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Background Aim of the study was assessment of efficacy and safety of transcutaneous stimulation of the auricular branch of the vagal nerve (t-VNS) in the treatment of chronic migraine. Methods A monocentric, randomized, controlled, double-blind study was conducted. After one month of baseline, chronic migraine patients were randomized to receive 25 Hz or 1 Hz stimulation of the sensory vagal area at the left ear by a handhold battery driven stimulator for 4 h/day during 3 months. Headache days per 28 days were compared between baseline and the last month of treatment and the number of days with acute medication was recorded The Headache Impact Test (HIT-6) and the Migraine Disability Assessment (MIDAS) questionnaires were used to assess headache-related disability. Results Of 46 randomized patients, 40 finished the study (per protocol). In the per protocol analysis, patients in the 1 Hz group had a significantly larger reduction in headache days per 28 days than patients in the 25 Hz group (−7.0 ± 4.6 vs. −3.3 ± 5.4 days, p  = 0.035). 29.4 % of the patients in the 1 Hz group had a ≥50 % reduction in headache days vs. 13.3 % in the 25 Hz group. HIT-6 and MIDAS scores were significantly improved in both groups, without group differences. There were no serious treatment-related adverse events. Conclusion Treatment of chronic migraine by t-VNS at 1 Hz was safe and effective. The mean reduction of headache days after 12 weeks of treatment exceeded that reported for other nerve stimulating procedures.

Clinical Examination of the Lumbar Spine Low back pain has the highest global prevalence of all musculoskeletal conditions. This video demonstrates how to perform a physical examination of the lumbar spine.

Clinical Examination of the Cervical SpineHealth care visits related to symptoms or concerns regarding the neck are common. This video reviews the cervical spine anatomy and demonstrates a physical examination of the cervical spine.

(1) Background: Length of stay (LOS) is a commonly reported metric used to assess surgical success, patient outcomes, and economic impact. The focus of this study is to use a variety of machine learning algorithms to reliably predict whether a patient undergoing posterior spinal fusion surgery treatment for Adult Spine Deformity (ASD) will experience a prolonged LOS. (2) Methods: Patients undergoing treatment for ASD with posterior spinal fusion surgery were selected from the American College of Surgeon’s NSQIP dataset. Prolonged LOS was defined as a LOS greater than or equal to 9 days. Data was analyzed with the Logistic Regression, Decision Tree, Random Forest, XGBoost, and Gradient Boosting functions in Python with the Sci-Kit learn package. Prediction accuracy and area under the curve (AUC) were calculated. (3) Results: 1281 posterior patients were analyzed. The five algorithms had prediction accuracies between 68% and 83% for posterior cases (AUC: 0.566–0.821). Multivariable regression indicated that increased Work Relative Value Units (RVU), elevated American Society of Anesthesiologists (ASA) class, and longer operating times were linked to longer LOS. (4) Conclusions: Machine learning algorithms can predict if patients will experience an increased LOS following ASD surgery. Therefore, medical resources can be more appropriately allocated towards patients who are at risk of prolonged LOS.

Study Design Retrospective cohort study using PearlDiver database. Objectives To evaluate the effect of prior thyroidectomy on complications of Anterior Cervical Discectomy and Fusion (ACDF) surgery. Methods PearlDiver was used to identify patients without prior dysphagia or dysphonia undergoing ACDF between the years 2010-2020Q1. Patients with and without prior thyroidectomy were matched by levels of fusion, alcohol use, and gastroesophageal reflux disease in a 1:5 ratio. Postoperative outcomes were assessed for each cohort with multivariable logistic regression, controlling for age, sex, and Elixhauser Comorbidity Index. Results Between 2010 and 2019, matched cohorts of 792 ACDF patients with prior thyroidectomy and 3960 ACDF only patients were included in the study. Of patients with previous thyroidectomy undergoing ACDF, 16.3% experienced dysphagia at 1-year compared with 10.6% for patients undergoing ACDF only (aOR=1.39, P=.004). Patients with previous thyroidectomy also had higher odds of dysphonia at 1-year following ACDF, as compared to patients with ACDF alone (2.7% vs 1.2%, aOR=1.74, P= .048). Patients undergoing ACDF with prior thyroidectomy did not have increased risk of revision at 1 year (aOR=1.10, P=.698), 2 years (aOR=1.16, P=.457), or 5 years (aOR=1.20, P=.255) following surgery. There were no differences in postoperative opioid utilization rates at 1 month (aOR=2.07, P=.138), 3 months (aOR=2.45, P=.095), 6 months (aOR=1.34, P=.520), and 12 months (aOR=1.69, P=.202). Prior thyroidectomy was not associated with reintubation following ACDF (P=.995). Conclusions Patients with prior thyroidectomy undergoing ACDF surgery experience increased odds of dysphagia and dysphonia at 1-year follow-up compared to those without prior thyroidectomy.

Discarding of old rubber tires is indeed a very serious environmental problem all over the world represented by a high risk for uncontrolled fires and other environmental and health hazards. It was estimated that every year about one billion tires get to the end of their life span. Recently, the construction industry has taken up the challenge to incorporate recycled materials in concrete mixtures by means aggregate replacement. Nowadays, many researches are focused on investigating rubberized concrete as a structural material due to its enhanced properties such as ductility, energy dissipation and damping ratio. Previous studies have suggested the use of fine rubber particles rather than coarse ones when high strength concrete is targeted despite the fact that using coarse ones provide enhanced energy dissipation, damping ratio and vibration behavior. This study is intended to address the effects of utilizing significant amount of well graded fine and coarse rubber aggregates on the properties of high strength concrete. On the basis of the investigations some mechanical, durability and dynamic tests will be conducted on concrete with different rubber replacement percentages. The results of the experimental works have shown that it is possible to develop high strength concrete when well graded fine and coarse rubber particles is used to replace 25% percent of the natural aggregates. Furthermore, the vibration behavior of the concrete mixture was improved considerably when high content of rubber aggregates was added into concrete.

Background/Objectives: Cervical spine disease requiring surgical intervention is a major cause of disability. Anterior cervical discectomy and fusion (ACDF) is a well-established procedure for treating cervical pathology; however, there remains no consensus on whether 1-level versus 2-level ACDF yields comparable outcomes. This study compares 1-level versus 2-level ACDF by evaluating surgery-related and postoperative outcomes, radiographic parameters, and patient-reported outcome measures (PROMs). Methods: PubMed, Embase, Scopus, and Cochrane Library were searched through 10 July 2024. Studies comparing 1-level with 2-level ACDF were included. Data on operating room (OR) time, estimated blood loss (EBL), length of hospital stay (LOS), complications, and PROMs, including Neck Disability Index (NDI) and Visual Analogue Scale (VAS) for neck and arm pain, were extracted. Results: Thirteen studies met our inclusion criteria, comprising 2091 patients (1078 undergoing 1-level and 1013 2-level ACDF). No statistically significant differences were observed in EBL or LOS between the cohorts. However, the 2-level ACDF group showed significantly longer OR times (p-value < 0.001) and higher odds of developing dysphagia (p-value = 0.05). Patients undergoing 2-level ACDF showed greater correction in cervical lordosis. Both cohorts reported similar statistically and clinically significant improvements in VAS neck and NDI scores at final follow-up. There was no difference in adjacent segment disease or revision surgery at final follow-up. Conclusions: Both 1-level and 2-level ACDF improve clinical and radiographic outcomes. The choice should be tailored to the patient’s pathology and anatomy while considering the higher dysphagia risk with additional fusion levels. This study highlights the importance of individualized surgical planning to optimize postoperative outcomes while minimizing complications.

Background Fragility hip fractures are a common orthopedic injury seen in Emergency Departments, with variable outcomes that can range from average to devastating. Currently, few reliable metrics to predict which patients will suffer post-operative complications exist. The aim of this study was to determine if the number and type of pre-operative medications can help predict post-operative complications. Methods A prospectively collected database of hip fracture patients was retrospectively reviewed. Patients with isolated greater trochanteric fractures, periprosthetic fractures, or re-fractures were excluded. Pre-operative baseline characteristics as well as number and type of post-operative complications were reviewed. Any complication within 6 months of surgery and complications that could be directly attributable to the surgical procedure within 2 years of surgery were examined. Major complications (return to the operating room, deep infection, pulmonary, cardiac, and hematologic) and minor medical complications were assessed. A multivariate regression model was performed to identify independent risk factors. Results Three-hundred ninety-one patients were included. A majority were aged 80–90 and female, and lived at home prior to presentation. Overall, 33.7% of patients suffered a complication within a 2-year follow-up period. Mortality rates were 5.4%, 10.0%, and 14.9% over 30 days, 1 year, and 2 years, respectively. After assessing this relationship while controlling for age, sex, injury type, pre-operative residence, ambulatory status, ASA score, and CCI score, the relationship remained significant for both an increased number of complications (P = .048) and a higher likelihood of having a complication (P = .008). Cardiovascular (P = .003), pulmonary (P = .001), gout (P = .002), or diabetes (P = .042) medications were associated with a higher likelihood for experiencing a complication. Conclusions Our study suggests that there is a strong and linear relationship between the number and type of pre-operative medications taken and risk of post-operative complications. This exists for up to 8 medications, at which point further increase does not contribute to an increased risk of complication. This relationship exists even after controlling for confounding variables and can be used by surgeons to better counsel patients and families regarding their specific risk for suffering perioperative complications.

BackgroundPatient empowerment integrates multiple concepts that allow a patient to effectively self-manage his disease, which are accessing to health information, education, bi-directional communication between patients and healthcare professionals, self-care support, chronic disease management support and shared decision making.ObjectivesTo evaluate whether an online personal health platform improves AS patients' health and enhances their effectiveness in managing their health.MethodsWithin the scope of European Commission supported PALANTE project [1], an online personal health platform is developed for AS patients in Turkey. The platform consists of two main modules: Personal Health Records and Virtual Arthritis Clinical Service. Personal Health Records module allows patients to access their basic health records like allergies, problems, medications, immunizations, lab results etc., which are retrieved from Turkish National Health Information System, namely SaglikNet2. Virtual Arthritis Clinical Service module contains AS disease specific sub modules, some of which are: diary module which allows patients to record their daily status like morning pains etc. and share them with healthcare professionals, messaging module which allows patients to ask questions to their healthcare professionals whenever they want and without getting any appointment, exercise module which allows patients to follow the exercise plan specified by physical therapist, videos module which allows patients to learn how to do exercises correctly.The developed system has been used by 131 patients and 3 healthcare professionals in Turkey. In order to evaluate the success of the system, a questionnaire was sent to the patients after they used the system for 6 months.ResultsQuestions are categorized in three groups as communication features, educational features, and informational features. For each group, same set of questions were asked to patients. 70 patients conducted the questionnaire and following responses are retrieved.CommunicationEducationalInformationalUsing the … functionalities enabled me to accomplish my healthcare tasks more quickly70%74%67%Using the … functionalities enhanced my effectiveness in managing my health66%73%66%I found the … functionalities useful for managing my health67%76%73%I want this service to continue86%83%83% ConclusionsAs it can be seen from the table above, majority of patients reacted positively and want the services to continue. Patients found educational features, which contains videos module that allows patients to do their daily exercises correctly without consulting physical therapist, as the most useful functionality of the system. Furthermore, patients mostly want communication features, which provide direct communication between patients and healthcare professionals, to continue. As a result, an online personal health platform improved AS patients' health and enhanced their effectiveness in managing their health.Referenceshttp://palante-project.eu/AcknowledgementsThe work presented in this paper is achieved in the scope of PALANTE project [1] supported by the European Community's Seventh Framework Programme (FP7/2007-2013) under grant agreement number 297260.Disclosure of InterestNone declared

Using data from a well-executed randomized experiment, I examine the effects of gender composition and peer achievement on high school students' outcomes in disadvantaged neighborhoods. Results show that having a higher proportion of female peers in the classroom improves girls' math test scores only in less-advanced courses. For male students, the estimated gender peer effects are positive but less precisely estimated. I also find no effect of average classroom achievement on female math test scores. Males, on the other hand, seem to benefit from a higher-achieving classroom. I propose mechanisms relating to lower gender stereotype influences and gender-specific attitudes toward competition as potential explanations for peer effects findings. Finally, having a higher proportion of female students in the classroom decreases student absenteeism among male students but has no impact on female attendance.