In clinical populations, prevalence rates for a number of anxiety disorders differ between males and females and gonadal hormones are thought to contribute to these differences. While these hormones have been shown to modulate the anxiolytic effects of the benzodiazepine agonist diazepam in some models, findings are inconsistent. Here, we tested for sex differences in response to anxiogenic stimuli following a 30-min diazepam (1.0 mg/kg) pre-treatment in male and female rats showing high (HAn) and low (LAn) anxiety-like behavior on the elevated plus maze. Acute diazepam administration resulted in decreased anxiety-like behavior only in HAn males as demonstrated by a significant increase in percent open arm time in the elevated plus maze (EPM). Immunohistochemical analysis for parvalbumin (PV; a calcium-binding protein that selectively stains GABAergic neurons) in central amygdala (CeA), caudate putamen (CPu) and the hippocampus indicated the number of GABAergic interneurons in these areas differed across sex and anxiety trait. In the CPu, females had significantly more PV-immunoreactive (IR) cells than males, and LAn females had greater PV-IR neurons than HAn females. In the CeA, males displayed an increased number of PV-IR neurons compared to females, with no differences found between LAn and HAn. Further, trait differences were evident in the CA2 region of the hippocampus, regardless of sex. Taken together, these data suggest that gonadal hormones and trait anxiety may influence the sensitivity to the anti-anxiety effects of diazepam and these differences may be due in part to the distribution of GABA-containing interneurons.

Background:Advancement in surgical techniques and implants has improved the ability to manage radial head and olecranon fractures. However, trends in management of these fractures are largely unstudied.Objective:This purpose of this study is to evaluate management trends for these common fractures.Methods:A retrospective review of a comprehensive Humana database was performed using Pearl Diver supercomputer (Warsaw, IN, USA) for radial head and neck (RHNF) and olecranon fractures (OF) between 2007 and 2014. Treatment methods including open reduction internal fixation (ORIF), radial head arthroplasty (RHA), and non-operative treatment were reviewed. Total reported incidence of office visits and utilization of each treatment modality were investigated. Sub-analysis with stratification by age 15-74 and greater than 75-years was performed for OF.Results:A total of 10,609 OF and 20,400 RHNF were identified between 2007 and 2014. A significant trend increase in the annual incidence of RHNF (266 cases/year, p<0.001) and OF (133.9 cases/year, p=0.001) was observed. A significant trend increase in annual percent utilization of RHA (0.22% per year, p=0.011) and a significant trend decrease in the annual percent utilization of ORIF (-1.0% per year, p=0.004) and non-operative management (-0.53% per year, p=0.046) was observed for RHNF. A significant trend increase was observed in percent utilization (0.40% per year, p=0.022) for OF non-operative management, especially in patients over 75 years (66% per year, p=0.034).Conclusion:The percentage of patients being treated with RHA is increasing. Non-operative management of OF has increased, specifically in the patients who are over 75 years.

Background: Due to increased postoperative complications with anterior cervical discectomy and fusion (ACDF), there has been an increasing interest in the use of cervical disc arthroplasty (CDA). Advancements in prosthetic designs and techniques have improved patient reported outcome measurements and minimized revision rates. There is a paucity in the literature regarding recent trends in CDA utilization and revision rates. The purpose of this study was to determine annual primary and revision CDA trends with the use of an administrative database. Methods: A retrospective review from 2005-2014 was performed using the Medicare Standard Analytical Files from the PearlDiver supercomputer (PearlDiver Technologies, Fort Wayne, IN, USA). Patients who underwent primary CDA were queried using International Classification of Disease, ninth revision (ICD-9) and current procedural terminology (CPT) code 84.62 and 22856, respectively. Revision CDAs were queried using ICD-9 procedure code 84.66. Primary outcomes of this study included annual primary procedures, annual revision incidence (RI), and additional demographic data such as age, gender, geographic location, Charlson-Comorbidity Index (CCI); in addition to length of stay (LOS), cost, and reimbursement. Results: The query returned 2,016 and 517 primary CDA and revision CDA procedures were performed in the Medicare database, respectively. The data showed that the CAGR of primary and revision CDA procedures to be 20.54% and 5.84% (P<0.001), respectively. RI and RB demonstrated a CAGR of −12.22% and −9.61%, respectively. Patients younger than the age of 65 represented the majority of the patients undergoing this procedure. Demographically, primary and revision CDAs were found highest in the South. Conclusions: The data demonstrates a high rate of annual growth in CDA utilization (20.54%) and revision CDA (5.84%), indicating there is an increase demand for CDA in the United States. Compared to ACDF, patients who undergo CDA have improved patient reported outcome measurements and lower rates of postoperative complications.

Hypothyroidism is a risk factor for worse postoperative outcomes in patients undergoing primary ACDF. Appropriate preoperative optimization with thyroid hormone supplementation could potentially minimize the incidence of developing numerous medical complications, in addition to potentially lowering readmission rates and the total cost of care.