Analysis of complications and revisions after spine surgery in 270 multiple myeloma patients with spinal involvement.

BACKGROUND CONTEXT: Patients with multiple myeloma (MM) are at increased risk of infections and suffer from poor bone quality due to their disseminated malignant bone disease. Therefore, postoperative complications may occur following surgical treatment of MM lesions. PURPOSE: In this study, we aimed to determine the incidence of postoperative complications and retreatments after spinal surgery in MM patients. Additionally, we sought to identify risk factors associated with complications and retreatments. STUDY DESIGN: Retrospective cohort study. PATIENT SAMPLE: In total, 270 patients with MM who received surgical treatment for spinal involvement between 2008 and 2021 were included. OUTCOME MEASURES: The incidence of perioperative complications within 6 weeks and reoperations within 2.5 years and individual odds ratios for factors associated with these complications and reoperations. METHODS: Data were collected through manual chart review. Hosmer and Lemeshow's purposeful regression method was used to identify risk factors for complications and reoperations. RESULTS: The median age of our cohort was 65 years (SD = 10.8), and 58% were male (n = 57). Intraoperative complications were present in 24 patients (8.9%). The overall 6-week complication rate after surgery was 35% (n = 95). The following variables were independently associated with 6-week complications: higher Genant grading of a present vertebral fracture (OR 1.41; 95% CI 1.04-1.95; p = .031), receiving intramuscular or intravenous steroids within a week prior to surgery (OR 3.97; 95% CI 1.79-9.06; p = .001), decompression surgery without fusion (OR 6.53; 95% CI 1.30-36.86; p = .026), higher creatinine levels (OR 2.18; 95% CI 1.19-5.60; p = .014), and lower calcium levels (OR 0.58; 95% CI 0.37-0.88; p = .013). A secondary surgery was indicated for 53 patients (20%), of which 13 (4.8%) took place within two weeks after the initial surgery. We additionally discovered factors associated with retreatments, which are elucidated within the manuscript. CONCLUSION: The goal of surgical treatment for MM bone disease is to enhance patient quality of life and reduce symptom burden. However, postoperative complication rates remain relatively high after spine surgery in patients with MM, likely attributable to both inherent characteristics of the disease and patient comorbidities. The risk for complications and secondary surgeries should be explored and a multidisciplinary approach is crucial.

Distribution of perioperative stroke in cardiac surgery.

BACKGROUND AND PURPOSE: The recent literature suggests that a cardiac origin in ischaemic stroke is more frequent than previously assumed. However, it is not always clear which patients benefit from additional cardiac investigations if obvious cardiac pathology is absent. METHODS: A single-center retrospective observational study was performed with 7454 consecutive patients admitted to the intensive care unit after cardiac surgery in the period 2006-2015 and who had postoperative brain imaging. Cerebral imaging was studied for the occurrence of stroke including subtype and involved vascular territory. It was assumed that all perioperative thromboembolic strokes are of cardiac origin. Data obtained from a hospital cohort of consecutive patients who received a diagnosis of ischaemic stroke were used for comparison. RESULTS: Thromboembolic stroke occurred in 135 cardiac surgery patients in 56 (41%) of whom the posterior cerebral circulation was involved. In the control group, 100 out of 503 strokes (20%) were located in the posterior cerebral circulation. The relative risk for a posterior location for stroke after cardiac surgery compared to patients with ischaemic stroke without prior cardiac surgery was 2.09; 95% confidence interval 1.60-2.72. CONCLUSIONS: Thromboembolic stroke after cardiac surgery occurs twice as often in the posterior cerebral circulation compared to ischaemic strokes in the general population. If confirmed in general stroke cohorts, the consequence of this finding may be that in patients with an ischaemic stroke that involves the posterior cerebral circulation the chance of a cardiac origin is increased and therefore might trigger additional cardiac investigations such as long-term heart rhythm monitoring or echocardiography.

A plant chamber system with downstream reaction chamber to study the effects of pollution on biogenic emissions.

A system of two plant chambers and a downstream reaction chamber has been set up to investigate the emission of biogenic volatile organic compounds (BVOCs) and possible effects of pollutants such as ozone. The system can be used to compare BVOC emissions from two sets of differently treated plants, or to study the photochemistry of real plant emissions under polluted conditions without exposing the plants to pollutants. The main analytical tool is a proton-transfer-reaction time-of-flight mass spectrometer (PTR-TOF-MS) which allows online monitoring of biogenic emissions and chemical degradation products. The identification of BVOCs and their oxidation products is aided by cryogenic trapping and subsequent in situ gas chromatographic analysis.

Natural variation of submergence tolerance among Arabidopsis thaliana accessions.

• The exploitation of natural variation in Arabidopsis thaliana (Arabidopsis) provides a huge potential for the identification of the molecular mechanisms underlying this variation as a result of the availability of a vast array of genetic and genomic resources for this species. Eighty-six Arabidopsis accessions were screened for natural variation in flooding tolerance. This forms the first step towards the identification and characterization of the role of candidate genes contributing to flooding tolerance. • Arabidopsis accessions at the 10-leaf stage were subjected to complete submergence in the dark. Survival curves were plotted to estimate median lethal times as a measure of tolerance. Flooding-associated survival parameters, such as root and shoot oxygen content, initial carbohydrate content and petiole elongation under water, were also measured. • There was a significant variation in submergence tolerance among Arabidopsis accessions. However, the order of tolerance did not correlate with root and shoot oxygen content or initial amounts of shoot starch and total soluble sugars. A negative correlation was observed between submergence tolerance and underwater petiole elongation. • Arabidopsis accessions show considerable variation in the ability to tolerate complete submergence, making it a good species in which to identify and characterize genes and to study mechanisms that contribute to survival under water.

Is elongation-induced leaf emergence beneficial for submerged Rumex species?

BACKGROUND AND AIMS: Plant species from various taxa 'escape' from low oxygen conditions associated with submergence by a suite of traits collectively called the low oxygen escape syndrome (LOES). The expression of these traits is associated with costs and benefits. Thus far, remarkably few studies have dealt with the expected benefits of the LOES. METHODS: Young plants were fully submerged at initial depths of 450 mm (deep) or 150-240 mm (shallow). Rumex palustris leaf tips emerged from the shallow flooding within a few days, whereas a slight lowering of shallow flooding was required to expose R. acetosa leaf tips to the atmosphere. Shoot biomass and petiole porosity were measured for all species, and treatments and data from the deep and shallow submergence treatments were compared with non-flooded controls. KEY RESULTS: R. palustris is characterized by submergence-induced enhanced petiole elongation. R. acetosa lacked this growth response. Upon leaf tip emergence, R. palustris increased its biomass, whereas R. acetosa did not. Furthermore, petiole porosity in R. palustris was twice as high as in R. acetosa. CONCLUSIONS: Leaf emergence restores gas exchange between roots and the atmosphere in R. palustris. This occurs to a much lesser extent in R. acetosa and is attributable to its lower petiole porosity and therefore limited internal gas transport. Leaf emergence resulting from fast petiole elongation appears to benefit biomass accumulation if these plants contain sufficient aerenchyma in petioles and roots to facilitate internal gas exchange.

How plants cope with complete submergence.

Flooding is a widespread phenomenon that drastically reduces the growth and survival of terrestrial plants. The dramatic decrease of gas diffusion in water compared with in air is a major problem for terrestrial plants and limits the entry of CO(2) for photosynthesis and of O(2) for respiration. Responses to avoid the adverse effects of submergence are the central theme in this review. These include underwater photosynthesis, aerenchyma formation and enhanced shoot elongation. Aerenchyma facilitates gas diffusion inside plants so that shoot-derived O(2) can diffuse to O(2)-deprived plant parts, such as the roots. The underwater gas-exchange capacity of leaves can be greatly enhanced by a thinner cuticle, reorientation of the chloroplasts towards the epidermis and increased specific leaf area (i.e. thinner leaves). At the same time, plants can outgrow the water through increased shoot elongation, which in some species is preceded by an adjustment of leaf angle to a more vertical position. The molecular regulatory networks involved in these responses, including the putative signals to sense submergence, are discussed and suggestions made on how to unravel the mechanistic basis of the induced expression of various adaptations that alleviate O(2) shortage underwater.

Density-induced plant size reduction and size inequalities in ethylene-sensing and ethylene-insensitive tobacco.

Plant competition for light is a commonly occurring phenomenon in natural and agricultural vegetations. It is typically size-asymmetric, meaning that slightly larger individuals receive a disproportionate share of the light, leaving a limited amount of light for the initially smaller individuals. As a result, size inequalities of such stands increase with competition intensity. A plant's ability to respond morphologically to the presence of neighbour plants with enhanced shoot elongation, the so-called shade avoidance response, acts against the development of size inequalities. This has been shown experimentally with transgenic plants that cannot sense neighbours and, therefore, show no shade avoidance responses. Stands of such transgenic plants showed a much stronger development of size inequalities at high plant densities than did wild type (WT) stands. However, the transgenic plants used in these experiments displayed severely hampered growth rates and virtually no response to neighbours. In order to more precisely study the impact of this phenotypic plasticity on size inequality development, experiments required plants that have normal growth rates and reduced, but not absent, shade avoidance responses. We made use of an ethylene-insensitive, transgenic tobacco genotype (Tetr) that has wild type growth rates and moderately reduced shade avoidance responses to neighbours. Here, we show that the development of size inequalities in monocultures of these plants is not affected unambiguously different from wild type monocultures. Plots of Tetr plants developed higher inequalities for stem length than did WT, but monocultures of the two genotypes had identical CV (Coefficient of Variance) values for shoot biomass that increased with plant density. Therefore, even though reduced shade avoidance capacities led to the expected higher size inequalities for stem length, this does not necessarily lead to increased size inequalities for shoot biomass.

Flooding tolerance of Carex species in relation to field distribution and aerenchyma formation.

The flooding tolerance of Carex species was studied in relation to their field distribution and their capacity to form root aerenchyma under controlled conditions. In an alpine meadow, six Carex species were selected which were distributed in a clear zonation correlating with water content of the soil. Carex sempervirens and C. ferruginea were only found on nonflooded soil, the latter species preferring moister conditions. Carex davalliana and C. nigra were both associated with water-saturated soil, whereas C. limosa and C. rostrata preferred partially submerged conditions. Carex davalliana and C. limosa were bound to flooded soils with a relatively high redox potential and horizontally flowing groundwater. Carex rostrata and C. nigra grew in stagnant soil-flooded conditions with low soil redox potentials. The amount of aerenchyma in the roots of all species increased when grown in oxygen-deficient stagnant agar. This increase in root porosity, combined with increased root diameter, presumably improved internal aeration of the roots. Although all species survived experimental soil flooding, partial submergence was lethal to C. sempervirens and, surprisingly, also to the wetland species C. davalliana. Carex ferruginea showed a reduced growth rate during partial submergence. The three other species, all wetland plants, reached highest biomass production under soil-flooded and partially submerged conditions, with slower growth on free-draining soil. It is concluded that aerenchyma is not constitutive in the Carex species under study, and is best developed in Carex species from wetlands. Species with less aerenchyma perform poorly when soil-flooded, but conditions of partial submergence could even affect species with a considerable amount of root aerenchyma.

Agar as a gelling agent: chemical and physical analysis.

Agars with different performance in bioassays were analysed for physical and chemical properties. Agars with the highest gel strength had the best performance. Good performance was also related to a low pH of a suspension of agars and to a low sulphur content. The diffusion rate of ions in gels differed between agars, but could not explain differences in agar performance. The time of autoclaving had a marked effect on the gel strength, however, without affecting the performance. Chemical analysis revealed large differences between agars. The best agars had a relatively low salt content. One of the best agars had an extremely high content of trace elements. Agar impurities, especially of the trace elements were tightly bound to the agars. Up to 30% of the Murashige and Skoog (MS) salts were also immobilized in the gel. At pH 4.2, less nitrogen and phosphate were available from the MS medium than at pH 5.7. Chlorine could be washed out completely and appeared to be a good marker for agar quality and purity. With AgNO3, chlorine contamination could easily be visualized.

Endoscopic ligation of perforating veins using a mediastinoscope.

Incompetent perforating veins play a major role in venous ulceration and recurrence of varicose veins. To reduce postoperative wound problems associated with classic subfascial exploration of the lower leg, endoscopic approaches have been developed. We describe a technique that makes use of a mediastinoscope to explore the subfascial area. This inexpensive and readily available instrument is present in most operating rooms. Although a learning curve must be anticipated, the results of this technique in retrospective studies are promising.