Survival of patients undergoing surgery for metastatic spinal tumours and the impact of surgical site 2 infection

Summary Background Patients with metastatic spinal tumours have a limited prognosis. Surgical complications that may result in prolonged hospitalization or readmission are highly undesirable. Surgical site infection (SSI) is one such complication, which can, in extreme cases, lead to death. Aim To assess the impact of SSI on patient survival after surgery for spinal metastases. Methods Demographic, operative, and survival data were collected on 152 patients undergoing surgery for spinal metastasis at a large UK tertiary referral centre. American Society of Anesthesiologists (ASA) grade and the Revised Tokuhashi Score (RTS) were determined as measures of health status and prognosis, respectively, at baseline. A semi-parametric Cox proportional hazards survival analysis was used to assess the relationships between covariates and survival. Findings Seventeen patients (11.2%) experienced SSI. Overall, median survival time from operation was 262 days (95% confidence interval: 190–334 days) and 12-month survival was 42.1%. RTS (hazard ratio: 0.82; 95% confidence interval: 0.76–0.89; P < 0.001) and ASA grade (1.37; 1.03–1.82; P = 0.028) were significantly associated with survival, with better survival found in patients with higher RTS and lower ASA scores. Infection status was of substantive importance, with better survival in those without SSI (P = 0.075). Conclusion Twelve-month survival in patients undergoing surgery for spinal metastasis is ∼42%. RTS and ASA scores may be used as indicators of patient survival either in combination or individually. Whereas SSI has some negative impact on survival, a larger study sample would be needed to confirm whether this is statistically significan

Risk factors for wound infection in surgery for spinal metastasis

Wound infection rates are generally higher in patients undergoing surgery for spinal metastasis. Risk factors of wound infection in these patients are poorly understood. Purpose To identify demographic and clinical variables that may be associated with patients experiencing a higher wound infection rate. Study design Retrospective study with prospectively collected data of spinal metastasis patients operated consecutively at a University Teaching Hospital, adult spine division which is a tertiary referral centre for complex spinal surgery. Patient sample Ninety-eight patients were all surgically treated, consecutively from January 2009 to September 2011. Three patients had to be excluded due to inadequate data. Outcome measures Physiological measures, with presence or absence of microbiologically proven infection. Methods Various demographic and clinical data were recorded, including age, serum albumin level, blood total lymphocyte count, corticosteroid intake, Malnutrition Universal Screening Tool (MUST) score, neurological disability, skin closure material used, levels of surgery and administration of peri-operative corticosteroids. No funding was received from any sources for this study and as far as we are aware, there are no potential conflict of interest-associated biases in this study. Results Higher probabilities of infection were associated with low albumin level, seven or more levels of surgery, use of delayed/non-absorbable skin closure material and presence of neurological disability. Of these factors, levels of surgery were found to be statistically significant at the 5 % significance level. Conclusion Risk of infection is high (17.9 %) in patients undergoing surgery for spinal metastasis. Seven or more vertebral levels of surgery increase the risk of infection significantly (p < 0.05). Low albumin level and presence of neurological disability appear to show a trend towards increased risk of infection. Use of absorbable skin closure material, age, low lymphocyte count, peri-operative administration of corticosteroids and MUST score do not appear to influence the risk of infection

Thin-Film Metamaterials called Sculptured Thin Films

Morphology and performance are conjointed attributes of metamaterials, of which sculptured thin films (STFs) are examples. STFs are assemblies of nanowires that can be fabricated from many different materials, typically via physical vapor deposition onto rotating substrates. The curvilinear--nanowire morphology of STFs is determined by the substrate motions during fabrication. The optical properties, especially, can be tailored by varying the morphology of STFs. In many cases prototype devices have been fabricated for various optical, thermal, chemical, and biological applications.Comment: to be published in Proc. ICTP School on Metamaterials (Augsut 2009, Sibiu, Romania

Different mechanisms of Ca2(+)-handling following nicotinic acetylcholine receptor stimulation, P2U-purinoceptor stimulation and K(+)-induced depolarization in C2C12 myotubes.

1. The increase in intracellular CA2+ on nicotinic acetylcholine receptor (nAChR) stimulation, P2U-purinoceptor stimulation and K(+)-induced depolarization was investigated in mouse C2C12 myotubes by use of fura-2 fluorescence to characterize the intracellular organisation of Ca2+ releasing stores and Ca(2+)-entry process. 2. Stimulation of nAChRs with carbachol induced a rapid rise in internal Ca2+ (EC50 = 0.85 +/- 0.09 microM), followed by a sustained phase. The Ca2+ response evoked by carbachol (10 microM) was completely blocked by the nAChR antagonist, pancuronium (3 microM), but was not affected by the muscarinic antagonist, atropine (3 microM), or under conditions when Ca2+ entry was blocked by La3+ (50 microM) or diltiazem (10 microM). Addition of pancuronium (3 microM) during the sustained phase of the carbachol-evoked response did not affect this phase. 3. Stimulation of P2U purinoceptors with ATP (1 mM) induced a somewhat higher biphasic Ca2+ response (EC50 of the rapid phase: 8.72 +/- 0.08 microM) than with carbachol. Pretreatment with La3+ abolished the sustained phase of the ATP-induced Ca2+ response, while the response was unaffected by diltiazem or pancuronium. 4. Stimulation of the cells with high K+ (60 mM), producing the same depolarization as with carbachol (10 microM), induced a rapid monophasic Ca2+ response, insensitive to diltiazem, pancuronium or La3+. 5. Under Ca(2+)-free conditions, the sustained phase of the carbachol- and ATP-evoked responses were abolished. Pre-emptying of depolarization-sensitive stores by high K+ under Ca(2+)-free conditions did not affect the carbachol- or ATP-evoked Ca2+ mobilization and vice versa. Preincubation of the cells with ATP in the absence of extracellular Ca2+ decreased the amplitude of the subsequent carbachol-induced Ca2+ response to 11%, while in the reverse procedure the ATP-induced response was decreased to 65%. Ca2+ mobilization evoked by simultaneous addition of optimal concentrations of carbachol and ATP was increased compared to levels obtained with either agonist. 6. Preincubation with high K+ under normal conditions abolished the sustained phase of the ATP-evoked Ca2+ response. The carbachol response consisted only of the sustained phase in the presence of high K+. 7. The carbachol-induced Ca2+ response was completely abolished under low Na+/Ca(2+)-free conditions, while under low Na+ conditions only a sustained Ca2+ response was observed. The ATP- and K(+)-induced responses were changed compared to Ca(2+)-free conditions. 8. ATP (300 microM) induced the formation of Ins(1,4,5)P3 under Ca(2+)-free conditions with a comparable time course to that found for the rise in internal Ca2+. In contrast to ATP, carbachol (10 microM) did not affect Ins(1,4,5)P3 levels under Ca(2+)-free conditions. 9. It is concluded that the Ca2+ release from discrete stores of C2C12 myotubes is induced by stimulation of nAChRs, P2U-purinoceptors and by high K+. Only the P2U-purinoceptor and nAChR activated stores show considerable overlap in releasable Ca2+. Sustained Ca(2+)-entry is activated by stimulation of nAChRs and P2U-purinoceptors via separate ion-channels, which are different from the skeletal muscle nAChR-coupled cation-channel

Effectiveness and Usability of a Developed Collaborative Online Tool for Children with ADHD

This study evaluated the effectiveness and usability of a developed collaborative online tool (chit-chat) for children with Attention Deficit Hyperactivity Disorder (ADHD). We studied whether this tool influenced children’s Knowledge and experience exchange, motivation, behavioral abilities and social skills while using another learning tool, ACTIVATE. A total of seven Saudi children with ADHD aged from 6 to 8 years were assigned to the collaborative intervention using iPads. They were asked to play mini games that positively affect children with ADHD cognitively and behaviorally, then chat using our developed collaborative online tool, for three sessions. Progress points were measured and quantitatively analyzed before and after the intervention, thematic analysis was applied on the qualitative data. Participants showed improvements in overall performance when using the learning tool ACTIVATE. Ecollaboration was found to be effective to children with ADHD and positively influencing their knowledge, experience, motivation and social skills