A retrospective controlled study of postoperative fever after posterior lumbar interbody fusion due to degenerative lumbar disease.

BACKGROUND: Postoperative fever is a common feature of spinal surgery. When fever occurs postoperatively in patients, surgeons are eager to rule out an infection. There are many reports about postoperative fever and infection; however, only a few have described the relationship between degenerative spinal disease and postoperative fever. This study aimed to investigate the causes of postoperative fever in patients with degenerative lumbar disease undergoing posterior screw fixation and interbody fusion and compare patients with non-pathologic fever and infected febrile patients. METHODS: From March 2015 to February 2016, 263 patients with degenerative lumbar disease underwent posterior lumbar screw fixation and interbody fusion surgery in our institution. We performed risk factor analysis by categorizing patients as afebrile and febrile. Comparisons were made between afebrile patients and patients with non-pathologic fever, and an analysis was performed between patients with non-pathologic fever and patients with febrile infection. We compared each group by examining the demographic factors before surgery, surgery features, drain duration, and postoperative transfusion. The postoperative day (POD) of fever onset, postoperative fever duration, and blood sample results in patients with fever were investigated. RESULTS: The drain duration was found to be an important factor between the afebrile febrile groups and between the non-pathologic fever and afebrile groups. POD of fever occurred earlier in the non-pathologic group than in the infection group (p = 0.04), and the duration of fever was shorter in the non-pathologic fever group than in the infection group (p = 0.01). Higher procalcitonin levels were observed at POD 5 in the infection group than in the non-pathologic fever group. (p < 0.01) The accidental dural rupture rate was higher in the infected group (p = 0.02); this was thought to be caused by the long non-ambulatory period after surgery. CONCLUSION: This study identified risk factors and differences between infectious diseases associated with postoperative fever. A significant risk factor for postoperative non-pathological fever was a shorter catheter drainage period. Fever after 3 days, fever for more than 4 days and higher procalcitonin levels after surgery suggest infection.

Randomized clinical trial comparing fixed-time split dosing and split dosing of oral Picosulfate regimen for bowel preparation.

AIM: To compare the efficacy of fixed-time split dose and split dose of an oral sodium picosulfate for bowel preparation. METHODS: This is study was prospective, randomized controlled study performed at a single Institution (2013-058). A total of 204 subjects were assigned to receive one of two sodium picosulfate regimens (i.e., fixed-time split or split) prior to colonoscopy. Main outcome measurements were bowel preparation quality and subject tolerability. RESULTS: There was no statistical difference between the fixed-time split dose regimen group and the split dose regimen group (Ottawa score mean 2.57 ± 1.91 vs 2.80 ± 2.51, P = 0.457). Cecal intubation time and physician's satisfaction of inspection were not significantly different between the two groups (P = 0.428, P = 0.489). On subgroup analysis, for afternoon procedures, the fixed-time split dose regimen was equally effective as compared with the split dose regimen (Ottawa score mean 2.56 ± 1.78 vs 2.59 ± 2.27, P = 0.932). There was no difference in tolerability or compliance between the two groups. Nausea was 21.2% in the fixed-time split dose group and 14.3% in the split dose group (P = 0.136). Vomiting was 7.1% and 2.9% (P = 0.164), abdominal discomfort 7.1% and 4.8% (P = 0.484), dizziness 1% and 4.8% (P = 0.113), cold sweating 1% and 0% (P = 0.302) and palpitation 0% and 1% (P = 0.330), respectively. Sleep disturbance was two (2%) patients in the fixed-time split dose group and zero (0%) patient in the split dose preparation (P = 0.143) group. CONCLUSION: A fixed-time split dose regimen with sodium picosulfate is not inferior to a split dose regimen for bowel preparation and equally effective for afternoon colonoscopy.

Morphological analysis of interbody fusion following posterior lumbar interbody fusion with cages using computed tomography.

Posterior lumbar interbody fusion (PLIF) using cages in conjunction with pedicle screw fixation is considered the gold standard for surgical treatment of degenerative lumbar spine disorders due to its biomechanical stability and high fusion rate. However, research regarding patterns of fusion in the interbody space during the early postoperative period is lacking.Sixty consecutive patients were recruited from May 2013 to June 2015. All patients underwent PLIF using 2 titanium cages filled with local bone chips from decompressed lamina and facet bone in conjunction with pedicle screw fixation. Computed tomography scans were obtained 3 to 6 months following surgery in order to evaluate the partial fusion state. Computed tomography (CT) classification of fusion morphology was divided into 8 groups and then into compartments according to fusion space, and the rate of fusion for each was calculated. Further follow-up was conducted to confirm fusion state and assess outcomes.The most frequent pattern of interbody fusion was bilateral intra-cage fusion with unilateral lateral bridging of extra-cage areas (N = 36, 43.4%); the least frequent was interspace bridging of the 2 cages alone (N = 0, 0%). The fusion rate for the intra-cage area (Compartment 1) reached 100%. However, the fusion in the lateral space outside of cages (Compartment 2) was not satisfactory, though reasonable (72.3%). All patients were confirmed as achieving adequate fusion at the final follow-up, with improved clinical outcomes.Widening of the contact area between the vertebral body and cages is recommended to promote increased interbody fusion during the early postoperative period.

A new multi-functional conjugated polymer for use in high-performance bulk heterojunction solar cells.

We report a new multi-functional copolymer, PDTP-DTBDT, containing DTP and DTBDT units. Surprisingly, the introduction of novel DTP and DTBDT units brings not only superior charge transfer properites but also charge transport characteristics for efficient bulk heterojunction solar cells.

Towards visible light hydrogen generation: quantum dot-sensitization via efficient light harvesting of hybrid-TiO2.

We report pronounced enhancement of photoelectrochemical hydrogen generation of a quantum dot-sensitized hybrid-TiO2 (QD/H-TiO2) electrode that is composed of a mesoporous TiO2 layer sandwiched by a double sided energy harvesting layer consisting of a surface-textured TiO2 inverse opals layer on the bottom and a patterned mesoporous TiO2 layer on the top. CdSe/H-TiO2 exhibits a maximum photocurrent density of ~16.2 mA/cm(2), which is 35% higher than that of the optimized control sample (CdSe/P25), achieved by matching of the bandgap of quantum dot-sensitization with the wavelength where light harvesting of H-TiO2 is observed. Furthermore, CdSe/H-TiO2 under filtered exposure conditions recorded current density of ~14.2 mA/cm(2), the greatest value in the visible range. The excellent performance of the quantum dot-sensitized H-TiO2 suggests that alteration of the photoelectrodes to suitable nanostructures with excellent light absorption may offer optimal strategies for attaining maximum efficiency in a variety of photoconversion systems.

Synthesis and electroluminescent properties of new conjugated bithiazole-containing polymers.

Three new bithiazole-based conjugated copolymers were synthesized and characterized. The EL device using PNBTV as the emitting layer showed red electroluminescence at 641 nm with a peak luminance of ca. 160 cd/m2 (0.008 cd/A). The red electroluminescence was attributed to the formation of excimers between the polymer chains. An EL device using PNBTV6 as the emitting material, which had two n-hexyl groups introduced to the phenylene in the main chain of PNBTV, showed a reddish orange emission that was blue shifted by approximately 52 nm compared with that observed with PNBTV. This observation was attributed to the significant decrease in interactions between the chains of the polymers due to the two bulky n-hexyl groups. On the other hand, PNBTV6 was found to have superior hole transporting ability compared with its electron transporting ability.