221 research outputs found

    Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis.

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    Study Design: Systematic literature review. Objectives: The aims of this study were to (1) describe the clinical features, disabilities, and incidence of neurologic deficits of pyogenic spondylodiscitis prior to treatment and (2) compare the functional outcomes between patients who underwent medical treatment alone or in combination with surgery for pyogenic spondylodiscitis. Methods: A systematic literature review was performed using PubMed according to PRISMA guidelines. No year restriction was put in place. Statistical analysis of pooled data, when documented in the original report (ie, number of patients with desired variable and number of patients evaluated), was conducted to determine the most common presenting symptoms, incidence of pre- and postoperative neurologic deficits, associated comorbidities, infectious pathogens, approach for surgery when performed, and duration of hospitalization. Outcomes data, including return to work status, resolution of back pain, and functional recovery were also pooled among all studies and surgery-specific studies alone. Meta-analysis of studies with subgroup analysis of pain-free outcome in surgical and medical patients was performed. Results: Fifty of 1286 studies were included, comprising 4173 patients undergoing either medical treatment alone or in combination with surgery. Back pain was the most common presenting symptom, reported in 91% of patients. Neurologic deficit was noted in 31% of patients. Conclusion: Medical management remains first-line treatment of infectious pyogenic spondylodiscitis. Surgery may be indicated for progressive pain, persistent infection on imaging, deformity or neurologic deficits. If surgery is required, reported literature shows potential for significant pain reduction, improved neurologic function and a high number of patients returning to a normal functional/work status

    Upper ocean manifestations of a reducing meridional overturning circulation

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    Most climate models predict a slowing down of the Atlantic Meridional Overturning Circulation during the 21st century. Using a 100year climate change integration of a high resolution coupled climate model, we show that a 5.3Sv reduction in the deep southward transport in the subtropical North Atlantic is balanced solely by a weakening of the northward surface western boundary current, and not by an increase in the southward transport integrated across the interior ocean away from the western boundary. This is consistent with Sverdrup balance holding to a good approximation outside of the western boundary region on decadal time scales, and may help to spatially constrain past and future change in the overturning circulation. The subtropical gyre weakens by 3.4Sv over the same period due to a weakened wind stress curl. These changes combine to give a net 8.7Sv reduction in upper western boundary transport. © 2012. American Geophysical Union. All Rights Reserved
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