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Oral e-Poster Presentations - Booth 2: Spine 1 (Trauma&Misc), September 25, 2023, 10:00 AM - 10:40 AM
Background: Spondylodiscitis is a prevalent type of spinal infection, with pyogenic spondylodiscitis being the most common subtype. While antibiotic therapy is the standard treatment, some argue that early surgery can aid in infection clearance, improve survival rates, and prevent long-term complications such as deformities. However, others view early surgery as excessively risky. Due to the high mortality rate of up to 20%, it is crucial to determine the most effective treatment.
Methods: The primary objective of this study was to compare the mortality rate, relapse rate, and length of hospital stay for conservative and early surgical treatments of pyogenic spondylodiscitis, including determinants of outcomes. The study was registered on PROSPERO with the registration number CRD42022312573. The databases MEDLINE, Embase, Scopus, PubMed, and JSTOR were searched for original studies comparing conservative and early surgical treatments of pyogenic spondylodiscitis. The included studies were assessed using the ROBINS-1 tool, and eligible studies were evaluated using meta-analyses, influence, and regression analyses.
Results: The systematic review included 31 studies. The meta-analysis, which had a pooled sample size of 10,954 patients from 21 studies, found that the pooled mortality rate among patients treated with early surgery was 8%, while the rate was 13% for patients treated conservatively. The mean proportion of relapse/failure was 15% for patients treated with early surgery and 21% for those treated conservatively. Furthermore, the analysis concluded that early surgical treatment is associated with a 40% and 39% risk reduction in relapse/failure and mortality rates, respectively, when compared to conservative management. Additionally, early surgical treatment resulted in a 7.75-day reduction in length of hospital stay per patient (p<0.01). The most highly significant predictors of treatment outcome were found to be intravenous drug use, diabetes, the presence of an epidural abscess, positive cultures, location of infection, and age (p<0.001).
Conclusions: Overall, early surgical management was found to be consistently significantly more effective than conservative management in terms of relapse/failure and mortality rates when treating pyogenic spondylodiscitis, particularly for non-spinal epidural abscess spondylodiscitis.
Non-standard errors
(2021)
In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in sample estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty: non-standard errors. To study them, we let 164 teams test six hypotheses on the same sample. We find that non-standard errors are sizeable, on par with standard errors. Their size (i) co-varies only weakly with team merits, reproducibility, or peer rating, (ii) declines significantly after peer-feedback, and (iii) is underestimated by participants.
Background: Simultaneous pancreas kidney transplantation (SPK), pancreas transplantation alone (PTA) or pancreas transplantation after kidney (PAK) are the only curative treatment options for patients with type 1 (juvenile) diabetes mellitus with or without impaired renal function. Unfortunately, transplant waiting lists for this indication are increasing because the current organ acceptability criteria are restrictive; morbidity and mortality significantly increase with time on the waitlist. Currently, only pancreas organs from donors younger than 50 years of age and with a body mass index (BMI) less than 30 are allocated for transplantation in the Eurotransplant (ET) area. To address this issue we designed a study to increase the available donor pool for these patients.
Methods/Design: This study is a prospective, multicenter (20 German centers), single blinded, non-randomized, two armed trial comparing outcome after SPK, PTA or PAK between organs with the currently allowed donor criteria versus selected organs from donors with extended criteria. Extended donor criteria are defined as organs procured from donors with a BMI of 30 to 34 or a donor age between 50 and 60 years. Immunosuppression is generally standardized using induction therapy with Myfortic, tacrolimus and low dose steroids. In principle, all patients on the waitlist for primary SPK, PTA or PAK are eligible for the clinical trial when they consent to possibly receiving an extended donor criteria organ. Patients receiving an organ meeting the current standard criteria for pancreas allocation (control arm) are compared to those receiving extended criteria organ (study arm); patients are blinded for a follow-up period of one year. The combined primary endpoint is survival of the pancreas allograft and pancreas allograft function after three months, as an early relevant outcome parameter for pancreas transplantation.
Discussion: The EXPAND Study has been initiated to investigate the hypothesis that locally allocated extended criteria organs can be transplanted with similar results compared to the currently allowed standard ET organ allocation. If our study shows a favorable comparison to standard organ allocation criteria, the morbidity and mortality for patients waiting for transplantation could be reduced in the future.
Trial registered at: NCT01384006
Zur Refugialfunktion von Weideparzellenrändern für Pflanzenarten und Vegetationstypen des Grünlandes
(1999)
Anhand ausgewählter Weideparzellen im nördlichen Nordrhein-Westfalen wurde 1995 der Frage nachgegangen, ob es an Weideparzellenrändern Rückzugsorte für Pflanzenarten und Vegetationstypen magerer Standorte gibt und inwieweit floristisch-soziologische, sowie standörtliche Unterschiede zwischen Weiderand und Parzelle bestehen. Hierzu wurden Vegetationsaufnahmen nach der BRAUN-BLANQUET-Methode erstellt. In insgesamt 52 Aufnahmepaaren wurden jeder Vegetationsaufnahme vom Weiderand eine Vegetationsaufnahme von der angrenzenden Parzelle zum Vergleich gegenübergestellt. Für ausgewählte Aufnahmepaare wurden darüber hinaus Bodenanalysen durchgeführt. Als Ergebnis konnten an den Weiderändern artenreiche Extensivgrünland-ähnliche Bestände gefunden werden, während in den Parzellen lediglich das Lolio-Cynosuretum nachgewiesen wurde. Zudem finden v.a. Arten des Extensivgrünlandes i.w.S. (Sedo-Scleranthetea, Nardo-Callunetea, Molinietalia), bzw. Magerkeitszeiger und Zeigerarten für extremere Feuchtigkeitsverhältnisse in den Weiderändern bessere Existenzmöglichkeiten. Die festgestellten Unterschiede werden v.a. auf die geringere Nährstoffversorgung der Randvegetation, den Wegfall des Trittfaktors am Parzellenrand, sowie das intensivere Abweiden der Unterzaunbereiche zurückgeführt.Die Weideränder können Refugien von Fragmenten gefährdeter bzw. vom Aussterben bedrohter Grünlandgesellschaften, sowie für einzelne bedrohte und zahlreiche rückläufige Grünlandarten darstellen und in dieser Funktion einen Beitrag gegen das Artensterben im Grünland leisten, sowie als Regenerationsreservoir für Extensivierungen dienen.
The transport of air masses originating from the Asian monsoon anticyclone into the extratropical upper troposphere and lower stratosphere (Ex-UTLS) above potential temperatures Θ = 380K was identified during the HALO aircraft mission TACTS in August and September 2012. In-situ measurements of CO, O3 and N2O during TACTS Flight 2 on the 30 August 2012 show the irreversible mixing of aged with younger (originating from the troposphere) stratospheric air masses within the Ex-UTLS. Backward trajectories calculated with the trajetory module of the CLaMS model indicate that these tropospherically affected air masses originate from the Asian monsoon anticyclone. From the monsoon circulation region these air masses are quasi-isentropically transported above Θ = 380 K into the Ex-UTLS where they subsequently mix with stratospheric air masses. The overall trace gas distribution measured during TACTS shows that this transport pathway has a significant impact on the Ex-UTLS during boreal summer and autumn. This leads to an intensification of the tropospheric influence on the Ex-UTLS with ∆Θ > 30 K (relative to the tropopause) within three weeks during the TACTS mission. In the same time period a weakening of the tropospheric influence on the lowermost stratosphere (LMS) is determined. Therefore, the study shows that the transport of air masses originating from the Asian summer monsoon region within the lower stratosphere above Θ = 380K is of major importance for the change of the chemical composition of the Ex-UTLS from summer to autumn.
The transport of air masses originating from the Asian monsoon anticyclone into the extratropical upper troposphere and lower stratosphere (Ex-UTLS) above potential temperatures Θ = 380 K was identified during the HALO aircraft mission TACTS in August and September 2012. In situ measurements of CO, O3 and N2O during TACTS flight 2 on 30 August 2012 show the irreversible mixing of aged stratospheric air masses with younger (recently transported from the troposphere) ones within the Ex-UTLS. Backward trajectories calculated with the trajectory module of CLaMS indicate that these tropospherically affected air masses originate from the Asian monsoon anticyclone. These air masses are subsequently transported above potential temperatures Θ = 380 K from the monsoon circulation region into the Ex-UTLS, where they subsequently mix with stratospheric air masses. The overall trace gas distribution measured during TACTS shows that this transport pathway had affected the chemical composition of the Ex-UTLS during boreal summer and autumn 2012. This leads to an intensification of the tropospheric influence on the extratropical lower stratosphere with PV > 8 pvu within 3 weeks during the TACTS mission. During the same time period a weakening of the tropospheric influence on the lowermost stratosphere (LMS) is determined. The study shows that the transport of air masses originating from the Asian summer monsoon region within the lower stratosphere affects the change in the chemical composition of the Ex-UTLS over Europe and thus contributes to the flushing of the LMS during summer 2012.
Über 130 Teilnehmer hatten sich zur Jahrestagung der Floristisch-soziologischen Arbeitsgemeinschaft in Münster eingefunden. Bei der Vorbereitung und Durchführung wurde der Tagungsleiter Prof. Dr. F. J. A. Daniels unterstützt von Prof. Dr. K. Burrichter (Münster), Prof. Dr. R. Pott (Hannover), Dr. F. Runge, Dr. E. Schröder, Dr. G. Vester, Dr. A. Vogel (Münster), Dr. J. Hüppe (Hannover), Dr. G. Verbücheln (Düsseldorf), Dr. R. Aerts und Dr. W. Koerselmann (Utrecht, NL), B. Stabenow (Kiel), G. Bremer, J. Pallas, S. Paus und Ch. Rückriem (Münster) sowie anderen Doktoranden und Diplomanden der Arbeitsgruppe Geobotanik in Münster. Nach der Begrüßung der Teilnehmer durch Prof. Daniels im Hotel Lindenhof wurden einführende Vorträge gehalten. Danach fand die ordentliche Jahresversammlung der Floristisch-soziologischen Arbeitsgemeinschaft statt. Am Freitagnachmittag, dem 30.6., wurden 4 Exkursionen in die Umgebung von Münster durchgeführt. Am Samstag und Sonntag, dem 1. und 2.7., fanden ganztägige Exkursionen statt, zudem am Montag, dem 03.07. eine Nachexkursion in die Niederlande.