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Study Design: Retrospective case-control study using prospectively collected data. Purpose: Evaluate the impact of liposomal bupivacaine (LB) on postoperative pain management and narcotic use following standardized single-level low lumbar transforaminal lumbar interbody fusion (TLIF). Overview of Literature: Poor pain control after surgery has been linked with decreased pain satisfaction and increased economic burden. Unfortunately, opioids have many limitations and side effects despite being the primary treatment of postoperative pain. LB may be a form of pre-emptive analgesia used to reduce the use of postoperative narcotics as evidence in other studies evaluating its use in single-level microdiskectomies. Methods: The infiltration of LB subcutaneously during wound closure was performed by a single surgeon beginning in July 2014 for all single-level lumbar TLIF spinal surgeries at Landstuhl Regional Medical Center. This cohort was compared against a control cohort of patients who underwent the same surgery by the same surgeon in the preceding 6 months. Statistical analysis was performed on relevant variables including: morphine equivalents of narcotic medication used (primary outcome), length of hospitalization, Visual Analog Scale pain scores, and total time spent on a patient-controlled analgesia (PCA) pump. Results: A total of 30 patients were included in this study; 16 were in the intervention cohort and 14 were in the control cohort. The morphine equivalents of intravenous narcotic use postoperatively were significantly less in the LB cohort from day of surgery to postoperative day 3. Although the differences lost their statistical significance, the trend remained for total (oral and intravenous) narcotic consumption to be lower in the LB group. The patients who received the study intervention required an acute pain service consult less frequently (62.5% in LB cohort vs. 78.6% in control cohort). The amount of time spent on a PCA pump in the LB group was 31 hours versus 47 hours in the control group (p =0.1506). Conclusions: Local infiltration of LB postoperatively to the subcutaneous tissues during closure following TLIF significantly decreased the amount of intravenous narcotic medication required by patients. Well-powered prospective studies are still needed to determine optimal dosing and confirm benefits of LB on total narcotic consumption and other measures of pain control following major spinal surgery.
Kim, Kyung Hwan,Spah, Alexander,Pathak, Harshad,Perakis, Fivos,Mariedahl, Daniel,Amann-Winkel, Katrin,Sellberg, Jonas A.,Lee, Jae Hyuk,Kim, Sangsoo,Park, Jaehyun,Nam, Ki Hyun,Katayama, Tetsuo,Nilsson, American Association for the Advancement of Scienc 2017 Science Vol.358 No.6370
<P><B>Pointing to a second critical point</B></P><P>One explanation for the divergence of many of the thermodynamic properties of water is that there is a critical point in deeply supercooled water at some positive pressure. For bulk water samples, these conditions are described as “no man's land,” because ice nucleates before such temperatures can be reached. Kim <I>et al.</I> used femtosecond x-ray laser pulses to probe micrometer-sized water droplets cooled to 227 K (see the Perspective by Gallo and Stanley). The temperature dependence of the isothermal compressibility and correlation length extracted from x-ray scattering functions showed maxima at 229 K for H<SUB>2</SUB>O and 233 K for D<SUB>2</SUB>O, rather than diverging to infinity. These results point to the existence of the Widom line, a locus of maximum correlation lengths emanating from a critical point in the supercooled regime.</P><P><I>Science</I>, this issue p. 1589; see also p. 1543</P><P>Femtosecond x-ray laser pulses were used to probe micrometer-sized water droplets that were cooled down to 227 kelvin in vacuum. Isothermal compressibility and correlation length were extracted from x-ray scattering at the low–momentum transfer region. The temperature dependence of these thermodynamic response and correlation functions shows maxima at 229 kelvin for water and 233 kelvin for heavy water. In addition, we observed that the liquids undergo the fastest growth of tetrahedral structures at similar temperatures. These observations point to the existence of a Widom line, defined as the locus of maximum correlation length emanating from a critical point at positive pressures in the deeply supercooled regime. The difference in the maximum value of the isothermal compressibility between the two isotopes shows the importance of nuclear quantum effects.</P>
Weikert Thomas,Rapaka Saikiran,Grbic Sasa,Re Thomas,Chaganti Shikha,Winkel David J.,Anastasopoulos Constantin,Niemann Tilo,Wiggli Benedikt J.,Bremerich Jens,Twerenbold Raphael,Sommer Gregor,Comaniciu 대한영상의학회 2021 Korean Journal of Radiology Vol.22 No.6
Objective: To extract pulmonary and cardiovascular metrics from chest CTs of patients with coronavirus disease 2019 (COVID-19) using a fully automated deep learning-based approach and assess their potential to predict patient management. Materials and Methods: All initial chest CTs of patients who tested positive for severe acute respiratory syndrome coronavirus 2 at our emergency department between March 25 and April 25, 2020, were identified (n = 120). Three patient management groups were defined: group 1 (outpatient), group 2 (general ward), and group 3 (intensive care unit [ICU]). Multiple pulmonary and cardiovascular metrics were extracted from the chest CT images using deep learning. Additionally, six laboratory findings indicating inflammation and cellular damage were considered. Differences in CT metrics, laboratory findings, and demographics between the patient management groups were assessed. The potential of these parameters to predict patients’ needs for intensive care (yes/no) was analyzed using logistic regression and receiver operating characteristic curves. Internal and external validity were assessed using 109 independent chest CT scans. Results: While demographic parameters alone (sex and age) were not sufficient to predict ICU management status, both CT metrics alone (including both pulmonary and cardiovascular metrics; area under the curve [AUC] = 0.88; 95% confidence interval [CI] = 0.79–0.97) and laboratory findings alone (C-reactive protein, lactate dehydrogenase, white blood cell count, and albumin; AUC = 0.86; 95% CI = 0.77–0.94) were good classifiers. Excellent performance was achieved by a combination of demographic parameters, CT metrics, and laboratory findings (AUC = 0.91; 95% CI = 0.85–0.98). Application of a model that combined both pulmonary CT metrics and demographic parameters on a dataset from another hospital indicated its external validity (AUC = 0.77; 95% CI = 0.66–0.88). Conclusion: Chest CT of patients with COVID-19 contains valuable information that can be accessed using automated image analysis. These metrics are useful for the prediction of patient management.