Negative pressure wound therapy in the management of postoperative spinal wound infections: a systematic review.

INTRODUCTION: Postoperative wound infection after spinal surgery might be a challenge to manage. A wide range of procedures have been described for managing infected spinal wounds. An increasingly common procedure in the management of surgical site infections (SSI) is negative pressure wound therapy (NPWT), also known as vacuum-assisted closure. As there is a paucity of clear clinical advice the present investigation aims to update current evidence on the use of NPWT to manage postoperative SSI occurring after instrumented spine surgery. METHODS: This systematic review was conducted according to the preferred reporting Items for systematic reviews and meta-analyses: the 2020 PRISMA statement. In January 2024, the following databases were accessed: PubMed, Web of Science, and Google Scholar. No time constraint was set for the search. All the clinical studies investigating the unique use of NPWT in treating postoperative spinal wound infections were accessed. RESULTS: A total of 381 patients were included in the present study. Of them 52.5% (200 of 381 patients) were women. The mean age was 52.2 ± 15.2 years. The average length of the NPWT was 21.2 days (range 7-90 days). CONCLUSION: NPWT could be a valuable adjuvant therapy for the management of SSI after spine surgery. Additional high-quality investigations are required to assess the efficacy and safety of NPWT in SSI after spine surgery, especially if combined with contraindications or risk factors, such as the presence of intraoperative CSF leak. LEVEL OF EVIDENCE: Level IV, Systematic review.

Successful learning with whiteboard animations - A question of their procedural character or narrative embedding?

Although whiteboard animations are increasingly used for educational purposes, there is little empirical evidence as to why such animations can enhance learning. To specify essential elements, their dynamic visual presentation, as well as their narrative embedding, were found to be theortically important. In a first Experiment (N = 133) with a 2 (presentation mode: static pictures vs. progressive drawing) x 2 (narrative context: with vs. without a narrative) between-subject factorial design, motivational, cognitive, affective variables, as well as learning outcomes, of secondary school students were measured. Results revealed that progressive drawing, as well as a narrative context, are mostly associated with an increase in learning-relevant variables. In a second experiment with the same sample and the same experimental design but a different whiteboard animation, results from Experiment 1 generalize to another learning content. Again, a progressive drawing, as well as a narrative context within whiteboard animation, fostered learning relevant variables as well as learning outcomes. Results are discussed considering the cognitive theory of multimedia learning, the contiguity effect as well as the instructional design theory of anchored instruction.

The influence of the order and congruency of correct and erroneous worked examples on learning and (meta-)cognitive load.

Several studies highlight the importance of the order of different instructional methods when designing learning environments. Correct but also erroneous worked examples are frequently used methods to foster students' learning performance, especially in problem-solving. However, so far no study examined how the order of these example types affects learning. While the expertise reversal effect would suggest presenting correct examples first, the productive failure approach hypothesizes the reversed order to be learning-facilitating. In addition, congruency of subsequent exemplified problems was tested as a moderator of the effect of order on learning. For example, with arithmetic tasks, congruent problems target exactly the same calculation while incongruent problems refer to different calculations. Following cascade theory, a model of cognitive skill acquisition, presenting correct examples first should be more effective when the subsequent exemplified problems are different. To test the (conflicting) hypotheses, 83 university students were assigned to one of the four conditions in a 2 (correct vs. erroneous example first) × 2 (same vs. different exemplified problems) between-subject design. Learners navigated through a slideshow on the topic of Vedic mathematics consisting of explicit instruction, worked examples differing in terms of the experimental condition, and transfer problems. Although no main or interaction effects were found regarding students' learning performance, mediational analysis offered support for the expertise reversal effect, as it indicated that there is a significant indirect effect of order via mental load on learning. Presenting correct examples first and erroneous examples second resulted in a lower mental load, which in turn was associated with better learning performance. In contrast, presenting erroneous examples first and correct examples second resulted in a more accurate self-assessment of learning performance. These findings offer first insights into the question of how the presentation order of different example types impacts learning and provide practical recommendations for the design of educational media. Results are discussed in light of the ongoing debate regarding the question if less guided instructional methods should precede or succeed more guided methods.

How the design and complexity of concept maps influence cognitive learning processes.

Concept maps are assumed to enhance learning as their inherent structure makes relations between information more salient. Nevertheless, research on how to design concept maps as conducive to learning as possible is still rare. In particular, the salience of spatial arrangement of thematically related concepts within the map as well as the complexity of the map were found to be central design elements that influence learning. This study aimed to examine how the structure (i.e., the salience of the spatial relationship between individual concepts) and the complexity (i.e., number of nodes per sub concept) influence learning. Accordingly, a 2 (low vs. high salience of map structure) × 2 (few vs. many nodes) between-subject design was used (N = 122) to examine cognitive processes while learning with a concept map. No significant learning performance differences were found. Concepts maps with a low salience of map structure increased perceptions of disorientation. A serial mediation with learning performances as dependent variable revealed that the salience of the map structure is significantly associated with disorientation and extraneous cognitive load perceptions. By this, current attempts to measure extraneous cognitive load are questioned.

The Cognitive-Affective-Social Theory of Learning in digital Environments (CASTLE).

For a long time, research on individuals learning in digital environments was primarily based on cognitive-oriented theories. This paper aims at providing evidence that social processes affect individual learning with digital materials. Based on these theories and empirical results, a social-processes-augmented theory is suggested: the Cognitive-Affective-Social Theory of Learning in digital Environments (CASTLE). This CASTLE postulates that social cues in digital materials activate social schemata in learners leading to enhanced (para-)social, motivational, emotional, and metacognitive processes. To substantiate this theory, socio-cognitive theories are used, which predict social influences on learning with digital materials. Besides, previous empirical findings are presented assuming that with a rising number of social cues in digital materials, the influence of social processes increases. Finally, consequences regarding the design of digital learning media are discussed.

Polymorphism of CD14 Gene Is Associated with Adverse Outcome among Patients Suffering from Cardiovascular Disease.

BACKGROUND: The biological link between severe periodontitis and cardiovascular disease is well established. Both complex inflammatory diseases are influenced by genetic background. Therefore, the impact of genetic variations of receptors of the innate immune system-(Toll-like receptors (TLRs)) TLR2, TLR4, cluster of differentiation 14 (CD14), and the transcription factor nuclear factor-κΒ (NF-κB)-was investigated. MATERIALS AND METHODS: In this study (ClinicalTrials.gov identifier: NCT01045070), 1002 cardiovascular (CV) patients were included. In a 3-year follow-up period, new vascular events were assessed. SNPs in CD14 (rs2569190), NF-κΒ (rs28362491), TLR2 (rs5743708), and TLR4 (rs4986790) were genotyped. The impact of these genetic variants on severe periodontitis as well as on CV outcome was assessed. RESULTS: All investigated genetic variants were not associated with preexisting CV events or severe periodontitis in CV patients. In Kaplan-Meier survival analyses, the CT genotype of CD14 single-nucleotide polymorphism (SNP) rs2569190 was shown to be an independent predictor for combined CV endpoint (log rank: p = 0.035; cox regression; hazard ratio: 1.572; p = 0.044) as well as cardiovascular death (log rank: p = 0.019; cox regression; hazard ratio: 1.585; p = 0.040) after three years of follow-up. CONCLUSIONS: SNPs in CD14, NF-κΒ, TLR2, and TLR4 are no risk modulators for preexisting CV events or severe periodontitis in CV patients. The CT genotype of CD14 SNP rs2569190 provides prognostic value for further CV events within 3 years of follow-up.

The effect of signaling in dependence on the extraneous cognitive load in learning environments.

Text-based learning media are often used in primary, secondary and university education. Therefore, text designers can support the learner by highlighting the most relevant information by using visual cues. Despite this signaling effect's broad empirical basis, the extent to which the effectiveness of educational signals is dependent on moderator variables, like the design and layout of the text has not been investigated to date. In the current experiment, 138 university students learned about the formation of tsunamis from an instructional text. The text was manipulated in terms of signaling (color cues vs. no color cues) and induced learning-irrelevant extraneous cognitive load (fluent text font vs. disfluent text font). The results revealed that learners who had received the signaled text outperformed those who received the non-signaled text in terms of transfer performance. These results are explained by cognitive load, which was reduced in the signaling condition. The text font had no influence on the learning outcomes. Extraneous load induction further led to higher metacognitive accuracy and invested effort, while cognitive load and frustration were also increased. Interaction effects only occurred in terms of testing time, ease of learning and navigation. Results indicate that signaling is beneficial for transfer performance, independent of the font design of text.

Higher risk of adjacent segment degeneration after floating fusions: long-term outcome after low lumbar spine fusions.

STUDY DESIGN: We report the long-term outcome after mono-segmental and bisegmental fusions at the lumbar L4-S1 region of the spine. OBJECTIVE: Long-term clinical and radiologic outcome measures were used to determine a lumbar fusion's contribution to degenerative changes in adjacent motion segments (ASD). SUMMARY OF BACKGROUND DATA: The role of low lumbar spinal fusions and their long-term contribution to accelerated degenerative changes in the adjacent motion segments continues to be a subject of controversy. PATIENTS AND METHODS: We followed-up 102 patients with an average age of 54 (22 to 78) years and a follow-up time of 14 (3 to 22) years. RESULTS: Overall results in patients were good, the Oswestry-Disability Index (ODI) showed an average of 26% (0% to 70%) at follow-up, the Visual Analog Scale rose from 2.7 (postoperative) and 2.9 (12 wk follow-up) to 3.6 (latest follow-up) points, respectively. Patient satisfaction with their health-related situation at follow-up was 69% (15% to 100%). Patients who underwent fusions of the segment L5/S1 showed a significant (P<0.05) lower risk for ASD than patients with fusions L4/5 (20% vs. 46%). Compared with L4/5 fusions, bisegmental L4-S1 fusions showed a similar trend (P=0.06) with a lower risk for ASD (24%). Objective and subjective clinical results showed no differences between these groups. Patients suffering from ASD showed significant (P<0.05) reduced sacral inclination and lumbar lordosis angles and also significant (P<0.05) higher ODI values compared with non-ASD patients. CONCLUSIONS: We conclude that floating fusions of single low lumbar segments are more likely to result in ASD and are negatively influenced by sagittal plane abnormalities.

Charité total disc replacement--clinical and radiographical results after an average follow-up of 17 years.

A retrospective clinical-radiological study to evaluate the long-term outcome after artificial disc replacement was performed. The objective is to investigate long-term results after implantation of a modular type artificial disc prosthesis in patients with degenerative disc disease (DDD). Total disc replacement (TDR) is a surgical procedure intended to save segmental spinal function, and thus replace spondylodesis. Short-term results are promising, whereas long-term results are scarce. The Charité TDR is the oldest existing implant, therefore, the longest possible follow-up is presented here. Seventy-one patients were treated with 84 Charité TDRs types I-III. Indication for TDR was moderate to severe DDD. Fifty-three patients (63 TDRs) were available for long-term follow-up of 17 years. Evaluation included Oswestry disability index, visual analog scale, overall outcome score, plain and extension/flexion radiographs. Implantation of Charité TDR resulted in a 60% rate of spontaneous ankylosis after 17 years. No significant difference between the three types of prostheses was found concerning clinical outcome. Reoperation was necessary in 11% of patients. Although no adjacent segment degeneration was observed in the functional implants (17%), these patients were significantly less satisfied than those with spontaneous ankylosis. TDR, nowadays, is an approved procedure. Proof that long-term results of TDR implantation in DDD are at least as good as fusion results is still missing.

The surgical treatment of the lumbar disc prolapse: nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone.

STUDY DESIGN: Clinical and radiologic study evaluating the outcome after nucleotomy with dynamic stabilization compared with nucleotomy alone. OBJECTIVES: To investigate the effect of dynamic stabilization on the progression of segmental degeneration after nucleotomy. SUMMARY OF BACKGROUND DATA: Nucleotomy as treatment for lumbar disc prolapse in combination with initial segment degeneration may lead to segmental instability. Dynamic stabilization systems restrict segmental motion and thus prevent further degeneration of the lumbar spine. They are designed to avoid the disadvantages of rigid fixation, such as pseudarthrosis and adjacent segment degeneration. METHODS: Eighty-four patients underwent nucleotomy of the lumbar spine for the treatment of symptomatic disc prolapse. Additional dynamic stabilization (DYNESYS) was performed in 35 of those cases. All patients showed signs of initial disc degeneration (MODIC I). They underwent evaluation before surgery, 3 months after surgery, and at follow-up. The mean duration of follow-up was 34 months. Examinations included radiographs, magnetic resonance imaging (MRI), physical examination, and subjective patient evaluation using Oswestry score and visual analog scale (VAS). RESULTS: Clinical symptoms, Oswestry score, and VAS improved significantly in both groups after 3 months. At follow-up, a significant increase in the Oswestry score and in the VAS was seen only in the nonstabilized group. In the dynamically stabilized group, no progression of disc degeneration was noted at follow-up, whereas radiologic signs of accelerated segmental degeneration existed in the solely nucleotomized group. There were no implant-associated complications. CONCLUSIONS: The applied dynamic stabilization system is useful to prevent progression of initial degenerative disc disease of lumbar spinal segments after nucleotomy.