Incidence and management of pulmonary embolism following spinal surgery occurring while under chemical thromboprophylaxis

Patients undergoing spinal surgery are at risk of developing thromboembolic complications even though lower incidences have been reported as compared to joint arthroplasty surgery. Deep vein thrombosis (DVT) has been studied extensively in the context of spinal surgery but symptomatic pulmonary embolism (PE) has engaged less attention. We prospectively followed a consecutive cohort of 270 patients undergoing spinal surgery at a single institution. From these patients, only 26 were simple discectomies, while the largest proportion (226) was fusions. All patients received both low molecular weight heparin (LMWH) initiated after surgery and compressive stockings. PE was diagnosed with spiral chest CT. Six patients developed symptomatic PE, five during their hospital stay. In three of the six patients the embolic event occurred during the first 3 postoperative days. They were managed by the temporary insertion of an inferior vena cava (IVC) filter thus allowing for a delay in full-dose anticoagulation until removal of the filter. None of the PE patients suffered any bleeding complication as a result of the introduction of full anticoagulation. Two patients suffered postoperative haematomas, without development of neurological symptoms or signs, requiring emergency evacuation. The overall incidence of PE was 2.2% rising to 2.5% after exclusion of microdiscectomy cases. The incidence of PE was highest in anterior or combined thoracolumbar/lumbar procedures (4.2%). There is a large variation in the reported incidence of PE in the spinal literature. Results from the only study found in the literature specifically monitoring PE suggest an incidence of PE as high as 2.5%. Our study shows a similar incidence despite the use of LMWH. In the absence of randomized controlled trials (RCT) it is uncertain if this type of prophylaxis lowers the incidence of PE. However, other studies show that the morbidity of LMWH is very low. Since PE can be a life-threatening complication, LMWH may be a worthwhile option to consider for prophylaxis. RCTs are necessary in assessing the efficacy of DVT and PE prophylaxis in spinal patient

Aerosol climatology: on the discrimination of aerosol types over four AERONET sites

International audienceAerosols have a significant regional and global effect on climate, which is about equal in magnitude but opposite in sign to that of greenhouse gases. Nevertheless, the aerosol climatic effect changes strongly with space and time because of the large variability of aerosol physical and optical properties, which is due to the variety of their sources, which are natural, and anthropogenic, and their dependence on the prevailing meteorological and atmospheric conditions. Characterization of aerosol properties is of major importance for the assessment of their role for climate. In the present study, 3-year AErosol RObotic NETwork (AERONET) data from ground-based sunphotometer measurements are used to establish climatologies of aerosol optical depth (AOD) and Ångström exponent ? in several key locations of the world, characteristic of different atmospheric environments. Using daily mean values of AOD at 500 nm (AOD500) and Ångström exponent at the pair of wavelengths 440 and 870 nm (? 440?870), a discrimination of the different aerosol types occurring in each location is achieved. For this discrimination, appropriate thresholds for AOD500 and ? 440?870 are applied. The discrimination of aerosol types in each location is made on an annual and seasonal basis. It is shown that a single aerosol type in a given location can exist only under specific conditions (e.g. intense forest fires or dust outbreaks), while the presence of well-mixed aerosols is the accustomed situation. Background clean aerosol conditions (AOD500<0.06) are mostly found over remote oceanic surfaces occurring on average in ~56.7% of total cases, while this situation is quite rare over land (occurrence of 3.8?13.7%). Our analysis indicates that these percentages change significantly from season to season. The spectral dependence of AOD exhibits large differences between the examined locations, while it exhibits a strong annual cycle

Dust impact on surface solar irradiance assessed with model simulations, satellite observations and ground-based measurements

This study assesses the impact of dust on surface solar radiation focussing on an extreme dust event. For this purpose, we exploited the synergy of AERONET measurements and passive and active satellite remote sensing (MODIS and CALIPSO) observations, in conjunction with radiative transfer model (RTM) and chemical transport model (CTM) simulations and the 1-day forecasts from the Copernicus Atmosphere Monitoring Service (CAMS). The area of interest is the eastern Mediterranean where anomalously high aerosol loads were recorded between 30 January and 3 February 2015. The intensity of the event was extremely high, with aerosol optical depth (AOD) reaching 3.5, and optical/microphysical properties suggesting aged dust. RTM and CTM simulations were able to quantify the extent of dust impact on surface irradiances and reveal substantial reduction in solar energy exploitation capacity of PV and CSP installations under this high aerosol load. We found that such an extreme dust event can result in Global Horizontal Irradiance (GHI) attenuation by as much as 40–50 % and a much stronger Direct Normal Irradiance (DNI) decrease (80–90 %), while spectrally this attenuation is distributed to 37 % in the UV region, 33 % in the visible and around 30 % in the infrared. CAMS forecasts provided a reliable available energy assessment (accuracy within 10 % of that obtained from MODIS). Spatially, the dust plume resulted in a zonally averaged reduction of GHI and DNI of the order of 150 W/m^2 in southern Greece, and a mean increase of 20 W/m^2 in the northern Greece as a result of lower AOD values combined with local atmospheric processes. This analysis of a real-world scenario contributes to the understanding and quantification of the impact range of high aerosol loads on solar energy and the potential for forecasting power generation failures at sunshine-privileged locations where solar power plants exist, are under construction or are being planned

Fundamental scaling laws of on-off intermittency in a stochastically driven dissipative pattern forming system

Noise driven electroconvection in sandwich cells of nematic liquid crystals exhibits on-off intermittent behaviour at the onset of the instability. We study laser scattering of convection rolls to characterize the wavelengths and the trajectories of the stochastic amplitudes of the intermittent structures. The pattern wavelengths and the statistics of these trajectories are in quantitative agreement with simulations of the linearized electrohydrodynamic equations. The fundamental $\tau^{-3/2}$ distribution law for the durations $\tau$ of laminar phases as well as the power law of the amplitude distribution of intermittent bursts are confirmed in the experiments. Power spectral densities of the experimental and numerically simulated trajectories are discussed.Comment: 20 pages and 17 figure

The European multicenter trial on the safety and efficacy of guided oblique lumbar interbody fusion (GO-LIF)

Background: Because of the implant-related problems with pedicle screw-based spinal instrumentations, other types of fixation have been tried in spinal arthrodesis. One such technique is the direct trans-pedicular, trans-discal screw fixation, pioneered by Grob for spondylolisthesis. The newly developed GO-LIF procedure expands the scope of the Grob technique in several important ways and adds security by means of robotic-assisted navigation. This is the first clinical trial on the GO-LIF procedure and it will assess safety and efficacy. Methods/Design: Multicentric prospective study with n = 40 patients to undergo single level instrumented spinal arthrodesis of the lumbar or the lumbosacral spine, based on a diagnosis of: painful disc degeneration, painful erosive osteochondrosis, segmental instability, recurrent disc herniation, spinal canal stenosis or foraminal stenosis. The primary target criteria with regards to safety are: The number, severity and cause of intra-and perioperative complications. The number of significant penetrations of the cortical layer of the vertebral body by the implant as recognized on postoperative CT. The primary target parameters with regards to feasibility are: Performance of the procedure according to the preoperative plan. The planned follow-up is 12 months and the following scores will be evaluated as secondary target parameters with regards to clinical improvement: VAS back pain, VAS leg pain, Oswestry Disability Index, short form - 12 health questionnaire and the Swiss spinal stenosis questionnaire for patients with spinal claudication. The secondary parameters with regards to construct stability are visible fusion or lack thereof and signs of implant loosening, implant migration or pseudarthrosis on plain and functional radiographs. Discussion: This trial will for the first time assess the safety and efficacy of guided oblique lumbar interbody fusion. There is no control group, but the results, the outcome and the rate of any complications will be analyzed on the background of the literature on instrumented spinal fusion. Despite its limitations, we expect that this study will serve as the key step in deciding whether a direct comparative trial with another fusion technique is warranted

Pedicle Screw Surgery in the UK and Ireland: A Questionnaire Study

Pedicle screw (PS) malpositioning rates are high in spine surgery. This has resulted in the use of computed navigational aids to reduce the rate of malposition; but these are often expensive and limited in availability. A simple mechanical device to aid PS insertion might overcome some of these disadvantages. The purpose of this study was to determine the demand and design criteria for a simple device to aid PS placement, as well as to collect opinions and experiences on PS surgery in the UK and Ireland. A postal questionnaire was sent to 422 spinal surgeons in the UK and Ireland. 101 questionnaires were received; 67 of these (16% of total sent) contained useful information. 78% of surgeons experienced problems with PS placement. The need for a simple mechanical device to aid PS placement was expressed by 59% of respondent surgeons. The proportion of respondents that inserted PSs in the cervical spine was 14%; PSs are mainly inserted in the thoracic, lumbar and sacral spine, but potential exists for a PS placement aid for the cervical and thoracic spine. From the experiences of these 67 surgeons, there is evidence to suggest that surgeons would prefer a pedicle aid that is multiple use, one-piece, hand-held, radiolucent, unilateral and uses the line of sight principle in traditional open surgery. Based on the experiences of 67 surgeons, there is evidence to suggest that computed navigational aids are not readily used in PS surgery and that a simple mechanical device could be a better option. This paper provides useful data for improving the outcomes of spinal surgery

The effect of starting point placement technique on thoracic transverse process strength: an ex vivo biomechanical study

<p>Abstract</p> <p>Background</p> <p>The use of thoracic pedicle screws in spinal deformity, trauma, and tumor reconstruction is becoming more common. Unsuccessful screw placement may require salvage techniques utilizing transverse process hooks. The effect of different starting point placement techniques on the strength of the transverse process has not previously been reported. The purpose of this paper is to determine the biomechanical properties of the thoracic transverse process following various pedicle screw starting point placement techniques.</p> <p>Methods</p> <p>Forty-seven fresh-frozen human cadaveric thoracic vertebrae from T2 to T9 were disarticulated and matched by bone mineral density (BMD) and transverse process (TP) cross-sectional area. Specimens were randomized to one of four groups: A, control, and three others based on thoracic pedicle screw placement technique; B, straightforward; C, funnel; and D, in-out-in. Initial cortical bone removal for pedicle screw placement was made using a burr at the location on the transverse process or transverse process-laminar junction as published in the original description of each technique. The transverse process was tested measuring load-to-failure simulating a hook in compression mode. Analysis of covariance and Pearson correlation coefficients were used to examine the data.</p> <p>Results</p> <p>Technique was a significant predictor of load-to-failure (<it>P </it>= 0.0007). The least squares mean (LS mean) load-to-failure of group A (control) was 377 N, group B (straightforward) 355 N, group C (funnel) 229 N, and group D (in-out-in) 301 N. Significant differences were noted between groups A and C, A and D, B and C, and C and D. BMD (0.925 g/cm²[range, 0.624-1.301 g/cm²]) was also a significant predictor of load-to-failure, for all specimens grouped together (<it>P </it>< 0.0001) and for each technique (<it>P <</it>0.05). Level and side tested were not found to significantly correlate with load-to-failure.</p> <p>Conclusions</p> <p>The residual coronal plane compressive strength of the thoracic transverse process is dependent upon the screw starting point placement technique. The funnel technique significantly weakens transverse processes as compared to the straightforward technique, which does not significantly weaken the transverse process. It is also dependent upon bone mineral density, and low failure loads even in some control specimens suggest limited usefulness of the transverse process for axial compression loading in the osteoporotic thoracic spine.</p

Results from the Fourth WMO Filter Radiometer Comparison for aerosol optical depth measurements

This study presents the results of the Fourth Filter Radiometer Comparison that was held in Davos, Switzerland, between 28 September and 16 October 2015. Thirty filter radiometers and spectroradiometers from 12 countries participated including reference instruments from global aerosol networks. The absolute differences of all instruments compared to the reference have been based on the World Meteorological Organization (WMO) criterion defined as follows: 95% of the measured data has to be within 0.005±0.001∕m (where m is the air mass). At least 24 out of 29 instruments achieved this goal at both 500 and 865nm, while 12 out of 17 and 13 out of 21 achieved this at 368 and 412nm, respectively. While searching for sources of differences among different instruments, it was found that all individual differences linked to Rayleigh, NO2, ozone, water vapor calculations and related optical depths and air mass calculations were smaller than 0.01 in aerosol optical depth (AOD) at 500 and 865nm. Different cloud-detecting algorithms used have been compared. Ångström exponent calculations showed relatively large differences among different instruments, partly because of the high calculation uncertainty of this parameter in low AOD conditions. The overall low deviations of these AOD results and the high accuracy of reference aerosol network instruments demonstrated a promising framework to achieve homogeneity, compatibility and harmonization among the different spectral AOD networks in the near future