SUMMARY Recent advances in the understanding of pneumococcal virulence factors provide potential opportunities for the development of novel putative therapeutic or preventive strategies.Continuous bedside pulse oximetry (SpO2) is universally used to monitor oxygenation for patients supported on veno-venous extracorporeal membrane oxygenation (VV-ECMO). Yet, elevated carboxyhemoglobin (COHb), a known event in VV-ECMO, diminishes the reliability of SpO2. This retrospective cohort study aims to assess the accuracy of SpO2 compared with oxyhemoglobin (SaO2) and quantify COHb levels by co-oximetry in the VV-ECMO population. Forty patients on VV_ECMO from 2012 to 2017 underwent 1,119 simultaneous SaO2 and SpO2 measurements. Most patients were male (60%) with average age of 46 years. SpO2 overestimated SaO2 values by 2.35% at time of cannulation and 0.0061% for each additional hour on VV-ECMO (p 3% of hemoglobin saturation) at least once during VV-ECMO support and 602 (40.2%) arterial blood gases yielded elevated COHb levels. Mean duration for ECMO with elevated COHb was 244 hours compared with 98 hours in patients without (p less then 0.0048). Patients who developed COHb were younger (mean age 40 vs. 55 years, p less then 0.024) and had single-site double-lumen cannulation (odds ratio = 4.5, p = 0.23). At time of cannulation, mean COHb was 2.18% and increased by 0.0054% for each additional hour (p less then 0.0001). For every 1% increase in COHb, SaO2 decreased by 1.1% (p less then 0.0001). During VV-ECMO, SpO2 often overestimates SaO2 by substantial margins. This is attributable to rising COHb levels proportional to duration on VV-ECMO. In this population where adequate oxygen delivery is often marginal, clinicians should be wary of the reliability of continuous pulse oximetry to assess oxygenation.Microchannel artificial lungs may provide highly efficient, long-term respiratory support, but a robust predictive oxygen transfer (VO2) model is needed to better design them. To meet this need, we first investigated the predictive accuracy of Mikic, Benn, and Drinker's advancing front (AF) oxygen transfer theory by applying it to previous microchannel lung studies. Here, the model that included membrane resistance showed no bias toward overprediction or underprediction of VO2 (median error -1.13%, interquartile range [-26.9%, 19.2%]) and matched closely with existing theory. Next, this theory was expanded into a general model for investigating a family of designs. The overall model suggests that, for VO2 = 100 ml/min, fraction of delivered oxygen (FDO2) = 40%, wall shear stress (τw) = 30 dyn/cm, and blood channel height = 20-50 μm, a compact design can be achieved with priming volume (Vprime) = 5.8-32 ml; however, manifolding may be challenging to satisfy the rigorous total width (Wtotal) requirement (Wtotal = 76-475 m). In comparison, 100-200 μm heights would yield larger dimensions (Vprime = 122-478 ml) but simpler manifolding (Wtotal = 4.75-19.0 m). The device size can be further adjusted by varying FDO2, τw, or VO2. This model may thus serve as a simple yet useful tool to better design microchannel artificial lungs.STUDY DESIGN Retrospective comparative study. OBJECTIVE The goal was to determine whether comorbid depression and/or anxiety influence outcomes after anterior cervical discectomy and fusion (ACDF) for patients with degenerative cervical pathology. BACKGROUND DATA The role preoperative mental health has on patient reported outcomes after ACDF surgery is not well understood. METHODS Patients undergoing elective ACDF for degenerative cervical pathology were identified. Patients were grouped based on their preoperative mental health comorbidities, including patients with no history, depression, anxiety, and those with both depression and anxiety. All preoperative medical treatment for depression and/or anxiety was identified. Outcomes including Physical Component Score (PCS-12), Mental Component Score (MCS-12), Neck Disability Index (NDI), Visual Analogue Scale neck pain score (VAS Neck ), and Visual Analogue Scale arm pain score (VAS Arm) were compared between groups from baseline to postoperative measurements us after ACDF. No differences were identified in postoperative outcomes between each of the groups. LEVEL OF EVIDENCE Level III.STUDY DESIGN Retrospective study. OBJECTIVE The goal of this study is to identify and validate the reliability and accuracy of 2 methods used to assess lumbar disk herniations (LDHs) anteroposterior length and cross-sectional area. BACKGROUND Many clinicians characterize LDHs through the measurement of the anteroposterior length in the axial plane. Radiologists, on the other hand, have utilized software to measure the disk and canal areas to define the injury. In this study, the authors consider the reliability and accuracy of anteroposterior length in comparison with the area.  https://www.selleckchem.com/products/alantolactone.html  METHODS Using International Classification of Diseases, 10th Revision (ICD-10) code M51.26, patients at a single academic medical center who received a diagnosis of primary lumbar radicular pain with subsequent magnetic resonance imaging documentation of a single-level disk herniation in 2015 and 2016 were identified. AGFA-IMPACS software was utilized to make the following measurements anterior-posterior canal length; anterior-posterioa herniation or canal in its measurement. Thus, it is superior in its characterization LDH particularly in light of its stronger reproducibility. LEVEL OF EVIDENCE Level III-retrospective study.STUDY DESIGN A retrospective review of a prospective, randomized control Food and Drug Administration (FDA) investigational device exemption trial comparing anterior cervical discectomy and fusion (ACDF) with Bryan cervical disc arthroplasty. OBJECTIVE Determine the clinical significance of adjacent-level ossification disease (ALOD) on long-term functional outcomes after ACDF or arthroplasty. SUMMARY OF BACKGROUND DATA ALOD occurs when the anterior longitudinal ligament and annulus adjacent to the index surgical level calcifies. As previously reported, ALOD happens more commonly after an arthrodesis than an arthroplasty. No investigation has previously examined 10-year clinical outcomes associated with ALOD. MATERIALS AND METHODS Forty patients were included in the 10-year follow-up. The index level was radiographically blinded and the cephalad-adjacent level was evaluated for ALOD. These scores underwent statistical analysis to compare the 2 surgical groups (ACDF and arthroplasty) for differences in the development of ALOD at a decade follow-up.