Negative Pressure Wound Therapy in Spinal Surgery.

Negative pressure wound therapy (NPWT) has demonstrated promise in the management of surgical site infections as well as assisting in surgical wound healing. In this manuscript, we describe the mechanisms and applications of NPWT for surgical wounds and existing evidence for NPWT in cardiac, plastic, and general surgery, followed by a discussion of the emerging evidence base for NPWT in spinal surgery. We also discuss the different applications of NPWT for open wounds and closed incisions, and the promise of newer closed-incision NPWT (ciNPWT) devices.

An Anatomy-Informed, Novel Technique for S1 Dorsal Root Ganglion Stimulation Lead Placement.

Objective: A heightened and organized understanding of sacral anatomy could potentially lead to a more effective and safe method of dorsal root ganglion stimulation (DRG-S) lead placement. The aim of this technical note is to describe a standardized access method for S1 DRG-S lead placement.

Design: Technical note.

Secondary encephalocele in an adult leading to subdural empyema.

Brain abscesses are an uncommon but potentially fatal infection. They can spread directly from an adjacent source or hematogenously from a distant source. Encephaloceles represent a rare form of neural tube defects that can potentially be complicated by the development of meningitis or brain abscess.

Effects of mindfulness training on emotional and physiologic recovery from induced negative affect.

Objective: Mindfulness training has been shown to improve psychological well-being and physical health. One proposed pathway for the positive effects of mindfulness training is through the development of new emotion regulation strategies, such as the ability to experience emotions by observing and accepting them without judgment. Theoretically, this should facilitate recovery from negative emotional states; however, this has rarely been examined empirically.

Relationships between obsessive-compulsive disorder, depression and functioning before and after exposure and response prevention therapy.

Objective: Obsessive-compulsive disorder (OCD) is associated with impaired functioning and depression. Our aim was to examine relationships between OCD symptoms, depression and functioning before and after exposure and response prevention (ERP), a type of cognitive-behavioural therapy for OCD, specifically examining whether functioning, depression and other cognitive factors like rumination and worry acted as mediators.

Methods: Forty-four individuals with OCD were randomised to 4 weeks of intensive ERP treatment first (n = 23) or waitlist then treatment (n = 21).

Cognitive behavioral therapy vs. Tai Chi for late life insomnia and inflammatory risk: a randomized controlled comparative efficacy trial.

Study Objectives: To investigate the comparative efficacy of cognitive behavioral therapy (CBT), Tai Chi Chih (TCC), and sleep seminar education control (SS) on the primary outcome of insomnia diagnosis, and secondary outcomes of sleep quality, fatigue, depressive symptoms, and inflammation in older adults with insomnia.

Design: Randomized controlled, comparative efficacy trial.

Setting: Los Angeles community.

Fatal intraoperative cardiac arrest after application of surgifoam into a bleeding iliac screw defect.

Study Design: Case report.

Objective: To describe the presentation, management, and autopsy findings in a case of a fatal intraoperative cardiac arrest after application of an absorbable hemostatic agent into a bleeding iliac bone screw defect.

Summary Of Background Data: To the authors' knowledge, this represents the first reported complication of intraoperative death associated with Surgifoam (Ethicon) thromboembolization to the heart and lung microcirculation after its application into a bleeding bone defect.

A randomized controlled trial of a self-guided, multimedia, stress management and resilience training program.

Background: Stress is a common and costly behavioral health issue. Technology-based behavioral health programs (e.g.

Pituitary disorders during pregnancy.

The pituitary gland undergoes much anatomic and physiologic variation during pregnancy. Pituitary disease may have a significant impact on a patient prior to conception as well as throughout her pregnancy. It is imperative to provide care to patients affected by pituitary disease with a multidisciplinary approach involving endocrinologists, obstetricians and, when appropriate, neurosurgical care, as this group of disorders can represent a substantial level of morbidity and mortality for both mother and fetus.

Sleep and inflammation: psychoneuroimmunology in the context of cardiovascular disease.

Background: Poor sleep is prospectively linked to all-cause and cardiovascular mortality. Inflammatory processes may be an important biological mechanism linking poor sleep to cardiovascular disease. Such processes involve active participation of signaling molecules called cytokines in development of atherosclerotic plaques.

Clinical correlates of sleep problems in systemic sclerosis: the prominent role of pain.

Objective: Problems with sleep are common in patients with SSc and impact daily function. Little research, however, has examined factors associated with sleep disruption in SSc. Therefore, the objective of this study was to investigate socio-demographic and medical factors associated with sleep disruption in SSc.

Assessing the scholarly impact of health psychology: a citation analysis of articles published from 1993 to 2003.

Objective: We conducted a citation analysis to explore the impact of articles published in Health Psychology and determine whether the journal is fulfilling its stated mission.

Design: Six years of articles (N = 408) representing three editorial tenures from 1993-2003 were selected for analysis.

Main Outcome Measures: Articles were coded for several dimensions enabling examination of the relationship of article features to subsequent citations rates.

Sleep depth and fatigue: role of cellular inflammatory activation.

Individuals with underlying inflammation present with a high prevalence of non-specific co-morbid symptoms including sleep disturbance and fatigue. However, the association between cellular expression of proinflammatory cytokines, alterations of sleep depth and daytime fatigue has not been concurrently examined. In healthy adults (24-61 years old), evening levels of monocyte intracellular proinflammatory cytokine production were assessed prior to evaluation of polysomnographic sleep and measures of fatigue the following day.

Nocturnal levels of ghrelin and leptin and sleep in chronic insomnia.

Experimental sleep deprivation in healthy humans affects levels of ghrelin and leptin, two primary hormones involved in energy balance that regulate appetite and body weight. No study to date has examined levels of these hormones in patients with chronic insomnia. In this study, men diagnosed with primary insomnia using DSM-IV criteria (n=14) and age and body weight comparable healthy control men (n=24) underwent polysomnography.

Improving sleep quality in older adults with moderate sleep complaints: A randomized controlled trial of Tai Chi Chih.

Study Objectives: To determine the efficacy of a novel behavioral intervention, Tai Chi Chih, to promote sleep quality in older adults with moderate sleep complaints.

Design: Randomized controlled trial with 16 weeks of teaching followed by practice and assessment 9 weeks later. The main outcome measure was sleep quality, as assessed by the Pittsburgh Sleep Quality Index (PSQI).

Stress activation of cellular markers of inflammation in rheumatoid arthritis: protective effects of tumor necrosis factor alpha antagonists.

Objective: Psychological stress is thought to aggravate disease activity in rheumatoid arthritis (RA), although the physiologic mechanisms are unclear. Tumor necrosis factor alpha (TNFalpha) is an inflammatory cytokine involved in the exacerbation of RA, and TNFalpha antagonists have emerged as efficacious treatments. The purpose of this study was to determine whether RA patients show increased monocyte production of TNFalpha following acute psychological stress and whether such responses are abrogated in RA patients taking TNFalpha antagonists.

Chronic stress and regulation of cellular markers of inflammation in rheumatoid arthritis: implications for fatigue.

Objectives: This study examined whether chronic interpersonal stress is associated with cellular markers of inflammation and regulation of these responses by in vitro doses of glucocorticoids in rheumatoid arthritis (RA) patients. The association between these markers of inflammation and fatigue was also tested.

Methods: Fifty-eight RA patients completed up to 30 daily ratings of the stressfulness of their interpersonal relations.

Sex differences in cardiac sympathovagal balance and vagal tone during nocturnal sleep.

Objective: To analyze sex differences in nocturnal vagal tone and cardiac sympathovagal balance during sleep in healthy men and women.

Methods: In two groups of healthy, non-obese adults (15 men and 14 women), sleep was polygraphically recorded and heart rate variability was assessed during an awake period prior to sleep and during sleep. Vagal tone was estimated by the high-frequency (HF) power component of heart rate variability, and sympathovagal balance was indexed by the ratio of low-frequency (LF) power to HF power.

Sex differences in monocyte expression of IL-6: role of autonomic mechanisms.

Sex differences in the prevalence of inflammatory disorders exist, perhaps due to sex differences in cellular mechanisms that contribute to proinflammatory cytokine activity. This study analyzed sex differences of monocyte intracellular expression of IL-6 and its associations with reproductive hormones and autonomic mechanisms in 14 matched pairs of men and women (n = 28). Monocyte intracellular IL-6 production was repeatedly assessed over two circadian periods.

Tai Chi Chih acutely decreases sympathetic nervous system activity in older adults.

Background: Aging is associated with increases of sympathetic nervous system activation implicated in the onset of hypertension and cardiovascular disease. The purpose of this study was to examine whether the practice of Tai Chi Chih (TCC), a movement-based relaxation practice, would acutely promote decreases of sympathetic activity in elderly persons.

Method: The sample included two groups of older men and women (age > or = 60 years): TCC practitioners (n = 19) and TCC-naïve participants (n = 13).

Cocaine dependence and acute cocaine induce decreases of monocyte proinflammatory cytokine expression across the diurnal period: autonomic mechanisms.

Cocaine dependence is associated with an increased risk of infectious diseases. The innate immune system triggers effector pathways to combat microbial pathogens through expression of tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6). It is not known whether cocaine alters the capacity of monocytes to respond to a bacterial challenge in humans.

Impairments in health functioning and sleep quality in older adults with a history of depression.

Objectives: To determine whether older adults with a history of depression show impairments in health functioning and sleep quality at a gradient between older adults with no history of depression and those with current major depression and to examine whether poor sleep quality contributes to declines in health functioning in addition to the contribution of depressive symptoms.

Design: Cross-sectional.

Setting: Three urban communities: Denver, Colorado, and Los Angeles and San Diego, California.