Reduction in wound healing complications and infection rate by lumbar CSF drainage after decompressive hemicraniectomy

Objective: Wound healing disorders and surgical site infections are the most frequently encountered complications after decompressive hemicraniectomy (DHC). Subgaleal CSF accumulation causes additional tension of the scalp flap and increases the risk of wound dehiscence, CSF fistula, and infection. Lumbar CSF drainage might relieve subgaleal CSF accumulation and is often used when a CSF fistula through the surgical wound appears. The aim of this study was to investigate if early prophylactic lumbar drainage might reduce the rate of postoperative wound revisions and infections after DHC. Methods: The authors retrospectively analyzed 104 consecutive patients who underwent DHC from January 2019 to May 2021. Before January 2020, patients did not receive lumbar drainage, whereas after January 2020, patients received lumbar drainage within 3 days after DHC for a median total of 4 (IQR 2-5) days if the first postoperative CT scan confirmed open basal cisterns. The primary endpoint was the rate of severe wound healing complications requiring surgical revision. Secondary endpoints were the rate of subgaleal CSF accumulations and hygromas as well as the rate of purulent wound infections and subdural empyema. Results: A total of 31 patients died during the acute phase; 34 patients with and 39 patients without lumbar drainage were included for the analysis of endpoints. The predominant underlying pathology was malignant hemispheric stroke (58.8% vs 66.7%) followed by traumatic brain injury (20.6% vs 23.1%). The rate of surgical wound revisions was significantly lower in the lumbar drainage group (5 [14.7%] vs 14 [35.9%], p = 0.04). A stepwise linear regression analysis was used to identify potential covariates associated with wound healing disorder and reduced them to lumbar drainage and BMI. One patient was subject to paradoxical herniation. However, the patient's symptoms rapidly resolved after lumbar drainage was discontinued, and he survived with only moderate deficits related to the primary disease. There was no significant difference in the rate of radiological herniation signs. The median lengths of stay in the ICU were similar, with 12 (IQR 9-23) days in the drainage group compared with 13 (IQR 11-23) days in the control group (p = 0.21). Conclusions: In patients after DHC and open basal cisterns on postoperative CT, lumbar drainage appears to be safe and reduces the rate of surgical wound revisions and intracranial infection after DHC while the risk for provoking paradoxical herniation is low early after surgery

Communication and signal exchange in the Rhizobium bradyrhizobium legume system

A new comprehensive communication concept in the Rhizobium/Bradyrhizobium legume symbiosis was developed. It includes a root zone specific flavonoid exudation, the differential activity of phenylpropane/acetate pathway derivatives on chemotaxis, nod-gene inducing activity and phytoalexin resistance induction on the microsymbiont side (Bradyrhizobium). Nod factor production from the microsymbiont affects the host plant in root hair curling and meristem induction. Phytoalexin production in the host plant is also an early response, however repressed to a low level after a few hours. Another strategy of the microsymbiont to overcome phytoalexin effects is degradation of phytoalexins in Rhizobium leguminosarum bv. vicieae. Competitiveness within the same infection group of the microsymbiont was studied with gus-gene fusion, using the blue coloured nodules to easily discriminate marked strains from unmarked competitors. New exopolysaccharide (EPS) mutants of Bradyrhizobium japonicum were reconstructed homologous with a DNA region to exoB gene of Rhizobium meliloti. Their clearly reduced competitiveness of nodulation, demonstrates that exopolysaccharides of Bradyrhizohium japonicum also have an important function during the early stages of this symbiotic interaction

Introducing a nationwide registry: the Swiss study on aneurysmal subarachnoid haemorrhage (Swiss SOS)

Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a haemorrhagic form of stroke and occurs in a younger population compared with ischaemic stroke or intracerebral haemorrhage. It accounts for a large proportion of productive life-years lost to stroke. Its surgical and medical treatment represents a multidisciplinary effort. Due to the complexity of the disease, the management remains difficult to standardise and quality of care is accordingly difficult to assess. Objective: To create a registry to assess management parameters of patients treated for aSAH in Switzerland. Methods: A cohort study was initiated with the aim to record characteristics of patients admitted with aSAH, starting January 1st 2009. Ethical committee approval was obtained or is pending from the institutional review boards of all centres. In the study period, seven Swiss hospitals (five university [U], two non-university medical centres) harbouring a neurosurgery department, an intensive care unit and an interventional neuroradiology team so far agreed to participate in the registry (Aarau, Basel [U], Bern [U], Geneva [U], Lausanne [U], St. Gallen, Zürich [U]). Demographic and clinical parameters are entered into a common database. Discussion: This database will soon provide (1) a nationwide assessment of the current standard of care and (2) the outcomes for patients suffering from aSAH in Switzerland. Based on data from this registry, we can conduct cohort comparisons or design diagnostic or therapeutic studies on a national level. Moreover, a standardised registration system will allow healthcare providers to assess the quality of car

Die Plangenehmigung als Instrument zur Verfahrensbeschleunigung : eine bundesweite empirische Studie unter besonderer Berücksichtigung des Straßenrechts

Ahlborn I-P. Die Plangenehmigung als Instrument zur Verfahrensbeschleunigung : eine bundesweite empirische Studie unter besonderer Berücksichtigung des Straßenrechts. Bielefeld (Germany): Bielefeld University; 2006.Für das deutsche Planfeststellungsrecht bedeutet das Beschleunigungsinstrument der qualifizierten Plangenehmigung einen erheblichen Bruch mit überkommenen Strukturen. Trotz der nun schon mehrjährigen Anwendung - vorwiegend in den neuen Bundesländern im Bereich des Eisenbahn- und Straßenrechts - ist die bedeutsame Frage, wie die Planungsalternative von den Vorhabenträgern sowie den Behörden angenommen wird und wo sich in der Praxis Anwendungsschwierigkeiten ergeben, noch nicht hinreichend geklärt. Stellt das nicht förmliche Plangenehmigungsverfahren tatsächlich eine praxistaugliche Alternative zum althergebrachten, allerdings komplexen Verfahren der Planfeststellung dar und haben sich die vielfältigen Erwartungen einer Verfahrensvereinfachung und vor allem Verfahrensbeschleunigung erfüllt? Darüber gibt die vorliegende Arbeit Aufschluss, indem anhand einer bundesweiten empirischen Studie im Bereich des (Fern-)Straßenrechts die gesammelten Erfahrungen mit diesem Planungsinstrument aufgezeigt werden. Die Erhebungen wurden in den Jahren 2001 - bezogen auf das gesamte Bundesgebiet - und 2004 betreffend § 17 I b FStrG für die neuen Länder durchgeführt. Ausschlaggebend für die zweite Behördenumfrage im Jahre 2004 ist das Artikelgesetz von 2001, welches u.a. die UVP-Änderungsrichtlinie umsetzte und den Anwendungsbereich im Bundesverkehrswegerecht strikt auf nicht UVP-pflichtige Vorhaben beschränkte - mit Ausnahme fernstraßenrechtlicher Plangenehmigungsverfahren in den neuen Bundesländern befristet bis zum 31.12.2006 (§ 17 Abs. 1 b FStrG) bzw. nunmehr 31.12.2007 (§ 17 b Abs. 1 Nr. 5 FStrG neu). Die Gesetzeslage hat sich also seit August 2001 grundlegend geändert. Mit Hilfe dieser empirischen rechtstatsächlichen Untersuchungen im Bereich des Straßenrechts wird der Diskussion über das Rechtsinstitut der Plangenehmigung erstmals eine gesicherte Bewertungsgrundlage verschafft. Es ist dabei ein deutliches Ost-West-Gefälle zu verzeichnen, d.h. dass die alten Bundesländer im Gegensatz zu den neuen Ländern dem Plangenehmigungsverfahren immer noch skeptisch gegenüber stehen. Zu Unrecht, wie der Autor belegt, da die Erteilung einer Plangenehmigung mit einer deutlichen Verfahrensbeschleunigung einhergeht und dies seit dem Artikelgesetz aus dem Jahre 2001 auch mit der erforderlichen Rechtssicherheit. Daher wird dafür plädiert, von den möglichen Beschleunigungspotentialen der Plangenehmigung auch in den alten Ländern Gebrauch zu machen. Erwägenswert erscheint schließlich die Übernahme von § 17 I b FStrG (§ 17 b I Nr. 5 FStrG neu), also die Möglichkeit eines Plangenehmigungsverfahrens auch für UVP-pflichtige Vorhaben, in das gesamtdeutsche Fachplanungsrecht bzw. fachgebietsübergreifend sogar in das allgemeine Verwaltungsverfahrensgesetz (VwVfG)

Beyond food safety: EU food information standards as a facilitator of political consumerism and international law enforcement mechanism

In Organisation juive européenne, Vignoble Psagot Ltd v Ministre de l'Économie et des Finances (Organisation juive européenne) (C-363/18), the Court of Justice of the European Union (CJEU or Court) was tasked with deciding what information on its country of origin or place of provenance is mandatory for business according to existing European legislation. This case note summarises the interpretative decisions taken by the AG Hogan (Advocate General or AG) and the Court in their opinion and judgment, respectively. It then considers the broader implications of this case from several perspectives: first, from the perspective of political consumerism and its (potential) role in EU internal market law; second, from the perspective of the enforcement of international law; and third, from the perspective of the coherence of EU food and consumer law including its behavioural dimension

Long-term field experiments in Germany: classification and spatial representation

The collective analysis of long-term field experiments (LTFEs), here defined as agricultural experiments with a minimum duration of 20 years and research in the context of sustainable soil use and yield, can be used for detecting changes in soil properties and yield such as those induced by climate change. However, information about existing LTFEs is scattered, and the research data are not easily accessible. In this study, meta-information on LTFEs in Germany is compiled and their spatial representation is analyzed. The study is conducted within the framework of the BonaRes project, which, inter alia, has established a central access point for LTFE information and research data. A total of 205 LTFEs which fit to the definition above are identified. Of these, 140 LTFEs are ongoing. The land use in 168 LTFEs is arable field crops, in 34 trials grassland, in 2 trials vegetables and in 1 trial pomiculture. Field crop LTFEs are categorized into fertilization (n=158), tillage (n=38) and crop rotation (n=32; multiple nominations possible) experiments, while all grassland experiments (n=34) deal with fertilization. The spatial representation is analyzed according to the climatic water balance of the growing season (1 May to 31 October) (CWBg), the Müncheberg Soil Quality Rating (MSQR) and clay content. The results show that, in general, the LTFEs well represent the area shares of both the CWBg and the MSQR classes. Eighty-nine percent of the arable land and 65 % of the grassland in Germany are covered by the three driest CWBg classes, hosting 89 % and 71 % of the arable and grassland LTFEs, respectively. LTFEs cover all six MSQR classes but with a bias towards the high and very high soil quality classes. LTFEs on arable land are present in all clay content classes according to the European Soil Data Centre (ESDAC) but with a bias towards the clay content class 4. Grassland LTFEs show a bias towards the clay content classes 5, 6 and 7, while well representing the other clay content classes, except clay content class 3, where grassland LTFEs are completely missing. The results confirm the very high potential of LTFE data for spatially differentiated analyses and modeling. However, reuse is restricted by the difficult access to LTFE research data. The common database is an important step in overcoming this restriction

Outcome and management of decompressive hemicraniectomy in malignant hemispheric stroke following cardiothoracic surgery

Abstract Management of malignant hemispheric stroke (MHS) after cardiothoracic surgery (CTS) remains difficult as decision-making needs to consider severe cardiovascular comorbidities and complex coagulation management. The results of previous randomized controlled trials on decompressive surgery for MHS cannot be generally translated to this patient population and the expected outcome might be substantially worse. Here, we analyzed mortality and functional outcome in patients undergoing decompressive hemicraniectomy (DC) for MHS following CTS and assessed the impact of perioperative coagulation management on postoperative hemorrhagic and cardiovascular complications. All patients that underwent DC for MHS resulting as a complication of CTS between June 2012 and November 2021 were included in this observational cohort study. Outcome was determined according to the modified Rankin Scale (mRS) score at 1 and 3–6 months. Clinical and demographic data, anticoagulation management and postoperative hemorrhagic and thromboembolic complications were assessed. In order to evaluate a predictive association between clinical and radiological parameters and the outcome, we used a multivariate logistic regression analysis. Twenty-nine patients undergoing DC for MHS after CTS with a female-to-male ratio of 1:1.9 and a median age of 60 (IQR 49–64) years were identified out of 123 patients undergoing DC for MHS. Twenty-four patients (83%) received pre- or intraoperative substitution. At 30 days, the in-hospital mortality rate and neurological outcome corresponded to 31% and a median mRS of 5 (5–6), which remained stable at 3–6 months [Mortality: 42%, median mRS: 5 (4–6)]. Postoperatively, 15/29 patients (52%) experienced new hemorrhagic lesions and Bayesian logistic regression predicting mortality (mRS = 6) after imputing missing data demonstrated a significantly increased risk for mortality with longer aPPT (OR = 13.94, p = .038) and new or progressive hemorrhagic lesions after DC (OR = 3.03, p = .19). Notably, all but one hemorrhagic lesion occurred before discontinued anticoagulation and/or platelet inhibition was re-initiated. Despite perioperative discontinuation of anticoagulation and/or platelet inhibition, no coagulation-associated cardiovascular complications were noted. In conclusion, Cardiothoracic surgery patients suffering MHS will likely experience severe neurological disability after DC, which should remain a central aspect during counselling and decision-making. The complex coagulation situation after CTS, however, should not per se rule out the option of performing life-saving surgical decompression

Age determination of Tangra Yumco lake sediments

Massive carbonate banks representing ancient lacustrine deposits are exposed in the catchment of the lake Tangra Yumco (southern-central Tibetan Plateau) and nearby lake Xuru Co. Nine sediment samples were taken below and above these lacustrine deposits to determine periods of changing lake level using optically stimulated luminescence (OSL) applying a multiple aliquot regeneration (MAR) protocol. According to facies and stratigraphy samples below the carbonate banks indicate a rising and samples from above a falling lake level. The results indicate that the rising lake level of Tangra Yumco passed the sampling location at 10.5 ka and 2.1 ka while a falling lake level passed the sampling location at 0.9 ka. The rising lake level of Xuru Co passed the sampling location 7.9 ka and 1.7 ka and a falling lake level passed the sampling location at 0.5 ka showing a similar trend. Combining these results with recalculated cosmogenic nuclide ages and previously published feldspar luminescence data allow the establishment of an improved Holocene lake level reconstruction for Tangra Yumco, which is unique for the southern-central Tibetan Plateau. Within the last 10.5 ka the lake level of Tangra Yumco crested a lake level highstand of 181-183 m above the recent lake level at 8.5 ka and has generally fallen since, with a minor lake level rise at 2.1 ka. Lake level variations at Tangra Yumco occur simultaneously with other lakes on the Tibetan Plateau indicating that variations were controlled by monsoonal dynamics with a moist early Holocene and a successive reduction of available moisture thereafter. The precipitation directly reaching the lake via runoff that was required for the lake level rise between 10.5-8.5 ka is 9 mm a-1 (compared to a modern value of 35 mm a-1), providing valuable insights in the magnitude of monsoonal variations on the southern central Tibetan Plateau