Power spectrum analysis of heart rate fluctuations provides a quantitative noninvasive means of assessing the functioning of the short-term cardiovascular control systems. We show that sympathetic and parasympathetic nervous activity make frequency-specific contributions to the heart rate power spectrum, and that renin-angiotensin system activity strongly modulates the amplitude of the spectral peak located at 0.04 hertz. Our data therefore provide evidence that the renin-angiotensin system plays a significant role in short-term cardiovascular control in the time scale of seconds to minutes.
The authors studied botulinum toxin type A therapy of severe biceps-triceps cocontractions after nerve regeneration following birth-related brachial plexus lesions. Six children (age, 2 to 4 years) were treated two to three times over a period of 8 to 12 months with 40 mouse units of botulinum toxin at two sites of the triceps muscle. Elbow range of motion improved from 0 to 25 to 50 deg to 0 to 25 to 100 deg (p < 0.05), and muscle force of elbow flexion increased from a mean of Medical Research Council classification 1.7 to 3.7 (p < 0.05). After a 1-year follow-up, there was no clinical recurrence.
OBJECTIVE: To compare the effect of same-day discharge on 30-day readmission risk after minimally invasive pelvic reconstructive surgery. METHODS: This retrospective cohort study included all minimally invasive pelvic reconstructive procedures with and without concomitant hysterectomy performed within a large managed care organization of 4.5 million members from 2008 to 2018. We queried the system-wide medical record for Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Revision codes for all included procedures and patient perioperative data. Our primary outcome was 30-day hospital readmission, and our secondary outcome was 30-day emergency department (ED) visits. Perioperative data and 30-day outcomes were compared using χ2 for categorical variables and Kruskal-Wallis for continuous variables. We performed a multivariate logistic regression adjusting for perioperative variables and their potential effect. RESULTS: Of the 13,445 patients undergoing pelvic reconstructive surgery, 5,506 were discharged the same day and 7,939 were discharged the next day. There was no difference in 30-day readmission comparing those discharged the same day with those discharged the next day (odds ratio [OR] 0.79; 95% CI 0.60–1.03; 1.5% vs 2.0%, P=.07). Concomitant hysterectomy was performed in 6,171 individuals: There was no difference (OR 0.90; 95% CI 0.60–1.33; 1.9% vs 2.1%, P=.59) in 30-day readmission rates when comparing those discharged on the same day with those discharged the next day. We also found no difference in 30-day readmissions rates when comparing same-day with next-day discharge (OR 1.33, 95% CI 0.79–2.26; 2.8% vs 2.1%, P=.28) in (n=3,482) individuals undergoing vaginal hysterectomy. For those who did not undergo hysterectomy at the time of their prolapse surgery, there was no difference (OR 0.77; 95% CI 0.53–1.13; 1.3% vs 1.7%, P=.18) in 30-day readmission when comparing those discharged the same day with those discharged the next day. After adjustment for patient and perioperative characteristics, there was no statistically significant difference in the readmission risk for individuals with same-day discharge compared with next-day discharge among those with (adjusted odds ratio [aOR] 0.91; 95% CI 0.61–1.36; P=.63) and without (aOR 0.86; 95% CI 0.58–1.27; P=.45) a concomitant hysterectomy. For the secondary outcome of 30-day ED visits, we found no statistically significant differences when comparing same-day with next-day discharge for the entire cohort, those with concomitant hysterectomy, or when controlling for patient and perioperative characteristics. CONCLUSION: In women undergoing minimally invasive pelvic reconstructive surgery within a large managed care organization, there is no difference in 30-day readmission or ED visit rates between those discharged the same day and those discharged the next day. When considering patient factors, same-day discharge after minimally invasive pelvic reconstructive surgery may be safe and play an important role in value-based care.
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