Background: Studies comparing endocrine-specific outcomes following parathyroidectomy (PTx) versus concurrent parathyroidectomy and thyroidectomy (PTx + Tx) are few. Methods: 10,019 patients were selected from the Collaborative Endocrine Surgery Quality Improvement Program (2014-2019). Baseline characteristics and short-term (<= 30 days) outcomes for PTx + Tx vs PTx patients were compared using bivariate and multivariable methods. Results: PTx + Tx patients were more likely to experience clinical hypoparathyroidism (6.7% vs 0.5%, p < 0.001), recurrent laryngeal nerve transection, (0.4% vs 0.1%, p = 0.002) and hematoma requiring evacuation (1.0% vs 0.2%, p < 0.001). Readmissions and ED visits for hypocalcemia were more frequent after PTx + Tx vs PTx. Concurrent surgery was associated with an 8-fold increase in risk of short-term complications (Odds Ratio (OR): 8.0, 95% Confidence Interval (CI): 5.7-11.1, p < 0.001). Conclusions: Patients undergoing PTx + Tx have increased rates of postoperative complications, ED visits, and readmissions compared to patients undergoing parathyroidectomy alone. These findings could help guide surgeon-patient discussions on the risks of concurrent surgery.

ABSTRACT Financial and accounting professionals, the IRS, and the legal community continually deliberate the value of a business based on its legal structure—most often comparing the value of a C-Corporation to pass-through entities such as S-Corporations and limited liability companies. Despite the continued deliberations and various court rulings, the cleavages of thought have not converged on a single hypothesis of value. We provide an empirical analysis on M&A transaction data that spans nearly two decades. Specifically, we conduct multiple ANOVA tests, and a programmatic matching analysis of nearly identical pass-through entities and C-Corporation transactions that occurred in the same industry. The results validate the premise that there exists no pass-through entity valuation premium. JEL Classifications: C60; G12; G32; G34; H29; K22.

Introduction Early detection and treatment of intracranial aneurysms can prevent hemorrhagic stroke. However, treatment requires an invasive surgical procedure, which is potentially risky and costly. Risk quantification systems based on aneurysm size are imperfect since the majority of ruptured aneurysms are small, and no robust method exists for predicting an individual aneurysm’s likelihood of rupture. Endothelial cell (EC) genetics have been proposed to play a critical role in aneurysm risk. However, with the advent of endovascular treatment of aneurysms, there is a decline in the availability of biological tissue for research. Method We used a minimally-invasive endovascular EC collection technique to obtain aneurysmal ECs from aneurysm coils and access sheaths during endovascular treatment. Cells were collected from unruptured and ruptured aneurysms with low- and high-risk PHASES scores, as well as control arteries. After fluorescent-activated cell sorting (FACS), cytoplasmic mRNA from individual cells were extracted with SmartSeq Single CellTM and cDNA libraries were constructed for single cell RNA-Seq. Results Non-deployed endovascular coils and access sheaths from 15 patients (8 unruptured and 7 ruptured aneurysms) with a median PHASES score of 7, ranging from 3 – 11, were safely collected during endovascular treatment without adverse event. Cells were dissociated from the hardware and viable endothelial cells were identified by FACS with CD31 antibodies in 8 patients (5 unruptured and 3 ruptured aneurysms. Extracted RNA from single cells produced >500 pg of cDNA which was used for cDNA library construction and submitted for RNA sequencing. Conclusion Endovascular sampling of unruptured and ruptured aneurysm is safe and feasible. Despite the dissociation and FACS processes, endothelial cells were viable and produced sufficient cDNA at a single cell level for the construction of cDNA library for RNA sequencing. We envisage that this technique will greatly enhance the availability of cellular material for genetic study of cerebrovascular diseases. Disclosures C. Young: 1; C; AANS/CNS CV Section Robert J Dempsey Award 2019/2020, Bee Foundation Aneurysm Research Grant. S. Levy: None. A. Patel: None. D. Cooke: None. Y. Zheng: None. C. Mandrycky: None. C. Kelly: None. L. Kim: None. M. Levitt: None.

Lumbar punctures (LPs) are important for obtaining CSF in neurology studies but are associated with adverse events and feared by many patients. We determined adverse event rates and pain scores in patients prospectively enrolled in two cohort studies who underwent LPs using a standardized protocol and 25 g needle. Eight hundred and nine LPs performed in 262 patients age ≥ 60 years in the MADCO-PC and INTUIT studies were analyzed. Medical records were monitored for LP-related adverse events, and patients were queried about subjective complaints. We analyzed adverse event rates, including headaches and pain scores. There were 22 adverse events among 809 LPs performed, a rate of 2.72% (95% CI 1.71–4.09%). Patient hospital stay did not increase due to adverse events. Four patients (0.49%) developed a post-lumbar puncture headache (PLPH). Twelve patients (1.48%) developed nausea, vasovagal responses, or headaches that did not meet PLPH criteria. Six patients (0.74%) reported lower back pain at the LP site not associated with muscular weakness or paresthesia. The median pain score was 1 [0, 3]; the mode was 0 out of 10. The LP protocol described herein may reduce adverse event rates and improve patient comfort in future studies.

The standard of value in shareholder oppression and dissolution cases for a valuation of a minority shareholder's interest in a business in most U.S. states is fair value. The fair value standard in most U.S. states excludes discounts for control and lack of marketability. However, the three valuation approaches commonly used (income, market, and asset) all yield different levels of value. Consequently, this can unfairly negatively or positively impact minority and oppressed shareholders. In this paper we examine these inconsistencies and offer a solution to arriving at a level of value the trier of fact is seeking to obtain.

Spinal-cord injury is characterized by primary damage as a direct consequence of mechanical insult, and secondary damage that is partly due to the acute inflammatory response. The extent of any hemorrhage within the injured cord is also known to be associated with the formation of intraparenchymal cavities and has been anecdotally linked to secondary damage. This study was designed to examine the contribution of blood components to the outcome of spinal-cord injury. We stereotaxically microinjected collagenase, which causes localized bleeding, into the spinal cord to model the hemorrhage associated with spinal cord injury in the absence of significant mechanical trauma. Tissue damage was observed at the collagenase injection site over time, and was associated with localized disruption of the blood-spinal-cord barrier, neuronal cell death, and the recruitment of leukocytes. The magnitude of the bleed was related to neutrophil mobilization. Interestingly, the collagenase-induced injury also provoked extended axonal damage. With this model, the down-stream effects of hemorrhage are easily discernible, and the impact of treatment strategies for spinal-cord injury on hemorrhage-related injury can be evaluated.

Bursaphelenchus xylophilus (Steiner & Buhrer) (Nematoda: Aphelenchoididae), the pinewood nematode and the causal agent of the pine wilt disease, is a globally important invasive pathogen of pine forests. It is phoretic in woodborer beetles of the genus Monochamus (Megerle) (Coleoptera, Cerambycidae) and has been able to exploit novel indigenous species of Monochamus (but only Monochamus) in newly-invaded areas. North America (NA) is the continent of origin for the B. xylophilus/Monochamus spp. phoretic system. NA also contains the largest number of Monochamus species known to act as vectors for B. xylophilus. Understanding this phoretic system in its native geographical area helps to explain the evolutionary ecology of pine wilt disease.In the present study, we measured the flight phenology, size, sex ratios and species identity of Monochamus species in five geographically distant forests in NA. We also measured phoresy by B. xylophilus.We found the nematode to be abundant across eastern NA but rare or absent in western NA. In eastern forests, nematode phoresy was highest on the Monochamus species that flew earliest in the year. However, in the southeast, where Monochamus is most likely multivoltine with a long flight season, we found vectors with high nematode loads throughout the season, indicating that B. xylophilus can be transmitted to new hosts during most part of the year. The frequency distribution of nematode dauers on Monochamus was highly aggregated. Bursaphelenchus xylophilus in NA appears to be able to use all available Monochamus species as vectors.In native NA pine forests, the pinewood nematode appears to have an ecology that is sufficiently flexible to exploit different species (and both genders) of Monochamus, and disperse at different times of the year. This flexibility may contribute to its recent success in invading Eurasian pine forests.

Several rehabilitation robots for upper limbs have been introduced so far, and their clinical effectiveness has been reported in many studies on recovery of motor abilities in the aged or poststroke patients. These studies, however, found little evidence of improving the functional abilities of patients. Moreover, it has been identified that the main problem of robot-assisted stroke rehabilitation is the lack of motivating and versatile robot-assisted exercises. In this article, we discuss the development of a novel upper limb rehabilitation robot integrated with video games. Our solution is operated via a novel human computer interface, which stimulates shoulder, elbow movements, and fine finger movements. It is capable to train patients with partially recovered motor control ability. The interface enables therapists to select motivating and engaging motor training exercises represented as video games and specify rehabilitation exercises for patients using a grasping and upper limb interface. The paper presents concept of this novel interface, discusses the implementation issues and demonstrates technical and practical feasibility of our concept through a number of application examples.

Previous scholarship analyzing cross-sectional international data has noted that religious monopolies impede the efficiency of religious markets and that the benefits of competitive markets apply in religion as elsewhere. Our paper, analyzing U.S. state-level data, is premised on the complementary point that competitive markets in religion as elsewhere may fail if there are externalities, public goods, or asymmetries in information. In our model, we hypothesize that perfect competition will foster forms of religion that fail to create positive externalities and that in turn engender doubts about religious faith. We test empirically the Iannaccone hypothesis that more religious competition/diversity engenders more religious faith and our contrary hypothesis using state-level data showing overall levels of religious competition among Protestants provokes less religious faith.

Early warning for heart attacks could save many lives. We conducted three studies to design and evaluate multimodal alarms and patient training for an implanted heart attack detector. An implanted device provided vibrotactile alarms subcutaneously, and a pager-like device provided auditory and visual alarms. Temporal alarm patterns connoted an urgent emergency alarm (“Call 911”) and a less urgent alarm (“See your doctor”). In the third, clinical, study, most patients (94%) correctly responded to the alarms at 1, 3, and 6 months after device implantation. Subcutaneous vibrotactile alarms show great potential for use in critical medical applications.