Long-term survivability of surgical and nonsurgical management of spinal epidural abscess.

BACKGROUND CONTEXT: Spinal epidural abscess (SEA) is a rare and life-threatening infection within the epidural space with significant functional impairment and morbidity. Active debate remains over whether to operate for SEAs, with limited existing data comparing the long-term survivability after surgical versus nonsurgical management. PURPOSE: This study aims to determine the long-term survival of patients who underwent surgical and nonsurgical management for SEA. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: A total of 250 consecutive SEA patients. OUTCOME MEASURES: Survival and mortality rates, complications. METHODS: All patients treated at a tertiary medical center for a primary SEA from January 2000 to June 2020 are identified. Data collection is by retrospective chart review. Cox proportional hazards regression models are used for all survival analyses while controlling for potential confounding variables and with multiple testing corrections. RESULTS: A total of 35 out of 250 patients died with an overall all-cause mortality of 14%. More than half of all deaths occurred within 90 days after treatment. The 90-day, 3-year, and 5-year survival rates are 92.8%, 89.2%, and 86.4%, respectively. Among surgery patients, the all-cause mortality was 13.07%, compared to 16.22% for medically-managed patients. Surgical treatment (decompression, fusion, debridement) significantly reduced the risk of death by 62.4% compared to medical therapy (p=.03), but surgery patients experienced a significantly longer mean length of stay (p=.01). Risk factors of short-term mortality included hypoalbuminemia (<3.5 g/dL), American Society of Anesthesiologists (ASA) 4+, and cardiac arrest. Risk factors of long-term mortality were immunocompromised state, elevated WBC count >12,000, sepsis, septic shock, ASA 4+, and cardiac arrest (p<.05). In terms of complications, surgically-managed patients experienced a higher proportion of deep vein thrombosis (p<.05). CONCLUSIONS: The overall long-term survivability of SEA treatment is relatively high at (86% at 5-year) in this study. The following SEA mortality risk factors were identified: hypoalbuminemia (short-term), immunocompromised state (long-term), leukocytosis (long-term), sepsis and septic shock (long-term), ASA 4+ and cardiac arrest (overall). For primary SEA patients, surgical management may reduce mortality risk compared to nonsurgical management.

Oxygen profiling of the unsaturated zone using direct push drilling.

A methodology for oxygen profile measurements in the unsaturated zone is developed based on direct push drilling using sampling liners equipped with homemade silicone septa. The oxygen measurement is carried out by puncturing the septum with a commercial retractable optode needle fitted with a fluorescent tip. Metrological characteristics and method validation were carried out under laboratory conditions using different levels of oxygen and various water contents. The relative standard deviations under dry and water saturated soil conditions were less than 0.3% and 5% for 0.5 mg L(-1) of oxygen and less than 2% and 3% for 9 mg L(-1). Field demonstrations in a calcareous-sandstone soil aquifer treatment system with a layered clayey, marl and sandstone lithology of widely different water contents provided down to 30 m deep profiles of the dissolved oxygen level with less than 1.5 m spatial resolution. A single sensor was used for over 50 field measurements, though recalibration was required after approximately 30 measurements due to the deterioration of the fluorescent tip.

International round-robin study on the Ames fluctuation test.

An international round-robin study on the Ames fluctuation test [ISO 11350, 2012], a microplate version of the classic plate-incorporation method for the detection of mutagenicity in water, wastewater and chemicals was performed by 18 laboratories from seven countries. Such a round-robin study is a precondition for both the finalization of the ISO standardization process and a possible regulatory implementation in water legislation. The laboratories tested four water samples (spiked/nonspiked) and two chemical mixtures with and without supplementation of a S9-mix. Validity criteria (acceptable spontaneous and positive control-induced mutation counts) were fulfilled by 92-100%, depending on the test conditions. A two-step method for statistical evaluation of the test results is proposed and assessed in terms of specificity and sensitivity. The data were first subjected to powerful analysis of variance (ANOVA) after an arcsine-square-root transformation to detect significant differences between the test samples and the negative control (NC). A threshold (TH) value based on a pooled NC was then calculated to exclude false positive test results. Statistically, positive effects observed by the William's test were considered negative, if the mean of all replicates of a sample did not exceed the calculated TH. By making use of this approach, the overall test sensitivity was 100%, and the test specificity ranged from 80 to 100%.

Optical and electrical interfacing technologies for living cell bio-chips.

Whole-cell bio-chips for functional sensing integrate living cells on miniaturized platforms made by micro-system-technologies (MST). The cells are integrated, deposited or immersed in a media which is in contact with the chip. The cells behavior is monitored via electrical, electrochemical or optical methods. In this paper we describe such whole-cell biochips where the signal is generated due to the genetic response of the cells. The solid-state platform hosts the biological component, i.e. the living cells, and integrates all the required micro-system technologies, i.e. the micro-electronics, micro-electro optics, micro-electro or magneto mechanics and micro-fluidics. The genetic response of the cells expresses proteins that generate: a. light by photo-luminescence or bioluminescence, b. electrochemical signal by interaction with a substrate, or c. change in the cell impedance. The cell response is detected by a front end unit that converts it to current or voltage amplifies and filters it. The resultant signal is analyzed and stored for further processing. In this paper we describe three examples of whole-cell bio chips, photo-luminescent, bioluminescent and electrochemical, which are based on the genetic response of genetically modified E. coli microbes integrated on a micro-fluidics MEMS platform. We describe the chip outline as well as the basic modeling scheme of such sensors. We discuss the highlights and problems of such system, from the point of view of micro-system-technology.

Clinical and pathological changes caused by the interaction of lasalocid and chloramphenicol in broiler chickens.

Uncommon and abnormal gait, characterised by toe walking and progressive leg weakness, was observed in a large broiler flock in Israel. Identical clinical signs were reproduced when young chicks received feed supplemented with lasalocid (Abatec-Roche), and chloramphenicol at normal recommended levels, for 12 days or more. The clinical and pathological findings suggest a neuromuscular toxic effect of lasalocid-chloramphenicol interaction in broiler chicks. To our best knowledge this is the first report on the toxic effect caused by the combination of lasalocid and chloramphenicol.