Objectives Document human motions associated with cochlear implant electrode insertion at different speeds and determine the lower limit of continuous insertion speed by a human. Study Design Observational. Setting Academic medical center. Subjects and Methods Cochlear implant forceps were coupled to a frame containing reflective fiducials, which enabled optical tracking of the forceps' tip position in real time. Otolaryngologists (n = 14) performed mock electrode insertions at different speeds based on recommendations from the literature: "fast" (96 mm/min), "stable" (as slow as possible without stopping), and "slow" (15 mm/min). For each insertion, the following metrics were calculated from the tracked position data: percentage of time at prescribed speed, percentage of time the surgeon stopped moving forward, and number of direction reversals (ie, going from forward to backward motion). Results Fast insertion trials resulted in better adherence to the prescribed speed (45.4% of the overall time), no motion interruptions, and no reversals, as compared with slow insertions (18.6% of time at prescribed speed, 15.7% stopped time, and an average of 18.6 reversals per trial). These differences were statistically significant for all metrics ( P < .01). The metrics for the fast and stable insertions were comparable; however, stable insertions were performed 44% slower on average. The mean stable insertion speed was 52 ± 19.3 mm/min. Conclusion Results indicate that continuous insertion of a cochlear implant electrode at 15 mm/min is not feasible for human operators. The lower limit of continuous forward insertion is 52 mm/min on average. Guidelines on manual insertion kinematics should consider this practical limit of human motion.

Background. Neurological respiratory insufficiency strongly correlates with mortality among rodents infected with West Nile virus (WNV), which suggests that this is a primary mechanism of death in rodents and possibly fatal West Nile neurological disease in human patients.Methods. To explore the possibility that neurological respiratory insufficiency is a broad mechanism of death in cases of viral encephalitis, plethysmography was evaluated in mice infected with 3 flaviviruses and 2 alphaviruses. Pathology was investigated by challenging the diaphragm, using electromyography with hypercapnia and optogenetic photoactivation.Results. Among infections due to all but 1 alphavirus, death was strongly associated with a suppressed minute volume. Virally infected mice with a very low minute volume did not neurologically respond to hypercapnia or optogenetic photoactivation of the C4 cervical cord. Neurons with the orexin 1 receptor protein in the ventral C3–5 cervical cord were statistically diminished in WNV-infected mice with a low minute volume as compared to WNV-infected or sham-infected mice without respiratory insufficiency. Also, WNV-infected cells were adjacent to neurons with respiratory functions in the medulla.Conclusions. Detection of a common neurological mechanism of death among viral encephalitides creates opportunities to create broad-spectrum therapies that target relevant neurological cells in patients with types of viral encephalitis that have not been treatable in the past.

Background and Objectives: Evidence regarding the impact of sarcopenia on operative outcomes in patients with sarcoma is lacking. We evaluated the relationship between sarcopenia and postoperative complications or mortality among patients undergoing tumor excision and reconstruction.Methods: We retrospectively reviewed 145 patients treated with tumor excision and limb reconstruction for sarcoma of the extremities. Sarcopenia was defined as psoas index (PI) < 5.45 cm 2 /m 2 for men and <3.85 cm 2 /m 2 for women from preoperative axial CT. Regression analyses were used to assess the association between postoperative complications or mortality with PI, age, gender, race, body mass index, tumor histology, grade, depth, location, size, and neoadjuvant/adjuvant therapy.Results: There were 101 soft tissue tumors and 44 primary bone tumors. Sarcopenia was present in 38 patients (26%). Sarcopenic patients were older (median age: 72 vs 59 years, P = .0010) and had larger tumors (86.5%, >5 cm vs 77.7%, P = .023).Seventy-three patients experienced complications (51%) and 18 patients died within 1 year. Sarcopenia and metastatic disease were associated with increased 12-month mortality (hazard ratio [HR] = 6.68, P < .001; HR: 8.51, P < .001, respectively) but not complications (HR 1.45, P = .155, odds ratio, 1.32, P = .426, respectively).Conclusions: Sarcopenia and metastatic disease were independently associated with postoperative mortality but no complications following surgery.

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Aims: In the setting of rising healthcare costs, more cost efficiency in total hip arthroplasty (THA) is required. Following THA, most patients are monitored with serial hemoglobin testing despite few needing blood transfusions.  This testing adds cost and may not be necessary in most patients.  This study aims to identify factors associated with transfusion, therefore guiding hemoglobin monitoring following THA.Patients and Methods: Patients who underwent primary THA in 2015 were identified using the National Surgical Quality Improvement Project (NSQIP) database.  Patient discharged on the day of surgery were excluded. Patients were classified into those receiving transfusion versus no transfusion. Demographics and comorbidities were compared between groups followed by univariate and multivariate analysis, allowing identification of patient characteristics and comorbidities associated with transfusion. Results: Overall, 28664 patients who underwent THA patients were identified.  Within this group, 6.1% (n=1737) had a post-operative transfusion.  Patients receiving a blood transfusion were older, had lower body mass index, and had higher rates of chronic obstructive pulmonary disease (COPD), heart failure, dialysis, prior transfusion, and were more frequently ASA class 3-4 (p<0.001).  Univariate analysis demonstrated that patients requiring transfusion had higher complication rates (4.3% vs. 12.8%, p<0.0001).  Multivariate analysis identified age >70, diabetes, smoking, COPD, prior transfusion, and operative time >2 hours as independent risk factors for transfusion.Conclusion: Among THA patients, characteristics and comorbidities exist that are associated with increased likelihood of transfusion.  Presence of these factors should guide hemoglobin monitoring post-operatively. Selective hemoglobin monitoring can potentially decrease the cost of THA.