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Through this incision, a guide wire was inserted down to the lamina of the stenotic vertebra. Over this guide wire a bullet system was inserted to dilate the tissues to a final diameter of 14.5mm. A 5mm laparoscopy scope, with 3.2X magnification, was used to visualize the procedure. A 6mm drill bit was used to create a laminotomy opening. Pituitaries and kerrisons were then used to remove bulk tissues and bone to open up the spinal canal. A standard burr with a 6mm bit was used to remove bone and smooth the bony edges of the opening. A holmium laser and electrocautery was used for hemocoaugulation and to remove soft issues. Once the region was decompressed, the surgery was completed. The surgery commenced as follows: The patient was properly draped and prepped. Intravenous (IV) antibiotics were administered perioperatively; cefazolin was used unless there was an allergy, in which case ciprofloxacin was substituted. The patient was sedated but alert. Remifentanil and midazolam were the most commonly used sedating agents. Utilizing fluoroscopy, the entry site was then determined and a 3/4-inch incision was made at a 30-degree angle to the vertebrae. Through this incision, a guide wire was inserted down to the lamina of the stenotic vertebra. Over this guide wire a bullet system was inserted to dilate the tissues to a final diameter of 14.5mm. A 5mm laparoscopy scope, with 3.2X magnification, was used to visualize the procedure. A 6mm drill bit was used to create a laminotomy opening. Pituitaries and kerrisons were then used to remove bulk tissues and bone to open up the spinal canal. A standard burr with a 6mm bit was used to remove bone and smooth the bony edges of the opening. A holmium laser and electrocautery was used for hemocoaugulation and to remove soft issues. Once the region was decompressed, the surgery was completed.. says Janetta.. 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Untreated antenatal depression has also been associated with smaller head circumference, lower Apgar scores, higher cortisol levels at birth, alteration in heart rate variability, and increased admissions to neonatal care units 18-20. Moreover, adverse long-term effects on early child development may be associated with depressive symptoms during pregnancy 21. Antenatal depression had been identified as a risk factor for postpartum depression and for adverse obstetric and neonatal outcomes 11-13. Neonatal adverse outcomes include preterm labour, low birth weight, and neonatal complications associated with increased morbidity and mortality in the infant 14-17. Untreated antenatal depression has also been associated with smaller head circumference, lower Apgar scores, higher cortisol levels at birth, alteration in heart rate variability, and increased admissions to neonatal care units 18-20. Moreover, adverse long-term effects on early child development may be associated with depressive symptoms during pregnancy 21..
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Tables 1 and 2 show the comparison of patient characteristics and biochemical parameters between the low-ACI group and the high-ACI group. The high-ACI group was significantly older and had a longer duration of PD and a more prevalent history of diabetes and CV disease compared to the low-ACI group..
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