Removal of Spinal Instrumentation Is Not Required to Successfully Treat Postoperative Wound Infections in Most Cases.

INTRODUCTION: Controversy exists regarding whether spinal implants need to be removed to treat postoperative deep wound infections (DWIs). This retrospective study aimed to determine whether the removal or retention of implants impacts the successful treatment of a DWI after spine surgery. METHODS: Postoperative spine surgery patients presenting with signs of infection who underwent irrigation and debridement (I&D) at Twin Cities Spine Surgeons at Abbott Northwestern Hospital, Minnesota, USA, were studied. First, the persistence of infection when implants were retained or removed was assessed. Second, we analyzed the persistence of infection with respect to the number of I&D, the use of vacuum-assisted closure (VAC) treatment, pseudoarthrosis status, and functional outcomes. RESULTS: One hundred thirty-five patients were included. Treatment of infection with retention of implants occurred in 64% (87/135); of these, 7% (6/87) had a persistent infection. Of patients with implant removal (36%, 48/135), 6% (3/48) had a persistent infection. Thus, we observed no difference between treatment with implants present compared to implants removed (p = 1.0). Fifty of the 135 patients (37%) received I&D and primary wound closure, and 85 (63%) patients received I&D and VAC treatment. There was no statistical difference between primary wound closure and VAC treatment (p = 0.15) with respect to persistence. Repeat I&D with VAC (three or more times) had a significantly lower rate of recurrence than those with two I&Ds. Pseudoarthrosis and persistent infection were unrelated. At minimum one-year follow-up, achieving a minimum clinically important difference in functional outcome was independent of persistent infection status. CONCLUSION: Persistent infection was unrelated to the retention of implants. When VAC treatment was deemed necessary, more than two I&Ds resulted in a significantly better cure for infection. Those with a persistent infection were no more likely to exhibit pseudoarthrosis than those with no persistent infection. All patients showed improvement in functional outcomes at minimum one-year follow-up.

Interatrial Septum Stenting for Hypoplastic Left Heart Syndrome in Ex Utero Intrapartum Therapy.

Patients with hypoplastic left heart syndrome (HLHS) with intact atrial septum have an increased mortality rate. This presentation occurs in 6% to 10% of cases. We present a patient with fetal diagnosis of HLHS with restrictive atrial septum. We performed a cesarean section at 37 weeks of gestation, and under ex utero intrapartum treatment proceeded with a median sternotomy and transatrial stenting for left atrial decompression due to findings of intact atrial septum on the fetal echocardiogram performed during the procedure. Subsequently, the patient underwent hybrid stage I palliation followed by a comprehensive stage II procedure at five months of age, but unfortunately died from postoperative complications.

Development of a Genome-Informed Protocol for Detection of Pseudomonas amygdali pv. morsprunorum Using LAMP and PCR.

One of the causal agents of bacterial canker is Pseudomonas amygdali pv. morsprunorum-Pam (formerly Pseudomonas syringae pv. morsprunorum). Recently detected in Chile, Pam is known to cause lesions in the aerial parts of the plant, followed by more severe symptoms such as cankers and gummosis in the later stages of the disease. This study presents the design of PCR and LAMP detection methods for the specific and sensitive identification of Pseudomonas amygdali pv. morsprunorum (Pam) from cherry trees. Twelve Pseudomonas isolates were collected, sequenced, and later characterized by Multi-locus Sequence Analysis (MLSA) and Average Nucleotide Identity by blast (ANIb). Three of them (11116B2, S1 Pam, and S2 Pam) were identified as Pseudomonas amygdali pv. morsprunorum and were used to find specific genes through RAST server, by comparing their genome with that of other Pseudomonas, including isolates from other Pam strains. The effector gene HopAU1 was selected for the design of primers to be used for both techniques, evaluating sensitivity and specificity, and the ability to detect Pam directly from plant tissues. While the PCR detection limit was 100 pg of purified bacterial DNA per reaction, the LAMP assays were able to detect up to 1 fg of purified DNA per reaction. Similar results were observed using plant tissues, LAMP being more sensitive than PCR, including when using DNA extracted from infected plant tissues. Both detection methods were tested in the presence of 30 other bacterial genera, with LAMP being more sensitive than PCR.

Transcriptome Analysis of Sweet Cherry (Prunus avium L.) Cultivar 'Lapins' upon Infection of Pseudomonas syringae pv. syringae.

Bacterial canker caused by Pseudomonas syringae pv. syringae (Pss) is responsible for substantial loss to the production of sweet cherry in Chile. To date, the molecular mechanisms of the Pss-sweet cherry interaction and the disease-related genes in the plant are poorly understood. In order to gain insight into these aspects, a transcriptomic analysis of the sweet cherry cultivar 'Lapins' for differentially expressed genes (DEGs) in response to Pss inoculation was conducted. Three Pss strains, A1M3, A1M197, and 11116_b1, were inoculated in young twigs, and RNA was extracted from tissue samples at the inoculation site and distal sections. RNA sequencing and transcriptomic expression analysis revealed that the three strains induced different patterns of responses in local and distal tissues. In the local tissues, A1M3 triggered a much more extensive response than the other two strains, enriching DEGs especially involved in photosynthesis. In the distal tissues, the three strains triggered a comparable extent of responses, among which 11116_b1 induced a group of DEGs involved in defense responses. Furthermore, tissues from various inoculations exhibited an enrichment of DEGs related to carbohydrate metabolism, terpene metabolism, and cell wall biogenesis. This study opened doors to future research on the Pss-sweet cherry interaction, immunity responses, and disease control.

Machine learning for adaptive deep brain stimulation in Parkinson's disease: closing the loop.

Parkinson's disease (PD) is the second most common neurodegenerative disease bearing a severe social and economic impact. So far, there is no known disease modifying therapy and the current available treatments are symptom oriented. Deep Brain Stimulation (DBS) is established as an effective treatment for PD, however current systems lag behind today's technological potential. Adaptive DBS, where stimulation parameters depend on the patient's physiological state, emerges as an important step towards "smart" DBS, a strategy that enables adaptive stimulation and personalized therapy. This new strategy is facilitated by currently available neurotechnologies allowing the simultaneous monitoring of multiple signals, providing relevant physiological information. Advanced computational models and analytical methods are an important tool to explore the richness of the available data and identify signal properties to close the loop in DBS. To tackle this challenge, machine learning (ML) methods applied to DBS have gained popularity due to their ability to make good predictions in the presence of multiple variables and subtle patterns. ML based approaches are being explored at different fronts such as the identification of electrophysiological biomarkers and the development of personalized control systems, leading to effective symptom relief. In this review, we explore how ML can help overcome the challenges in the development of closed-loop DBS, particularly its role in the search for effective electrophysiology biomarkers. Promising results demonstrate ML potential for supporting a new generation of adaptive DBS, with better management of stimulation delivery, resulting in more efficient and patient-tailored treatments.

Bilateral deep brain stimulation of the subthalamic nucleus: Targeting differences between the first and second side / Estimulación cerebral profunda bilateral del núcleo subtalámico: diferencias de posicionamiento entre el primer y el segundo lado

Introduction and objectives Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a recognized treatment for drug-refractory Parkinson's disease (PD). However, the therapeutic success depends on the accuracy of targeting. This study aimed to evaluate potential accuracy differences in the placement of the first and second electrodes implanted, by comparing chosen electrode trajectories, STN activity detected during microelectrode recording (MER), and the mismatch between the initially planned and final electrode positions on each side. Materials and methods In this retrospective cohort study, we analyzed data from 30 patients who underwent one-stage bilateral DBS. For most patients, three arrays of microelectrodes were used to determine the physiological location of the STN. Final target location depended also on the results of intraoperative stimulation. The choice of central versus non-central channels was compared. The Euclidean vector deviation was calculated using the initially planned coordinates and the final position of the tip of the electrode according to a CT scan taken at least a month after the surgery. Results The central channel was chosen in 70% of cases on the first side and 40% of cases on the second side. The mean length of high-quality STN activity recorded in the central channel was longer on the first side than the second (3.07±1.85mm vs. 2.75±1.94mm), while in the anterior channel there were better MER recordings on the second side (1.59±2.07mm on the first side vs. 2.78±2.14mm on the second). Regarding the mismatch between planned versus final electrode position, electrodes on the first side were placed on average 0.178±0.917mm lateral, 0.126±1.10mm posterior and 1.48±1.64mm inferior to the planned target (AU)

Introducción y objetivos La estimulación cerebral profunda (ECP) del núcleo subtalámico (NST) es reconocida como un tratamiento para la enfermedad de Parkinson (EP) refractaria al tratamiento farmacológico. Sin embargo, el éxito de esta intervención depende de la precisión de la colocación de los electrodos. Este estudio tuvo como objetivo evaluar las posibles diferencias de precisión entre la colocación del primer y segundo electrodo, comparando las trayectorias elegidas para cada lado, la actividad del NST detectada durante el microrregistro (MER) y la discrepancia entre las posiciones inicialmente planeadas y las finales. Materiales y métodos En este estudio retrospectivo analizamos datos de 30 pacientes sometidos a ECP bilateral. En la mayoría de los casos se usaron tres conjuntos de microelectrodos para determinar la ubicación fisiológica del NST. El posicionamiento final del electrodo estuvo asimismo condicionado por los resultados de la estimulación intraoperatoria. Se comparó la elección de canales centrales vs. no centrales. El vector euclidiano del desvío se calculó a partir de las coordenadas planeadas inicialmente y la posición final de la punta del electrodo, según una tomografía computarizada realizada al menos un mes después de la cirugía. Resultados La trayectoria central se eligió en 70% de los casos en el primer lado y en el 40% de los casos en el segundo lado. La duración media de la actividad de alta calidad del NST registrada en el canal central fue mayor en el primer lado que en el segundo (3,07±1,85mm vs. 2,75±1,94mm), mientras que en el canal anterior hubo mejores registros de MER en el segundo lado (1,59±2,07mm en el primer lado vs. 2,78±2,14mm en el segundo) (AU)

Bilateral deep brain stimulation of the subthalamic nucleus: Targeting differences between the first and second side.

INTRODUCTION AND OBJECTIVES: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a recognized treatment for drug-refractory Parkinson's disease (PD). However, the therapeutic success depends on the accuracy of targeting. This study aimed to evaluate potential accuracy differences in the placement of the first and second electrodes implanted, by comparing chosen electrode trajectories, STN activity detected during microelectrode recording (MER), and the mismatch between the initially planned and final electrode positions on each side. MATERIALS AND METHODS: In this retrospective cohort study, we analyzed data from 30 patients who underwent one-stage bilateral DBS. For most patients, three arrays of microelectrodes were used to determine the physiological location of the STN. Final target location depended also on the results of intraoperative stimulation. The choice of central versus non-central channels was compared. The Euclidean vector deviation was calculated using the initially planned coordinates and the final position of the tip of the electrode according to a CT scan taken at least a month after the surgery. RESULTS: The central channel was chosen in 70% of cases on the first side and 40% of cases on the second side. The mean length of high-quality STN activity recorded in the central channel was longer on the first side than the second (3.07±1.85mm vs. 2.75±1.94mm), while in the anterior channel there were better MER recordings on the second side (1.59±2.07mm on the first side vs. 2.78±2.14mm on the second). Regarding the mismatch between planned versus final electrode position, electrodes on the first side were placed on average 0.178±0.917mm lateral, 0.126±1.10mm posterior and 1.48±1.64mm inferior to the planned target, while the electrodes placed on the second side were 0.251±1.08mm medial, 0.355±1.29mm anterior and 2.26±1.47mm inferior to the planned target. CONCLUSION: There was a tendency for the anterior trajectory to be chosen more frequently than the central on the second side. There was also a statistically significant deviation of the second electrodes in the anterior and inferior directions, when compared to the electrodes on the first side, suggesting that another cause other than brain shift may be responsible. We should therefore factor this during planning for the second implanted side. It might be useful to plan the second side more anteriorly, possibly reducing the number of MER trajectories tested and the duration of surgery.

Examining physiological, water relations, and hydraulic vulnerability traits to determine anisohydric and isohydric behavior in almond (Prunus dulcis) cultivars: Implications for selecting agronomic cultivars under changing climate.

The search for drought tolerant species or cultivars is important to address water scarcity caused by climate change in Mediterranean regions. The anisohydric-isohydric behavior concept has been widely used to describe stomatal regulation during drought, simply in terms of variation of minimal water potential (Ψmin) in relation to pre-dawn water potential (Ψpd). However, its simplicity has sometimes failed to deliver consistent results in describing a complex behavior that results from the coordination of several plant functional traits. While Prunus dulcis (almond) is known as a drought tolerant species, little information is available regarding consistent metrics to discriminate among cultivars or the mechanisms underlying drought tolerance in almond. Here we show a sequence of plant stomatal, hydraulic, and wilting responses to drought in almonds, and the main differences between anisohydric and isohydric cultivars. In a pot desiccation experiment we observed that stomatal closure in P. dulcis is not driven by loss in turgor or onset of xylem cavitation, but instead, occurs early in response to decreasing Ψmin that could be related to the protection of the integrity of the hydraulic system, independently of cultivar. Also, we report that anisohydric cultivars of P. dulcis are characterized by maximum stomatal conductance, lower water potentials for stomatal closure and turgor loss, and lower vulnerability to xylem cavitation, which are traits that correlated with metrics to discriminate anisohydric and isohydric behavior. Our results demonstrate that P. dulcis presents a strategy to avoid cavitation by closing stomata during the early stages of drought. Future research should also focus on below-ground hydraulic traits, which could trigger stomatal closure in almond.

Choose Wisely: Surgical Selection of Candidates for Outpatient Anterior Cervical Surgery Based on Early Complications Among Inpatients.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) are attractive targets for transition to the outpatient setting. We assessed the prevalence of rapid responses and major complications in the inpatient setting following 1 or 2-level ACDFs and CDAs. We evaluated factors that may place patients at greater risk for a rapid response or a postoperative complication. METHODS: This was an institutional review board-approved, retrospective cohort study of adults undergoing 1 or 2-level ACDF or CDA at 1 hospital over a 2-year period (2018 and 2019). Data on patient demographic characteristics, surgical procedures, and comorbidities were collected. Rapid response events were identified by hospital floor staff and involved acute changes in a patient's clinical condition. Complications were events that were life-threatening, required an intervention, or led to delayed hospital discharge. RESULTS: In this study, 1,040 patients were included: 888 underwent ACDF and 152 underwent CDA. Thirty-six patients (3.5%) experienced a rapid response event; 22% occurred >24 hours after extubation. Patients having a rapid response event had a significantly higher risk of developing a complication (risk ratio, 10; p < 0.01) and had a significantly longer hospital stay. Twenty-four patients (2.3%) experienced acute complications; 71% occurred >6 hours after extubation. Patients with a complication were older and more likely to be current or former smokers, have chronic obstructive pulmonary disease, have asthma, and have an American Society of Anesthesiologists (ASA) score of >2. The length of the surgical procedure was significantly longer in patients who developed a complication. All patients who developed dysphagia had a surgical procedure involving C4-C5 or more cephalad. Patients with a rapid response event or complication were more commonly undergoing revision surgical procedures. CONCLUSIONS: Rapid response and complications are uncommon following 1 or 2-level ACDFs or CDAs but portend a longer hospital stay and increased morbidity. Revision surgical procedures place patients at higher risk for rapid responses and complications. Additionally, older patients, patients with chronic obstructive pulmonary disease or asthma, patients who are current or former smokers, and patients who have an ASA score of ≥3 are at increased risk for postoperative complications. LEVEL OF EVIDENCE: Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Provocative Discography: Diagnostic Efficacy and Safety in Symptomatic Degenerative Disk Disease.

STUDY DESIGN: This was a retrospective cohort analysis. OBJECTIVE: The objective of this study was to report the efficacy and safety profile of provocative discography. SUMMARY OF BACKGROUND DATA: It is reported that the provocative discogram as a diagnostic test for symptomatic degenerative disk disease induces disk degeneration. MATERIALS AND METHODS: Discogram cases from 1998 to 2011 were identified. A matched control group with no discogram was identified. Both had pre-magnetic resonance imaging (MRI) and post-MRI with 5 years minimum between MRI studies. Statistics were generated by group for each level and for all levels combined. RESULTS: The discogram cohort comprised 53 patients (193 disks). The control group had 51 subjects (255 disks). There were no significant demographic differences between the groups. Time intervals between the index and follow-up MRI were 11 and 8 years for the discogram and control groups, respectively. The most common injected level was L4-L5; the most painful level was L5-S1 (Visual Analog Scale=7.9); the most concordant level was L5-S1 (75%). The most deranged level as seen on discography was L5-S1 (98%). Degeneration from normal to abnormal MRI among discogram patients was 60%. For controls, the rate was 33%. The discogram and control cohorts were statistically different (P<0.01). Among discogram patients, 58% had a fusion surgery between MRI studies. Comparing the discogram group without interval fusion to controls, the degeneration rate was not different at a 5 years' minimum follow-up. CONCLUSIONS: The L5-S1 intervertebral disk level was the most painful, concordant, and deranged level as seen on discogram. Patients who underwent a provocative discogram and interval fusion had a higher rate of subsequent degeneration than similar low back pain sufferers with no discogram. Degeneration rates were comparable at 5 years' minimum follow-up between discogram patients without interval spine fusion and patients without discogram exposure. The provocative discogram did not accelerate degeneration among these patients.

Smooth stable manifolds for the non-instantaneous impulsive equations with applications to Duffing oscillators.

In this paper, we present a theory of smooth stable manifold for the non-instantaneous impulsive differential equations on the Banach space or Hilbert space. Assume that the non-instantaneous linear impulsive evolution differential equation admits a uniform exponential dichotomy, we give the conditions of the existence of the global and local stable manifolds. Furthermore, C k -smoothness of the stable manifold is obtained, and the periodicity of the stable manifold is given. Finally, an application to nonlinear Duffing oscillators with non-instantaneous impulsive effects is given, to demonstrate the existence of stable manifold.

Effect of post-operative goal-directed fluid therapy (GDFT) on organ function after orthotopic liver transplantation: Secondary outcome analysis of the COLT randomised control trial.

BACKGROUND: Goal-directed fluid therapy (GDFT) has been shown to reduce the complications following a variety of major surgical procedures, possibly mediated by improved organ perfusion and function. We have shown that it is feasible to randomise patients to GDFT or standard fluid management following liver transplant in the cardiac-output optimisation following liver transplantation (COLT) trial. The current study compares end organ function in patients from the COLT trial who received GDFT in comparison to those receiving standard care (SC) following liver transplant. METHODS: Adult patients with liver cirrhosis undergoing liver transplantation were randomised to GDFT or SC for the first 12 h following surgery as detailed in a published trial protocol. GDFT protocol was based on stroke volume (SV) optimisation using 250 ml crystalloid boluses. Total fluid administration and time to extubation were recorded. Hourly SV and cardiac output (CO) readings were recorded from the non-invasive cardiac output monitoring (NICOM) device in both groups. Pulmonary function was assessed by arterial blood gas (ABG) and ventilatory parameters. Lung injury was assessed using PaO2:FiO2 ratios and calculated pulmonary compliance. The KDIGO score was used for determining acute kidney injury. Renal and liver graft function were assessed during the post-operative period and at 3 months and 1-year. RESULTS: 60 patients were randomised to GDFT (n = 30) or SC (n = 30). All patients completed the 12 h intervention period. GDFT group received a significantly higher total volume of fluid during the 12 h trial intervention period (GDFT 5317 (2335) vs. SC 3807 (1345) ml, p = 0.003); in particular crystalloids (GDFT 3968 (2073) vs. SC 2510 (1027) ml, p = 0.002). There was no evidence of significant difference between the groups in SV or CO during the assessment periods. Time to extubation, PaO2: FIO2 ratios, pulmonary compliance, ventilatory or blood gas measurements were similar in both groups. There was a significant rise in serum creatinine from baseline (77 µmol/L) compared to first (87 µmol/L, p = 0.039) and second (107 µmol/L, p = 0.001) post-operative days. There was no difference between GDFT and SC in the highest KDIGO scores for the first 7 days post-LT. At 1-year follow-up, there was no difference in need for renal replacement therapy or graft function. CONCLUSIONS: In this randomised trial of fluid therapy post liver transplant, GDFT was associated with an increased volume of crystalloids administered but did not alter early post-operative pulmonary or renal function when compared with standard care.

Manejo quirúrgico de la hernia perineal primaria / Surgical management of primary perineal hernia

Las hernias perineales presentan una incidencia variable entre el 0,3-6 %. El abordaje quirúrgico se puede realizar por vía perineal o por vía laparoscópica. Se presentan las imágenes de una paciente con una hernia perineal adquirida primaria, tratada exitosamente mediante un abordaje mixto.

Perineal hernias present a variable incidence between 0.3-6%. The surgical approach can be performed perineally or laparoscopically. Images of a patient with a primary acquired perineal hernia, successfully treated using a mixed approach, are presented.

Hydroscapes: A Useful Metric for Distinguishing Iso-/Anisohydric Behavior in Almond Cultivars.

As a consequence of climate change, water scarcity has increased the use of the iso-/anisohydric concept with the aim of identifying anisohydric or drought-tolerant genotypes. Recently, Meinzer and colleagues developed a metric for discriminating between iso- and anisohydric behavior called the hydroscape, which describes a range in which stomata control leaf water potential (Ψ) with decreasing water availability, and it is linked to several water-regulation and drought-tolerance traits. Thus, our objective was to test the usefulness of the hydroscape in discriminating between iso- and anisohydric Prunus dulcis cultivars, a species that is widely cultivated in Mediterranean central Chile due to its ability to withstand water stress. Through a pot desiccation experiment, we determined that the hydroscape was able to discriminate between two contrasting Prunus cultivars; the more anisohydric cultivar had a hydroscape 4.5 times greater than that of the other cultivar, and the hydroscape correlated with other metrics of plant water-use strategies, such as the maximum range of daily Ψ variation and the Ψ at stomatal closure. Moreover, the photosynthesis rates were also differently affected between cultivars. The more isohydric cultivar, which had a smaller hydroscape, displayed a steeper photosynthesis reduction at progressively lower midday Ψ. This methodology could be further used to identify drought-tolerant anisohydric Prunus cultivars.

Functional diversity for body actions in the mesencephalic locomotor region.

The mesencephalic locomotor region (MLR) is a key midbrain center with roles in locomotion. Despite extensive studies and clinical trials aimed at therapy-resistant Parkinson's disease (PD), debate on its function remains. Here, we reveal the existence of functionally diverse neuronal populations with distinct roles in control of body movements. We identify two spatially intermingled glutamatergic populations separable by axonal projections, mouse genetics, neuronal activity profiles, and motor functions. Most spinally projecting MLR neurons encoded the full-body behavior rearing. Loss- and gain-of-function optogenetic perturbation experiments establish a function for these neurons in controlling body extension. In contrast, Rbp4-transgene-positive MLR neurons project in an ascending direction to basal ganglia, preferentially encode the forelimb behaviors handling and grooming, and exhibit a role in modulating movement. Thus, the MLR contains glutamatergic neuronal subpopulations stratified by projection target exhibiting roles in action control not restricted to locomotion.

The Importance of Non-Diffusional Factors in Determining Photosynthesis of Two Contrasting Quinoa Ecotypes (Chenopodium quinoa Willd.) Subjected to Salinity Conditions.

The broad distribution of quinoa in saline and non-saline environments is reflected in variations in the photosynthesis-associated mechanisms of different ecotypes. The aim of this study was to characterize the photosynthetic response to high salinity (0.4 M NaCl) of two contrasting Chilean genotypes, Amarilla (salt-tolerant, salares ecotype) and Hueque (salt-sensitive, coastal ecotype). Our results show that saline stress induced a significant decrease in the K+/Na+ ratio in roots and an increase in glycine betaine in leaves, particularly in the sensitive genotype (Hueque). Measurement of the photosynthesis-related parameters showed that maximum CO2 assimilation (Amax) in control plants was comparable between genotypes (ca. 9-10 µmol CO2 m-2 s-1). However, salt treatment produced different responses, with Amax values decreasing by 65.1% in the sensitive ecotype and 37.7% in the tolerant one. Although both genotypes maintained mesophyll conductance when stomatal restrictions were removed, the biochemical components of Amarilla were impaired to a lesser extent under salt stress conditions: for example, the maximum rate of ribulose-1,5-bisphosphate carboxylase/oxygenase (RubisCO; Vcmax) was not as affected in Amarilla, revealing that this enzyme has a higher affinity for its substrate in this genotype and, thus, a better carboxylation efficiency. The present results show that the higher salinity tolerance of Amarilla was also due to its ability to control non-diffusional components, indicating its superior photosynthetic capacity compared to Hueque, particularly under salt stress conditions.

Treatment of degenerative spondylolisthesis by instrumented posterolateral versus instrumented posterolateral with transforaminal lumbar interbody single-level fusion.

BACKGROUND: The purpose of this study was to compare outcomes of patients with degenerative spondylolisthesis treated by posterolateral lumbar fusion (PLF) versus PLF with transforaminal lumbar interbody fusion (PLF + TLIF). Studies of PLF versus PLF + TLIF have shown either equivalence or support for PLF + TLIF in lumbar spine surgery. Many are heterogeneous in the conditions treated, with few considering only spondylolisthesis of degenerative origin. Radiographic outcomes tend to favor PLF + TLIF, but this has not translated into better clinical outcomes. METHODS: This was a retrospective cohort study. Forty-nine patients undergoing single-level PLF and seventy patients undergoing single-level PLF + TLIF with two-year follow-up were retrospectively reviewed. Demographics, Oswestry Disability Index (ODI), implant cost, surgical data, and complications were analyzed. RESULTS: There was no difference in ODI improvement at two-year follow-up between the cohorts (P=0.97). Dural tears were more common in the PLF cohort (P<0.01), but otherwise complication and reoperation rates were similar. Implant cost (P<0.01) and operative time (P=0.01) were higher in the PLF + TLIF cohort. CONCLUSIONS: The addition of a TLIF to a PLF did not result in a functional improvement in the treatment of degenerative spondylolisthesis as measured by the ODI.

Quality of the Indoor Environment in Elderly Care Centers in Two Cities in Central Portugal: Viseu and Covilhã.

Assessments of Indoor Environment Quality (IEQ) present a very significant challenge when analyses are undertaken mainly in buildings that include a particularly sensitive and vulnerable population, such as elderly people. In order to maintain an indoor environment that is adequate for occupants, it is necessary to comply with a set of requirements (for TVOC, the Portuguese threshold values) regarding concentrations of airborne pollutants and hygrothermal comfort conditions. This paper studies IEQ in compartments in 3 buildings in two cities in central Portugal, Viseu and Covilhã, which hold elderly care centers. The following environmental parameters were continuously recorded: air temperature, relative humidity, concentration of carbon dioxide, formaldehyde, and total volatile organic compounds and ventilation rates. An analysis of the obtained results was performed, taking recommended guidelines and threshold values into account, thus making it possible to evaluate the IEQ conditions and hygrothermal comfort in the selected indoor spaces. On the basis of the conclusions reached and the observed problems of hygrothermal comfort and indoor pollutants in the indoor spaces, a number of recommendations are proposed, specifically in terms of climate control, ventilation, and maintenance, in order to obtain an overall improvement of IEQ.

Interleukin-8 as a therapeutic target for chronic low back pain: Upregulation in human cerebrospinal fluid and pre-clinical validation with chronic reparixin in the SPARC-null mouse model.

BACKGROUND: Low back pain (LBP) is the leading global cause of disability and is associated with intervertebral disc degeneration (DD) in some individuals. However, many adults have DD without LBP. Understanding why DD is painful in some and not others may unmask novel therapies for chronic LBP. The objectives of this study were to a) identify factors in human cerebrospinal fluid (CSF) associated with chronic LBP and b) examine their therapeutic utility in a proof-of-concept pre-clinical study. METHODS: Pain-free human subjects without DD, pain-free human subjects with DD, and patients with chronic LBP linked to DD were recruited and lumbar MRIs, pain and disability levels were obtained. CSF was collected and analyzed by multiplex cytokine assay. Interleukin-8 (IL-8) expression was confirmed by ELISA in CSF and in intervertebral discs. The SPARC-null mouse model of progressive, age-dependent DD and chronic LBP was used for pre-clinical validation. Male SPARC-null and control mice received systemic Reparixin, a CXCR1/2 (receptors for IL-8 and murine analogues) inhibitor, for 8 weeks. Behavioral signs of axial discomfort and radiating pain were assessed. Following completion of the study, discs were excised and cultured, and conditioned media was evaluated with a protein array. FINDINGS: IL-8 was elevated in CSF of chronic LBP patients with DD compared to pain-free subjects with or without DD. Chronic inhibition with reparixin alleviated low back pain behaviors and attenuated disc inflammation in SPARC-null mice. INTERPRETATION: These studies suggest that the IL-8 signaling pathway is a viable therapy for chronic LBP. FUND: Supported by NIH, MMF, CIHR and FRQS.