Predictive factors of positive online patient ratings of spine surgeons

BACKGROUND

Online physician rating websites are increasingly used by patients to evaluate their doctors. The purpose of this investigation was to evaluate factors associated with better spine surgeon ratings.

Biochemical, histological and echocardiographic changes during experimental cardiomyopathy in STZ-induced diabetic rats.

Diabetes mellitus is associated with an increased susceptibility to cardiovascular disease and it has been suggested that alterations in myocardial function may contribute to the development of diabetic cardiovascular complications. The objective of the present study is to examine the left ventricular (LV) function in streptozotocin (STZ)-induced diabetic rats in a definite course of time by non-invasive methods, i.e. M-mode and Doppler echocardiography. From the results, it was found that treatment of animals with STZ resulted in increase in blood glucose, triglycerides, cholesterol, low density lipoproteins (LDL) and decrease in serum total protein levels.Echocardiographic studies revealed that LV internal dimension (mm) during systole was significantly increased after 12 weeks of diabetes when compared to base line data of the same animals and with control animals 6.50+/-0.13 versus 4.25+/-0.17, versus 4.34+/-0.25 (P<0.05), however there was no significant change after 4-8 weeks of diabetes. Also LV internal dimension (mm) during end diastole increased significantly only after 12 weeks of diabetes than to base line data of the same animals and with control animals 7.71+/-0.34 versus 6.18+/-0.25, versus 6.25+/-0.18 (P<0.05). Fractional shortening (%), 15.69+/-5.1 versus 31.22+/-1.7, versus 30.56+/-2.1 (P<0.05), and ejection fraction (%) 37+/-2.31 versus 68.18+/-2.8, versus 60.32+/-3.5 (P<0.05), differ significantly after 12 weeks of diabetes when compared to base line data of the same animals and with control animals. E-wave (cm/s) was significantly decreased after 12 weeks of diabetes 21.11+/-1.5 versus 35.19+/-4.5, versus 32.75+/-3.0 (P<0.05), and A-wave (cm/s) was significantly increased after 12 weeks of diabetes 34.88+/-4.2 versus 19.21+/-2.8, versus 20.59+/-2.1 (P<0.05); thus, diabetic animals after 12 weeks had an inversed E/A ratio. Histological studies revealed that after 8 weeks of diabetes, necrosis was minimal, but after 12 weeks of diabetes extensive focal endomyocardial necrosis was observed. From this study, we conclude that overt LV systolic and diastolic dysfunction was fully visible at 12 weeks of diabetes on echocardiography and this non-invasive technique of echocardiography is useful in diagnosing LV dysfunction in diabetic rats without the need of invasive histopathological procedures.     

Vitrification of human 8-cell embryos, a modified protocol for better pregnancy rates

Human day 3 embryos were vitrified in modified ethylene glycol-based protocol. The present study reports a post-thaw survival rate of 95.3%, which was significantly higher than that of the conventional slow-freezing protocol (60.0%, P < 0.05). The implantation and pregnancy rates were also higher (14.9% and 35.0%) than that in the slow-freezing protocol (4.2% and 17.4%). On average, three embryos were transferred per patient. Out of the 40 transfer cycles, five deliveries and nine ongoing pregnancies were achieved. Four ended with delivery of a singleton and one a miscarriage. Ethylene glycol is a good cryoprotectant to preserve human 8-cell embryos because of its low toxicity as shown by the high survival rate, and vitrification is a promising alternate to the conventional slow-freezing method.     

Aorta-Right Atrial Tunnel

Aorta–right atrial tunnel is a vascular channel that originates from one of the sinuses of Valsalva and terminates in either the superior vena cava or the right atrium. The tunnel is classified as anterior or posterior, depending upon its course in relation to the ascending aorta. An origin above the sinotubular ridge differentiates the tunnel from an aneurysm of the sinus of Valsalva, and the absence of myocardial branches differentiates it from a coronary–cameral fistula. Clinical presentation ranges from an asymptomatic precordial murmur to congestive heart failure. The embryologic background and pathogenesis of this lesion are attributable either to an aneurysmal dilation of the sinus nodal artery or to a congenital weakness of the aortic media. In either circumstance, progressive enlargement of the tunnel and ultimate rupture into the low-pressure right atrium could occur under the influence of the systemic pressure.The lesion is diagnosed by use of 2-dimensional echocardiography and cardiac catheterization. Computed tomographic angiography is an additional noninvasive diagnostic tool. The possibility of complications necessitates early therapy, even in asymptomatic patients or those with a hemodynamically insignificant shunt. Available treatments are catheter-based intervention, external ligation under controlled hypotension, or surgical closure with the patient under cardiopulmonary bypass.Herein, we discuss the cases of 2 patients who had this unusual anomaly. We highlight the outcome on follow-up imaging (patient 1) and the identification and safe reimplantation of the coronary artery (patient 2).Key words: Aorta/abnormalities/surgery, coronary vessel anomalies/classification/diagnosis, diagnosis, differential, heart atria/abnormalities/surgery, sinus of Valsalva, tomography, X-ray computed, treatment outcome, vena cava, superior/abnormalitiesAorta–right atrial (RA) tunnel is a vascular channel with its origin in one of the sinuses of Valsalva, a tortuous course anterior or posterior to the ascending aorta, and termination in the superior vena cava or in the RA. Herein, we discuss the diagnosis, treatment, and follow-up evaluation of 2 patients with this lesion who were treated at our institute: an 11-year-old girl who had a posterior tunnel and a 24-year-old man who had an anterior tunnel.     

Association between obesity and sperm quality

There is awareness of likelihood of abnormal spermatozoa in obese men; however, results from previous studies are inconclusive. Advances in computer‐aided sperm analysis (CASA) enable precise evaluation of sperm quality and include assessment of several parameters. We studied a retrospective cohort of 1285 men with CASA data from our infertility clinic during 2016. Obesity (BMI ≥30) was associated with lower (mean ± SE) volume (?0.28 ± 0.12, p‐value = .04), sperm count (48.36 ± 16.51, p‐value = .002), concentration (?15.83 ± 5.40, p‐value = .01), progressive motility (?4.45 ± 1.92, p‐value = .001), total motility (?5.50 ± 2.12, p‐value = .002), average curve velocity (μm/s) (?2.09 ± 0.85, p‐value = .001), average path velocity (μm/s) (?1.59 ± 0.75, p‐value = .006), and higher per cent head defects (0.92 ± 0.81, p‐value = .02), thin heads (1.12 ± 0.39, p‐value = .007) and pyriform heads (1.36 ± 0.65, p‐value = .02). Obese men were also more likely to have (odds ratio, 95% CI) oligospermia (1.67, 1.15–2.41, p‐value = .007) and asthenospermia (1.82, 1.20–2.77, p‐value = .005). This is the first report of abnormal sperm parameters in obese men based on CASA. Clinicians may need to factor in paternal obesity prior to assisted reproduction.     

Submitral aneurysm with left atrial communication.

Annular sub-mitral aneurysms are rare lesions of varied etiology. A sub-mitral membranous curtain may be a potential area of weakness through which these lesions expand. Initially described in young males of African origin and reported from varying geographical areas, these lesions arise from the atrioventricular groove in close relation to the mural leaflet. They may cause pressure effects, lead to mitral incompetence and left ventricular dysfunction. Key issues during repair are proximity to the circumflex coronary artery, atrioventricular junction and progressive involvement of the mitral valve. This case report of a calcified bi-lobed sub-mitral aneurysm with communication to the left atrium discusses the anatomical basis of the lesion, the role of computed tomogram angiography in pre-operative evaluation and surgical management.     

Effect of vitamin D3 supplementation on the pharmacokinetics of digoxin--a pilot study

Emerging evidence from preclinical, clinical and epidemiological studies suggests that vitamin D3 plays vital roles in several diseases in addition to bone disorders. According to new medical evidence, it is being recommended that vitamin D3 intake to be increased for maximal benefits in human health. However, it is necessary to consider potential side effects of increased intake of vitamin D3. Vitamin D3 exerts its actions through the vitamin D receptor, which is known to be an important regulator of P-glycoprotein (P-gp). As P-gp plays a significant role in limiting drug bioavailability, we undertook a study to compare single-dose digoxin (a P-gp substrate) pharmacokinetics in eight healthy male subjects before and after vitamin D3 supplementation (1000 IU per day). The geometric mean ratios for AUC(0-3h), AUC(0-48h) and C(max) were 1.06 (90% CI 0.92, 1.21) and 1.02 (90% CI 0.97, 1.08) and 1.03 (95% CI 0.86, 1.24), respectively. The median for digoxin T(max) was 0.75 h before and after vitamin D3 ingestion. The mean plasma 25-hydroxyvitamin D3 (25(OH)D3) levels remained constant after the intake of vitamin D3 (15.4 ± 3.7 and 14.4 ± 3.6 ng/mL, respectively), while there was a modest but statistically significant increase in plasma calcium levels, from 9.32-9.68 mg/dL (P = 0.0277). These results suggest that vitamin D3 supplementation (1000 IU per day) in human volunteers does not produce a P-gp-mediated drug interaction with orally administered digoxin.     

Sarcopenia as a Risk Factor for Prosthetic Infection After Total Hip or Knee Arthroplasty

Background

Sarcopenia, an age-related loss of muscle mass and function, has been previously linked to an increased risk of morbidity, mortality, and infection after a variety of surgical procedures. This study is the first to evaluate the impact of the psoas-lumbar vertebral index (PLVI), a validated marker for central sarcopenia, on determining post-arthroplasty infection status.