Implant Prophylaxis: The Next Best Practice Toward Asepsis in Spine Surgery.

Study designA literature review.ObjectivesAn evaluation of the contaminants prevalent on implants used for surgery and the aseptic methods being employed against them.MethodsPubMed was searched for articles published between 2000 and 2017 for studies evaluating the contaminants present on spine implants, and associated pre- and intraoperative implant processing and handling methodology suggested to avoid them. Systematic reviews, observational studies, bench-top studies, and expert opinions were included.ResultsEleven studies were identified whose major focus was the asepsis of implants to reduce the incidence of surgical site infection incidences during surgery. These studies measured the colony forming units of bacteria on sterilized implants and/or gloves from the surgeon, scrub nurse, and assistants, as well as reductions of surgical site infection rates in spine surgery due to changes in implant handling techniques. Additionally, the search included assessments of endotoxins and carbohydrates present on reprocessed implants. The suggested changes to surgical practice based on these studies included handling implants with only fresh gloves, keeping implants covered until the immediate time of use, reducing operating room traffic, avoiding reprocessing of implants (ie, providing terminally sterilized implants), and avoiding touching the implants altogether.ConclusionsBoth reprocessing (preoperative) and handling (intraoperative) of implants seem to lead to contamination of sterilized implants. Using a terminally sterilized device may mitigate reprocessing (preoperative implant prophylaxis), whereas the use of fresh gloves for handling each implant and/or a permanent shielding technique (intraoperative implant prophylaxis) could potentially avoid recontamination at the theatre

Coral reef fish abundance and diversity of seagrass beds in Kavaratti atoll, Lakshadweep, India

The community organization of coral reef fishes in the seagrass sub-habitat of Kavaratti toll, Lakshadweep, India was studied during the period from January 1991 to June 1992. Twenty-seven families represented by 65 species were recorded by the visual censes method. The community diversity for families and species was 2.49 and 3.14 respectively. Juveniles and sub-adults of the most adult reef fish, which inhabit other sub-habitats, were recorded here. The high species diversity in the seagrass beds is due to their roles as nurseries, shelter and foraging grounds for many species. Labridae, Chaetodontidae, Acanthuridae and Mullidae were the most speciose families. Ocurrence of siganids was highly seasonal. The cover that seagrass canopy provides conceals many species and perhaps influenced counts. The occurrence of balistids could be related to the presence of interstitial and patches and abundant invertebrate food. Scorpaenids subsisted on abundant invertebrates and juveniles fishes. High counts and pronounced variations make seagrass beds unstable habitats. However, monsoon assemblages were relatively stable perhaps due to lack of excessive new recruits and a habitat shift by most species

Topological Data Analysis of Human Brain Networks Through Order Statistics

Understanding the topological characteristics of the brain network across a population is central to understanding brain functions. The abstraction of human connectome as a graph has been pivotal in gaining insights on the topological features of the brain network. The development of group-level statistical inference procedures in brain graphs while accounting for the heterogeneity and randomness still remains a difficult task. In this study, we develop a robust statistical framework based on persistent homology using the order statistics for analyzing brain networks. The use of order statistics greatly simplifies the computation of the persistent barcodes. We validate the proposed methods using comprehensive simulation studies and subsequently apply to the resting-state functional magnetic resonance images. We conclude a statistically significant topological difference between the male and female brain networks

Sensory origin of lobeline-induced sensations: a correlative study in man and cat

1. Intravenous injections of lobeline HCl into twenty-six normal young male human volunteers produced sensations of choking, pressure or fumes in the throat and upper chest at a mean threshold dose of 12 μg kg-1. 2. Reflex changes in breathing pattern usually appeared just before the sensations. Increasing the dose of lobeline increased the intensity of the sensations gradually until a dry cough appeared at a mean threshold dose of 24.3 μg kg-1. At these doses there was a mean difference of 0.3 s in the latencies for sensation and respiratory reflex; in four subjects there was no difference at all. 3. In cats anaesthetized with 35 μg kg-1 sodium pentobarbitone, injecting 25-67 μg kg-1 lobeline into the right atrium sensitized thirteen out of seventeen rapidly adapting receptors (RARs). In three out of four cats lobeline had no excitatory effect on the RARs in the absence of normal activity (i.e. when it was injected while artificial respiration was suspended), but on restarting the respiration the activity increased greatly. After injecting lobeline, the activity increased during inflation or deflation or in both phases of the respiratory cycle. It also increased greatly during deflation produced by suction of air from the lungs after lobeline. Such presumed increased activity in the RARs of man produced by forced expiration to residual volume at the time lobeline-induced sensations were expected did not enhance the sensations in any subject. 4. In all the subjects tested, forced expiration alone, which should stimulate RARs, never produced a dry cough or sensations similar to those produced by lobeline.5. The results suggest that since the reflex respiratory effects of lobeline are due to J receptors, the sensations and cough can also be attributed to them, since both events occur at about the same time, and also because the RARs, and the slowly adapting receptors (SARs), do not seem to play a primary role in producing or potentiating the sensations

Impact of FLAMM scoring on cesarean section rate in previous one lower segment cesarean section patient

Background: The aim of this study was to evaluate the impact of Flamm scoring for Successful VBAC (vaginal birth after cesarean) and Failed TOLAC (Emergency cesarean section) in case of previous one lower segment cesarean delivery.Methods: This is prospective observation study. Out of 150, 111 patients gave consent for TOLAC. 111 patients with previous one caesarean section with gestational weeks between 37 to 40 weeks with spontaneous onset of labour admitted in labour room of Obstetrics and Gynecology Department in Sola Civil Hospital over a period of 1 year from April 2014 to April 2015.Results: In the present study, 111 (74%) patients had undergone TOLAC trial. Out of 111, 77(69.36%) patients had successful VBAC whereas 34 (30.63%) had emergency cesarean. Among the successful VBAC, 7 patients had assisted vaginal delivery to cut short the second stage in prolonged labour. 26% patients refused to give consent for TOLAC from total number of patients in this study. Mean FLAMM score for Successful VBAC was 5.35 (95% CI, 3.9 to 6.7) compared to Failed TOLAC (EME CS) was 3.62 (95% CI, 3.27 to 4.57) Chances of success of TOLAC was increased with increasing FLAMM score according to this study.Conclusions: Application of FLAMM scoring gives fare judgment of successful vaginal birth in TOLAC. So FLAMM scoring can be applied in each previous one lower segment cesarean section patient undergoing TOLAC without increasing morbidity. Practice of protocol of applying FLAMM score and monitoring by partogram will reduce the rate of cesarean section in previous one lower segment cesarean section patient

Occurrence of juvenile fishes on the seagrass beds of Kavaratti Atoll, Lakshadweep, India

In the atolls of Lakshadweep, juveniles of Acanthuridae and Labridae were most abundant on seagrass beds, the former during pre-monsoon and postmonsoon periods and the latter in pre-monsoon. Schooling species showed variable recruitment. Non-schooling species were rare. Peak settlement was observed during pre-monsoon and post-monsoon seasons. Continuous occurrence of juveniles in different size ranges confirms the continuous spawning habits. Chaetodontids and holocentrids occurred consistently round the year. Seasonality in occurrence was most pronounced in Carangidae and Siganidae, but not so in Apogonidae, Lutjanidae and Mullidae. Seasonal abundance of juveniles was influenced by summer peaks, timing and magnitude of settlement, adult spawning and local migrations. Abundance of larvae increased with salinity. Juvenile abundance, independent of environmental parameters seemed to be controlled by seasons, tides and currents. Lunar phases and abundance of juveniles were found to be co-related

Community organization of coral reef fishes in the rubble sub-habitat of Kavaratti Atoll, Lakshadweep, India

A visual census of the coral reef fishes, conducted during January 1991 to June 1992, indicated the occurrence of 64 species belonging to fifteen families in the rubble sub-habitat of Kavaratti A toll (Lat. 10°33'N; Long. 7Z038'E) in Lakshadweep. The community diversity for families and species was 2.68 and 3.58 respectively. Family assemblages were not stable during different seasons. Labridae and pomacentridae made use of the rubble zone efficiently. Pomacentrids were characteristically site attached but varied in relative abundance. Rhinecanthus aculeatus among balistids depended on rubble for food and nesting sites. The occurrence of chaetodontids was due to their flexible feeding habits, in the absence of coral cover. Availability of food strongly determined the distribution of the surgeonfish, Acanthurus triostegus. The abundant turf algae harbored by rubble attracted schools of sub-adult herbivores resulting in variations

Habitat distribution and species diversity of coral reef fishes in the reefslope of the Kavaratti atoll, Lakshadweep, India

Habitat distribution and species diversity of coral reef fishes in the reef slope of Kavaratti atoll was studied by the visual census method during January 1991 to June 1992. Twenty seven families represented by 121 species, the highest for any sub-habitat of the atoll were recorded. The community diversity, also the highest both for families and species was 3.32 and 4.45 respectively. Family assemblages were not stable between censuses and pre-monsoon, mon- soon and post-monsoon seasons. Labridae, Chaetodontidae, Balistidae, Pomacentridae and Acanthuridae were the most specious families. Low abundance of coral feeders indicated unhealthy reef condition. While dominance of some surgeonfish indicated availability of al- gal food, balistids provided clues for topographic complexity