Objective Elevated inflammation has been repeatedly observed in posttraumatic stress disorder (PTSD), and it may drive the development of both psychiatric symptoms and physical comorbidities. However, it is not clear if elevated inflammation is a feature of both remitted and current PTSD, and little is known about relationships between specific clusters of PTSD symptoms and inflammation. Exaggerated threat sensitivity, as indexed by threat reactivity and avoidance of perceived threats, may be particularly closely associated with inflammation. Methods We assessed PTSD symptoms and threat sensitivity using the Clinician Administered PTSD Scale in 735 Veterans Affairs patients (35% current PTSD; 16% remitted PTSD) who participated in the Mind Your Heart Study (mean age = 59±11; 94% male). High sensitivity C-reactive protein (hsCRP), white blood cell count (WBC), and fibrinogen were used as indices of inflammation. Analysis of covariance models with planned contrasts were used to examine differences in inflammation by PTSD status, adjusting for age, sex, race, kidney function and socioeconomic status. Results Individuals with current PTSD had significantly higher hsCRP and WBC than patients with no history of PTSD, but there were no significant differences in inflammatory markers between those with remitted versus no history of PTSD. Within patients with current PTSD, higher threat reactivity was independently associated with higher hsCRP (β = .16, p = .01) and WBC count (β = .24, <.001), and higher effortful avoidance was associated with higher fibrinogen (β = .13, p = .04). Conclusion Our data indicate that elevated inflammation may be a feature of current, but not remitted, PTSD. Within patients with PTSD, higher threat reactivity was also associated with elevated inflammation. A better understanding of the relationship between threat sensitivity and inflammation may inform interventions for patients with PTSD.
The use of robotic systems to aid in surgical procedures has greatly increased over the past decade. Fields such as general surgery, urology, and gynecology have widely adopted robotic surgery as part of everyday practice. The use of robotic systems in the field of spine surgery has recently begun to be explored. Surgical procedures involving the spine often require fixation via pedicle screw placement, which is a task that may be augmented by the use of robotic technology. There is little margin for error with pedicle screw placement, because screw malposition may lead to serious complications, such as neurologic or vascular injury. Robotic systems must provide a degree of accuracy comparable to that of already-established methods of screw placement, including free-hand, fluoroscopically assisted, and computed tomography–assisted screw placement. In the past several years, reports have cataloged early results that show the robotic systems are associated with equivalent accuracy and decreased radiation exposure compared with other methods of screw placement. However, the literature is still lacking with regard to long-term outcomes with these systems. This report provides a technical overview of robotics in spine surgery based on experience at a single institution using the ExcelsiusGPS (Globus Medical; Audobon, PA, USA) robotic system for pedicle screw fixation. The current state of the field with regard to salient issues in robotics and future directions for robotics in spinal surgery are also discussed.
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