Perioperative prophylactic middle meningeal artery embolization for chronic subdural hematoma: a series of 44 cases

OBJECTIVE Chronic subdural hematoma (cSDH) is a common and challenging pathology to treat due to both the historically high recurrence rate following surgical evacuation and the medical comorbidities inherent in the aging patient population that it primarily affects. Middle meningeal artery (MMA) embolization has shown promise in the treatment of cSDHs, most convincingly to avoid surgical evacuation in relatively asymptomatic patients. Symptomatic patients requiring surgical evacuation may also benefit from perioperative MMA embolization to prevent cSDH recurrence. The goal of this study was to determine the utility of perioperative MMA embolization for symptomatic cSDH requiring surgical evacuation and to assess if there is a decrease in the cSDH recurrence rate compared to historical recurrence rates following surgical evacuation alone. METHODS Symptomatic cSDHs were evacuated using a subdural evacuating port system (SEPS) with 5-mm twist-drill craniostomy in an intensive care unit or by performing a craniotomy in the operating room, using either a small (silver dollar, < 4 cm) or large (≥ 4 cm) craniotomy. MMA embolization was performed perioperatively using angiography, selective catheterization of the MMA, and infusion of polyvinyl particles. Outcomes were assessed clinically and radiographically with interval head CT imaging. RESULTS There were 44 symptomatic cSDHs in 41 patients, with 3 patients presenting with bilateral symptomatic cSDH. All cSDHs were evacuated using an SEPS (n = 18), a silver-dollar craniotomy (n = 16), or a large craniotomy (n = 10). Prophylactic MMA embolization was performed successfully in all cSDHs soon after surgical evacuation. There were no deaths and no procedural complications. There was an overall reduction of greater than 50% or resolution of cSDH in 40/44 (90.9%) cases, regardless of the evacuation procedure used. Of the 44 prophylactic cases, there were 2 (4.5%) cases of cSDH recurrence that required repeat surgical evacuation at the 1-year follow-up. These 2 cSDHs were initially evacuated using an SEPS and subsequently required a craniotomy, thereby representing an overall 4.5% recurrence rate of treated cSDH requiring repeat evacuation. Most notably, of the 26 patients who underwent surgical evacuation with a craniotomy followed by MMA embolization, none had cSDH recurrence requiring repeat intervention. CONCLUSIONS Perioperative prophylactic MMA embolization in the setting of surgical evacuation, via either craniotomy or SEPS, may help to lower the recurrence rate of cSDH.

Isolation and molecular identification of Aeromonas species from the tank water of ornamental fishes

Aeromonads are recognised as important pathogens of fishes. In this study, ten water samples were randomly collected from pet shops' fish tanks and home aquaria inhabited by several fish species (silver arowana, koi, goldfish, catfish, pictus fish, silver shark and silver dollar fish). Altogether 298 colonies were isolated using Aeromonas selective agar. A total of 154 isolates were then confirmed as belonging to the genus Aeromonas using the GCAT gene. Using ERIC-PCR, a total of 40 duplicate isolates were excluded from the study and 114 isolates were subjected to PCR-RFLP targeting the RNA polymerase sigma factor (rpoD) gene using lab-on-chip. A total of 13 different Aeromonas species were identified. The most prevalent species were A. veronii (27%, 31/114), followed by A. dhakensis (17%, 19/114), A. finlandiensis (9%, 10/114), A. caviae (8%, 9/114), A. hydrophila (4%, 4/114), A. jandaei (4%, 4/114), A. rivuli (3%, 3/114), A. enteropelogens (2%, 2/114), A. tecta (2%, 2/114), A. allosaccharophila (1%, 1/114), A. eucrenophila (1%, 1/114), A. media (1%, 1/114) and A. diversa (1%, 1/114). Twenty-six isolates (23%) were unidentifiable at species level. The present study demonstrates that Aeromonas species are highly diverse in freshwater fish tanks, and suggests the potential risks posed by the isolated bacteria to the health of ornamental fish species.

Evaluating On-demand Irrigation Systems for Container-grown Woody Plants Grown in Biochar-amended Pine Bark

Controlling irrigation using timers or manually operated systems is the most common irrigation scheduling method in outdoor container production systems. Improving irrigation efficiency can be achieved by scheduling irrigation based on plant water needs and the appropriate use of sensors rather than relying on periodically adjusting irrigation volume based on perceived water needs. Substrate amendments such as biochar, a carbon (C)-rich by-product of pyrolysis or gasification, can increase the amount of available water and improve irrigation efficiency and plant growth. Previous work examined two on-demand irrigation schedules in controlled indoor (greenhouse) environments. The goal of this study was to evaluate the impact of these on-demand irrigation schedules and hardwood biochar on water use and biomass gain of container-grown Hydrangea paniculata ‘Silver Dollar’ in a typical outdoor nursery production environment. Eighteen independently controlled irrigation zones were designed to test three irrigation schedules on ‘Silver Dollar’ hydrangea grown in pine bark amended with 0% or 25% hardwood biochar. The three irrigation schedules were conventional irrigation and two on-demand schedules, which were based on substrate physical properties or plant physiology. Conventional irrigation delivered 1.8 cm water in one event each day. The scheduling of substrate-based irrigation was based on the soilless substrate moisture characteristic curve, applying water whenever the substrate water content corresponding to a substrate water potential of –10 kPa was reached. The plant-based irrigation schedule was based on a specific substrate moisture content derived from a previously defined relationship between substrate moisture content and photosynthetic rate, maintaining the volumetric water content (VWC) to support photosynthesis at 90% of the maximum predicted photosynthetic rate. Total water use for the substrate-based irrigation was the same as for the conventional system; the plant-based system used significantly less water. However, plant dry weight was 22% and 15% greater, water use efficiency (WUE) was 40% and 40% greater, and total leachate volume was 25% and 30% less for the substrate-based and plant-based irrigation scheduling systems, respectively, than for conventional irrigation. The 25% biochar amendment rate reduced leachate volume per irrigation event, and leaching fraction, but did not affect total water use or plant dry weight. This research demonstrated that on-demand irrigation scheduling that is plant based or substrate based could be an effective approach to increase WUE for container-grown nursery crops without affecting plant growth negatively.

“Sweat a little water, sweat a little blood”: A spectacle of convict labor at an American amusement park

This article examines a representation of convict leasing in an unexpected and seemingly inconsequential place—an amusement park. Located in Branson, Missouri, the popular 1880s-themed Silver Dollar City proudly claims to offer historical education and entertainment through “realistic” constructions of the past. One of the park’s oldest and most popular attractions is the Flooded Mine ride, where park guests travel in “mine carts” through a depiction of a flooding mine, trying to “help the sheriff” by shooting laser light guns at kitschy animatronic convict laborers who are trying to escape. We first examine the Flooded Mine as a unique form of penal spectatorship, arguing that riders are able to enjoy the lighthearted mockery of the convict laborers’ suffering through a process of moral disengagement. Second, we use the lens of collective memory in an endeavor to expose the processes of remembering and forgetting at work in Silver Dollar City. We argue that the simulations of the past constructed in the park are not an apolitical platform for entertainment, but rather work to produce a narrative that perpetuates a kind of white nostalgia that erases black suffering. While ostensibly displaying a story of convict labor, the Flooded Mine depicts all the prisoners as white men, effectively performing an historical erasure of chattel slavery and its transmutation into convict leasing. By obscuring the incalculable pain produced by convict leasing and incarceration, the dissimulation allows riders to avoid any ethical engagement with these systems of racialized control.

Temperature Impacts Cactus and Succulent Development Rate

One cactus and 17 succulent species/cultivars were grown at 10, 16, 22, or 28 °C (plant temperature) for 10 or 15 weeks. The change in leaf/tubercle number at each temperature (after 10 or 15 weeks) was determined, and leaf/tubercle-unfolding rate was calculated. ‘Jade Necklace’ kebab bush (Crassula rupestris ssp. marnieriana), ‘Lola’ echeveria (Echeveria), ‘Green Ice’ gasteraloe (Gasteraloe), and lithops (Lithops species) leaf-unfolding rate per day was unaffected by temperature. Leaf-unfolding rate per day increased as temperature increased from 10 to 16 °C on ‘Firebird’ aloe (Aloe), ‘Key Lime Pie’ adromischus (Adromischus cristatus), prostate rainbow bush (Portulacaria afra variegata), burro’s tail (Sedum burrito), and ‘Sir William Lawrence’ houseleek (Sempervivum calcareum). Leaf-unfolding rate per day increased as temperature increased from 10 to 22 °C on mescal agave (Agave parryi truncata), ‘Firebird’ aloe, Sunrise anacampseros (Anacampseros telephiastrum variegata), ponytail palm (Beaucarnea recurvata), subsessilis echeveria (Echeveria subsessilis), zebra plant (Haworthia fasciata), prostrate rainbow bush, burro’s tail and ‘Sir William Lawrence’ houseleek. Increasing temperature from 22 to 28 °C decreased ‘Kiwi’ tree houseleek (Aeonium percarneum) leaf-unfolding rate per day, increased ‘Firebird’ aloe and tiger tooth aloe (Aloe juvenna) leaf-unfolding rate, and resulted in shoot tip death on burro’s tail, and plant death of ‘Sir William Lawrence’ houseleek and ‘Silver Dollar’ jade (Crassula arborescens). The cactus, ‘Arizona Snowcap’ mammillaria (Mammillaria gracilis fragilis), tubercle-unfolding rate per day increased as temperature increased from 16 to 28 °C. Taken together, temperature (10 to 28 °C) effects on development rate were species specific and related to the indigenous environment of a species.