optimal growth at 24 °C and the cell line have been expanded in culture for more than 70 passages. Authentication of the cell line was carried out using mitochondrial DNA markers (Cytochrome Oxidase subunit I and 16S ribosomal RNA). Presence of vimentin in the cells confirmed the fibroblastic origin of cell line. Significant cytopathic effects were observed upon exposure of PCF cell line to bacterial extracellular products and the study also validated the suitability of cell line in transgenic applications as well as in genotoxicity assessment as an in vitro model.