Head and Neck Diseases by Alexandros G.Sfakianakis: 01/23/18

Τρίτη 23 Ιανουαρίου 2018

Transfusion practices in traumatic brain injury

Purpose of review The aim of this review is to summarize the recent studies looking at the effects of anemia and red blood cell transfusion in critically-ill patients with traumatic brain injury (TBI), describe the transfusion practice variations observed worldwide, and outline the ongoing trials evaluating restrictive versus liberal transfusion strategies for TBI. Recent findings Anemia is common among critically-ill patients with TBI, it is also thought to exacerbate secondary brain injury, and is associated with an increased risk of poor outcome. Conversely, allogenic red blood cell transfusion carries its own risks and complications, and has been associated with worse outcomes. Globally, there are large reported differences in the hemoglobin threshold used for transfusion after TBI. Observational studies have shown differential results for improvements in cerebral oxygenation and metabolism after red blood cell transfusion in TBI. Summary Currently, there is insufficient evidence to make strong recommendations regarding which hemoglobin threshold to use as a transfusion trigger in critically-ill patients with TBI. There is also uncertainty whether the restrictive transfusion strategy used in general critical care can be extrapolated to acutely brain injured patients. Ultimately, the consequences of anemia-induced cerebral injury need to be weighed up against the risks and complications associated with red blood cell transfusion. Correspondence to Victoria A. McCredie, MBChB, PhD, Department of Critical Care Medicine, 2nd Floor McLaughlin Rm 411-J, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, Canada M5T 2S8. Tel: +1 416 302 1959; e-mail: Victoria.McCredie@uhn.ca Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Staff and family response to end-of-life care in the ICU

Purpose of review End-of-life (EOL) care can be stressful for clinicians as well as patients and their relatives. Decisions to withhold or withdraw life-sustaining therapy vary widely depending on culture, beliefs and organizational norms. The following review will describe the current understanding of the problem and give an overview over interventional studies. Recent findings EOL care is a risk factor for clinician burnout; poor work conditions contribute to emotional exhaustion and intent to leave. The impact of EOL care on families is part of the acute Family Intensive Care Unit Syndrome (FICUS) and the Post Intensive Care Syndrome–Family (PICS-F). Family-centered care (FCC) acknowledges the importance of relatives in the ICU. Several interventions have been evaluated, but evidence for their effectiveness is at best moderate. Some interventions even increased family stress. Interventional studies, which address clinician burnout are rare. Summary EOL care is associated with negative outcomes for ICU clinicians and relatives, but strength of evidence for interventions is weak because we lack understanding of associated factors like work conditions, organizational issues or individual attitudes. In order to develop complex interventions that can successfully mitigate stress related to EOL care, more research is necessary, which takes into account all potential determinants. Correspondence to Dr Konrad Reinhart, ML, Senior Professor, Jena University Hospital, Chairman Global Sepsis Alliance, Paul-Schneider-Street 2, 07747 Jena, Germany. E-mail: konrad.reinhart@med.uni-jena.de Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Pediatric trauma transfusion and cognitive aids

Purpose of review Trauma is the most common cause of pediatric mortality. Much of the research that led to life-saving interventions in adults, however, has not been replicated in the pediatric population. Children have important physiologic and anatomic differences from adults, which impact hemostasis and transfusion. Hemorrhage is a leading cause of death in trauma, and children have important differences in their coagulation profiles. Transfusion strategies, including the massive transfusion protocol and use of antifibrinolytics, are still controversial. In addition to the blood that is lost from the injury itself, trauma leads to inflammation and to a dysfunction in hemostasis, causing coagulopathy. Recent findings In one study in which children suffered from mainly blast and penetrating injuries in a combat setting (PEDTRAX trial), the early administration of tranexamic acid was associated with decreased mortality. Some authors suggest that this result may not apply to blunt trauma, which is much more common in children in noncombat settings. Using thromboelastography to guide the administration of recombinant Factor VIIa has been done in selected cases and may represent a future avenue of research. Summary This article explores new research from the past year in pediatric trauma, starting with the physiologic differences in pediatric red blood cells and coagulation profiles. We also looked at the dramatic change in thinking over the past decade in the tolerable level of anemia in critically ill pediatric patients, as well as scales for determining the need for massive transfusion and exploring if the concepts of damage control resuscitation apply to children. Other strategies, such as avoiding hypothermia, and the selective administration of antifibriniolytics, are important in pediatric trauma as well. Future research that is pediatric focused is needed for the optimal care of our youngest patients. Correspondence: Anna Clebone, MD, Assistant Professor, Department of Anesthesia and Critical Care, University of Chicago, 5841 S. Maryland Ave. MC-4028, Chicago, IL 60637, USA. Tel: +773 702 6700; e-mail: aclebone@dacc.uchicago.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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Spirituality at the end of life

Purpose of review There is increasing emphasis on medical care of the whole patient. This holistic approach encompasses supporting the spiritual or religious needs of the patient. Particularly at the end of life, spiritual concerns may come to the fore as patients recognize and accept their impending death. Physicians may also recognize this spiritual distress but may not be clear on how to provide spiritual support. Recent findings Tools to screen for spiritual concerns are available for physicians to use. Some physicians wish to go further, supporting patients at the end of life in their spiritual quest. Other physicians express concern about causing more distress to patients in a time of significant need. Descriptions of educational tools, as well as the difference between spiritual generalists and spiritual specialists have emerged. Integration of chaplains into the medical team caring for patients at the end of life will also enhance care of the whole patient. Summary The increasing emphasis on whole patient care is leading to increasing focus on spiritual concerns of patients. Although not every patient has an interest in spiritual conversation, most do and medical teams will need to become more educated about appropriate spiritual engagement. Correspondence to Cynthiane J. Morgenweck, MD, MA, Center for Bioethics and Medical Humanities, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA. Tel: +1 414 955 8498; e-mail: cmorg@mcw.edu Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Nutrition Screening and Therapy Within a Surgical Enhanced Recovery Pathway

Perioperative malnutrition has proven to be challenging to define, diagnose, and treat. Despite these challenges, it is well known that suboptimal nutritional status is a strong independent predictor of poor postoperative outcomes. Although perioperative caregivers consistently express recognition of the importance of nutrition screening and optimization in the perioperative period, implementation of evidence-based perioperative nutrition guidelines and pathways in the United States has been quite limited and needs to be addressed in surgery-focused recommendations. The second Perioperative Quality Initiative brought together a group of international experts with the objective of providing consensus recommendations on this important topic with the goal of (1) developing guidelines for screening of nutritional status to identify patients at risk for adverse outcomes due to malnutrition; (2) address optimal methods of providing nutritional support and optimizing nutrition status preoperatively; and (3) identifying when and how to optimize nutrition delivery in the postoperative period. Discussion led to strong recommendations for implementation of routine preoperative nutrition screening to identify patients in need of preoperative nutrition optimization. Postoperatively, nutrition delivery should be restarted immediately after surgery. The key role of oral nutrition supplements, enteral nutrition, and parenteral nutrition (implemented in that order) in most perioperative patients was advocated for with protein delivery being more important than total calorie delivery. Finally, the role of often-inadequate nutrition intake in the posthospital setting was discussed, and the role of postdischarge oral nutrition supplements was emphasized. Accepted for publication October 27, 2017. Funding: The Perioperative Quality Initiative (POQI) meeting received financial assistance from the American Society for Enhanced Recovery (ASER). Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). For the Perioperative Quality Initiative (POQI) 2 Workgroup, see Supplemental Digital Content, Appendix 1, http://ift.tt/2n5LfOn. Reprints will not be available from the authors. Address correspondence to Timothy E. Miller, MB, ChB, FRCA, Division of General, Vascular and Transplant Anesthesia, Duke University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to timothy.miller2@duke.edu. © 2018 International Anesthesia Research Society

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Age Does Not Affect Metoprolol’s Effect on Perioperative Outcomes (From the POISE Database)

BACKGROUND: Perioperative β-blockade reduces the incidence of myocardial infarction but increases that of death, stroke, and hypotension. The elderly may experience few benefits but more harms associated with β-blockade due to a normal effect of aging, that of a reduced resting heart rate. The tested hypothesis was that the effect of perioperative β-blockade is more significant with increasing age. METHODS: To determine whether the effect of perioperative β-blockade on the primary composite event, clinically significant hypotension, myocardial infarction, stroke, and death varies with age, we interrogated data from the perioperative ischemia evaluation (POISE) study. The POISE study randomly assigned 8351 patients, aged ≥45 years, in 23 countries, undergoing major noncardiac surgery to either 200 mg metoprolol CR daily or placebo for 30 days. Odds ratios or hazard ratios for time to events, when available, for each of the adverse effects were measured according to decile of age, and interaction term between age and treatment was calculated. No adjustment was made for multiple outcomes. RESULTS: Age was associated with higher incidences of the major outcomes of clinically significant hypotension, myocardial infarction, and death. Age was associated with a minimal reduction in resting heart rate from 84.2 (standard error, 0.63; ages 45–54 years) to 80.9 (standard error, 0.70; ages >85 years; P

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Using the Ventrain With a Small-Bore Catheter: Ventilation or Just Oxygenation?

No abstract available

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The Effects of Agrin Isoforms on Diabetic Neuropathic Pain in a Rat Streptozotocin Model

BACKGROUND: Diabetes mellitus affects 9.3% of the US population and increases risks of surgery and complications. Diabetic neuropathic pain (DNP), one of the main consequences of diabetes mellitus, is extremely difficult to treat. Current medications yield limited benefits and/or have severe adverse effects. Therefore, new, effective treatment is needed. METHODS: Streptozotocin at 55 mg/kg was injected intraperitoneally in rats to induce diabetes mellitus. Diabetic rats exhibiting neuropathic pain underwent intrathecal injection of purified agrin proteins at various doses and were then tested for tactile allodynia to evaluate whether DNP was inhibited. The agrin effects were also analyzed with patch-clamp recording on spinal cord slices. RESULTS: Fifty–kilo Dalton agrin (Agr50) at 0.2 and 2 ng suppressed DNP when given intrathecally, while 25- and 75-kDa agrin (Agr25, Agr75) had little effect. The suppressive effect of Agr50 lasted 4 hours after a single bolus injection. The difference in effects of Agr50 on mean withdrawal threshold (4.6 ± 2.2 g before treatment to 26 ± 0 g after treatment) compared with that of Agr25 (4.9 ± 2.0 g to 4.9 ± 2.0 g) and Agr75 (5.3 ± 2.3 g to 9.2 ± 2.5 g) was highly significant (P

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Electroencephalography and Brain Oxygenation Monitoring in the Perioperative Period

Maintaining brain function and integrity is a pivotal part of anesthesiological practice. The present overview aims to describe the current role of the 2 most frequently used monitoring methods for evaluation brain function in the perioperative period, ie, electroencephalography (EEG) and brain oxygenation monitoring. Available evidence suggests that EEG-derived parameters give additional information about depth of anesthesia for optimizing anesthetic titration. The effects on reduction of drug consumption or recovery time are heterogeneous, but most studies show a reduction of recovery times if anesthesia is titrated along processed EEG. It has been hypothesized that future EEG-derived indices will allow a better understanding of the neurophysiological principles of anesthetic-induced alteration of consciousness instead of the probabilistic approach most often used nowadays. Brain oxygenation can be either measured directly in brain parenchyma via a surgical burr hole, estimated from the venous outflow of the brain via a catheter in the jugular bulb, or assessed noninvasively by near-infrared spectroscopy. The latter method has increasingly been accepted clinically due to its ease of use and increasing evidence that near-infrared spectroscopy–derived cerebral oxygen saturation levels are associated with neurological and/or general perioperative complications and increased mortality. Furthermore, a goal-directed strategy aiming to avoid cerebral desaturations might help to reduce these complications. Recent evidence points out that this technology may additionally be used to assess autoregulation of cerebral blood flow and thereby help to titrate arterial blood pressure to the individual needs and for bedside diagnosis of disturbed autoregulation. Accepted for publication December 8, 2017. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Reprints will not be available from the authors. Address correspondence to Thomas W. L. Scheeren, MD, PhD, Department of Anaesthesiology, University Medical Center Groningen, PO Box 30 001, 9700 RB Groningen, the Netherlands. Address e-mail to t.w.l.scheeren@umcg.nl. © 2018 International Anesthesia Research Society

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In Response

No abstract available

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Comparison of Intranasal Dexmedetomidine and Oral Pentobarbital Sedation for Transthoracic Echocardiography in Infants and Toddlers: A Prospective, Randomized, Double-Blind Trial

BACKGROUND: Acquisition of transthoracic echocardiographic (TTEcho) images in children often requires sedation. The optimal sedative for TTEcho has not been determined. Children with congenital heart disease are repeatedly exposed to sedatives and anesthetics that may affect brain development. Dexmedetomidine, which in animals alters brain structure to a lesser degree, may offer advantages in this vulnerable population. METHODS: A prospective, randomized, double-blind trial enrolled 280 children 3–24 months of age undergoing outpatient TTEcho, comparing 2.5 µg·kg−1 intranasal dexmedetomidine to 5 mg·kg−1 oral pentobarbital. Rescue sedation, for both groups, was intranasal dexmedetomidine 1 µg·kg−1. The primary outcome was adequate sedation within 30 minutes without rescue sedation, assessed by blinded personnel. Secondary outcomes included number of sonographer pauses, image quality in relation to motion artifacts, and parental satisfaction. RESULTS: Success rates with a single dose were not different between sedation techniques; 85% in the pentobarbital group and 84% in the dexmedetomidine group (P = .8697). Median onset of adequate sedation was marginally faster with pentobarbital (16.5 [interquartile range, 13–21] vs 18 [16–23] minutes for dexmedetomidine [P = .0095]). Time from drug administration to discharge was not different (P = .8238) at 70.5 (64–83) minutes with pentobarbital and 70 (63–82) minutes with dexmedetomidine. Ninety-five percent of sedation failures with pentobarbital and 100% of dexmedetomidine failures had successful rescue sedation with intranasal dexmedetomidine. CONCLUSIONS: Intranasal dexmedetomidine was comparable to oral pentobarbital sedation for TTEcho sedation in infants and did not increase the risk of clinically important adverse events. Intranasal dexmedetomidine appears to be an effective "rescue" sedative for both failed pentobarbital and dexmedetomidine sedation. Dexmedetomidine could be a safer option for repeated sedation in children, but further studies are needed to assess long-term consequence of repeated sedation in this high-risk population. Accepted for publication December 1, 2017. Funding: This research was funded by a grant from the Children's Heart Association of Cincinnati and departmental support. The authors declare no conflicts of interest. Clinical trial registration: NCT02250820. LMA is a registered trademark of Teleflex Incorporated or its affiliates. Reprints will not be available from the authors. Address correspondence to Jeffrey W. Miller, MD, Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2001, Cincinnati, OH. Address e-mail to Jeff.Miller@cchmc.org. © 2018 International Anesthesia Research Society

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Physiological and Anatomical Outputs of Rat Genital Cortex

Abstract

Rat somatosensory genital cortex contains a large sexually monomorphic representation of the penis in males and the clitoris in females. Genital cortex microstimulation-evoked movements of legs, trunk and genitals, which showed sex-specific differences related to mating behaviors and included thrusting in males and lordosis-like movements in females. Erections/tumescence of penis or clitoris could not be evoked, however. Anterograde tracer injections into penis/clitoris cortex revealed eleven corticocortical and 10 subcortical projection targets, which were qualitatively similar in both sexes. Corticocortical genital-cortex-projections innervated about 3% of the cortical surface and most were analog to other somatosensory projections targeting motor cortex, secondary somatosensory cortex, parietal cortex and perirhinal cortex. Corticocortical projections that differed from other parts of somatosensory cortex targeted male scrotum cortex, female vulva cortex, the somatosensory–ear–auditory-cortex-region and the caudal parietal area. Aligning cytoarchitectonic borders with motor topography, sensory genital responses and corticocortical projections identified a candidate region for genital motor cortex. Most subcortical genital-cortex-projections were analog to other thalamic, tectal or pontine projections of somatosensory cortex. Genital-cortex-specific subcortical projections targeted amygdala and nucleus submedius and accumbens. Microstimulation-effects and projections support a sexual function of genital cortex and suggest that genital cortex is a major hub of sexual sensorimotor processing in rodents.

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A Brief History of the Encoding of Hand Position by the Cerebral Cortex: Implications for Motor Control and Cognition

Abstract

Encoding hand position by the cerebral cortex is essential not only for the neural representation of the body image but also for different actions based on eye–hand coordination. These include reaching for visual objects as well as complex movement sequences, such as tea-making, tool use, and object construction, among many others. All these functions depend on a continuous refreshing of the hand position representation, relying on both predictive signaling and afferent information. The hand position influence on neural activity in the parietofrontal system, together with eye position signals, are the basic elements of an eye–hand matrix from which all the above functions can emerge and could be regarded as key features of a network with several entry points, command nodes and outflow pathways, as confirmed by the discovery of a direct parietospinal projection for the control of hand action. The integrity of this system is crucial for daily life, as testified by the consequences of cortical lesions, spanning from severe paralysis to complex forms of apraxia. In this review, I will sketch my personal understanding of the scientific and conceptual trajectory of a line of investigation with many unexpected influences on cortical function and disease, from motor behavior to cognition.

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Presynaptic GABAA Receptors Modulate Thalamocortical Inputs in Layer 4 of Rat V1

Abstract

Fast inhibitory GABAergic transmission plays a fundamental role in neural circuits. Current theories of cortical function assume that fast GABAergic inhibition acts via GABA_A receptors on postsynaptic neurons, while presynaptic effects of GABA depend on GABA_B receptor activation. Manipulations of GABA_A receptor activity in vivo produced different effects on cortical function, which were generally ascribed to the mode of action of a drug, more than its site of action. Here we show that in rodent primary visual cortex, α4-containing GABA_A receptors can be located on subsets of glutamatergic and GABAergic presynaptic terminals and decrease synaptic transmission. Our data provide a novel mechanistic insight into the effects of changes in cortical inhibition; the ability to modulate inputs onto cortical circuits locally, via presynaptic regulation of release by GABA_A receptors.

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On the Neural and Mechanistic Bases of Self-Control

Abstract

Intertemporal choice requires a dynamic interaction between valuation and deliberation processes. While evidence identifying candidate brain areas for each of these processes is well established, the precise mechanistic role carried out by each brain region is still debated. In this article, we present a computational model that clarifies the unique contribution of frontoparietal cortex regions to intertemporal decision making. The model we develop samples reward and delay information stochastically on a moment-by-moment basis. As preference for the choice alternatives evolves, dynamic inhibitory processes are executed by way of asymmetric lateral inhibition. We find that it is these lateral inhibition processes that best explain the contribution of frontoparietal regions to intertemporal decision making exhibited in our data.

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Fear Extinction Recall Modulates Human Frontomedial Theta and Amygdala Activity

Abstract

Human functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) studies, as well as animal studies, indicate that the amygdala and frontomedial brain regions are critically involved in conditioned fear and that frontomedial oscillations in the theta range (4–8 Hz) may support communication between these brain regions. However, few studies have used a multimodal approach to probe interactions among these key regions in humans. Here, our goal was to bridge the gap between prior human fMRI, EEG, and animal findings. Using simultaneous EEG–fMRI recordings 24 h after fear conditioning and extinction, conditioned stimuli presented (CS+E, CS−E) and not presented during extinction (CS+N, CS−N) were compared to identify effects specific to extinction versus fear recall. Differential (CS+ vs. CS−) electrodermal, frontomedial theta (EEG) and amygdala responses (fMRI) were reduced for extinguished versus nonextinguished stimuli. Importantly, effects on theta power covaried with effects on amygdala activation. Fear and extinction recall as indicated by theta explained 60% of the variance for the analogous effect in the right amygdala. Our findings show for the first time the interplay of amygdala and frontomedial theta activity during fear and extinction recall in humans and provide insight into neural circuits consistently linked with top-down amygdala modulation in rodents.

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Cortical Responses to Input From Distant Areas are Modulated by Local Spontaneous Alpha/Beta Oscillations

Abstract

Any given area in human cortex may receive input from multiple, functionally heterogeneous areas, potentially representing different processing threads. Alpha (8–13 Hz) and beta oscillations (13–20 Hz) have been hypothesized by other investigators to gate local cortical processing, but their influence on cortical responses to input from other cortical areas is unknown. To study this, we measured the effect of local oscillatory power and phase on cortical responses elicited by single-pulse electrical stimulation (SPES) at distant cortical sites, in awake human subjects implanted with intracranial electrodes for epilepsy surgery. In 4 out of 5 subjects, the amplitudes of corticocortical evoked potentials (CCEPs) elicited by distant SPES were reproducibly modulated by the power, but not the phase, of local oscillations in alpha and beta frequencies. Specifically, CCEP amplitudes were higher when average oscillatory power just before distant SPES (−110 to −10 ms) was high. This effect was observed in only a subset (0–33%) of sites with CCEPs and, like the CCEPs themselves, varied with stimulation at different distant sites. Our results suggest that although alpha and beta oscillations may gate local processing, they may also enhance the responsiveness of cortex to input from distant cortical sites.

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Free flaps for head and neck cancer in paediatric and neonatal patients

Purpose of review To review recent literature on the subject of free tissue transfer options in paediatric head and neck surgery, with a particular emphasis on highlighting the advantages and disadvantages of different reconstructions in the paediatric patient. Recent findings Free tissue transfer in paediatric patients is predictable and applicable for a wide range of congenital and acquired defects in the head and neck. The free fibula flap is a mainstay of mandibular reconstruction and allows excellent implant-supported prosthodontic rehabilitation and growth potential at the recipient site with little or no donor site morbidity. Other less commonly explored options include the deep circumflex iliac artery flap, scapula flap and medial femoral condyle flap. The gracilis mucle remains the mainstay for facial reanimation with other options including pectoralis minor, rectus abdominis, extensor digitorum brevis and latissimus dorsi. There are compelling arguments for centralization of services and creative strategies in postoperative rehabilitation (e.g. play therapy). Summary Free flaps in paediatric patients are a viable option and may even have advantages relative to adults because of the absence of atherosclerosis, purported lower risk of vasospasm and proportionally larger vessel size. Transfer earlier in life maximizes functional potential and 'normalizes' treatment. Correspondence to Ross Elledge, Specialty Registrar (ST6) in Oral and Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, Queen Elizabeth Hospital, Birmingham B15 2TH, West Midlands, UK. Tel: +44(0)78 758 28359;. E-mail: rosselledge@doctors.net.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Evidence establishing a link between prenatal and early-life stress and asthma development

Purpose of review The objective of this review is to provide an update on our evolving understanding of the effects of stress in pregnancy and during early development on the onset of asthma-related phenotypes across childhood, adolescence, and into early adulthood. Recent findings Accumulating evidence over the past 2 decades has established that prenatal and early-life psychological stress and stress correlates (e.g., maternal anxiety or depression) increase the risk for childhood respiratory disorders. Recent systematic reviews and meta-analyses including numerous prospective epidemiological and case–control studies substantiate a significant effect of prenatal stress and stress in early childhood on the development of wheeze, asthma, and other atopic-related disorders (eczema and allergic rhinitis), with many studies showing an exposure–response relationship. Offspring of both sexes are susceptible to perinatal stress, but effects differ. The impact of stress on child wheeze/asthma can also be modified by exposure timing. Moreover, coexposure to prenatal stress can enhance the effect of chemical stressors, such as prenatal traffic-related air pollution, on childhood respiratory disease risk. Understanding complex interactions among exposure dose, timing, child sex, and concurrent environmental exposures promises to more fully characterize stress effects and identify susceptible subgroups. Although the link between perinatal stress and childhood asthma-related phenotypes is now well established, pathways by which stress predisposes children to chronic respiratory disorders are not as well delineated. Mechanisms central to the pathophysiology of wheeze/asthma and lung growth and development overlap and involve a cascade of events that include disrupted immune, neuroendocrine, and autonomic function as well as oxidative stress. Altered homeostatic functioning of these integrated systems during development can enhance vulnerability to asthma and altered lung development. Summary Mechanistic studies that more comprehensively assess biomarkers reflecting alterations across interrelated stress response systems and associated regulatory processes, in both pregnant women and young children, could be highly informative. Leveraging high-throughput systems-wide technologies to include epigenomics (e.g., DNA methylation, microRNAs), transcriptomics, and microbiomics as well as integrated multiomics are needed to advance this field of science. Understanding stress-induced physiological changes occurring during vulnerable life periods that contribute to chronic respiratory disease risk could lead to the development of preventive strategies and novel therapeutic interventions. Correspondence to Rosalind J. Wright, MD, MPH, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1198, New York, NY 10029, USA. Tel: +1 212 241 5287; fax: +1 212 289 8569; e-mail: rosalind.wright@mssm.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Evidence establishing a link between prenatal and early-life stress and asthma development

Design and preparation of efficient, stable and superhydrophobic copper foam membrane for selective oil absorption and consecutive oil–water separation

Publication date: 15 March 2018
Source:Materials & Design, Volume 142
Author(s): Jian Rong, Tao Zhang, Fengxian Qiu, Jicheng Xu, Yao Zhu, Dongya Yang, Yuting Dai
It is extremely important and challenging to develop an effective device for the continuous separation and recovery of large-scale oil–water mixtures due to their contribution to ecological remediation and contamination control. In this work, a superhydrophobic copper foam with high oil–water separation efficiency was successfully fabricated, which could serve both as oil absorption material and oil–water separation membrane, by in situ self-sacrificial template method combining the subsequent steaming modification. The obtained characterization results present that copper foam possesses large pore structure, micro-/nanoscale two-tier surface roughness, high water contact angle (153.6°), and low sliding angle (4.5°). Experimental results show that as-prepared copper foam could not only rapidly absorb residual oil either on the water surface or underwater, but also separate a series of oils from water, like carbon tetrachloride, trichloromethane, methylbenzene, pump oil and diesel. Furthermore, the separation efficiencies of copper foam on trichloromethane-water and diesel-water mixture were maintained above 96.9% and 90.8% after 10 cycles, respectively. Additionally, as-prepared copper foam exhibits excellent corrosion resistant ability and superior hydrophobic stability. The facile, low-cost and controllable strategy presented herein has a bright future in oil–water separation, and also can be further expanded to prepare various anti-corrosion, self-cleaning and water-proof sport materials.

Graphical abstract

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A simple descriptor for energetics at fcc-bcc metal interfaces

Publication date: 15 March 2018
Source:Materials & Design, Volume 142
Author(s): Linda A. Zotti, Stefano Sanvito, David D. O'Regan
We have developed a new and user-friendly interface energy calculation method that avoids problems deriving from numerical differences between bulk and slab calculations, such as the number of k points along the direction perpendicular to the interface. We have applied this to 36 bcc-fcc metal interfaces in the (100) orientation and found a clear dependence of the interface energy on the difference between the work functions of the two metals, on the one hand, and the total number of d electrons on the other. Greater mechanical deformations were observed in fcc crystals than in their bcc counterparts. For each bcc metal, the interface energy was found to follow the position of its d band, whereas the same was not observed for fcc.

Graphical abstract

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Experimental and theoretical analysis of microstructural evolution and deformation behaviors of CuW composites during equal channel angular pressing

Publication date: 15 March 2018
Source:Materials & Design, Volume 142
Author(s): Wenge Chen, Pei Feng, Longlong Dong, Bing Liu, Shuxin Ren, Yongqing Fu
CuW composites were synthesized using an equal channel angular pressing (ECAP) technique. Microstructural evolution during sintering process was investigated using both optical microscopy and transmission electron microscopy (TEM), and their deformation mechanisms were studied using finite element analysis (FEA). Results showed severe plastic deformation of the CuW composites and effective refinement of W grains after the ECAP process. TEM observation revealed that the ECAP process resulted in lamellar bands with high densities dislocations inside the composites. Effects of extrusion temperature and extrusion angles on stress-strain relationship and sizes of deformation zones after the ECAP process were investigated both theoretically and experimentally. When the extrusion angle was 90°, a maximum equivalent stress of ~1001 MPa was obtained when the extrusion test was done at room temperature of 22 °C, and this value was lower than compression strength of the CuW composites (1105.43 MPa). The maximum equivalent strains were varied between 0.5 and 0.7. However, when the extrusion temperature was increased to 550 °C and further to 900 °C, the maximum equivalent stresses were decreased sharply, with readings of 311 MPa and 68 MPa, respectively. When the extrusion angle was increased to 135°, the maximum equivalent stresses were found to be 716.9 MPa, 208 MPa, and 32 MPa for the samples extruded at temperatures of 22 °C, 550 °C and 900 °C, respectively. Simultaneously, the maximum equivalent strains were decreased to 0.2–0.4. Furthermore, results showed that the maximum equivalent stress was located on the sample's external surface and the stress values were gradually decreased from the surface to the center of samples, and the magnitudes of plastic deformation zones at the surface were much larger than those at the central part of the sintered samples. FEA simulation results were in good agreements with experimentally measured ones.

Graphical abstract

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Influence of manganese content on ε-/α′-martensitic transformation and tensile properties of low-C high-Mn TRIP steels

Publication date: 15 March 2018
Source:Materials & Design, Volume 142
Author(s): Xing Li, Liqing Chen, Yang Zhao, Raja Devesh Kumar Misra
Low carbon steels containing 15–19 wt% Mn were processed to study the influence of Mn content on the thermally induced and deformation-induced ε-/α′-martensitic transformation and tensile properties of high-Mn TRIP steels. The stability of austenite and ε-martensite was studied in terms of thermodynamics, and the work hardening behavior during tensile deformation was divided into two stages using Hollomon analysis. The results indicated that Mn increased the stability of austenite and ε-martensite and austenite grain refinement had a larger effect on γ → ε than γ → α′ transformation. During early stages of tensile deformation, the steel having ~15 wt% Mn continued the γ → ε, ε → α′ and γ → α′ transformation because deformation energy compensated the Gibbs free energy required for phase transformation. But α′-martensitic transformation was difficult in steel having ~19 wt% Mn even after fracture because of the high stability of ε-martensite. On account of high density of dislocations in α′-martensite, the dynamic strain aging process was obvious when deformation-induced α′-martensitic transformation occurred in steel. The significant α′-martensitic transformation and intense dynamic strain aging improved work hardening exponent and ultimate tensile strength of steel, while the coordinated transformation of γ → ε and ε → α′ during tensile deformation was beneficial to improve ultimate elongation.

Graphical abstract

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Celiac disease associated with aplastic anemia in a 6-year-old girl: a case report and review of the literature

Celiac disease may present with hematological abnormalities including long-standing anemia. Both aplastic anemia and celiac disease have a similar underlying autoimmune process but an association between the t...

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Payback: The Custom of Assault and Rape of Sistergirls and Brotherboys; Australia's Trans and Sex/Gender Diverse First Peoples

Violence and Gender , Vol. 0, No. 0.

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Motor skills intervention research of children with disabilities

Publication date: March 2018
Source:Research in Developmental Disabilities, Volume 74
Author(s): Jason C. Bishop, Melissa Pangelinan
BackgroundPhysical inactivity and obesity among children with physical and cognitive disabilities is an emerging public health issue. Children's motor skill development is a determinant of lifelong physical activity and obesity.AimsThe purpose of this article is to critically evaluate motor skill intervention literature among children with physical and cognitive disabilities.Methods and proceduresElectronic searches were completed to identity research articles published from 1984 to 2014. Major findings were categorized among subtopics including characteristics of intervention studies, research designs, diagnostic method, motor skill interventions and motor skill outcome.Outcomes and results21 studies were found and included participants with developmental delay (42.8%), autism (19.0%), cross-disability (19.0%), intellectual disability (4.8%), cerebral palsy (4.8%), developmental coordination disorder (4.8%), and learning disabilities (4.8%). Only one study was a randomized controlled trial.Conclusionsand implications: The current literature on motor skill intervention research is broad in scope and has limited generalizability within and across disability groups. Future research is needed to develop cross-disability intervention methods adaptable to disability and function-specific needs, including the utilization of rapidly developing technology. Researchers are encouraged to utilize sound methodology with robust theoretical foundations. Family and community engagement is encouraged in intervention delivery.

http://ift.tt/2E2MG7G

Handwriting difficulties in children with attention deficit hyperactivity disorder (ADHD)

Publication date: March 2018
Source:Research in Developmental Disabilities, Volume 74
Author(s): Agnese Capodieci, Simona Lachina, Cesare Cornoldi
Handwriting is fundamental in school and everyday life situations. Legibility guarantees that writing productions communicate information, and speed is often crucial, especially in children with attention deficit and hyperactivity disorder (ADHD), in order to increase the likelihood of their being able to work efficiently and stay on-task during school activities. Preliminary reports have shown an impairment in handwriting of children with ADHD, but evidence is still unclear, especially in the case of speed where research has offered contradictory results. Children's performance, furthermore, has yet to be investigated under the cognitive loading conditions typical of academic tasks in classroom. To shed light on this matter, we examined the handwriting performance in a simple condition but also under (verbal or spatial) working memory (WM) load in 16 fourth- and fifth-grade children with symptoms of ADHD and 16 matched control children. Our results showed that the groups speed differed significantly only in the verbal WM loading condition, where children with symptoms of ADHD wrote more slowly and showed a greater intra-individual variability than controls. Handwriting legibility was affected by verbal WM loading too. These findings are discussed in relation to their educational and clinical implications.

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Examination of gait parameters during perturbed over-ground walking in children with autism spectrum disorder

Publication date: March 2018
Source:Research in Developmental Disabilities, Volume 74
Author(s): Jeffrey D. Eggleston, Merrill R. Landers, Barry T. Bates, Ed Nagelhout, Janet S. Dufek
BackgroundMany children with Autism Spectrum Disorder (ASD) are school-aged and typically carry a backpack. It is important to understand how this task affects walking. Weighted vests (WVs) often prescribed to mitigate behavioral effects of ASD. The effects of backpack and WV walking have not been examined in children with ASD.AimsTo quantify differences in lower extremity mechanics in children with ASD during WV and backpack walking.MethodsEight male participants completed 15 trials in three conditions: body mass, and carrying or wearing a backpack or WV with 15% added body mass. Three-dimensional kinematic data were collected and normalized to 100% of the gait cycle. The Model Statistic was utilized to test for bilateral asymmetries between the lower extremity joints at all points along the gait cycle.ResultsAnalysis revealed similar numbers of significant asymmetries in hip (71.0, 70.4, 60.6), knee (68.4, 71.5, 74.6), and ankle (64.1, 68.9, 68.4) for unloaded, backpack, and WV, respectively.ConclusionParticipants exhibited individualized kinematic symmetry-responses to the loaded conditions compared to the unloaded condition. These findings suggest that 15% body mass backpack or WV does not affect gait symmetry in children with ASD.

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A Group Lifestyle Intervention Program Is Associated with Reduced Emergency Department Presentations for People with Metabolic Syndrome: A Retrospective Case–Control Study

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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Relationship of Circulating miRNAs with Insulin Sensitivity and Associated Metabolic Risk Factors in Humans

Metabolic Syndrome and Related Disorders , Vol. 0, No. 0.

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Cover Image

The cover image, by P. Aïdan et al., is based on the Technical Note Bilateral vagal automatic periodic stimulation in single-incision transaxillary robotic total thyroidectomy, DOI 10.1111/coa.12698.

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Author Guidelines

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Issue Information

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Endoscopic ultrasonography (EUS)-guided laser ablation (LA) of adrenal metastasis from pancreatic adenocarcinoma

Abstract

Endoscopic ultrasonography (EUS)-guided laser ablation (LA) is potentially applicable to tumours in the left lobe of the liver and pancreas. This report seeks to introduce the novel use of EUS-guided LA for left adrenal metastases from pancreatic adenocarcinoma. A 70-year-old female was referred to our hospital for dull abdominal pain and tiredness for 1 month. Computed tomography (CT) discovered a 1.0 × 1.7 cm mass in the area of the left adrenal gland. The lesion was highly suspicious for metastasis due to her history of pancreatic adenocarcinoma 1 year ago, which was removed through radical surgery. Intraoperative frozen-section pathology revealed a tumour invading the left adrenal gland. The left adrenal mass was clearly visualised on EUS and exhibited irregular hyper-enhancement during contrast. The tumour was successfully treated by four sessions of EUS-guided LA. After the procedure, symptomatic relief was achieved and remained. At the 4-month follow-up, contrast-enhanced CT revealed that the volume of the target was significantly decreased. Here, we introduced a new method for left adrenal metastasis using thermal ablation through EUS. As a potential alternative access to the percutaneous approach, EUS-guided LA may provide a minimally invasive treatment to relieve the tumour burdens and symptoms when applied accurately.

http://ift.tt/2DyTgFX

Direct augmented reality computed tomographic angiography technique (ARC): an innovation in preoperative imaging

Abstract

Background

Since the advent of free tissue transfer approximately 40 years ago, constant improvement particularly in the preoperative planning phase has led to flap success rate reaching 99% and improved patient outcomes. The use of imaging, such as computed tomographic angiography (CTA) or magnetic resonance angiography (MRA), for preoperative planning is now routine. However, current image modalities are restricted by being represented in two dimensions (2D) and have led to clinicians seeking novel methods of utilising the scan data, such as augmented (AR) or virtual reality (VR) and holograms. These mixed-reality devices facilitate a natural mode of visual perception and have the capacity to introduce tactile feedback. However, most AR devices are currently expensive, bulky and complicated and require tedious image registration processes. We illustrate our projector-based direct AR technique using CTA, or ARC, for preoperative planning.

Methods

Our bespoke ARC method consists of compact, affordable hardware (MacBook, Philips pocket projector and a 15-cm ruler) and free, open-source software (OsiriX). We have utilised this technique in six cases of perforator flaps of the thigh and abdomen (anterolateral thigh (ALT), transverse upper gracilis (TUG) and deep inferior epigastric artery perforator (DIEP) flaps.

Results

In all cases, 3D-reconstructed images of perforators from CTA were accurately projected onto the donor site. System calibration was rapid and convenient to use.

Conclusions

We illustrate a novel technique of projector-based AR CTA (or ARC) for preoperative planning in perforator flaps. The technique is affordable and readily reproducible.

Level of Evidence: Level IV, diagnostic study.

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Bridge flap repair for central nasal dorsum defect

Abstract

Surgery of the nose to remove skin cancer often requires the use of local flaps. We present a defect after the extirpation of a previously incompletely excised infiltrative squamous cell carcinoma, which we repaired with a Bridge flap, a bipedicled and subcutaneous islanded flap whose excellent vascularity allows reliable reconstruction and rapid mobilisation, with dependable results.

http://ift.tt/2n6SqpT

Hidradenitis suppurativa, a review of pathogenesis, associations and management. Part 2

Abstract

Hidradenitis suppurativa is a chronic, painful, autoinflammatory condition resulting in nodules, abscesses and sinus tracts. We present an evidence-based review providing new understanding of the pathogenesis of hidradenitis suppurativa and associated comorbidities. By the nature of their speciality, dermatologists are uniquely positioned to investigate and treat patients.

http://ift.tt/2Bp6nU8

"Ann Rehabil Med"[jour]; +24 new citations

24 new pubmed citations were retrieved for your search. Click on the search hyperlink below to display the complete search results:

"Ann Rehabil Med"[jour]

These pubmed results were generated on 2018/01/23

PubMed comprises more than millions of citations for biomedical literature from MEDLINE, life science journals, and online books. Citations may include links to full-text content from PubMed Central and publisher web sites.

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Bridge flap repair for central nasal dorsum defect

Abstract

http://ift.tt/2n6SqpT

Hidradenitis suppurativa, a review of pathogenesis, associations and management. Part 2

Abstract

http://ift.tt/2Bp6nU8

Case of victims of modern imaging technology: Increased information noise concealing the diagnosis.

Case of victims of modern imaging technology: Increased information noise concealing the diagnosis.

World J Radiol. 2017 Dec 28;9(12):454-458

Authors: Mahajan A, Santhoshkumar GV, Kawthalkar AS, Vaish R, Sable N, Arya S, Desai S

Abstract
We present a case of tubercular arthritis who underwent numerous unnecessary investigations what is known as "victims of modern imaging technology" or VOMIT. Today there is an exponential rise in the volume of the medical imaging, part of which is contributed by unnecessary and unjustified indications. We discuss about the untoward effects of the uninhibited and careless use of modern imaging modalities and possible ways to avoid. Skeletal manifestation of the tuberculosis is still common in the endemic countries like India. Although the final diagnosis of the skeletal tuberculosis like tubercular arthritis is made by bacteriological and histological studies, few demographic, clinical and radiological features might help making early diagnosis.

PMID: 29354211 [PubMed]

http://ift.tt/2rySSSk

Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion: Case report and imaging perspective.

Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion: Case report and imaging perspective.

World J Radiol. 2017 Dec 28;9(12):448-453

Authors: Gavito-Higuera J, Khatri R, Qureshi IA, Maud A, Rodriguez GJ

Abstract
Hypoperfusion injury related to blood pressure decrease in acute hypertensive intracerebral hemorrhage continues to be a controversial topic. Aggressive treatment is provided with the intent to stop the ongoing bleeding. However, there may be additional factors, including autoregulation and increased intracranial pressure, that may limit this approach. We present here a case of acute hypertensive intracerebral hemorrhage, in which aggressive blood pressure management to levels within the normal range led to global cerebral ischemia within multiple border zones. Global cerebral ischemia may be of concern in the management of hypertensive hemorrhage in the presence of premorbid poorly controlled blood pressure and increased intracranial pressure.

PMID: 29354210 [PubMed]

http://ift.tt/2G9xYwj

Imaging features of intrathoracic complications of lung transplantation: What the radiologists need to know.

Imaging features of intrathoracic complications of lung transplantation: What the radiologists need to know.

World J Radiol. 2017 Dec 28;9(12):438-447

Authors: Chia E, Babawale SN

Abstract
Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transplant recipients are still at a high risk of developing post-operative complications which tend to impact negatively the patients' outcome if not recognised early. The recognised complications post lung transplantation can be broadly categorised into acute and chronic complications. Recognising the radiological features of these complications has a significant positive impact on patients' survival post transplantation. This manuscript provides a comprehensive review of the radiological features of post lung transplantations complications over a time continuum.

PMID: 29354209 [PubMed]

http://ift.tt/2rySIuc

Dynamic contrast-enhanced magnetic resonance imaging of prostate cancer: A review of current methods and applications.

Dynamic contrast-enhanced magnetic resonance imaging of prostate cancer: A review of current methods and applications.

World J Radiol. 2017 Dec 28;9(12):416-425

Authors: Mazaheri Y, Akin O, Hricak H

Abstract
In many areas of oncology, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has proven to be a clinically useful, non-invasive functional imaging technique to quantify tumor vasculature and tumor perfusion characteristics. Tumor angiogenesis is an essential process for tumor growth, proliferation, and metastasis. Malignant lesions demonstrate rapid extravasation of contrast from the intravascular space to the capillary bed due to leaky capillaries associated with tumor neovascularity. DCE-MRI has the potential to provide information regarding blood flow, areas of hypoperfusion, and variations in endothelial permeability and microvessel density to aid treatment selection, enable frequent monitoring during treatment and assess response to targeted therapy following treatment. This review will discuss the current status of DCE-MRI in cancer imaging, with a focus on its use in imaging prostate malignancies as well as weaknesses that limit its widespread clinical use. The latest techniques for quantification of DCE-MRI parameters will be reviewed and compared.

PMID: 29354207 [PubMed]

http://ift.tt/2rwNxuB

Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion: Case report and imaging perspective.

Aggressive blood pressure treatment of hypertensive intracerebral hemorrhage may lead to global cerebral hypoperfusion: Case report and imaging perspective.

World J Radiol. 2017 Dec 28;9(12):448-453

Authors: Gavito-Higuera J, Khatri R, Qureshi IA, Maud A, Rodriguez GJ

PMID: 29354210 [PubMed]

http://ift.tt/2G9xYwj

Imaging features of intrathoracic complications of lung transplantation: What the radiologists need to know.

Imaging features of intrathoracic complications of lung transplantation: What the radiologists need to know.

World J Radiol. 2017 Dec 28;9(12):438-447

Authors: Chia E, Babawale SN

PMID: 29354209 [PubMed]

http://ift.tt/2rySIuc

Endovascular treatment of pulmonary embolism: Selective review of available techniques.

Endovascular treatment of pulmonary embolism: Selective review of available techniques.

World J Radiol. 2017 Dec 28;9(12):426-437

Authors: Nosher JL, Patel A, Jagpal S, Gribbin C, Gendel V

Abstract
Acute pulmonary embolism (PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team.

PMID: 29354208 [PubMed]

http://ift.tt/2GdE4fi

Dynamic contrast-enhanced magnetic resonance imaging of prostate cancer: A review of current methods and applications.

Dynamic contrast-enhanced magnetic resonance imaging of prostate cancer: A review of current methods and applications.

World J Radiol. 2017 Dec 28;9(12):416-425

Authors: Mazaheri Y, Akin O, Hricak H

PMID: 29354207 [PubMed]

http://ift.tt/2rwNxuB

Intraparenchymal Atypical Meningioma in Basal Ganglia Region in a Child: Case Report and Literature Review.

Intraparenchymal Atypical Meningioma in Basal Ganglia Region in a Child: Case Report and Literature Review.

J Korean Neurosurg Soc. 2018 Jan;61(1):120-126

Authors: Liu X, Zhang Y, Zhang S, Tao C, Ju Y

Abstract
Intraparenchymal meningiomas without dural attachment are extremely rare, especially when they occur in basal ganglia region in child. An 8-year-old boy was admitted at our hospital, complaining of recurrent headache and vomiting for 3 months. Neurological examination showed impaired vision and mild paresis of the left extremities. Magnetic resonance imaging demonstrated a lesion located in the right basal ganglia region extending to superasellar cistern with solid, multiple cystic and necrotic components. Computed tomography revealed calcification within the mass. Due to the anterior cerebral artery involvement, a subtotal resection was achieved and postoperative radiotherapy was recommended. Histopathological examination indicated that the lesion was an atypical meningioma. The postoperative rehabilitation was uneventful. Mildly impaired vision and motor weakness of left extremities improved significantly and the patient returned to normal life after surgery. To our knowledge, intraparenchymal atypical meningioma in basal ganglia extending to superasellar cistern was never reported. The significance in differential diagnosis of lesions in basal ganglia should be emphasized.

PMID: 29354244 [PubMed]

http://ift.tt/2ryQKtO

Posterior Screw Fixation in Previously Augmented Vertebrae with Bone Cement: Is It Inapplicable?

Posterior Screw Fixation in Previously Augmented Vertebrae with Bone Cement: Is It Inapplicable?

J Korean Neurosurg Soc. 2018 Jan;61(1):114-119

Authors: Park JH, Ju CI, Kim SW

Abstract
Objective: The purpose of this study was to determine the feasibility of screw fixation in previously augmented vertebrae with bone cement. We also investigated the influence of cement distribution pattern on the surgical technique.
Methods: Fourteen patients who required screw fixation at the level of the previous percutaneous vertebroplasty or balloon kyphoplasty were enrolled in this study. The indications for screw fixation in the previously augmented vertebrae with bone cement included delayed complications, such as cement dislodgement, cement leakage with neurologic deficits, and various degenerative spinal diseases, such as spondylolisthesis or foraminal stenosis. Clinical outcomes, including pain scale scores, cement distribution pattern, and procedure-related complications were assessed.
Results: Three patients underwent posterior screw fixation in previously cemented vertebrae due to cement dislodgement or progressive kyphosis. Three patients required posterior screw fixation for cement leakage or displacement of fracture fragments with neurologic deficits. Eight patients underwent posterior screw fixation due to various degenerative spinal diseases. It was possible to insert screws in the previously augmented vertebrae regardless of the cement distribution pattern; however, screw insertion was more difficult and changed directions in the patients with cemented vertebrae exhibiting a solid pattern rather than a trabecular pattern. All patients showed significant improvements in pain compared with the preoperative levels, and no patient experienced neurologic deterioration as seen at the final follow-up.
Conclusion: For patients with vertebrae previously augmented with bone cement, posterior screw fixation is not a contraindication, but is a feasible option.

PMID: 29354243 [PubMed]

http://ift.tt/2GasrFZ

Geographic Analysis of Neurosurgery Workforce in Korea.

Geographic Analysis of Neurosurgery Workforce in Korea.

J Korean Neurosurg Soc. 2018 Jan;61(1):105-113

Authors: Park HR, Park SQ, Kim JH, Hwang JC, Lee GS, Chang JC

Abstract
Objective: In respect of the health and safety of the public, universal access to health care is an issue of the greatest importance. The geographic distribution of doctors is one of the important factors contributing to access to health care. The aim of this study is to assess the imbalances in the geographic distribution of neurosurgeons across Korea.
Methods: Population data was obtained from the National Statistical Office. We classified geographic groups into 7 metropolitan cities, 78 non-metropolitan cities, and 77 rural areas. The number of doctors and neurosurgeons per 100000 populations in each county unit was calculated using the total number of doctors and neurosurgeons at the country level from 2009 to 2015. The density levels of neurosurgeon and doctor were calculated and depicted in maps.
Results: Between 2009 and 2015, the number of neurosurgeons increased from 2002 to 2557, and the ratio of neurosurgeons per 100000 populations increased from 4.02 to 4.96. The number of neurosurgeons per 100000 populations was highest in metropolitan cities and lowest in rural areas from 2009 to 2015. A comparison of the geographic distribution of neurosurgeons in 2009 and 2015 showed an increase in the regional gap. The neurosurgeon density was affected by country unit characteristics (p=0.000).
Conclusion: Distribution of neurosurgeons throughout Korea is uneven. Neurosurgeons are being increasingly concentrated in a limited number of metropolitan cities. This phenomenon will need to be accounted when planning for a supply of neurosurgeons, allocation of resources and manpower, and the provision of regional neurosurgical services.

PMID: 29354242 [PubMed]

http://ift.tt/2ryQISI

The Potential of Diffusion-Weighted Magnetic Resonance Imaging for Predicting the Outcomes of Chronic Subdural Hematomas.

The Potential of Diffusion-Weighted Magnetic Resonance Imaging for Predicting the Outcomes of Chronic Subdural Hematomas.

J Korean Neurosurg Soc. 2018 Jan;61(1):97-104

Authors: Lee SH, Choi JI, Lim DJ, Ha SK, Kim SD, Kim SH

Abstract
Objective: Diffusion-weighted magnetic resonance imaging (DW-MRI) has proven useful in the study of the natural history of ischemic stroke. However, the potential of DW-MRI for the evaluation of chronic subdural hematoma (CSDH) has not been established. In this study, we investigated DW-MRI findings of CSDH and evaluated the impact of the image findings on postoperative outcomes of CSDH.
Methods: We studied 131 CSDH patients who had undergone single burr hole drainage surgery. The images of the subdural hematomas on preoperative DW-MRI and computed tomography (CT) were divided into three groups based on their signal intensity and density: 1) homogeneous (iso or low) density on CT and homogeneous low signal intensity on DW-MRI; 2) homogeneous (iso or low) density on CT and mixed signal intensity on DW-MRI; and 3) heterogeneous density on CT and mixed signal intensity on DW-MRI. On the basis of postoperative CT, we also divided the patients into 3 groups of surgical outcomes according to residual hematoma and mass effect.
Results: Analysis showed statistically significant differences in surgical (A to B: p<0.001, A to C: p<0.001, B to C: p=0.129) and functional (A to B: p=0.039, A to C: p<0.001, B to C: p=0.108) outcomes and treatment failure rates (A to B: p=0.037, A to C: p=0.03, B to C: p=1) between the study groups. In particular, group B and group C showed worse outcomes and higher treatment failure rates than group A.
Conclusion: CSDH with homogeneous density on CT was characterized by signal intensity on DW-MRI. In CSDH patients, performing DW-MRI as well as CT helps to predict postoperative treatment failure or complications.

PMID: 29354241 [PubMed]

http://ift.tt/2G6VN7T

Morphometric Study of the Lumbar Posterior Longitudinal Ligament.

Morphometric Study of the Lumbar Posterior Longitudinal Ligament.

J Korean Neurosurg Soc. 2018 Jan;61(1):89-96

Authors: Lee SB, Chang JC, Lee GS, Hwang JC, Bae HG, Doh JW

Abstract
Objective: Morphometric data for the lumbar posterior longitudinal ligament (PLL) was investigated to identify whether there is a difference in the morphometry of the PLL of the lumbar spine at each level with respect to the pattern of intervertebral disc displacement.
Methods: In 14 formalin-fixed adult cadavers (12 males and 2 females), from L1 to L5, the authors measured the width and height of the PLL and compared them with other landmarks such as the disc and the pedicle.
Results: Horizontally, at the upper margin of the disc, the central portion of the superficial PLL covered 17.8-36.9% of the disc width and the fan-like portion of the PLL covered 63.9-76.7% of the disc width. At the level of the median portion of the disc, the PLL covered 69.1-74.5% of the disc width. Vertically, at the level of the medial margin of the pedicle, the fan-like portion of the PLL covered 23.5-29.9% of the disc height. In general, a significant difference in length was not found in the right-left and male-female comparisons.
Conclusion: This study presents the morphometric data on the pattern of intervertebral disc displacement and helps to improve the knowledge of the surgical anatomy of the lumbar PLL.

PMID: 29354240 [PubMed]

http://ift.tt/2ryQGKA

Comparative Analysis of Spontaneous Infectious Spondylitis : Pyogenic versus Tuberculous.

Comparative Analysis of Spontaneous Infectious Spondylitis : Pyogenic versus Tuberculous.

J Korean Neurosurg Soc. 2018 Jan;61(1):81-88

Authors: Lee Y, Kim BJ, Kim SH, Lee SH, Kim WH, Jin SW

Abstract
Objective: Spondylitis is often chemotherapy resistant and requires long-term treatment. Without adequate chemotherapy, the outcome can be fatal or result in severe neurologic damage. Therefore, differentiating the etiology of spondylitis is very important, particularly in spontaneous cases. As the prevalence of tuberculosis in Korea has decreased in recent years, updated clinical research about spondylitis is warranted.
Methods: From April 2010 to March 2016, data from spondylitis patients were collected retrospectively. In total, 69 patients (51 with pyogenic spondylitis and 18 with tuberculous spondylitis) were included. Clinical data, laboratory findings including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level, measurements of Cobb angles at the initial and final follow-up, and radiologic features on magnetic resonance imaging (MRI) scans were evaluated. To test differences between the pyogenic and tuberculous groups, numerical data were compared using the student's t-test and Mann-Whitney U test, and categorical data were compared using the chi-square test and Fisher's exact test.
Results: The patients' mean age was 60.0 years. Male sex was slightly predominant (56.5%). There was no difference in mean age and sex between the two groups. The pyogenic group had a relatively higher proportion of immunocompromised patients. The peak CRP value was higher in the pyogenic group than in the tuberculous group (14.08 mg/dL and 8.50 mg/dL, respectively, p=0.009), whereas the ESR was not significantly different between the groups (81.5 mm/h and 75.6 mm/h, respectively, p=0.442). Radiologically, the presence of disc space sparing and vertebral body collapse differed between the groups. In the tuberculous group, the disc was more commonly preserved on contrast-enhanced MRI (50% and 23.5%, respectively, p=0.044), and vertebral body collapse was more common (66.6% and 15.7%, respectively, p<0.001). The mean length of hospitalization was longer in the pyogenic group (56.5 days and 41.2 days, respectively, p=0.001). Four mortality cases were observed only in the pyogenic group. The most commonly isolated microorganism in the pyogenic group was Staphylococcus aureus (S. aureus) (methicillin susceptible S. aureus and methicillin resistant S. aureus [MRSA] in 8 and 4 cases, respectively).
Conclusion: The clinical and radiological manifestations of spontaneous spondylitis differ based on the causative organism. Pyogenic spondylitis patients tend to have a higher CRP level and a more severe clinical course, whereas tuberculous spondylitis patients present with destruction of the vertebral body with disc sparing more frequently. The presence of MRSA is increasing in community-acquired spondylitis cases.

PMID: 29354239 [PubMed]

http://ift.tt/2Gaskdx

Freehand S2 Alar-Iliac Screw Placement Using K-Wire and Cannulated Screw : Technical Case Series.

Freehand S2 Alar-Iliac Screw Placement Using K-Wire and Cannulated Screw : Technical Case Series.

J Korean Neurosurg Soc. 2018 Jan;61(1):75-80

Authors: Choi HY, Hyun SJ, Kim KJ, Jahng TA, Kim HJ

Abstract
Objective: Among the various sacropelvic fixation methods, S2 alar-iliac (S2AI) screw fixation has several advantages compared to conventional iliac wing screw. However, the placement of S2AI screw still remains a challenge. The purpose of this study was to describe a novel technique of free hand S2AI screw insertion using a K-wire and cannulated screw, and to evaluate the accuracy of the technique.
Methods: S2AI screw was inserted by free hand technique in sixteen consecutive patients without any fluoroscopic guidance. The gearshift was advanced to make a pilot hole passing through the sacroiliac joint and directing the anterior inferior iliac spine. A K-wire was placed through the pilot hole. After introducing a cannulated tapper along with the K-wire, a cannulated S2AI screw was installed over the K-wire.
Results: Thirty-three S2AI screws were placed in sixteen consecutive patients. Thirty-two screws were cannulated screws, and one screw was a conventional non-cannulated screw. Thirty out of 32 (93.8%) cannulated screws were accurately positioned, whereas two cannulated screws and one non-cannulated screw violated lateral cortex of the ilium.
Conclusion: The technique using K-wire and cannulated screw can provide accurate placement of free hand S2AI screw.

PMID: 29354238 [PubMed]

http://ift.tt/2ryQDyo

Novel Genetic Variants Associated with Lumbar Spondylosis in Koreans : A Genome-Wide Association Study.

Novel Genetic Variants Associated with Lumbar Spondylosis in Koreans : A Genome-Wide Association Study.

J Korean Neurosurg Soc. 2018 Jan;61(1):66-74

Authors: Kim HA, Heo SG, Park JW, Jung YO

Abstract
Objective: The aim of this study was to identify the susceptibility genes responsible for lumbar spondylosis (LS) in Korean patients.
Methods: Data from 1427 subjects were made available for radiographic grading and genome wide association studies (GWAS) analysis. Lateral lumbar spine radiographs were obtained and the various degrees of degenerative change were semi-quantitatively scored. A pilot GWAS was performed using the AffymetrixGenome-Wide Human single-nucleotide polymorphisms (SNPs), 500K array. A total of 352228 SNPs were analyzed and the association between the SNPs and case-control status was analyzed by stepwise logistic regression analyses.
Results: The top 100 SNPs with a cutoff p-value of less than 3.7×10-4 were selected for joint space narrowing, while a cutoff p-value of 6.0×10-4 was applied to osteophytes and the Kellgren-Lawrence (K-L) osteoarthritis grade. The SNPs with the strongest effect on disc space narrowing, osteophytes, and K-L grade were serine incorporator 1 (rs155467, odds ratio [OR]=17.58, p=1.6×10-4), stromal interaction molecule 2 (STIM1, rs210781, OR=5.53, p=5×10-4), and transient receptor potential cation channel, subfamily C (rs11224760, OR=3.99, p=4.8×10-4), respectively. Leucine-rich repeat-containing G protein-coupled receptor 4 was significantly associated with both disc space narrowing and osteophytes (rs1979400, OR=2.01, p=1.1×10-4 for disc space narrowing, OR=1.79, p=3×10-4 for osteophytes), while zinc finger and BTB domain containing 7C was significantly and negatively associated with both osteophytes and a K-L grade >2 (rs12457004,OR=0.25, p=5.8×10-4 and OR=0.27, p=5.3×10-4, respectively).
Conclusion: We identified SNPs that potentially contribute to the pathogenesis of LS. This is the first report of a GWAS in an Asian population.

PMID: 29354237 [PubMed]

http://ift.tt/2Gasi5p

Gamma Knife Radiosurgery for Cancer Metastasized to the Ocular Choroid.

Gamma Knife Radiosurgery for Cancer Metastasized to the Ocular Choroid.

J Korean Neurosurg Soc. 2018 Jan;61(1):60-65

Authors: Cho KR, Lee KM, Han G, Kang SW, Lee JI

Abstract
Objective: Choroidal metastases (CMs) are the most common intraocular tumor. Management is mainly radiation therapy with goals of pain control and visual improvement. However, many radiation-related complications are reported. Since gamma knife radiosurgery (GKS) for CM was first reported in 1995, few cases have been reported. We report 7 cases of CMs treated with GKS.
Methods: From April 2011 to November 2014, 7 patients with CM underwent GKS. Their median age at treatment was 64 years (range, 51-71 years). Four males and three females were treated. Lung cancer was the most common primary pathology, followed by renal cell carcinoma and stomach cancer. Four patients had multiple cerebral lesions and were treated simultaneously for choroidal lesions. The median marginal dose of 20 Gy (range, 15-25 Gy) was administered at the 50% isodose line.
Results: Median follow-up period after GKS was 8 months (range, 2-38.3 months). Four patients expired due to underlying malignancy progression. Except for two patients who were not followed with magnetic resonance image after GKS, all patients showed size reduction in the treated lesions, but a new choroidal lesion appeared in one patient and one recurred. Six of seven patients reported subjectively improved visual symptoms. Visual acuity improved in 2 patients, and 2 were stable upon objective examination. One patient showed no improvement in visual acuity, but ocular pain was relieved; another patient showed improved vision and tumor remission, but visual deterioration recurred.
Conclusion: GKS was shown to be safe and effective and should be considered for CM treatment.

PMID: 29354236 [PubMed]

http://ift.tt/2BkJcu9

Compare the Intracranial Pressure Trend after the Decompressive Craniectomy between Massive Intracerebral Hemorrhagic and Major Ischemic Stroke Patients.

Compare the Intracranial Pressure Trend after the Decompressive Craniectomy between Massive Intracerebral Hemorrhagic and Major Ischemic Stroke Patients.

J Korean Neurosurg Soc. 2018 Jan;61(1):42-50

Authors: Huh J, Yang SY, Huh HY, Ahn JK, Cho KW, Kim YW, Kim SL, Kim JT, Yoo DS, Park HK, Ji C

Abstract
Objective: Massive intracerebral hemorrhage (ICH) and major infarction (MI) are devastating cerebral vascular diseases. Decompression craniectomy (DC) is a common treatment approach for these diseases and acceptable clinical results have been reported. Author experienced the postoperative intracranaial pressure (ICP) trend is somewhat different between the ICH and MI patients. In this study, we compare the ICP trend following DC and evaluate the clinical significance.
Methods: One hundred forty-three patients who underwent DC following massive ICH (81 cases) or MI (62 cases) were analyzed retrospectively. The mean age was 56.3±14.3 (median=57, male : female=89 : 54). DC was applied using consistent criteria in both diseases patients; Glasgow coma scale (GCS) score less than 8 and a midline shift more than 6 mm on brain computed tomography. In all patients, ventricular puncture was done before the DC and ICP trends were monitored during and after the surgery. Outcome comparisons included the ictus to operation time (OP-time), postoperative ICP trend, favorable outcomes and mortality.
Results: Initial GCS (p=0.364) and initial ventricular ICP (p=0.783) were similar among the ICH and MI patients. The postoperative ICP of ICH patients were drop rapidly and maintained within physiological range if greater than 80% of the hematoma was removed. While in MI patients, the postoperative ICP were not drop rapidly and maintained above the physiologic range (MI=18.8 vs. ICH=13.6 mmHg, p=0.000). The OP-times were faster in ICH patients (ICH=7.3 vs. MI=40.9 hours, p=0.000) and the mortality rate was higher in MI patients (MI=37.1% vs. ICH=17.3%, p=0.007).
Conclusion: The results of this study suggest that if greater than 80% of the hematoma was removed in ICH patients, the postoperative ICP rarely over the physiologic range. But in MI patients, the postoperative ICP was above the physiologic range for several days after the DC. Authors propose that DC is no need for the massive ICH patient if a significant portion of their hematoma is removed. But DC might be essential to improve the MI patients' outcome and timely treatment decision.

PMID: 29354235 [PubMed]

http://ift.tt/2ruc4kg

Risk Factors of Rehemorrhage in Postoperative Patients with Spontaneous Intracerebral Hemorrhage : A Case-Control Study.

Risk Factors of Rehemorrhage in Postoperative Patients with Spontaneous Intracerebral Hemorrhage : A Case-Control Study.

J Korean Neurosurg Soc. 2018 Jan;61(1):35-41

Authors: Ren Y, Zheng J, Liu X, Li H, You C

Abstract
Objective: Rehemorrhage is the most severe complication of postoperative patients with spontaneous intracerebral hemorrhage. The aim of the present study was to assess independent predictors of rehemorrhage and find the possibility of preventing rehemorrhage in postoperative patients with spontaneous intracerebral hemorrhage (sICH).
Methods: Medical records of 263 postoperative patients with sICH from our Hospital were reviewed. The relationships between rehemorrhage and parameters were examined by univariate and multivariate analyses. The parameters include time from onset to surgery, hematologic paremeters, neuroimaging characteristics, level and variability of systolic blood pressure, medical histories, operation duration, and blood loss. In addition, relationship between rehemorrhage and clinical outcome were analyzed by using multivariate analyses.
Results: Thirty-five (13.31%) patients experienced rehemorrhage after operation. Multivariate analyses indicated that the following factors were independently associated with rehemorrhage : history of diabetes mellitus (odds ratio [OR], 2.717; 95% confidence interval [CI], 1.005-7.346; p=0.049), and midline shift (for every 1 mm increase, OR, 1.117; 95% CI, 1.029-1.214; p=0.009). Rehemorrhage was an independent risk factor of poor functional outcome (OR, 3.334; 95% CI, 1.094-10.155; p=0.034).
Conclusion: Our finding revealed that history of diabetes mellitus and admission midline shift were possibly associated with rehemorrhage in postoperative patients with sICH.

PMID: 29354234 [PubMed]

http://ift.tt/2GcAZvZ

Duplicated Vertebral Artery : Literature Review and Clinical Significance.

Duplicated Vertebral Artery : Literature Review and Clinical Significance.

J Korean Neurosurg Soc. 2018 Jan;61(1):28-34

Authors: Kim MS

Abstract
Objective: Duplication of the vertebral artery (VA) is a rare vascular variant. This paper describes the anatomy and embryological development of duplicated VAs and reviews the clinical significance.
Methods: Computed tomography (CT) angiography was performed in 3386 patients (1880 females, 1506 males) between March 2014 and November 2015. We defined duplication of the VA as a condition in which the VA has two origins that fused at different levels of the neck.
Results: Ten of the 3386 patients (0.295%) who received CT angiography had a dual origin of the VA; three on the left side, and seven on the right side. In all seven with right dual origin of the VA, both limbs of the VA origin originated from the right subclavian artery. In all three patients with left dual origin of the VA, both limbs of the VA originated from the left subclavian artery and aortic arch. In all 10 patients, the medial limb of the duplicated VA was located posteriorly and medially to the common carotid artery (CCA) and anteriorly and laterally to the vertebral transverse foramen. In two patients, the medial limb of the duplicated VA was located in close proximity to the CCA. In another two patients, the medial limb of the duplicated VA was located in close proximity to the CCA, carotid bifurcation, and proximal internal carotid artery.
Conclusion: Although duplication of the VA is asymptomatic in most patients, clinicians should consider this anomaly during diagnosis and treatment.

PMID: 29354233 [PubMed]

http://ift.tt/2ryQzPa

Treatment Outcomes with Selective Coil Embolization for Large or Giant Aneurysms : Prognostic Implications of Incomplete Occlusion.

Treatment Outcomes with Selective Coil Embolization for Large or Giant Aneurysms : Prognostic Implications of Incomplete Occlusion.

J Korean Neurosurg Soc. 2018 Jan;61(1):19-27

Authors: Jo KI, Yang NR, Jeon P, Kim KH, Hong SC, Kim JS

Abstract
Objective: The objectives of this study were to evaluate the immediate and long-term efficacy and safety of coil embolization for large or giant aneurysms.
Methods: One hundred and fifty large or giant aneurysm cases treated with endovascular coil embolization between January 2005 and February 2014 at a single institute were included in this study. Medical records and imaging findings were reviewed. Statistical analysis was performed to evaluate prognostic factors associated with major recurrence (major recanalization or rupture) and delayed thromboembolism after selective coil embolization.
Results: Procedure-related symptomatic complications occurred in five (3.3%) patients. The mean clinical and radiological follow-up periods were 38 months (range, 2-110) and 26 months (range, 6-108), respectively. During the follow-up period, the estimated recurrence rate was 4.6% per year. Multivariate analysis using Cox regression showed the degree of occlusion to be the only factor associated with recurrence (p=0.008, hazard ratio 3.15, 95% confidence interval 1.34-7.41). The patient's history of rupture in addition to the size and location of the aneurysm were not associated with recurrence in this study. Delayed infarction occurred in eight cases, and all were incompletely occluded.
Conclusion: Although immediate postprocedural safety profiles were reasonable, longterm results showed recanalization and thromboembolic events to occur continuously, especially in patients with incomplete occlusion. In addition, incomplete occlusion was associated with delayed thromboembolic complications. Patients with incomplete occlusions should be followed carefully for delayed recurrence or delayed thromboembolic events.

PMID: 29354232 [PubMed]

http://ift.tt/2GaseCH

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τρίτη 23 Ιανουαρίου 2018

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