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Collects four stories of friendship featuring such popular Disney characters as Olaf, Anger, Scuttle, and Happy and Grumpy.

Intravenous ketamine is posited to rapidly reverse depression by rapidly enhancing neuroplasticity. In human patients, we quantified gray matter microstructural changes on a rapid (24-h) timescale within key regions where neuroplasticity enhancements post-ketamine have been implicated in animal models. In this study, 98 unipolar depressed adults who failed at least one antidepressant medication were randomized 2:1 to a single infusion of intravenous ketamine (0.5 mg/kg) or vehicle (saline) and completed diffusion tensor imaging (DTI) assessments at pre-infusion baseline and 24-h post-infusion. DTI mean diffusivity (DTI-MD), a putative marker of microstructural neuroplasticity in gray matter, was calculated for 7 regions of interest (left and right BA10, amygdala, and hippocampus; and ventral Anterior Cingulate Cortex) and compared to clinical response measured with the Montgomery-Asberg Depression Rating Scale (MADRS) and the Quick Inventory of Depressive Symptoms-Self-Report (QIDS-SR). Individual differences in DTI-MD change (greater decrease from baseline to 24-h post-infusion, indicative of more neuroplasticity enhancement) were associated with larger improvements in depression scores across several regions. In the left BA10 and left amygdala, these relationships were driven primarily by the ketamine group (group * DTI-MD interaction effects: p = 0.016–0.082). In the right BA10, these associations generalized to both infusion arms (p = 0.007). In the left and right hippocampus, on the MADRS only, interaction effects were observed in the opposite direction, such that DTI-MD change was inversely associated with depression change in the ketamine arm specifically (group * DTI-MD interaction effects: p = 0.032–0.06). The acute effects of ketamine on depression may be mediated, in part, by acute changes in neuroplasticity quantifiable with DTI.

To evaluate the efficacy of dexmedetomidine with midazolam (DEX-MDZ) versus midazolam only (MDZ) for sedation during awake fiberoptic intubation (AFOI). Randomized, double-blinded study. Academic medical center. 55 ASA physical status I, II, III, and IV patients, aged 18-85 years, scheduled for non-emergency surgery with AFOI. All patients received intravenous (IV) glycopyrrolate 0.2 mg premedication, oxygen by nasal cannula, and topical local anesthetics to the airway. MDZ subjects received IV midazolam 0.05 mg/kg with additional doses to achieve a Ramsay Sedation Scale (RSS) score of ≥ 2. DEX-MDZ patients received midazolam 0.02 mg/kg followed by dexmedetomidine one μg/kg, then an infusion of dexmedetomidine 0.1 μg/kg/hr and titrated to 0.7 μg/kg/hr to achieve RSS≥2. Observers' Assessment of Alertness/Sedation (OAA/S) and RSS were evaluated. The anesthesiologist rated AFOI ease of placement. Two observers rated patients' comfort and reaction to placement at three time points: preoxygenation, at introduction of the fiberoptic laryngoscope, and at introduction of the endotracheal tube (ET) before surgery. Following surgery, patients were asked if they recalled the AFOI and also to rate their satisfaction with the intubation. DEX-MDZ patients were significantly calmer and more cooperative during AFOI and had fewer adverse reactions to AFOI than did the MDZ patients. They also were more satisfied with the AFOI ( P < 0.001) than were the midazolam-only patients. There were no significant hemodynamic differences between the two subject groups. Dexmedetomidine in combination with low doses of midazolam is more effective than midazolam alone for sedation in AFOI.

Kinesin-13 motors are unusual in that they do not walk along microtubules, but instead diffuse to the ends, where they remove tubulin dimers, regulating microtubule dynamics. Here we show that Drosophila kinesin-13 klp10A regulates oocyte meiosis I spindle length and is haplo-insufficient – KLP10A, reduced by RNAi or a loss-of-function P element insertion mutant, results in elongated and mispositioned oocyte spindles, and abnormal cortical microtubule asters and aggregates. KLP10A knockdown by RNAi does not significantly affect microtubule growth rates in oocyte spindles, but, unexpectedly, EB1 binding and unbinding are slowed, suggesting a previously unobserved role for kinesin-13 in mediating EB1 binding interactions with microtubules. Kinesin-13 may regulate spindle length both by disassembling subunits from microtubule ends and facilitating EB1 binding to plus ends. We also observe an increased number of paused microtubules in klp10A RNAi knockdown spindles, consistent with a reduced frequency of microtubule catastrophes. Overall, our findings indicate that reduced kinesin-13 decreases microtubule disassembly rates and affects EB1 interactions with microtubules, rather than altering microtubule growth rates, causing spindles to elongate and abnormal cortical microtubule asters and aggregates to form.

Objectives: Tibial tubercle osteotomy (TTO) can be used to treat patellar instability, patellar maltracking/compression, and patellofemoral cartilage damage. Reported complication rates following TTO range from 1% to 46%, with varied definitions of complication. The purpose of our study was to define the incidence of complications following TTO in a large cohort at a tertiary-care institution. Methods: Patients who underwent TTO between 2011 and 2023 were retrospectively identified. Patients who did not have at least 30 days of follow-up were excluded. Revision cases were excluded. Information about complications was obtained through review of the electronic medical record. Major complications included intraoperative fracture, postoperative fracture, loss of fixation, delayed union, non-union, pulmonary embolism (PE), patella tendon rupture, deep infection, painful hardware requiring removal, arthrofibrosis requiring reoperation, re-dislocation, reoperation for other indications, readmission, and revision. Minor complications included superficial infection, deep venous thrombosis (DVT), wound dehiscence, and postoperative neurapraxia. Chi-square tests were used for categorical variables, t tests for continuous variables. Results: Four hundred and seventy-six TTOs in 436 patients were included in the final cohort with a mean follow-up of 1.9 years. Patients were 68.5% female with average age 28.3 years.The overall complication rate was 27.5 percent. Major complications were recorded in 23.7% of patients, and minor complications in 8.4% of patients. Reoperation was required in 16.6% of patients at an average of 14 months after index procedure. The most common complications were painful hardware requiring removal (6.5%), superficial infection (5.7%), and arthrofibrosis requiring return to the operating room (5.0%). These and other complications are reported in Table 1 at 30 days, 90 days, 1 year, and final follow-up. Table 2 compares patient characteristics for those who had a major complication versus those who did not. Patients who had a major complication were older than those who did not (30.2 vs 27.7, p = .013). A higher proportion of patients who had a major complication had a previous ipsilateral surgery (57.5% vs. 36.6%, p < .001), had an indication of cartilage lesion/arthritis (71.7% vs. 60.6%, p = .034), and underwent a concomitant cartilage reconstruction/repair procedure (51.8% vs. 39.1%, p = .012). A lower proportion of patients who had a major complication had an indication of instability (56.6% vs. 67.2%, p = .043) and underwent a soft tissue reconstruction (46.4% vs. 60.1%, p = .012). There were no differences in the proportion of major complications by sex or American Society of Anesthesiologists score. Mean body mass index (BMI) did not differ significantly between patients who had a major complication and those who did not. Hardware removal was required in 6.5% of patients. More patients with headed as compared to headless screws required hardware removal (13.2% vs. 1.7%, p < .001). Arthrofibrosis requiring reoperation was observed in 5.7% of patients. A significantly higher proportion of patients who underwent a concomitant cartilage restoration/repair procedure had arthrofibrosis postoperatively (10.0% vs. 2.5%, p < 001). There was no difference in arthrofibrosis requiring reoperation by race, sex, age, BMI, smoking status, prior ipsilateral surgery, or other concomitant procedures. Conclusions: The complication rate following TTO was 27.5%, with painful hardware requiring removal (6.5%) as the most common complication, and a reoperation rate of 16.6% at a mean follow-up of 1.9 years. Major complications were observed in 23.7% of patients and were more common in older patients, patients with an indication of cartilage lesion/arthritis, patients who underwent a cartilage restoration/repair procedure, and patients with a previous ipsilateral surgery. Hardware removal was more common in patients with headed screws. Arthrofibrosis was more common in patients who underwent a concomitant cartilage restoration/repair procedure.

Background: Sleep issues are commonly reported in athletes after a sport-related concussion (SRC). Further studies are needed to evaluate screening methods for sleep disturbances and the risk of persisting symptoms after an SRC. Purpose: To evaluate the association between the Sport Concussion Assessment Tool 5 (SCAT5) symptoms of trouble falling asleep, fatigue (or low energy), and drowsiness and the risk of persisting symptoms (≥28 days to recovery) in adolescent athletes. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 519 athletes aged 13 to 18 years reported any sleep-related symptoms with an SRC, scored as none (0), mild (1-2), moderate (3-4), or severe (5-6), at their initial office visit (median, 5.4 days after an SRC). Scores were correlated with the risk of persisting symptoms. A composite “sleep cluster” score (range, 0-18) was calculated by summing the SCAT5 component items for trouble falling asleep, fatigue, and drowsiness. Results: The results indicated that, compared with athletes who reported that they did not have each symptom, (1) athletes who reported mild, moderate, or severe trouble falling asleep were 3.0, 4.6, and 6.7 times more likely to have persisting symptoms, respectively; (2) athletes reporting mild, moderate, or severe fatigue (or low energy) were 2.6, 4.8, and 7.6 times more likely to have persisting symptoms, respectively; and (3) athletes reporting mild, moderate, or severe drowsiness were 1.9, 4.6, and 6.8 times more likely to have persisting symptoms, respectively (P < .001 for all). For every 1-point increase in the sleep cluster score, there was a 1.2-fold increased risk of persisting symptoms and an additional 2.4 days of recovery required (P < .001 for both). Conclusion: Athletes who reported mild, moderate, or severe sleep-related symptoms on the SCAT5 were at a proportionally increased risk of persisting symptoms at the initial office visit.