Σφακιανάκης Αλέξανδρος
ΩτοΡινοΛαρυγγολόγος
Αναπαύσεως 5 Άγιος Νικόλαος
Κρήτη 72100
00302841026182
00306932607174
alsfakia@gmail.com

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Πέμπτη 30 Ιουνίου 2016

Internal adaptation of resin composites at two configurations: Influence of polymerization shrinkage and stress

Publication date: Available online 30 June 2016
Source:Dental Materials
Author(s): Seung-Hoon Han, Alireza Sadr, Junji Tagami, Sung-Ho Park
ObjectiveThis study compared internal adaptation of composites under different C-factors and examined the relationship between internal adaptation and polymerization shrinkage parameters.MethodsCylindrical cavities 3mm in diameter were prepared in 100 human third molars in two depths: 4mm high C-factor (H-CF) or 1mm low C-factor (L-CF). After adhesive application (Clearfil SE One, Kuraray Noritake), the composite was placed in two increments in three subgroups: Filtek Supreme (FS, 3M ESPE); Charisma Diamond (CD, Heraeus Kulzer); Amelogen Plus (AP, Ultradent); and as a single increment in two subgroups: Tetric EvoCeram Bulk Fill (TB, Ivoclar Vivadent) and Venus Bulk Fill (VB, Heraeus Kulzer). After thermo-mechanical load-cycles, imperfect margin percentage (%IM) was calculated using swept-source optical coherence tomography (SS-OCT) imaging. The relationships between %IM and linear shrinkage (LS) and shrinkage stress, measured under either zero-compliance (PS0) or compliance-allowed (PS) conditions were evaluated.ResultsThe %IM was significantly different between H-CF and L-CF groups. The %IM in H-CF turned out to be as groups CD, FS≤TB<AP, VB. The %IM in L-CF showed as groups CD, TB≤FS, AP<VB. There were significant correlations between shrinkage parameters and %IM, except between PS0 and %IM in L-CF.SignificanceInternal adaptation in a high C-factor cavity was inferior to that in a low C-factor cavity for both conventional and bulk-filled composites. Internal adaptation, polymerization shrinkage, and stress were different among composite materials. Polymerization stress under the compliance-allowed condition showed significant correlations with internal adaptations in high and low C-factor cavities.



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Stiffness of uncured resin-composites assessed via cavity-packing forces

Publication date: Available online 27 June 2016
Source:Dental Materials
Author(s): Muhammad Kaleem, David C. Watts
ObjectivesTo evaluate the stiffness and packability of unset resin-composites at different temperatures, taking into account the cavity wall effect.Materials and MethodsSix representative commercial resin-composites were selected. Each material was placed in mould of different sizes for example (φ=7, depth=5mm; or φ=3, depth=5mm) held at 26 or 37°C. Maximum packing force (Fp) of the resin-composite was measured. A flat-ended stainless-steel probe with a diameter of either 6mm or 3mm was mechanically lowered onto and into the surface of each unset sample with a speed of 0.50mm/s to a depth of 2mm, which was held constant for 10s. The compressive force produced on the probe by the unset resin-composites was plotted against time and the maximum value was identified (Fp). Peak stress Sp was calculated by dividing the Fp by area of the probe used. Data were analyzed by univariate ANOVA and multiple pair wise comparisons were performed using a Tukey post-hoc test to establish homogenous subsets (at p=0.05).ResultsSp was taken as potential measure of stiffness. It ranged from 0.12 to 4.21MPa and from 0.07 to 3.08MPa at 26 and 37°C, respectively. Univariate ANOVA showed significant influence of the plunger cavity ratios, temperature and materials on Sp (p<0.001). A strong interaction was also found between plunger cavity ratios, temperature and materials for Sp (p<0.05).ConclusionPeak stress Sp is a useful parameter for characterizing the stiffness of uncured resin-composite materials, additionally resin-composite formulation, temperature and wall effect did effect the packability of resin-composite.



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Biaxial flexural strength of new Bis-GMA/TEGDMA based composites with different fillers for dental applications

Publication date: Available online 29 June 2016
Source:Dental Materials
Author(s): Sebastian Wille, Iris Hölken, Galina Haidarschin, Rainer Adelung, Matthias Kern
ObjectiveThe aim of this study was to evaluate whether the mechanical properties of the modern dental composites can be improved by using tetrapodal ZnO particles as fillers in a Bis-GMA/TEGDMA matrix. Another aim was to test whether the mechanical properties of the composite are influenced by functionalization of the ZnO particles with lauric acid to achieve antibacterial activity.MethodsDifferent filler materials and particle shapes (spherical zirconia, spherical zinc oxide, tetrapodal zinc oxide) were used to produce Bis-GMA/TEGDMA based composites with a filler content of 40wt.-% and 60wt.-%, respectively. In addition, functionalization with lauric acid was investigated. For the biaxial flexural strength testing 104 test disks (N=8) with a diameter of 15mm and a thickness of 1.5mm were produced.ResultsFunctionalization with lauric acid resulted in a decrease in biaxial flexural strength for all filler materials. The biaxial flexural strength decreased when using a higher filler content with spherical particles but increased when using tetrapodal zinc oxide particles.SignificanceA higher durability of the composites using tetrapodal zinc oxide particles. An antibacterial functionalization with lauric acid cannot be recommended as the mechanical stability of the composite will be reduced.



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Vaccinations for Neuroinfectious Disease: A Global Health Priority

Abstract

Vaccines for neuroinfectious diseases are becoming an ever-increasing global health priority, as neurologic manifestations and sequelae from existing and emerging central nervous system infections account for significant worldwide morbidity and mortality. The prevention of neurotropic infections can be achieved through globally coordinated vaccination campaigns, which have successfully eradicated nonzoonotic agents such as the variola viruses and, hopefully soon, poliovirus. This review discusses vaccines that are currently available or under development for zoonotic flaviviruses and alphaviruses, including Japanese and tick-borne encephalitis, yellow fever, West Nile, dengue, Zika, encephalitic equine viruses, and chikungunya. Also discussed are nonzoonotic agents, including measles and human herpesviruses, as well as select bacterial, fungal, and protozoal pathogens. While therapeutic vaccines will be required to treat a multitude of ongoing infections of the nervous system, the ideal vaccination strategy is pre-exposure vaccination, with the ultimate goals of minimizing disease associated with zoonotic viruses and the total eradication of nonzoonotic agents.



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Goal striving strategies and effort mobilization: When implementation intentions reduce effort-related cardiac activity during task performance

Publication date: Available online 30 June 2016
Source:International Journal of Psychophysiology
Author(s): Laure Freydefont, Peter M. Gollwitzer, Gabriele Oettingen
Two experiments investigate the influence of goal and implementation intentions on effort mobilization during task performance. Although numerous studies have demonstrated the beneficial effects of setting goals and making plans on performance, the effects of goals and plans on effort-related cardiac activity and especially the cardiac preejection period (PEP) during goal striving have not yet been addressed. According to the Motivational Intensity Theory, participants should increase effort mobilization proportionally to task difficulty as long as success is possible and justified. Forming goals and making plans should allow for reduced effort mobilization when participants perform an easy task. However, when the task is difficult, goals and plans should differ in their effect on effort mobilization. Participants who set goals should disengage, whereas participants who made if-then plans should stay in the field showing high effort mobilization during task performance. As expected, using an easy task in Experiment 1, we observed a lower cardiac PEP in both the implementation intention and the goal intention condition than in the control condition. In Experiment 2, we varied task difficulty and demonstrated that while participants with a mere goal intention disengaged from difficult tasks, participants with an implementation intention increased effort mobilization proportionally with task difficulty. These findings demonstrate the influence of goal striving strategies (i.e., mere goals vs. if-then plans) on effort mobilization during task performance.



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Sample size calculations in human electrophysiology (EEG and ERP) studies: A systematic review and recommendations for increased rigor

Publication date: Available online 29 June 2016
Source:International Journal of Psychophysiology
Author(s): Michael J. Larson, Kaylie A. Carbine
There is increasing focus across scientific fields on adequate sample sizes to ensure non-biased and reproducible effects. Very few studies, however, report sample size calculations or even the information needed to accurately calculate sample sizes for grants and future research. We systematically reviewed 100 randomly selected clinical human electrophysiology studies from six high impact journals that frequently publish electroencephalography (EEG) and event-related potential (ERP) research to determine the proportion of studies that reported sample size calculations, as well as the proportion of studies reporting the necessary components to complete such calculations. Studies were coded by the two authors blinded to the other's results. Inter-rater reliability was 100% for the sample size calculations and kappa above 0.82 for all other variables. Zero of the 100 studies (0%) reported sample size calculations. 77% utilized repeated-measures designs, yet zero studies (0%) reported the necessary variances and correlations among repeated measures to accurately calculate future sample sizes. Most studies (93%) reported study statistical values (e.g., F or t values). Only 40% reported effect sizes, 56% reported mean values, and 47% reported indices of variance (e.g., standard deviations/standard errors). Absence of such information hinders accurate determination of sample sizes for study design, grant applications, and meta-analyses of research and whether studies were adequately powered to detect effects of interest. Increased focus on sample size calculations, utilization of registered reports, and presenting information detailing sample size calculations and statistics for future researchers are needed and will increase sample size-related scientific rigor in human electrophysiology research.



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Minimal Hearing Loss: From a Failure-Based Approach to Evidence-Based Practice

Purpose
A representative sample of the literature on minimal hearing loss (MHL) was reviewed to provide evidence of challenges faced by children with MHL and to establish the need for evidence-based options for early intervention.
Method
Research articles published from 1950 to 2013 were searched in the Medline database using the keywords minimal hearing loss, unilateral hearing loss, and mild hearing loss. References cited in retrieved articles were also reviewed.
Results
In total, 69 articles contained relevant information about pediatric outcomes and/or intervention for unilateral hearing loss, 50 for mild hearing loss, and 6 for high-frequency hearing loss. Six challenges associated with MHL emerged, and 6 interventions were indicated. Evidence indicates that although some individuals may appear to have no observable speech-language or academic difficulties, others experience considerable difficulties. It also indicates that even though children with MHL may appear to catch up in some areas, difficulties in select domains continue into adulthood.
Conclusions
Evidence indicates significant risks associated with untreated MHL. Evidence also demonstrates the need for early intervention and identifies several appropriate intervention strategies; however, no single protocol is appropriate for all children. Therefore, families should be educated about the impact of MHL and about available interventions so that informed decisions can be made.

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(18)F-DOPA PET in medulloblastoma: two case reports.

(18)F-DOPA PET in medulloblastoma: two case reports.

World Neurosurg. 2016 Jun 21;

Authors: Cicone F, Clerico A, Minniti G, Paiano M, Carideo L, Scaringi C, Langen KJ, Scopinaro F

Abstract
BACKGROUND: Medulloblastoma (MDB) is an aggressive embryonal brain tumor, whose underlying altered genetics and biological pathways account for very heterogeneous natural histories and clinical behaviors. PET using radiolabeled amino acids provides important metabolic information for the diagnosis of cerebral glioma but only few data are available on amino acid PET in MDB. In particular, no cases of MDB imaging with 6-[(18)F]-fluoro-L-3,4-dihydroxyphenylalanine (F-DOPA) have previously been described.
CASE DESCRIPTION: Two patients with very different histological subtypes of MDB were referred for F-DOPA PET in order to define the extent and metabolic degree of their diseases. The patients had a newly diagnosed large cell/anaplastic MDB and a fourth relapse of classical MDB, respectively. F-DOPA PET was unremarkable in the first case; F-DOPA uptake was low in the second patient with tumor-to-background ratio as high as 1.29. Comparison was made with magnetic resonance imaging which showed fluid-attenuated inversion recovery (FLAIR) positive diseases. An aggressive tumor growth was shown in the clinical course of both patients.
CONCLUSION: The two case reported here suggest that sensitivity of F-DOPA PET in MDB can be low. However, more comprehensive data are needed to conclude on the overall accuracy of F-DOPA PET in MDB.

PMID: 27354292 [PubMed - as supplied by publisher]



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Rapid time to positivity of cerebrospinal fluid culture with coagulase-negative Staphylococcus is more likely to reflect a true infection rather than contamination.

Rapid time to positivity of cerebrospinal fluid culture with coagulase-negative Staphylococcus is more likely to reflect a true infection rather than contamination.

World Neurosurg. 2016 Jun 21;

Authors: Da R, Wu Y, Liu W, Shi H, Wang W

Abstract
OBJECTIVE: Cerebrospinal fluid (CSF) culture is the gold standard for diagnosing post-operative central nervous system (CNS) infection. The time to positivity (TTP) of an automated continuous blood culture system may indicate the original concentration of the organism. Coagulase-negative Staphylococcus (CoNS), the common organism recovered in CSF, poses difficulty to differentiate infection from contamination. This study investigated the TTP of CSF culture with CoNS and its relationship to clinical parameters and prognosis.
METHODS: Adult neurosurgical patients with CoNS who recovered via the use of CSF culture in BacT/ALERT Pediatric FAN blood culture bottles and were admitted from September 2013 to July 2015 were enrolled. The demographics, clinical and microbiological data, and treatment were reviewed, and the TTP of each culture was retrieved.
RESULTS: Thirty-nine adult patients with CoNS recovered from CSF culture were included. The TTP ranged from 7.68 to 57.36 hours (hrs). A univariate logistic regression analysis indicated patients with rapid TTP (<21.5 hrs) compared with those with longer TTP were more likely to be female, demonstrate an effective response to antibiotic therapy within 7 days, have clean-contaminated surgical incisions, and exhibit CSF leak. A multivariate logistic regression analysis indicated that being female, an effective antibiotic therapy within 7 days, and clean-contaminated surgical incisions were independent predictors of rapid TTP.
CONCLUSIONS: Targeted antibiotic therapy was more likely to be beneficial to patients with a rapid TTP within 7 days, which suggested that CoNS with a rapid TTP would represent the pathogen of CNS infection rather than contamination in neurosurgical patients.

PMID: 27354293 [PubMed - as supplied by publisher]



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(18)F-DOPA PET in medulloblastoma: two case reports.

(18)F-DOPA PET in medulloblastoma: two case reports.

World Neurosurg. 2016 Jun 21;

Authors: Cicone F, Clerico A, Minniti G, Paiano M, Carideo L, Scaringi C, Langen KJ, Scopinaro F

Abstract
BACKGROUND: Medulloblastoma (MDB) is an aggressive embryonal brain tumor, whose underlying altered genetics and biological pathways account for very heterogeneous natural histories and clinical behaviors. PET using radiolabeled amino acids provides important metabolic information for the diagnosis of cerebral glioma but only few data are available on amino acid PET in MDB. In particular, no cases of MDB imaging with 6-[(18)F]-fluoro-L-3,4-dihydroxyphenylalanine (F-DOPA) have previously been described.
CASE DESCRIPTION: Two patients with very different histological subtypes of MDB were referred for F-DOPA PET in order to define the extent and metabolic degree of their diseases. The patients had a newly diagnosed large cell/anaplastic MDB and a fourth relapse of classical MDB, respectively. F-DOPA PET was unremarkable in the first case; F-DOPA uptake was low in the second patient with tumor-to-background ratio as high as 1.29. Comparison was made with magnetic resonance imaging which showed fluid-attenuated inversion recovery (FLAIR) positive diseases. An aggressive tumor growth was shown in the clinical course of both patients.
CONCLUSION: The two case reported here suggest that sensitivity of F-DOPA PET in MDB can be low. However, more comprehensive data are needed to conclude on the overall accuracy of F-DOPA PET in MDB.

PMID: 27354292 [PubMed - as supplied by publisher]



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Breath-taking jobs: a case-control study of respiratory work disability by occupation in Norway

Background

The current knowledge on respiratory work disability is based on studies that used crude categories of exposure. This may lead to a loss of power, and does not provide sufficient information to allow targeted workplace interventions and follow-up of patients with respiratory symptoms.

Objectives

The aim of this study was to identify occupations and specific exposures associated with respiratory work disability.

Methods

In 2013, a self-administered questionnaire was mailed to a random sample of the general population, aged 16–50, in Telemark County, Norway. We defined respiratory work disability as a positive response to the survey question: 'Have you ever had to change or leave your job because it affected your breathing?' Occupational exposures were assessed using an asthma-specific job-exposure matrix, and comparison of risks was made for cases and a median of 50 controls per case.

Results

247 workers had changed their work because of respiratory symptoms, accounting for 1.7% of the respondents ever employed. The 'breath-taking jobs' were cooks/chefs: adjusted OR 3.6 (95% CI 1.6 to 8.0); welders: 5.2 (2.0 to 14); gardeners: 4.5 (1.3 to 15); sheet metal workers: 5.4 (2.0 to 14); cleaners: 5.0 (2.2 to 11); hairdressers: 6.4 (2.5 to 17); and agricultural labourers: 7.4 (2.5 to 22). Job changes were also associated with a variety of occupational exposures, with some differences between men and women.

Conclusions

Self-report and job-exposure matrix data showed similar findings. For the occupations and exposures associated with job change, preventive measures should be implemented.



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Wooden foreign body in the skull base: How we missed it?

Wooden foreign body in the skull base: How we missed it?

World Neurosurg. 2016 Jun 21;

Authors: Jusué-Torres I, Burks SS, Levine CG, Bhatia RG, Casiano R, Bullock MR

Abstract
BACKGROUND: Timely detection of intraorbital and skull base wooden foreign bodies is crucial. Wooden foreign bodies are difficult to detect on imaging. The radiologist may not identify them in up to two thirds of initial scans and can miss wooden foreign bodies in almost one third of total cases.
CASE DESCRIPTION: A 66 year-old lady sustained a penetrating injury through her left upper eyelid with a small-tree branch. The branch was immediately removed in the field, and she was provided with prompt medical care at a local hospital. Initial CT scan diagnosis was "post-traumatic sinusitis" and treated empirically with Vancomycin and Piperacillin/tazobactam. On the eighth day post injury, she developed progressive swelling and pain of her eyelid with left trigeminal/supraorbital numbness and complete left opthalmoplegia. A new CT scan showed an open "track" from the region of the left upper orbit/superior rectus, to the contralateral sphenoid sinus which raised suspicion for a retained foreign body. Further imaging confirmed the suspicion. Endoscopic sinus surgery was performed with extraction of the wooden object and evacuation of the left orbital infection.
CONCLUSIONS: This case indicates that intraorbital and skull base wooden foreign bodies are elusive; demanding a high index of suspicion from both the clinicians and radiologists to identify retained material in the setting of ocular or sinus trauma. For better identification of wooden foreign bodies bone windows on CT should have a width of -1000 HU with a soft tissue window level of -500 HU.

PMID: 27354291 [PubMed - as supplied by publisher]



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Hope as determinant for psychiatric morbidity in family caregivers of advanced cancer patients

Hope as determinant for psychiatric morbidity in family caregivers of advanced cancer patients:

Abstract

Objective

Home care of advanced cancer patients often has adverse effects on physical and mental health of family caregivers. Little is known about the long-term effects of continuous caregiving on mental health as compared to the effects of bereavement. The objectives of this study were to describe the course of psychiatric morbidity in family caregivers over time, to identify the impact of the patients' death on caregivers, and to explore possible predictor variables for psychiatric morbidity.

Methods

This multi-institutional, prospective study included 80 family caregivers of 80 advanced cancer patients for baseline and nine months follow-up assessment. Possible psychiatric disorders (i.e. depression, anxiety, posttraumatic stress disorder (PTSD), and alcohol abuse/dependence) as well as potentially predictive factors (i.e. socio-demographic factors, burden, hope, and coping mechanisms) were assessed.

Results

Follow-up assessment was conducted on average 9.2 months (±2.9) after baseline assessment. Prevalence rates of anxiety and PTSD decreased significantly over time, whereas depression and alcoholism remained stable. Bereavement was experienced by 53% of caregivers in the follow-up period. The patients' death had no influence on psychiatric morbidity at follow-up. Predictors for the development of a psychiatric disorder varied according to condition, with hope and emotion-oriented coping identified as important influences, especially for anxiety and depression.

Conclusion

Family caregivers with certain psychiatric disorders might need targeted psychosocial support to ensure their mental wellbeing and prevent long-term disability. Supporting hope and functional coping strategies early after the patient's diagnosis might limit development and extent of psychiatric morbidity.

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Use of Adjuvant Therapy For Resected Oropharyngeal SCC

This cohort study uses National Cancer Database data to describe the use of adjuvant chemoradiotherapy and boost radiotherapy for postoperative treatment of oropharyngeal squamous cell carcinoma, and investigates associations between adjuvant treatment and overall survival.

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Thyroarytenoid Botulinum Toxin Type A Injection for Refractory Chronic Cough

This case series describes self-reported outcomes and complications of patients with refractory chronic cough treated with bilateral electromyography-guided thyroarytenoid botulinum toxin type A injection.

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Detection of Occult Papillary Thyroid Cancer Metastasis Using Radioguided Biopsy

This case series describes the ability of SPECT/CT lymphoscintigraphy and radioguided SLN biopsy to detect occult lymph node metastases in patients with papillary thyroid carcinoma, and changes in clinical management in response.

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Diabolical Coughing— Prima Facie Protocols for Diagnosis and Treatment of Medically Jaded Patients

The use of botulinum toxin injection as a new treatment for chronic (neurogenic) cough is new and novel. In an article by Sasieta and colleagues in this issue of JAMA Otolaryngology—Head & Neck Surgery, 22 patients whose chronic coughing had been repeatedly evaluated and treated for many years without benefit received 31 distinct injections of very large doses of botulinum toxin type A (BtxA) into each thyroarytenoid muscle. In this retrospective study, response to treatment was assessed via telephone follow-up using patient self-reporting of percent improvement of cough at 1 and 2 months. The primary outcome of treatment success was defined as a 50% or greater reduction in the patient's subjective perception or assessment of their cough severity.

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Low prevalence of fetal-type posterior cerebral artery in patients with basilar tip aneurysms

Background

Basilar tip aneurysms (BTA) are multifactorial in origin, with luminal forces playing a major role in their formation. Considering the reduced hemodynamic stress on the basilar apex in the fetal-type posterior cerebral artery (fPCA), we hypothesize that BTA should be less common in patients with this variant.

Objective

To investigate, in a retrospective case–control study, the frequency of fPCA in patients with and without BTA.

Materials and methods

We collected clinical and imaging data from consecutive patients with BTA undergoing catheter angiography between July 2010 and July 2015, and from a randomly selected, age- and sex-matched non-BTA control population from our prospective database. Anatomical variants of the distal basilar artery region were assessed in the two groups and compared using parametric and non-parametric tests.

Results

Fifty-nine BTA cases and 337 controls were included. fPCA was present in 3% of patients with BTA and 23% in the control group (p<0.001; OR=0.11, 95% CI 0.03 to 0.48). Basilar tip disposition was cranial in 49% of BTA and 63% of non-BTA cases (p=0.04; OR=0.57, 95% CI 0.33 to 0.99); a caudal disposition was found in 24% and 6% of cases, respectively (p<0.001; OR=4.65, 95% CI 2.21 to 9.80).

Conclusions

We found a statistically significant association between the absence of fPCA and BTA. Our findings underline the importance of hemodynamic stress in the formation of intracranial aneurysms, and suggest that fPCA is a protective variant for formation of BTA.



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(18)F-DOPA PET in medulloblastoma: two case reports.

(18)F-DOPA PET in medulloblastoma: two case reports.

World Neurosurg. 2016 Jun 21;

Authors: Cicone F, Clerico A, Minniti G, Paiano M, Carideo L, Scaringi C, Langen KJ, Scopinaro F

Abstract
BACKGROUND: Medulloblastoma (MDB) is an aggressive embryonal brain tumor, whose underlying altered genetics and biological pathways account for very heterogeneous natural histories and clinical behaviors. PET using radiolabeled amino acids provides important metabolic information for the diagnosis of cerebral glioma but only few data are available on amino acid PET in MDB. In particular, no cases of MDB imaging with 6-[(18)F]-fluoro-L-3,4-dihydroxyphenylalanine (F-DOPA) have previously been described.
CASE DESCRIPTION: Two patients with very different histological subtypes of MDB were referred for F-DOPA PET in order to define the extent and metabolic degree of their diseases. The patients had a newly diagnosed large cell/anaplastic MDB and a fourth relapse of classical MDB, respectively. F-DOPA PET was unremarkable in the first case; F-DOPA uptake was low in the second patient with tumor-to-background ratio as high as 1.29. Comparison was made with magnetic resonance imaging which showed fluid-attenuated inversion recovery (FLAIR) positive diseases. An aggressive tumor growth was shown in the clinical course of both patients.
CONCLUSION: The two case reported here suggest that sensitivity of F-DOPA PET in MDB can be low. However, more comprehensive data are needed to conclude on the overall accuracy of F-DOPA PET in MDB.

PMID: 27354292 [PubMed - as supplied by publisher]

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Replacement of glass particles by multidirectional short glass fibers in experimental composites: Effects on degree of conversion, mechanical properties and polymerization shrinkage

Publication date: Available online 29 June 2016
Source:Dental Materials
Author(s): Anne C.E. Bocalon, Daniela Mita, Isabela Narumyia, Paul Shouha, Tathy A. Xavier, Roberto Ruggiero Braga
ObjectiveTo test the null hypothesis that the replacement of a small fraction of glass particles with random short glass fibers does not affect degree of conversion (DC), flexural strength (FS), fracture toughness (FT) and post-gel polymerization shrinkage (PS) of experimental composites.MethodsFour experimental photocurable composites containing 1 BisGMA:1 TEGDMA (by weight) and 60vol% of fillers were prepared. The reinforcing phase was constituted by barium glass particles (2μm) and 0%, 2.5%, 5.0% or 7.5% of silanated glass fibers (1.4mm in length, 7–13μm in diameter). DC (n=4) was obtained using near-FTIR. FS (n=10) was calculated via biaxial flexural test and FT (n=10) used the "single edge notched beam" method. PS at 5min (n=8) was determined using the strain gage method. Data were analyzed by ANOVA/Tukey test (DC, FS, PS) or Kruskal–Wallis/Dunn's test (FT, alpha: 5% for both tests).ResultsDC was similar among groups (p>0.05). Only the composite containing 5.0% of fibers presented lower FS than the control (p<0.001). FT increased significantly between the control (1.3±0.17MPam0.5) and the composites containing either 5.0% (2.7±0.6MPam0.5) or 7.5% of fibers (2.8±0.6MPam0.5, p<0.001). PS in relation to control was significantly reduced at 2.5% fibers (from 0.81±0.13% to 0.57±0.13%) and further reduced between 5.0% and 7.5% (from 0.42±0.12% to 0.23±0.07%, p<0.001).SignificanceThe replacement of a small fraction of filler particles with glass fibers significantly increased fracture toughness and reduced post-gel shrinkage of experimental composites.



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Stiffness of uncured resin-composites assessed via cavity-packing forces

Publication date: Available online 27 June 2016
Source:Dental Materials
Author(s): Muhammad Kaleem, David C. Watts
ObjectivesTo evaluate the stiffness and packability of unset resin-composites at different temperatures, taking into account the cavity wall effect.Materials and MethodsSix representative commercial resin-composites were selected. Each material was placed in mould of different sizes for example (φ=7, depth=5mm; or φ=3, depth=5mm) held at 26 or 37°C. Maximum packing force (Fp) of the resin-composite was measured. A flat-ended stainless-steel probe with a diameter of either 6mm or 3mm was mechanically lowered onto and into the surface of each unset sample with a speed of 0.50mm/s to a depth of 2mm, which was held constant for 10s. The compressive force produced on the probe by the unset resin-composites was plotted against time and the maximum value was identified (Fp). Peak stress Sp was calculated by dividing the Fp by area of the probe used. Data were analyzed by univariate ANOVA and multiple pair wise comparisons were performed using a Tukey post-hoc test to establish homogenous subsets (at p=0.05).ResultsSp was taken as potential measure of stiffness. It ranged from 0.12 to 4.21MPa and from 0.07 to 3.08MPa at 26 and 37°C, respectively. Univariate ANOVA showed significant influence of the plunger cavity ratios, temperature and materials on Sp (p<0.001). A strong interaction was also found between plunger cavity ratios, temperature and materials for Sp (p<0.05).ConclusionPeak stress Sp is a useful parameter for characterizing the stiffness of uncured resin-composite materials, additionally resin-composite formulation, temperature and wall effect did effect the packability of resin-composite.



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Six-year clinical performance of etch-and-rinse and self-etch adhesives

Publication date: Available online 25 June 2016
Source:Dental Materials
Author(s): Lee W. Boushell, Harald O. Heymann, Andre V. Ritter, John R. Sturdevant, Edward J. Swift, Aldridge D. Wilder, Yunro Chung, Cynthia A. Lambert, Ricardo Walter
ObjectiveTo evaluate the 6-year clinical performance of Xeno IV, Xeno III, and XP Bond adhesives in the restoration of non-carious cervical lesions (NCCLs).MethodsThis was a randomized controlled clinical trial where 39 participants met the inclusion/exclusion criteria and were enrolled. Lesions restored were notch-shaped NCCLs. Prior to adhesive procedures, NCCLs were roughened. No enamel bevel was placed and no mechanical retention was created. Adhesive systems were applied following manufacturer's instructions and the NCCLs were restored with composite resin (TPH3). Restorations were finished immediately after placement and scored with regard to retention, marginal discoloration, marginal adaptation, sensitivity, and secondary caries using modified USPHS criteria. Descriptive statistics were performed. Logistic regression models were performed for each outcome separately with compound symmetry correlation structure where teeth were clustered by participants. All analyses were conducted using SAS 9.2.ResultsThe 6-year recall rate was 77.5% of the restorations (76.9% of the participants). No statistical differences were found between adhesives for retention, marginal discoloration, and marginal adaptation. Restorations failed by loss of retention (16.7%, 27.6%, and 11.8% of Xeno IV, Xeno III, and XP Bond restorations, respectively) and marginal discoloration (7.4% of Xeno IV restorations). For every unit increase in restoration volume it was 1.31 (95%C.I. 1.05, 1.63, P=0.01) times more likely that the restoration retention would be maintained.SignificanceThe tested adhesive systems presented similar clinical performance after six years of service, with annual failure rates of 2.8%, 4.6%, and 2.0% for Xeno IV, Xeno III, and XP Bond, respectively.



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Rapid time to positivity of cerebrospinal fluid culture with coagulase-negative Staphylococcus is more likely to reflect a true infection rather than contamination.

Rapid time to positivity of cerebrospinal fluid culture with coagulase-negative Staphylococcus is more likely to reflect a true infection rather than contamination.

World Neurosurg. 2016 Jun 21;

Authors: Da R, Wu Y, Liu W, Shi H, Wang W

Abstract
OBJECTIVE: Cerebrospinal fluid (CSF) culture is the gold standard for diagnosing post-operative central nervous system (CNS) infection. The time to positivity (TTP) of an automated continuous blood culture system may indicate the original concentration of the organism. Coagulase-negative Staphylococcus (CoNS), the common organism recovered in CSF, poses difficulty to differentiate infection from contamination. This study investigated the TTP of CSF culture with CoNS and its relationship to clinical parameters and prognosis.
METHODS: Adult neurosurgical patients with CoNS who recovered via the use of CSF culture in BacT/ALERT Pediatric FAN blood culture bottles and were admitted from September 2013 to July 2015 were enrolled. The demographics, clinical and microbiological data, and treatment were reviewed, and the TTP of each culture was retrieved.
RESULTS: Thirty-nine adult patients with CoNS recovered from CSF culture were included. The TTP ranged from 7.68 to 57.36 hours (hrs). A univariate logistic regression analysis indicated patients with rapid TTP (<21.5 hrs) compared with those with longer TTP were more likely to be female, demonstrate an effective response to antibiotic therapy within 7 days, have clean-contaminated surgical incisions, and exhibit CSF leak. A multivariate logistic regression analysis indicated that being female, an effective antibiotic therapy within 7 days, and clean-contaminated surgical incisions were independent predictors of rapid TTP.
CONCLUSIONS: Targeted antibiotic therapy was more likely to be beneficial to patients with a rapid TTP within 7 days, which suggested that CoNS with a rapid TTP would represent the pathogen of CNS infection rather than contamination in neurosurgical patients.

PMID: 27354293 [PubMed - as supplied by publisher]



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(18)F-DOPA PET in medulloblastoma: two case reports.

(18)F-DOPA PET in medulloblastoma: two case reports.

World Neurosurg. 2016 Jun 21;

Authors: Cicone F, Clerico A, Minniti G, Paiano M, Carideo L, Scaringi C, Langen KJ, Scopinaro F

Abstract
BACKGROUND: Medulloblastoma (MDB) is an aggressive embryonal brain tumor, whose underlying altered genetics and biological pathways account for very heterogeneous natural histories and clinical behaviors. PET using radiolabeled amino acids provides important metabolic information for the diagnosis of cerebral glioma but only few data are available on amino acid PET in MDB. In particular, no cases of MDB imaging with 6-[(18)F]-fluoro-L-3,4-dihydroxyphenylalanine (F-DOPA) have previously been described.
CASE DESCRIPTION: Two patients with very different histological subtypes of MDB were referred for F-DOPA PET in order to define the extent and metabolic degree of their diseases. The patients had a newly diagnosed large cell/anaplastic MDB and a fourth relapse of classical MDB, respectively. F-DOPA PET was unremarkable in the first case; F-DOPA uptake was low in the second patient with tumor-to-background ratio as high as 1.29. Comparison was made with magnetic resonance imaging which showed fluid-attenuated inversion recovery (FLAIR) positive diseases. An aggressive tumor growth was shown in the clinical course of both patients.
CONCLUSION: The two case reported here suggest that sensitivity of F-DOPA PET in MDB can be low. However, more comprehensive data are needed to conclude on the overall accuracy of F-DOPA PET in MDB.

PMID: 27354292 [PubMed - as supplied by publisher]



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Wooden foreign body in the skull base: How we missed it?

Wooden foreign body in the skull base: How we missed it?

World Neurosurg. 2016 Jun 21;

Authors: Jusué-Torres I, Burks SS, Levine CG, Bhatia RG, Casiano R, Bullock MR

Abstract
BACKGROUND: Timely detection of intraorbital and skull base wooden foreign bodies is crucial. Wooden foreign bodies are difficult to detect on imaging. The radiologist may not identify them in up to two thirds of initial scans and can miss wooden foreign bodies in almost one third of total cases.
CASE DESCRIPTION: A 66 year-old lady sustained a penetrating injury through her left upper eyelid with a small-tree branch. The branch was immediately removed in the field, and she was provided with prompt medical care at a local hospital. Initial CT scan diagnosis was "post-traumatic sinusitis" and treated empirically with Vancomycin and Piperacillin/tazobactam. On the eighth day post injury, she developed progressive swelling and pain of her eyelid with left trigeminal/supraorbital numbness and complete left opthalmoplegia. A new CT scan showed an open "track" from the region of the left upper orbit/superior rectus, to the contralateral sphenoid sinus which raised suspicion for a retained foreign body. Further imaging confirmed the suspicion. Endoscopic sinus surgery was performed with extraction of the wooden object and evacuation of the left orbital infection.
CONCLUSIONS: This case indicates that intraorbital and skull base wooden foreign bodies are elusive; demanding a high index of suspicion from both the clinicians and radiologists to identify retained material in the setting of ocular or sinus trauma. For better identification of wooden foreign bodies bone windows on CT should have a width of -1000 HU with a soft tissue window level of -500 HU.

PMID: 27354291 [PubMed - as supplied by publisher]



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Replacement of glass particles by multidirectional short glass fibers in experimental composites: Effects on degree of conversion, mechanical properties and polymerization shrinkage

Publication date: Available online 29 June 2016
Source:Dental Materials
Author(s): Anne C.E. Bocalon, Daniela Mita, Isabela Narumyia, Paul Shouha, Tathy A. Xavier, Roberto Ruggiero Braga
ObjectiveTo test the null hypothesis that the replacement of a small fraction of glass particles with random short glass fibers does not affect degree of conversion (DC), flexural strength (FS), fracture toughness (FT) and post-gel polymerization shrinkage (PS) of experimental composites.MethodsFour experimental photocurable composites containing 1 BisGMA:1 TEGDMA (by weight) and 60vol% of fillers were prepared. The reinforcing phase was constituted by barium glass particles (2μm) and 0%, 2.5%, 5.0% or 7.5% of silanated glass fibers (1.4mm in length, 7–13μm in diameter). DC (n=4) was obtained using near-FTIR. FS (n=10) was calculated via biaxial flexural test and FT (n=10) used the "single edge notched beam" method. PS at 5min (n=8) was determined using the strain gage method. Data were analyzed by ANOVA/Tukey test (DC, FS, PS) or Kruskal–Wallis/Dunn's test (FT, alpha: 5% for both tests).ResultsDC was similar among groups (p>0.05). Only the composite containing 5.0% of fibers presented lower FS than the control (p<0.001). FT increased significantly between the control (1.3±0.17MPam0.5) and the composites containing either 5.0% (2.7±0.6MPam0.5) or 7.5% of fibers (2.8±0.6MPam0.5, p<0.001). PS in relation to control was significantly reduced at 2.5% fibers (from 0.81±0.13% to 0.57±0.13%) and further reduced between 5.0% and 7.5% (from 0.42±0.12% to 0.23±0.07%, p<0.001).SignificanceThe replacement of a small fraction of filler particles with glass fibers significantly increased fracture toughness and reduced post-gel shrinkage of experimental composites.



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Stiffness of uncured resin-composites assessed via cavity-packing forces

Publication date: Available online 27 June 2016
Source:Dental Materials
Author(s): Muhammad Kaleem, David C. Watts
ObjectivesTo evaluate the stiffness and packability of unset resin-composites at different temperatures, taking into account the cavity wall effect.Materials and MethodsSix representative commercial resin-composites were selected. Each material was placed in mould of different sizes for example (φ=7, depth=5mm; or φ=3, depth=5mm) held at 26 or 37°C. Maximum packing force (Fp) of the resin-composite was measured. A flat-ended stainless-steel probe with a diameter of either 6mm or 3mm was mechanically lowered onto and into the surface of each unset sample with a speed of 0.50mm/s to a depth of 2mm, which was held constant for 10s. The compressive force produced on the probe by the unset resin-composites was plotted against time and the maximum value was identified (Fp). Peak stress Sp was calculated by dividing the Fp by area of the probe used. Data were analyzed by univariate ANOVA and multiple pair wise comparisons were performed using a Tukey post-hoc test to establish homogenous subsets (at p=0.05).ResultsSp was taken as potential measure of stiffness. It ranged from 0.12 to 4.21MPa and from 0.07 to 3.08MPa at 26 and 37°C, respectively. Univariate ANOVA showed significant influence of the plunger cavity ratios, temperature and materials on Sp (p<0.001). A strong interaction was also found between plunger cavity ratios, temperature and materials for Sp (p<0.05).ConclusionPeak stress Sp is a useful parameter for characterizing the stiffness of uncured resin-composite materials, additionally resin-composite formulation, temperature and wall effect did effect the packability of resin-composite.



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Six-year clinical performance of etch-and-rinse and self-etch adhesives

Publication date: Available online 25 June 2016
Source:Dental Materials
Author(s): Lee W. Boushell, Harald O. Heymann, Andre V. Ritter, John R. Sturdevant, Edward J. Swift, Aldridge D. Wilder, Yunro Chung, Cynthia A. Lambert, Ricardo Walter
ObjectiveTo evaluate the 6-year clinical performance of Xeno IV, Xeno III, and XP Bond adhesives in the restoration of non-carious cervical lesions (NCCLs).MethodsThis was a randomized controlled clinical trial where 39 participants met the inclusion/exclusion criteria and were enrolled. Lesions restored were notch-shaped NCCLs. Prior to adhesive procedures, NCCLs were roughened. No enamel bevel was placed and no mechanical retention was created. Adhesive systems were applied following manufacturer's instructions and the NCCLs were restored with composite resin (TPH3). Restorations were finished immediately after placement and scored with regard to retention, marginal discoloration, marginal adaptation, sensitivity, and secondary caries using modified USPHS criteria. Descriptive statistics were performed. Logistic regression models were performed for each outcome separately with compound symmetry correlation structure where teeth were clustered by participants. All analyses were conducted using SAS 9.2.ResultsThe 6-year recall rate was 77.5% of the restorations (76.9% of the participants). No statistical differences were found between adhesives for retention, marginal discoloration, and marginal adaptation. Restorations failed by loss of retention (16.7%, 27.6%, and 11.8% of Xeno IV, Xeno III, and XP Bond restorations, respectively) and marginal discoloration (7.4% of Xeno IV restorations). For every unit increase in restoration volume it was 1.31 (95%C.I. 1.05, 1.63, P=0.01) times more likely that the restoration retention would be maintained.SignificanceThe tested adhesive systems presented similar clinical performance after six years of service, with annual failure rates of 2.8%, 4.6%, and 2.0% for Xeno IV, Xeno III, and XP Bond, respectively.



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Rapid time to positivity of cerebrospinal fluid culture with coagulase-negative Staphylococcus is more likely to reflect a true infection rather than contamination.

Rapid time to positivity of cerebrospinal fluid culture with coagulase-negative Staphylococcus is more likely to reflect a true infection rather than contamination.

World Neurosurg. 2016 Jun 21;

Authors: Da R, Wu Y, Liu W, Shi H, Wang W

Abstract
OBJECTIVE: Cerebrospinal fluid (CSF) culture is the gold standard for diagnosing post-operative central nervous system (CNS) infection. The time to positivity (TTP) of an automated continuous blood culture system may indicate the original concentration of the organism. Coagulase-negative Staphylococcus (CoNS), the common organism recovered in CSF, poses difficulty to differentiate infection from contamination. This study investigated the TTP of CSF culture with CoNS and its relationship to clinical parameters and prognosis.
METHODS: Adult neurosurgical patients with CoNS who recovered via the use of CSF culture in BacT/ALERT Pediatric FAN blood culture bottles and were admitted from September 2013 to July 2015 were enrolled. The demographics, clinical and microbiological data, and treatment were reviewed, and the TTP of each culture was retrieved.
RESULTS: Thirty-nine adult patients with CoNS recovered from CSF culture were included. The TTP ranged from 7.68 to 57.36 hours (hrs). A univariate logistic regression analysis indicated patients with rapid TTP (<21.5 hrs) compared with those with longer TTP were more likely to be female, demonstrate an effective response to antibiotic therapy within 7 days, have clean-contaminated surgical incisions, and exhibit CSF leak. A multivariate logistic regression analysis indicated that being female, an effective antibiotic therapy within 7 days, and clean-contaminated surgical incisions were independent predictors of rapid TTP.
CONCLUSIONS: Targeted antibiotic therapy was more likely to be beneficial to patients with a rapid TTP within 7 days, which suggested that CoNS with a rapid TTP would represent the pathogen of CNS infection rather than contamination in neurosurgical patients.

PMID: 27354293 [PubMed - as supplied by publisher]



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(18)F-DOPA PET in medulloblastoma: two case reports.

(18)F-DOPA PET in medulloblastoma: two case reports.

World Neurosurg. 2016 Jun 21;

Authors: Cicone F, Clerico A, Minniti G, Paiano M, Carideo L, Scaringi C, Langen KJ, Scopinaro F

Abstract
BACKGROUND: Medulloblastoma (MDB) is an aggressive embryonal brain tumor, whose underlying altered genetics and biological pathways account for very heterogeneous natural histories and clinical behaviors. PET using radiolabeled amino acids provides important metabolic information for the diagnosis of cerebral glioma but only few data are available on amino acid PET in MDB. In particular, no cases of MDB imaging with 6-[(18)F]-fluoro-L-3,4-dihydroxyphenylalanine (F-DOPA) have previously been described.
CASE DESCRIPTION: Two patients with very different histological subtypes of MDB were referred for F-DOPA PET in order to define the extent and metabolic degree of their diseases. The patients had a newly diagnosed large cell/anaplastic MDB and a fourth relapse of classical MDB, respectively. F-DOPA PET was unremarkable in the first case; F-DOPA uptake was low in the second patient with tumor-to-background ratio as high as 1.29. Comparison was made with magnetic resonance imaging which showed fluid-attenuated inversion recovery (FLAIR) positive diseases. An aggressive tumor growth was shown in the clinical course of both patients.
CONCLUSION: The two case reported here suggest that sensitivity of F-DOPA PET in MDB can be low. However, more comprehensive data are needed to conclude on the overall accuracy of F-DOPA PET in MDB.

PMID: 27354292 [PubMed - as supplied by publisher]



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Wooden foreign body in the skull base: How we missed it?

Wooden foreign body in the skull base: How we missed it?

World Neurosurg. 2016 Jun 21;

Authors: Jusué-Torres I, Burks SS, Levine CG, Bhatia RG, Casiano R, Bullock MR

Abstract
BACKGROUND: Timely detection of intraorbital and skull base wooden foreign bodies is crucial. Wooden foreign bodies are difficult to detect on imaging. The radiologist may not identify them in up to two thirds of initial scans and can miss wooden foreign bodies in almost one third of total cases.
CASE DESCRIPTION: A 66 year-old lady sustained a penetrating injury through her left upper eyelid with a small-tree branch. The branch was immediately removed in the field, and she was provided with prompt medical care at a local hospital. Initial CT scan diagnosis was "post-traumatic sinusitis" and treated empirically with Vancomycin and Piperacillin/tazobactam. On the eighth day post injury, she developed progressive swelling and pain of her eyelid with left trigeminal/supraorbital numbness and complete left opthalmoplegia. A new CT scan showed an open "track" from the region of the left upper orbit/superior rectus, to the contralateral sphenoid sinus which raised suspicion for a retained foreign body. Further imaging confirmed the suspicion. Endoscopic sinus surgery was performed with extraction of the wooden object and evacuation of the left orbital infection.
CONCLUSIONS: This case indicates that intraorbital and skull base wooden foreign bodies are elusive; demanding a high index of suspicion from both the clinicians and radiologists to identify retained material in the setting of ocular or sinus trauma. For better identification of wooden foreign bodies bone windows on CT should have a width of -1000 HU with a soft tissue window level of -500 HU.

PMID: 27354291 [PubMed - as supplied by publisher]



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Intracerebral hemorrhage, Vagus Nerve Stimulation and Anti-inflammatory response.

Intracerebral hemorrhage, Vagus Nerve Stimulation and Anti-inflammatory response.

World Neurosurg. 2016 Jun 25;

Authors: Welling LC, Welling MS, Teixeira MJ, Figueiredo EG

PMID: 27353559 [PubMed - as supplied by publisher]



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Minimal access posterior approach for extrapleural thoracic sympathectomy: a cadaveric study and cases.

Minimal access posterior approach for extrapleural thoracic sympathectomy: a cadaveric study and cases.

World Neurosurg. 2016 Jun 25;

Authors: Raskin JS, Liu JJ, Sun H, Nemecek A, Balaji S, Raslan AM

Abstract
OBJECTIVE: Operatively, video-assisted thoracoscopic sympathectomy (VATS) involves pleural entry and poses risk in small children, and in patients with pulmonary disease. A conventional posterior sympathectomy is more invasive than VATS. We investigated a cadaveric feasibility study of a minimal access posterior approach for endoscopic extrapleural sympathectomy and discuss this minimal approach in children with cardiac sympathectomy.
METHODS: A posterior endoscopic extrapleural approach for thoracic sympathectomy was performed using lightly embalmed cadavers; surgical corridor depth, width, and associated pleural violation were recorded. Two pediatric cases undergoing secondary prevention for breakthrough cardiac dysrhythmias utilizing this approach are discussed in brief; case 1- a 9-year old female with refractory long QT syndrome, and case 2- a 13-year old male with hypertrophic cardiomyopathy.
RESULTS: The cadaveric study supported 100% identification of cranial-caudal oriented sympathetic chain using an 18 mm tubular retractor, and a 10% pleural violation rate. There were no clinically significant pneumothoracies in either proof of concept cases.
CONCLUSION: Minimal access posterior extrapleural sympathectomy is feasible to expose the sympathetic chain in the thoracic region with good visualization using either endoscopic or microscopic magnification. Single position bilateral thoracic sympathectomy can be performed in pediatric patients with life threatening ventricular arrhythmias. Based on the cadaveric study and the two preliminary cases, we believe a posterior minimal access approach allows safe and effective access to the thoracic sympathetic chain for etiologies requiring sympathectomy using single positioning with minimal risk of pneumothorax or Horner's syndrome.

PMID: 27353558 [PubMed - as supplied by publisher]



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Multiple Osseous Loose Bodies Associated with Lumbar Isthmic Spondylolisthesis.

Multiple Osseous Loose Bodies Associated with Lumbar Isthmic Spondylolisthesis.

World Neurosurg. 2016 Jun 25;

Authors: Takeshima Y, Hanakita J, Takahashi T, Nakase H

Abstract
BACKGROUND: Multiple osseous loose bodies in the lumbar spine have never been reported. We describe a rare surgical case of multiple osseous loose bodies associated with lumbar isthmic spondylolisthesis.
CASE DESCRIPTION: A 74-year-old man who experienced left foot numbness and bilateral gluteal pain was diagnosed with lumbar spondylolisthesis 7 years previously and managed conservatively. He reported recurrence of the left foot numbness 6 months previously, at which time aggressive (rather than conservative) therapy became a consideration. Radiographs of the lumbar spine revealed L5 isthmic spondylolisthesis with dynamic instability at L5/S1. Magnetic resonance imaging (MRI) of the lumbar spine revealed multiple mass lesions dorsally located in the lumbar canal. Computed tomography (CT) myelography demonstrated multiple osseous materials near the isthmic portion at the L5 level where compression of the dural sac by the lesions induced lumbar canal stenosis. The patient underwent posterior decompression surgery that enabled total removal of the osseous lesions. Intraoperative findings revealed osseous lesions located in the fibrocartilage materials and no connection of the lytic portion at the L5 level or ligamentum flavum. Postoperative course of the patient was uneventful as his neurological symptoms improved.
CONCLUSION: We described the first instance of multiple loose bodies in the spinal canal with lumbar canal stenosis. It is presumed that long standing minor trauma due to dynamic instability with a trend of hyper-ossification induced secondary synovial osteochondromatosis forming multiple loose bodies.

PMID: 27353557 [PubMed - as supplied by publisher]



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Bioresorbable Intracranial Sensors: A New Frontier for Neurosurgeons.

Bioresorbable Intracranial Sensors: A New Frontier for Neurosurgeons.

World Neurosurg. 2016 Jun 25;

Authors: Panchanathan R, Aoun RJ, Pines AR, Sattur MG, Welz ME, Swanson K, Bendok BR

PMID: 27353555 [PubMed - as supplied by publisher]



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Outcome after decompressive craniectomy in different pathologies.

Outcome after decompressive craniectomy in different pathologies.

World Neurosurg. 2016 Jun 25;

Authors: Kapapa T, Brand C, Wirtz CR, Woischneck D

Abstract
BACKGROUND: We compare the outcome after decompressive craniectomy for various neurological diseases with the final common pathway of coma, compression of the basal cisterns, a midline shift and/or refractory intracranial hypertension.
METHODS: Between January 2005 and June 2009, 134 patients underwent decompressive craniectomy for traumatic brain injury (N=74), intracerebral haemorrhage (N=21), spontaneous subarachnoid haemorrhage (N=11), malignant cerebral infarction (N=27) or encephalitis (N=1). The outcome was classified at discharge and up to 12 months after treatment in accordance with the Glasgow Outcome Scale (GOS), as well as the Glasgow Coma Scale (GCS), Marshall Classification or National Institute of Health Stroke Scale. Significance was established as p≤0.05.
RESULTS: Median and mean scores on the GCS at time of neurosurgical assessment in all was ≤7. Midline shift was reduced in each subset as a result of surgery (mean 0.26 cm to 0.46 cm (p≤0.049)). Overall outcome based on the median GOS score at discharge ranged from death to severe disability. After 12 months, the median range narrowed to a range of death to persistent vegetative state. At various time-points, mean GOS score was not found to differ significantly between the subsets. Unfavourable outcome after 3 months was found in a smaller group of patients following traumatic brain injury than with other pathologies (p=0.016).
CONCLUSIONS: The outcome after decompressive craniectomy does not differ significantly in different pathologies once the final pathophysiological pathway of refractory intracranial hypertension, coma, compression of the basal cisterns and/or midline shift has been reached.

PMID: 27353556 [PubMed - as supplied by publisher]



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Association between comorbidities, nutritional status, and anticlotting drugs and neurological outcomes in geriatric patients with traumatic brain injury.

Association between comorbidities, nutritional status, and anticlotting drugs and neurological outcomes in geriatric patients with traumatic brain injury.

World Neurosurg. 2016 Jun 25;

Authors: Okazaki T, Hifumi T, Kawakita K, Nakashima R, Matsumoto A, Shishido H, Ogawa D, Okauchi M, Shindo A, Kawanishi M, Tamiya T, Kuroda Y

Abstract
BACKGROUND: Several studies using trauma data banks and registers showed that age, Glasgow Coma Scale (GCS), Injury Severity Score, and intraventricular hemorrhage were independent factors for neurological outcomes in geriatric patients with traumatic brain injury (TBI). However, these analyses did not comprehensively evaluate factors particularly associated with geriatric patients. We aimed to identify factors particularly associated with geriatric patients that affect neurological outcomes in TBI.
METHODS: Patients aged ≥65 years who were hospitalized consecutively in Kagawa University Hospital with severe TBI between January 1, 2008 and October 31, 2015 were retrospectively reviewed. We evaluated background factors particularly associated with geriatric patients, including comorbidities (Charlson comorbidity index; CCI), nutritional status (serum albumin level), and presence/absence of antiplatelet and anticoagulant drugs, in addition to baseline characteristics. Multivariate analyses were performed to identify independent predictors of unfavorable neurological outcomes (UO), as defined as a Glasgow outcome scale score of 1-3 at discharge from hospital. The association between CCI and UO was evaluated in a subgroup analysis.
RESULTS: UO occurred in 65.0% of 140 patients. Multivariate analyses showed that the CCI (odds ratio, 1.91; 95% confidence interval, 1.21-3.29; p = 0.011), age, and GCS were independent predictors of UO. In subgroup analyses of patients with an initial GCS score of 13-15, the rate of UO significantly increased with CCI score (CCI = 0, 35.5%; CCI = 1 or 2, 39.4%; CCI >2, 83.3%; p < 0.01).
CONCLUSIONS: CCI was an independent predictor of UO in geriatric patients with severe TBI.

PMID: 27353554 [PubMed - as supplied by publisher]



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Endovascular Neurosurgery: Personal Experience and Future Perspectives.

Endovascular Neurosurgery: Personal Experience and Future Perspectives.

World Neurosurg. 2016 Jun 25;

Authors: Raymond J

Abstract
BACKGROUND: From Luessenhop's early clinical experience until present day, experimental methods have been introduced to make progress in endovascular neurosurgery.
METHODS: A personal historical narrative, spanning 1980's to 2010's, with a review of past opportunities, current problems, and future perspectives.
RESULTS: While the technology has significantly improved, our clinical culture remains a barrier to methodologically sound and safe innovative care and progress.
CONCLUSION: We must learn how to safely practice endovascular neurosurgery in the presence of uncertainty and verify patient outcomes in real time.

PMID: 27353553 [PubMed - as supplied by publisher]



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Brain Metastasis from Malignant Peripheral Nerve Sheath Tumors.

Brain Metastasis from Malignant Peripheral Nerve Sheath Tumors.

World Neurosurg. 2016 Jun 25;

Authors: Puffer RC, Graffeo C, Mallory GW, Jentoft ME, Spinner RJ

Abstract
INTRODUCTION: Metastatic disease is a well-known sequela of malignant peripheral nerve sheath tumors (MPNSTs). Metastic spread to the brain is unusual.
CASE REPORT: A 56-year-old man was found to have a high grade MPNST of the sciatic nerve. Despite en-bloc excision of the sciatic nerve and local radiation post-operatively, he developed pathologically confirmed systemic metastases: 25 months after the diagnosis he was found to have lung nodules and received chemotherapy; and thirty-two months after initial diagnosis, he presented with left leg weakness and sensory changes and was found to have a lesion of the frontal lobe, received palliative radiation following which he developed systemic metastases and died 35 months after initial presentation.
REVIEW OF A CLINICAL COHORT: We retrospectively reviewed the charts of 179 patients treated at our institution with MPNSTs since 1994. This was the only case of a pathology proven brain metastasis, resulting in an incidence of 0.5%.
DISCUSSION: Literature review revealed 22 total cases. The mean age was found to be 37.5 years, and mean survival after development of a brain metastasis was 9.9 months.
CONCLUSION: Brain metastases from MPNSTs are very rare and represent a poor prognosis, with survival after brain metastasis reported to be approximately 10 months. Early and effective initial diagnosis and treatment of MPNSTs likely represent the best opportunity for increased overall survival.

PMID: 27353552 [PubMed - as supplied by publisher]



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A phase II study of clinical activity of SCH 717454 (robatumumab) in patients with relapsed osteosarcoma and Ewing sarcoma

Abstract

Background

Robatumumab (19D12; MK-7454 otherwise known as SCH717454) is a fully human antibody that binds to and inhibits insulin-like growth factor receptor-1 (IGF-1R). This multiinstitutional study (P04720) determined the safety and clinical efficacy of robatumumab in three separate patient groups with resectable osteosarcoma metastases (Group 1), unresectable osteosarcoma metastases (Group 2), and Ewing sarcoma metastases (Group 3).

Procedure

Robatumumab infusions were administered every 2 weeks and were well tolerated with minimal toxicity. Centrally reviewed response data were available for 144 patients.

Results

Low disease burden was important for osteosarcoma response: three of 31 patients had complete response or partial response (PR) by Response Evaluation Criteria in Solid Tumors (RECIST) in resectable patients (Group 1) versus zero of 29 in unresectable patients (Group 2); median overall survival was 20 months in Group 1 versus 8.2 months in Group 2. In centrally reviewed patients with Ewing sarcoma with PET-CT data (N = 84/115), there were six PR, 23 stable disease, and 55 progression of disease by RECIST at 2 months. Patients with Ewing sarcoma had a median overall survival of 6.9 months. However, responding patients with Ewing sarcoma were allowed to continue on treatment after study closure. A minority of patients with metastatic Ewing sarcoma showed clinical responses and have remained healthy after receiving 25–115 doses of robatumumab with remissions of >4 years duration (N = 6).

Conclusions

These findings show that although the IGF-1R remains an attractive treatment target, additional research is needed to identify responders and/or means to achieve durable remissions in order to successfully exploit IGF-1R signal blockade in Ewing sarcoma (clinicaltrials.gov: NCT00617890).



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El registro íntimo en la literatura y el cine: la adaptación cinematográfica de Bonsái de Alejandro Zambra, por Cristián Jiménez



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Abhidharma in China: reflections on 'Matching meanings' and Xuanxue

This chapter of the volume "Tekst, History, and Philosophy. Abhidharma across Buddhist Scholastic Traditions" discusses the phenomenon of 'Matching Meanings' (Geyi), a technique allegedly used to translate Indian and Central Asian Buddhist Texts into Chinese. Building on previous scholarship, this article formulates a new hypothesis: rather than interpreting 'Geyi' as a technique to make Abhidharma Texts understandable and palatable for the Chinese audience, this article suggests that 'Geyi' should rather be seen as a Neo-Confucian technique to rally Chinese intellectuals under the umbrella of 'Confucianism' after the disunity of the empire of the third to sixth centuries.

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Appearances of Dawla and Political Order in late medieval Syro-Egypt. The state, social theory, and the political history of the Cairo Sultanate (thirteenth-sixteenth centuries)

This paper is a reflexive essay that re-imagines the historical agency of what traditionally tends to be subsumed under the phenomenon of the Mamluk state. It is argued that the notions of state in modern research and of dawla in contemporary texts remain an issue of related analytical confusion. Engaging with this confusion in the generalising fashion of a historical sociology of late medieval Syro-Egyptian political action, this essay proposes an alternative analytical model that is inspired by Michael Chamberlain's prioritisation of social practices of household reproduction and by Timothy Mitchell's related understanding of the state as a structural effect of practices of social differentiation. The proposed model sees sultanic political order —the state— as process, in constant flux as the structural effect and structuring embodiment of constantly changing practices of social reproduction, of elite integration and of political distinction, in contexts that range between multipolar and unipolar social organisation at and around Cairo's court and its military elites. The essay ends with summarily suggesting from this model how the socio-culturally structured and structuring memories of dynastic political order that had remained politically dominant for most of the thirteenth and fourteenth centuries were all but obliterated in the fifteenth century by a new layer of particularly 'Mamluk' socio-political meaning.

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Abhidharma as rational inquiry

This introductory article to the volume "Tekst, History, and Philosophy. Abhidharma across Buddhist Scholastic Traditions" discusses how the Abhidharma genre of Buddhist literature can be interpreted as the result of philosophical debate with, for orginal Indian Buddhism, different indigenous and foreign philosophies and religions. The Abhidharma genre as such is the product of historical and philosophical development.

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Voice symptoms and risk factors for developing voice disorders in future musical actors

Musical theater students follow an intensive program of singing, acting and physical excercises (dancing) and are expected to participate in long rehearsals and full performances. As they are absolutely depending on their vocal quality and vocal capacities for their studies and their future profession, an optimal voice coaching is very important. The purpose of this study was to determine the voice quality, voice symptoms and the risk factors for developing voice problems in future elite vocal performers (musical theater performers). Thirty-one Musical students (7 men and 24 women) with a mean age of 20 years participated to the study. To determine the objective voice quality aerodynamic measurements, voice range profile, acoustic analysis and Dysphonia Severity Index were used. To inventory the voice symptoms and the risk factors for developing voice disorders the Dutch version of the checklists (De Bodt et al. 2008) of Russel et al. (2000) were used. The questionnaires investigate the presence and the frequency (never, daily, weekly, monthly) of voice symptoms and risk factors (vocal abuse, vocal misuse) as reported by the subjects. Psychosocial impact of a voice disorder was investigated using the the Voice Handicap Index and Singing Voice Handicap Index. The mean DSI in male and female Musical theater students was respectively 3.9 and 5.6, both corresponding with an overall good vocal quality. The results of the VHI showed no important psychosocial impact on the speaking voice. Despite the overall good vocal quality, more than 40% experienced voice symptoms on a regular basis. Vocal misuse and abuse was also frequently reported. Videolaryngostroboscopy revealed a high presence of organic and functional voice disorders. Note: The objective vocal quality in this group was presented in a poster at the voice conference in Philadelphia in 2015. This presentation focuses on new data regarding the symptoms and risk factors reported by the subjects.

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El espacio narrativo en la novela chilena postdictatorial. Casas habitadas

In El espacio narrativo en la novela chilena postdictatorial, Bieke Willem undertakes an analysis of the representation of space to identify a change in the poetics of recent fiction in Chile. Through a series of close readings of eight novels by some of Chile's most influential contemporary writers (Eltit, Marín, Bolaño, Fernández, Zambra and Zúñiga), she examines how Chilean authors in the period following the dictatorship deal in a melancholic or nostalgic way with the recent past and with changes in the meaning of space. The book combines reflections on literature, sociology, architecture and urbanism to paint a picture of what it means for these authors to be living in contemporary Chile.

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The impact of a theater performance on the vocal quality of actors

Background: Theater actors are a special group of elite vocal performers where the slightest vocal difficulty can have serious professional consequences. Little is known about the presence of vocal complaints and dysphonia in this group. Aims: The purpose of this study was to investigate vocal quality, vocal complaints and risk factors for developing voice disorders in theater actors. Secondly, the impact of one vocal performance on the voice was investigated by comparing objective and subjective voice quality immediately before and after a theater performance of one and a half hour. Methods and procedures: Speech samples of 26 theater actors (15 men, 11 women) with a mean age of 41.9 years were recorded before and after a theater performance of one and a half hour and analyzed using the software program PRAAT. Speech samples consisted of the combination of sustained phonation and continuous speech. For each speech sample the multiparameter index Acoustic Voice Quality Index was calculated. Auditory perceptual evaluations were performed using the GRBASI scale. Questionnaires were used to inventory vocal symptoms and influencing factors. Outcome and results: Acoustic analysis showed a mean AVQI of 3.48 corresponding with a mild dysphonia. Fifty percent of the theater actors reported having (sometimes or regularly) vocal complaints after a performance. The questionnaire revealed a high presence of vocally violent behavior and poor vocal hygiene habits. Objective vocal quality, measured by the AVQI did not change after a theater performance. The auditory perceptual evaluation of the overall grade of dysphonia showed a subtle amelioration of the vocal quality. Conclusion and implications: The results of this study showed the presence of mild dysphonia, regular vocal complaints and poor vocal hygiene habits in theater actors. A theater performance did not have an impact on the objective vocal quality. Further research is necessary to confirm these preliminary results and to investigate the long-term impact of performing on the objective vocal quality.

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Mental distress detection and triage in forum posts: the LT3 CLPsych 2016 shared task system

This paper describes the contribution of LT3 for the CLPsych 2016 Shared Task on automatic triage of mental health forum posts. Our systems use multiclass Support Vector Machines (SVM), cascaded binary SVMs and ensembles with a rich feature set. The best systems obtain macro-averaged F-scores of 40% on the full task and 80% on the green versus alarming distinction. Multiclass SVMs with all features score best in terms of F-score, whereas feature filtering with bi-normal separation and classifier ensembling are found to improve recall of alarming posts.

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Text, history, and philosophy: Abhidharma across scholastic traditions

Tekst, History, and Philosophy. Abhidharma across Buddhist Scholastic Traditions discusses Abhidharmma / Abhidharma as a specific exegetical method. In the first part of the volume, the development of the Buddhist argumentative technique is discussed. The second part investigates the importance of the Buddhist rational tradition for the development of Buddhist philosophy. The third part focuses on some peculiar doctrinal issues that resulted from rational Abhidharmic reflections. In this way, an outline of the development of the Abhidharma genre and of Abhidharmic notions and Concepts in India, Central Asia, China, and Tibet from the life time of the historical Buddha to the tenth century CE is given.

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Floating universal quantifier as a base-generated head in the VP periphery

The universal quantifier niz in Kavalan can immediately precede its DP associate or appear in a quantifier-floating construction where it is separated from its DP associate. This paper argues that floating niz is not derived from its non-floating counterpart as a result of stranding. They differ morphosyntactically and semantically. First of all, while non-floating niz in a negative sentence exhibits scope reconstruction, floating niz in a negative sentence induces scope-freezing effect. Secondly, floating niz should be analyzed as a full-fledged verb, whereas non-floating niz is a nominal modifier. Thirdly, floating niz is not sensitive to A/A' distinction. Fourthly, floating and non-floating niz can co-occur in a sentence. Finally, floating niz can receive interpretations that are not available to non-floating niz. The differences between floating and non-floating niz indicate that they are derivationally distinct. The fact that floating niz is morphosyntactically realized as a verb further suggests that it is base-generated in a functional head in the VP periphery.

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