Nutritional optimization in patients undergoing spine surgery is important as improved surgical outcomes and decreased rates of complications have been noted in optimized patients. With the increasingly high numbers of elderly patient and patients with metabolic comorbidities undergoing spine procedures, perioperative nutritional status should be enhanced for the best possible surgical outcomes. Methods of optimization include preoperative screening with Nutritional Risk Score or other scoring systems, looking for changes in body mass index, detecting sarcopenia, and screening for metabolic abnormalities. Assessment of blood glucose, electrolytes, cholesterol, vitamin levels, visceral proteins, and lean body mass must be done preoperatively and close monitoring should be continued postoperatively. Albumin helps to determine the health status of patients before surgery and prealbumin as a predictor of surgical outcomes is being investigated. Malnourished patients should be given balanced diets replenishing key nutrient deficits, glucose should be maintained with sliding scale insulin or continuous infusions and immunonutrition may be implemented. Postoperatively, patients should initiate a diet as soon as possible to decrease overall length of stay and complication rates, facilitating return to normal activities.

In many organisms, homolog pairing and synapsis at meiotic prophase depend on interactions between chromosomes and the nuclear membrane. Male Drosophila lack synapsis, but nonetheless, their chromosomes closely associate with the nuclear periphery at prophase I. To explore the functional significance of this association, we characterize mutations in nuclear blebber (nbl), a gene required for both spermatocyte nuclear shape and meiotic chromosome transmission. We demonstrate that nbl corresponds to dtopors, the Drosophila homolog of the mammalian dual ubiquitin/small ubiquitin-related modifier (SUMO) ligase Topors. We show that mutations in dtopors cause abnormalities in lamin localizations, centriole separation, and prophase I chromatin condensation and also cause anaphase I bridges that likely result from unresolved homolog connections. Bridge formation does not require mod(mdg4) in meiosis, suggesting that bridges do not result from misregulation of the male homolog conjunction complex. At the ultrastructural level, we observe disruption of nuclear shape, an uneven perinuclear space, and excess membranous structures. We show that dTopors localizes to the nuclear lamina at prophase, and also transiently to intranuclear foci. As a role of dtopors at gypsy insulator has been reported, we also asked whether these new alleles affected expression of the gypsy-induced mutation ct 6 and found that it was unaltered in dtopors homozygotes. Our results indicate that dTopors is required for germline nuclear structure and meiotic chromosome segregation, but in contrast, is not necessary for gypsy insulator function. We suggest that dtopors plays a structural role in spermatocyte lamina that is critical for multiple aspects of meiotic chromosome transmission.A SSOCIATIONS between chromosomes and the nuclear envelope during meiotic prophase are a widely conserved phenomenon important for proper chromosome transmission. In many species, such interactions are required for bouquet formation, an arrangement in which telomeres cluster in association with the nuclear envelope to facilitate homolog pairing and synapsis (reviewed in Scherthan 2007). In Caenorhabditis elegans, analogous interactions between nuclear envelope proteins and chromosomes are mediated by zinc finger proteins that connect chromosomespecific pairing sites to integral nuclear membrane proteins ). These connections establish bridges across the nuclear envelope and allow for interactions between meiotic chromosomes and cytoskeletal actin. Chromosome movements dependent on these connections are important for homolog pairing (Sato et al. 2009).The association of meiotic chromosomes with the nuclear periphery is particularly striking in Drosophila males, in which paired homologs occupy discreet domains closely apposed to the nuclear membrane. The relevance of this organization to meiotic chromosome segregation in this organism, however, has not been explored. Drosophila males have an unconventional meiosis in which homologs pair but do not assemble synapto...

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Background: Deep Brain Stimulation (DBS) is an underutilized surgical therapy for Parkinson's Disease (PD). Both physician and patient hesitancies have been described as potential barriers to DBS, but the specifics of patient perceptions of DBS have not been well-characterized in the general PD population.Objective: To characterize the understanding and impressions of surgical therapy in PD patients prior to formal surgical evaluation.Methods: A 30-question survey assessing impressions of surgical therapy for PD and understanding of DBS for PD was administered to PD patients seen at an urban movement disorders clinic.Results: One hundred and two patients completed the survey. When asked if they would undergo a hypothetical risk-free, curative brain surgery for PD, 98 patients responded “yes.” Patients were more agreeable to “reversible,” “minimally-invasive,” and “incisionless” surgery. 51.2% thought DBS is an “effective” treatment for PD, 76.6% thought it was “invasive,” and 18.3% thought it was “reversible.” 45.2% reported fear of being awake during DBS surgery. Regarding costs, 52.4% were concerned that DBS was “very expensive” or “not covered by insurance.” Initial source of information and perceived treatment effectiveness were not associated with concerns about DBS effectiveness or threats to normality. Negative perceptions of past surgery were associated with concerns about DBS altering mood and personality.Conclusion: Overall, patients expressed concerns regarding procedural efficacy, invasiveness, cost, and irreversibility—independent of the original source of information. Future studies are required to allow us to better understand the impact of these initial findings on DBS hesitancy and underutilization.

Brucella arthritis is common in Mosul, Iraq, with peripheral arthritis being the most common presenting manifestation. A prospective analysis of 80 patients (43 female, 37 male) attending the Ibn-Sina General Teaching Hospital between October 2001 and September 2002 recorded information on gender, age, residence, contact with animals and intake of unsterilized dairy products and studied the distribution of arthritis according to the pattern of joint involvement. The knee joint was the most common joint affected (34%), followed by the hip joint (30%). Of the totaljoints involved, the arthritis was monoarticular in 563% andpausiarticular in 43.7%. It is recommended that the public and primary healthcare physicians are made aware of the occurrence, manifestations and importance of having correct treatment for this condition in view of its prevalence and economic implications.