Effect of Drain Duration and Output on Perioperative Outcomes and Readmissions after Lumbar Spine Surgery

Study design: Single-center retrospective cohort. Purpose: To compare surgical outcomes of patients based on lumbar drain variables relating to output and duration. Overview of literature: The use of drains following lumbar spine surgery, specifically with respect to hospital readmission, postoperative hematoma, postoperative anemia, and surgical site infections, has been controversial. Methods: Patients aged ≥18 years who underwent lumbar fusion with a postoperative drain between 2017 and 2020 were included and grouped based on hospital readmission status, last 8-hour drain output (\u3c40 mL cutoff), or drain duration (2 days cutoff). Total output of all drains, total output of the primary drain, drain duration in days, drain output per day, last 8-hour output, penultimate 8-hour output, and last 8-hour delta (last 8-hour output subtracted by penultimate 8-hour output) were collected. Continuous and categorical data were compared between groups. Multivariate logistic regression analysis and receiver operating characteristic (ROC) analysis were performed to determine whether drain variables can predict hospital readmission, postoperative blood transfusions, and postoperative anemia. Alpha was 0.05. Results: Our cohort consisted of 1,166 patients with 111 (9.5%) hospital readmissions. Results of regression analysis did not identify any of the drain variables as independent predictors of hospital readmission, postoperative blood transfusion, or postoperative anemia. ROC analysis demonstrated the drain variables to be poor predictors of hospital readmission, with the highest area under curve of 0.524 (drain duration), corresponding to a sensitivity of 61.3% and specificity of 49.9%. Conclusions: Drain output or duration did not affect readmission rates following lumbar spine surgery

Electrical and electromagnetic geophysical prospecting for the monitoring of rock glaciers in the Dolomites, northeast Italy

The monitoring of rock glaciers plays a relevant role in relation to natural hazards in high mountain environments. Due to the climate warming, mountain permafrost is thawing, and its degradation is influencing the triggering and the evolvement of processes such as rockfalls, landslides, debris flows and floods. Therefore, the study and monitoring of these periglacial forms have both a scientific and economic importance. We tested electrical and electromagnetic measurements along the same investigation lines, in two different sites of the Dolomites area (Northeast Italy). Electrical prospecting exploits the high resistivity contrast between frozen and non-frozen debris. However, these measurements have high logistic demands, considering the complex rock glaciers surface and the need of ground galvanic contact. For this reason, we tried to compare electrical measurements with electromagnetic contactless ones, that theoretically can be used to define the distribution of electrical resistivity in the first subsoil in a quicker and easier way. The obtained results show that the joint use of the two methods allows us to characterize a rock glacier subsoil with good confi-dence. Finally, the advantages and disadvantages of both the techniques are discussed

Neurological Symptoms in Type A Aortic Dissections

Background and Purpose— Aortic dissection typically presents with severe chest or back pain. Neurological symptoms may occur because of occlusion of supplying vessels or general hypotension. Especially in pain-free dissections diagnosis can be difficult and delayed. The purpose of this study is to analyze the association between type A aortic dissection and neurological symptoms. Methods— Clinical records of 102 consecutive patients with aortic dissection (63% male, median age 58 years) over 7.5 years were analyzed for medical history, preoperative clinical characteristics, treatment and outcome with main emphasis on neurological symptoms. Results— Thirty patients showed initial neurological symptoms (29%). Only two-thirds of them reported chest pain, and most patients without initial neurological symptoms experienced pain (94%). Neurological symptoms were attributable to ischemic stroke (16%), spinal cord ischemia (1%), ischemic neuropathy (11%), and hypoxic encephalopathy (2%). Other frequent symptoms were syncopes (6%) and seizures (3%). In half of the patients, neurological symptoms were transient. Postoperatively, neurological symptoms were found in 48% of all patients encompassing ischemic stroke (14%), spinal cord ischemia (4%), ischemic neuropathy (3%), hypoxic encephalopathy (8%), nerve compression (7%), and postoperative delirium (15%). Overall mortality was 23% and did not significantly differ between patients with and without initial neurological symptoms or complications. Conclusion— Aortic dissections might be missed in patients with neurological symptoms but without pain. Neurological findings in elderly hypertensive patients with asymmetrical pulses or cardiac murmur suggest dissection. Especially in patients considered for thrombolytic therapy in acute stroke further diagnostics is essential. Neurological symptoms are not necessarily associated with increased mortality

First experience with the new Sorin Crown PRT bioprosthetic aortic valve: Early postoperative outcome and hemodynamic performance in 90 patients

AIM: The Crown PRT (The Phospholipid Reduction Treatment) is a new stent bovine bioprosthesis for aortic valve replacement (AVR). Aim of this paper is to report the postoperative clinical and hemodynamic results after ninety consecutive implants. METHODS: After receiving CE mark in July 2014, two European university centers implanted the new Crown PRT (Sorin Group, Burnaby, Canada) for the first time. Up to now, ninety patients underwent aortic valve replacement, in isolated or combined procedures, for aortic stenosis or insufficiency. Intraoperative transesophageal echocardiogram was used to assess the prosthesis’s function. In hospital outcomes and echocardiographic parameters were recorded. RESULTS: Age and Log Euroscore were 71.8±7.9 years and 10.2%±4.5 respectively. In-hospital mortality for isolated AVR was 0%; one patient died after a multiple procedure (overall 30-days mortality 1.1%). No adverse device effects were recorded. Intensive Care Unit stay was 2±5.8 days. At discharge, echocardiogram showed no paravalvular leaks and normal postoperative gradients. CONCLUSION: Our starting results showed that the Crown PRT is safe and reliable, with excellent hemodynamic performance. Further clinical results with a larger population and long term follow-up are needed to assess the versatility and the durability of this new device

Puglia 2003 -Final Conference Project IGCP 437 Coastal Environmental Change During Sea-Level Highstands: A Global Synthesis with implications for management of future coastal change Project 437 Molluscs, Palaeoenvironments and Palaeoclimates during late P

warm highstand acknowledged for MOIS11 (MTIII) can help objective comparisons with pre-Quaternary terraces in Patagonia (MTI-II and Salamanca Fm.). Abstract The Quaternary sea level history along the Patagonian coastal area has been explained by several factors (i.e., eustasy, sediment supply, wave action, current energy)

Multidomain Targeting of Bcr-Abl by Disruption of Oligomerization and Tyrosine Kinase Inhibition: Toward Eradication of CML

The oncoprotein Bcr-Abl, the causative agent of chronic myeloid leukemia (CML), requires homo-oligomerization via a coiled-coil domain to function [Bartram, C. R.; et al. <i>Nature</i> <b>1983</b>, <i>306</i> (5940), 277–280; and Zhao, X.; et al. <i>Nat. Struct. Biol.</i> <b>2002</b>, <i>9</i>(2), 117–120]. While tyrosine kinase inhibitors (TKIs) have shown great efficacy as treatment options for CML, their use may cause an acquisition of mutations in the tyrosine kinase domain, which prevent TKI binding and lead to a loss in activity [Woessner, D. W.; et al. <i>Cancer J.</i> <b>2011</b>, <i>17</i>(6), 477–486]. Previously, we have shown that a rationally modified coiled-coil domain (CC^mut3) can disrupt this oligomerization, inhibit proliferation, and induce apoptosis in CML cells [Dixon, A. S.; et al. <i>Mol. Pharmaceutics</i> <b>2012</b>, <i>9</i>(1), 187–195]. Here, we show that using the most recently approved TKI, ponatinib (Iclusig), in combination with CC^mut3 allows a dose reduction of ponatinib and increased therapeutic efficacy in vitro measured by reduction in kinase activity, induction of apoptosis via caspase-3/7 and 7-AAD/Annexin V assays, and reduced transformative ability measured by a colony forming assay. The combination was effective not only in cells containing wild-type Bcr-Abl (K562, Ba/F3-p210) but also cells with Bcr-Abl containing the T315I mutation (Ba/F3-p210-T315I). In addition, we report for the first time the ability of CC^mut3 alone to inhibit the T315I mutant form of Bcr-Abl. This novel combination may prove to be more potent than single agent therapies and should be further explored for clinical use