Infection Prevention and the Protective Effects of Unidirectional Displacement Flow Ventilation in the Turbulent Spaces of the Operating Room

Background: Unidirectional displacement flow (UDF) ventilation systems in operating rooms are characterized by a uniformity of velocity 80% and protect patients and operating room personnel against exposure to hazardous substances. However, the air below the surgical lights and in the surrounding zone is turbulent, which impairs the ventilation system’s effect. Aim: We first used the recovery time (RT) as specified in International Organization for Standardization 14644 to determine the particle reduction capacity in the turbulent spaces of an operating room with a UDF system. Methods: The uniformity of velocity was analyzed by comfort-level probe grid measurements in the protected area below a hemispherical closed-shaped and a semi-open column-shaped surgical light (tilt angles: 0/15/30) and in the surrounding zone of a research operating room. Thereafter, RTs were calculated. Results: At a supply air volume of 10,500 m3/h, the velocity, reported as average uniformity+standard deviation, was uniform in the protected area without lights (95.8% + 1.7%), but locally turbulent below the hemispherical closedshaped (69.3% + 14.6%), the semi-open column-shaped light (66.9% + 10.9%), and in the surrounding zone (51.5%+17.6%). The RTs ranged between 1.1 and 1.7 min below the lights and 3.5+0.28 min in the surrounding zone and depended exponentially on the volume flow rate. Conclusions: Compared to an RT of 20 min as required for operating rooms with mixed dilution flow, particles here were eliminated 12–18 times more quickly from below the surgical lights and 5.7 times from the surrounding zone. Thus, the effect of the lights was negligible and the UDF’s retained its strong protective effect

Influence of preoperative nucleus pulposus status and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry

Background: Currently, herniated nucleus pulposus (HNP) with radiculopathy and other preconditions are regarded as relative or absolute contraindications for lumbar total disc replacement (TDR). In Switzerland it is left to the surgeon's discretion when to operate. The present study is based on the dataset of SWISSspine, a governmentally mandated health technology assessment registry. We hypothesized that preoperative nucleus pulposus status and presence or absence of radiculopathy has an influence on clinical outcomes in patients treated with mono-segmental lumbar TDR. Methods. Between March 2005 and April 2009, 416 patients underwent mono-segmental lumbar TDR, which was documented in a prospective observational multicenter mode. The data collection consisted of perioperative and follow-up data (physician based) and clinical outcomes (NASS, EQ-5D). Patients were divided into four groups according to their preoperative status: 1) group degenerative disc disease ("DDD"): 160 patients without HNP and no radiculopathy, classic precondition for TDR; 2) group "HNP-No radiculopathy": 68 patients with HNP but without radiculopathy; 3) group "Stenosis": 73 patients without HNP but with radiculopathy, and 4) group "HNP-Radiculopathy": 132 patients with HNP and radiculopathy. The groups were compared regarding preoperative patient characteristics and pre- and postoperative VAS and EQ-5D scores using general linear modeling. Results: Demographics in all four groups were comparable. Regarding the improvement of quality of life (EQ-5D) there were no differences across the four groups. For the two main groups DDD and HNP-Radiculopathy no differences were found in the adjusted postoperative back- and leg pain alleviation levels, in the stenosis group back- and leg pain relief were lower. Conclusions: Despite higher preoperative leg pain levels, outcomes in lumbar TDR patients with HNP and radiculopathy were similar to outcomes in patients with the classic indication; this because patients with higher preoperative leg pain levels benefit from a relatively greater leg pain alleviation. The group with absence of HNP but presence of radiculopathy showed considerably less benefits from the operation, which is probably related to ongoing degenerative processes of the posterior segmental structures. This observational multicenter study suggests that the diagnoses HNP and radiculopathy, combined or alone, may not have to be considered as absolute or relative contraindications for mono-segmental lumbar TDR anymore, whereas patients without HNP but with radiculopathy seem to be suboptimal candidates for the procedure. © 2011 Zweig et al; licensee BioMed Central Ltd

Injury prophylaxis in paragliding

Objectives: To show trends in paragliding injuries and derive recommendations for safety precautions for paraglider pilots on the basis of accident statistics, interviews, questionnaires, medical reports, and current stage of development of paragliding equipment. Methods: All paragliding accidents in Germany have to be reported. Information on 409 accidents was collected and analysed for the period 1997–1999. Results: There was a substantial decrease in reported accidents (166 in 1997; 127 in 1998; 116 in 1999). The number of accidents resulting in spinal injuries was 62 in 1997, 42 in 1998, and 38 in 1999. The most common cause of accident was deflation of the glider (32.5%), followed by oversteering (13.9%), collision with obstacles (12.0%), take off errors (10.3%), landing errors (13.7%), misjudgment of weather conditions (4.9%), unsatisfactory preflight checks (4.9%), mid-air collisions with other flyers (2.2%), accidents during winching (2.2%), and defective equipment (0.5%). Accidents predominantly occurred in mountain areas. Fewer than 100 flights had been logged for 40% of injured pilots. In a total of 39 accidents in which emergency parachutes were used, 10 pilots were seriously injured (26%) and an additional three were killed (8%). Conclusions: Injuries in paragliding caused by unpredictable situations can be minimised by (a) using safer gliders in the beginner or intermediate category, (b) improving protection systems, such as padded back protection, and (c) improving pilot skills through performance and safety training

Biomechanical response simulation of tetrahedral mass-spring model of intervertebral disc in a spine segment with haptic interface

Innovative Developments in Design and Manufacturing - Advanced Research in Virtual and Rapid Prototyping631-63