bluuebunny/crossref_metadata_2025 huggingface dataset:
Amnion–Chorion Allograft Barrier Used for Guided Tissue Regeneration Treatment of Periodontal Intrabony Defects: A Retrospective Observational Report
Authors: Holtzclaw Dan J. , Toscano Nicholas J.
Published: June 2012

Introduction: Combination guided tissue regeneration (GTR) for the treatment of periodontal intrabony defects has been an accepted treatment modality for nearly 30 years and has undergone a number of changes during this time, including the use of multiple different barrier membrane materials. Amnion–chorion membrane (ACM) is a placental‐derived tissue that has been used in medicine for >100 years and recently introduced for combination GTR use in dentistry. This retrospective observational report documents use of ACM for combination GTR treatment of periodontal intrabony defects with a minimum of 12‐month post‐surgical observation.

Case Series: Review of the practice's electronic database revealed that 114 patients were treated with GTR therapy from March 2010 to October 2011. Of these patients, 64 were treated with ACM combination GTR therapy and had ≥12 months of follow‐up. All patients were diagnosed with localized moderate‐to‐severe chronic periodontitis and exhibited radiographic evidence of ≥1 vertical osseous defect. All patients were treated by thorough degranulation of intrabony periodontal defects and placement of bone allograft covered by ACM. Clinical measurements 12 months after surgery revealed an average probing depth reduction of 5.06 ± 1.37 mm and clinical attachment level improvement of 4.61 ± 1.29 mm.

Conclusion: The results of this retrospective observational report are promising and warrant additional controlled, long‐term studies to further evaluate the effectiveness of ACM for combination GTR treatment of periodontal intrabony defects.
Locally Delivered 0.5% Azithromycin as an Adjunct to Non‐Surgical Treatment in Patients With Chronic Periodontitis With Type 2 Diabetes: A Randomized Controlled Clinical Trial
Authors: Agarwal Esha , Bajaj Pavan , Naik Savitha B. , Pradeep A.R.
Published: June 2012

Background: Several epidemiologic studies have identified a greater incidence of periodontitis in patients with type 2 diabetes. Recent developments suggest that local delivery of antimicrobials into periodontal pockets improve periodontal health. The present study is designed to investigate the adjunctive effects of subgingivally delivered azithromycin (AZM; 0.5% concentration) as an adjunct to scaling and root planing (SRP) for treating chronic periodontitis in patients with type 2 diabetes.

Methods: A total of 63 patients were categorized into two treatment groups: 1) group 1: SRP + placebo gel and 2) group 2: SRP + 0.5% AZM. Clinical parameters were recorded at baseline and 3, 6, and 9 months; they included modified sulcus bleeding index (mSBI), plaque index (PI), probing depth (PD), and clinical attachment level (CAL).

Results: Both therapies resulted in significant improvements. Using a patient‐based analysis, patients in group 2 treated with SRP + 0.5% AZM showed enhanced reductions in PI, GI, mSBI, and PD and gains in CAL (P <0.05) over 9 months compared with group 1.

Conclusion: Although both treatment strategies seem to benefit the patients, the adjunctive use of 0.5% AZM as a controlled drug delivery system enhances the clinical outcome.
Differential Outcomes of Expanded-Criteria Donor Renal Allografts According to Recipient Age
Authors: Mezrich Joshua D. , Pirsch John D. , Fernandez Luis A. , Foley David P. , Bellingham Janet M. , Odorico Jon S. , Leverson Glen E. , Munoz-del-Rio Alejandro , Sollinger Hans W. , Kaufman Dixon B. , D’Alessandro Anthony M.
Published: June 2012

Background and objectives

Expanded-criteria donor (ECD) kidneys are used to expand the number of deceased-donor kidney transplants, often for elderly recipients. This study sought to determine whether older recipients had significantly worse outcomes from receiving ECD kidneys and whether outcomes of ECD versus standard-criteria donor (SCD) kidneys differed in younger recipients.

Design, setting, participants, & measurements

This is a single-center, retrospective review of all primary deceased-donor kidney transplantations performed between 2000 and 2005. Group 1 consisted of patients ≥60 years of age (n=189) who received an ECD (n=96) or an SCD (n=93) kidney. Group 2 consisted of patients 40–59 years of age (n=370) who received an ECD (n=105) or an SCD (n=265) kidney.

Results

Older recipients (group 1) who received ECD kidneys demonstrated significantly shortened 5-year actuarial patient and graft survival rates compared with older recipients of SCD allografts. Group 1 ECD recipients also had significantly worse outcomes than younger (group 2) ECD recipients. In multivariate analysis, ECD kidneys remained an independent predictor of poorer outcome in group 1.

Conclusions

Morbidity and mortality were increased in elderly recipients of ECD kidneys. These findings may have implications in kidney allocation policy developments that encourage placement of ECD kidneys for older recipients.
Sustainable development indicators: Case study for South Morava river basin
Authors: Veljkovic Nebojsa
Published: June 2012

The subject of research is elaboration and evaluation of indicators of
sustainable development in the field of river basin management. Aggregate
indicator entitled Ecoregion Sustainable Development Index is identified by
calculation of average value by the procedure of leveling of proportion
changes of three key indicators (demographic emission index, water quality
index, industrial production index). Developed aggregate indicator of
sustainable development is calculated and analyzed for South Morava river
basin in Serbia, for the period from 1980 to 2010. The beneficiaries of these
indicators are the experts from the field of environmental protection and
water management who should use it for elaboration of reports directed
towards the creators of economic development policy and river basin
management planning. Elaborated according to the given methodology, the
indicator Ecoregion Sustainable Development Index is available for the
decision makers on the national level, internationally comparative and it
provides the conditions for further elaboration and application.
A survey of Tennessee veterinarian and physician attitudes, knowledge, and practices regarding zoonoses prevention among animal owners with HIV infection or AIDS
Authors: Hill William Allen , Petty Gregory C. , Erwin Paul C. , Souza Marcy J.
Published: June 2012

Objective—To examine the attitudes, knowledge, and practices of Tennessee veterinarians and physicians engaged in clinical practice regarding the risk for and prevention of zoonoses in people with HIV infection or AIDS.

Design—Cross-sectional survey.

Sample—Licensed Tennessee veterinarians and physicians engaged in clinical practice.

Procedures—A survey was mailed in January 2010 to 454 licensed veterinarians and 1,737 licensed physicians.

Results—181 of 419 (43.20%) eligible veterinarians and 201 of 1,376 (14.61%) eligible physicians responded to the survey. A majority of both veterinarians (131/179 [73.18%]) and physicians (97/192 [50.52%]) indicated that veterinarians should always or almost always be involved in advising clients with HIV infection or AIDS. The majority of veterinarians (120/173 [69.36%]) indicated they always or almost always discussed with clients the potential risk to immune-compromised persons after diagnosing a zoonosis. A high proportion (88/94 [93.62%]) of physicians indicated they never or rarely initiated discussions about zoonoses with patients with HIV infection or AIDS. All physicians (94/94 [100%]) indicated they never or rarely contacted veterinarians for advice on zoonoses. Similarly, 174 of 180 (96.76%) veterinarians had never or rarely contacted physicians for advice on zoonoses risks. Only 25.97% of veterinarians and 33.33% of physicians were correctly able to identify zoonotic pathogens of greatest concern to people with HIV infection or AIDS.

Conclusions and Clinical Relevance—We identified several implications for veterinary medical and medical practice that may reduce zoonoses transmission risks for people with HIV infection or AIDS, including increased communication between veterinarians and physicians, increased communication between people with HIV infection or AIDS and health-care providers, increased availability of client educational materials, and increased participation in zoonoses continuing education opportunities by health-care providers.
Factors associated with methicillin-resistant versus methicillin-susceptible Staphylococcus pseudintermedius infection in dogs
Authors: Weese J. Scott , Faires Meredith C. , Frank Linda A. , Reynolds Lisa M. , Battisti Antonio
Published: June 2012

Objective—To compare methicillin-resistant Staphylococcus pseudintermedius (MRSP) and methicillin-susceptible S pseudintermedius (MSSP) infections in dogs.

Design—Multicenter case-control study.

Animals—Dogs with MRSP infections were matched, by hospital, with 2 MSSP controls, with the infections occurring immediately before and after the case infection.

Procedures—Signalment, historical, clinical, treatment, and outcome data were documented. Conditional logistic regression was performed. A manual stepwise backward elimination procedure was used to build the multivariable model.

Results—56 case and 112 control dogs were enrolled. Pyoderma was the most common infection type in both groups. In the final multivariable model, systemic administration of antimicrobials within 30 days prior to infection was significantly associated with an MRSP versus an MSSP infection (OR, 9.9; 95% confidence interval, 3.59 to 27.53).

Conclusions and Clinical Relevance—The association of prior antimicrobial administration and MRSP infection indicated the potential impact of routine antimicrobial use in veterinary medicine on antimicrobial resistance and the need for prudent use of these important drugs. Mortality rate was not significantly different between MRSP and MSSP infections; the lack of a significant difference suggested that MRSP was inherently no more virulent than MSSP, provided the infection was properly diagnosed and appropriate treatment was started. Basic concepts such as prudent antimicrobial use and early diagnosis through timely submission of appropriate culture specimens therefore can be important measures to try to reduce the impact of this pathogen.
An Internet-based survey of risk factors for surgical gastric dilatation-volvulus in dogs
Authors: Pipan Marko , Brown Dorothy Cimino , Battaglia Carmelo L. , Otto Cynthia M.
Published: June 2012

Objective—To evaluate risk factors for gastric dilatation-volvulus (GDV) in a large number of privately owned dogs across a wide geographic area.

Design—Internet-based, cross-sectional study.

Animals—2,551 privately owned dogs.

Procedures—A questionnaire addressed dog-specific, management, environmental, and personality-associated risk factors for GDV in dogs. Respondents were recruited through the posting of the electronic link to the questionnaire on websites for dog owners; the information was also disseminated at meetings of dog owners and via newsletters, e-mail lists for dog owners and breeders, owner-oriented dog publications, and e-mails forwarded by participants. Descriptive statistics and logistic regression analysis were performed.

Results—Factors significantly associated with an increased risk of GDV were being fed dry kibble, anxiety, residence in the United Kingdom, being born in the 1990s, being a family pet, and spending at least 5 hours a day with the owner. Factors associated with a decreased risk of GDV were playing with other dogs and running the fence after meals, fish and egg dietary supplements, and spending equal time indoors and outdoors. A significant interaction between sex and neuter status was observed, with sexually intact females having the highest risk for GDV.

Conclusions and Clinical Relevance—In dogs with a high risk of GDV, regular moderate daily and postprandial activity appeared to be beneficial. Feeding only commercial dry dog food may not be the best choice for dogs at risk; however, supplements with fish or eggs may reduced this risk. The effect of neuter status on GDV risk requires further characterization.
Prevalence and antimicrobial resistance of Enterococcus spp and Staphylococcus spp isolated from surfaces in a veterinary teaching hospital
Authors: Hamilton Elizabeth , Kaneene John B. , May Katherine J. , Kruger John M. , Schall William , Beal Matthew W. , Hauptman Joe G. , DeCamp Charles E.
Published: June 2012

Objective—To determine the prevalence and antimicrobial resistance of enterococci and staphylococci collected from environmental surfaces at a veterinary teaching hospital (VTH).

Design—Longitudinal study.

Sample—Samples collected from surfaces in 5 areas (emergency and critical care, soft tissue and internal medicine, and orthopedic wards; surgery preparation and recovery rooms; and surgery office and operating rooms) of a VTH.

Procedures—Selected surfaces were swabbed every 3 months during the 3-year study period (2007 to 2009). Isolates of enterococci and staphylococci were identified via biochemical tests, and antimicrobial susceptibility was evaluated with a microbroth dilution technique. A subset of isolates was analyzed to assess clonality by use of pulsed-field gel electrophoresis.

Results—430 samples were collected, and isolates of enterococci (n = 75) and staphylococci (110) were identified. Surfaces significantly associated with isolation of Enterococcus spp and Staphylococcus spp included cages and a weight scale. Fourteen Enterococcus spp isolates and 17 Staphylococcus spp isolates were resistant to ≥ 5 antimicrobials. Samples collected from the scale throughout the study suggested an overall increase in antimicrobial resistance of Enterococcus faecium over time. Clonality was detected for E faecium isolates collected from 2 different surfaces on the same day.

Conclusions and Clinical Relevance—Although not surprising, the apparent increase in antimicrobial resistance of E faecium was of concern because of the organism's ability to transmit antimicrobial resistance genes to other pathogens. Results reported here may aid in identification of critical control points to help prevent the spread of pathogens in VTHs.
Myenteric ganglionitis as a cause of recurrent colic in an adult horse
Authors: Blake Karen R. , Affolter Verena K. , Lowenstine Linda J. , Vilches-Moure Jose G. , le Jeune Sarah S.
Published: June 2012

Case Description—A 10-year-old Lipizzaner stallion was evaluated over the course of 1.5 years because of intermittent, recurrent colic.

Clinical Findings—The horse was initially treated medically for gastric ulcers; dietary changes were made, and a deworming protocol was instituted, without resolution of colic episodes. Subsequently, the horse underwent exploratory celiotomy and a large colon volvulus was identified with diffuse colonic wall thickening. A pelvic flexure biopsy sample was submitted for histologic examination, which revealed lymphocytic (CD3-positive T cells) myenteric ganglionitis (MG). The horse developed a cecal impaction after surgery, which did not resolve, despite aggressive medical management; subsequently a complete cecal bypass was performed. Cecal and colonic wall biopsy samples were evaluated histologically and confirmed the diagnosis of MG. After surgery, the horse developed a large colon impaction, which initially responded to aggressive medical treatment, and the horse was discharged.

Treatment and Outcome—Despite rigorous feed restrictions and prokinetic and corticosteroid treatment, the horse continued to have signs of colic and was euthanized 3 weeks after discharge from the hospital because of a recurrent large colon impaction. Intestinal biopsy samples obtained at the time of death revealed chronic changes in intramural ganglia consistent with generalized MG.

Clinical Relevance—MG is a rare disease in horses, causing gastrointestinal motility dysfunction and signs of colic, which is challenging to diagnose and treat successfully. Further studies are needed to identify the etiology of this disease and to explore treatment options.
Glassy carbon and boron doped glassy carbon electrodes for voltammetric determination of linuron herbicide in the selected samples
Authors: Đorđević Jelena , Kalijadis Ana , Kumrić Ksenija , Jovanović Zoran , Laušević Zoran , Trtić-Petrović Tatjana
Published: May 2012

In this study the application of home-made unmodified (GC) and bulk modified boron doped glassy carbon (GCB) electrodes for the voltammetric determination of the linuron was investigated. The electrodes were synthesized with a moderate temperature treatment (1000°C). Obtained results were compared with the electrochemical determination of the linuron using a commercial glassy carbon electrode (GC-Metrohm). The peak potential (E p ) of linuron oxidation in 0.1 mol dm−3 H2SO4 as electrolyte was similar for all applied electrodes: 1.31, 1.34 and 1.28 V for GCB, GC and GC-Metrohm electrodes, respectively. Potential of linuron oxidation and current density depend on the pH of supporting electrolyte. Applying GCB and GC-Metrohm electrodes the most intensive electrochemical response for linuron was obtained in strongly acidic solution (0.1 mol dm−3 H2SO4). Applying the boron doped glassy carbon electrode the broadest linear range (0.005–0.1 µmol cm−3) for the linuron determination was obtained. The results of voltammetric determination of the linuron in spiked water samples showed good correlation between added and found amounts of linuron and also are in good agreement with the results obtained by HPLC-UV method. This appears to be the first application of a boron doped glassy carbon electrode for voltammetric determination of the environmental important compounds.
In Tribute: Dennis L. Hart, PT, PhD, A Functional Outcome Measurement Visionary
Authors: Werneke Mark W. , Deutscher Daniel , George Steven Z.
Published: June 2012

In remembrance of Dennis L. Hart, PT, PhD.

J Orthop Sports Phys Ther 2012;42(6):489–490. doi:10.2519/jospt.2012.0109
Comparison of Two Methods for Interpreting Lifting Performance During Functional Capacity Evaluation
Authors: Oesch Peter , Meyer Kathrin , Bachmann Stefan , Hagen Kåre Birger , Vøllestad Nina K.
Published: June 2012

Background

Functional capacity evaluation (FCE) requires determination of effort by observation of effort indexes for performance interpretation. Waddell signs have been shown to be associated with decreased functional performance. Whether determination of effort by observational criteria and Waddell sign testing can be used interchangeably to interpret lifting performance is unknown.

Objective

The purposes of this study were to assess the concurrent validity of submaximal effort and Waddell signs and to determine whether these contribute independently to lifting performance.

Design

This investigation was an analytical cross-sectional study.

Methods

A total of 130 people who had chronic nonspecific low back pain and were referred for fitness-for-work evaluation were included. Physical effort was determined on the basis of observational criteria for lifting from floor to waist, lifting from waist to shoulder, and horizontal lifting during FCE. A second assessor conducted Waddell sign testing. The concurrent validity of Waddell signs and submaximal effort was assessed by calculating sensitivity and specificity. Hierarchical regression analysis was used to determine the contributions of Waddell signs and submaximal effort to lifting performance. Age and sex were covariates.

Results

The FCE assessor found a low sensitivity of Waddell signs for submaximal effort determination. Between 53% and 63% of the participants who were classified as showing submaximal effort had Waddell signs. Waddell signs and submaximal effort were independent contributors to lifting performance. The contribution of submaximal effort was larger than that of Waddell signs, as shown by 20% to 29% higher explained variance in lifting performance when submaximal effort was added to the model first versus 3% to 6% higher explained variance when Waddell signs were added first.

Limitations

Assessor variability could have influenced the study results.

Conclusions

In people with chronic nonspecific low back pain, Waddell sign testing and determination of physical effort by observational criteria should not be used interchangeably to interpret lifting performance during FCE.
Unplanned reoperation rates in pediatric neurosurgery: a single center experience and proposed use as a quality indicator
Authors: Mukerji Nitin , Jenkins Alistair , Nicholson Claire , Mitchell Patrick
Published: June 2012

Object

The pediatric neurosurgery practice over 2 years was reviewed at a tertiary neurosciences center. The intention was to establish the frequency of unplanned reoperations at the center, investigate the factors responsible, and consider using unplanned reoperations as a quality indicator.

Methods

All pediatric neurosurgical operations done between January 2008 and January 2010 were reviewed using data from operation theater logs and hospital records. Data were recorded as per the standard requirements of the Society of British Neurological Surgeons for incorporation into the national database. “Unplanned reoperation” was defined as any unscheduled secondary procedure required for a complication resulting directly or indirectly from the index operation or as an unscheduled return to the operating theater for the same condition. Operations were defined as “urgent” if they had to be performed out of hours (that is, outside the hours of 8:00 a.m. to 5:00 p.m.), “emergency elective” if they were included on the emergency list but within working hours, and “routine elective” if they were on the scheduled operations list. Both overall and 30-day unplanned reoperation rates were considered. Factors influencing unplanned reoperations were explored using a logistic regression model.

Results

Four hundred ten operations were analyzed. The overall unplanned reoperation rate was 28%. The median time to an unplanned reoperation was 9 days. Risk factors for unplanned reoperations included a CSF diversion procedure (OR 7, p < 0.0001) and an urgent procedure (OR 2.5, p = 0.02, higher unplanned reoperations for urgent procedures relative to routine electives). The 30-day unplanned reoperation rate was 17%. Urgent cases composed 32% of all operations. Trainees performed 52% of the urgent operations. Forty-four percent of all operations were related to CSF diversion. Sixty-four percent of patients had reoperations during the course of the study period, and 44% of these reoperations were unplanned.

Conclusions

An unplanned return to the operation theater is common in the authors' pediatric neurosurgical practice and is procedure specific. Unplanned reoperation rates may be useful for monitoring quality across hospitals and identifying opportunities for quality improvement. The authors propose the use of this index as a quality indicator and advocate its validation in a prospective multicenter study.
Longitudinal comparison of diffusion tensor imaging parameters and neuropsychological measures following endoscopic third ventriculostomy for hydrocephalus
Authors: Buckley Robert T. , Yuan Weihong , Mangano Francesco T. , Phillips Jannel M. , Powell Stephanie , McKinstry Robert C. , Rajagopal Akila , Jones Blaise V. , Holland Scott , Limbrick David D.
Published: June 2012

The authors report the case of a 25-month-old boy who underwent endoscopic third ventriculostomy (ETV) for hydrocephalus resulting from aqueductal stenosis. The patient's recovery was monitored longitudinally and prospectively using MR diffusion tensor imaging (DTI) and formal neuropsychological testing. Despite minimal change in ventricle size, improvement in the DTI characteristics and neurodevelopmental trajectory was observed following ETV. These data support the use of DTI as a biomarker to assess therapeutic response in children undergoing surgical treatment for hydrocephalus. In the patient featured in this report, DTI appeared to provide more information regarding postoperative neurodevelopmental outcome than ventricle size alone.
Craniocervical fusions in children
Authors: Menezes Arnold H.
Published: June 2012

The surgical management of craniovertebral junction (CVJ) instability in pediatric patients presents unique challenges. As compared with the adult patient, the anatomical variations of the CVJ in the pediatric patient are significant, complicate the approach, and limit the use of internal fixation. Diminutive osseous and ligamentous structures and syndromic craniovertebral abnormalities complicate the issue. Advances in imaging analysis and instrumentation have improved the armamentarium for managing the pediatric patient who requires craniocervical stabilization. In this paper, the author's experience of performing more than 850 pediatric CVJ fusions is reviewed. This work includes the indications for atlantoaxial arthrodesis and occipitocervical fusion. Early atlantoaxial fusions were performed using interlaminar rib graft fusion, and more recently using either transarticular screw fixation in the older patient, or lateral mass screws at C-1 and rod fixation with either C-2 pars interarticular screw fixation or pedicle screw fixation. A C-2 translaminar screw fixation is also described. Occipitocervical fusions are performed with rib grafts in patients younger than 6 years of age. Subsequently, above that age, contoured loop fixation was performed, and in the past 8–10 years, screw and rod fixation was used. Abnormal spine growth was not observed in children who underwent craniocervical stabilization below the age of 5 years (clearly the bone grew with the patient). However, no deleterious effects were noted in the children treated with rigid instrumentation. The success rate for bone fusion alone was 98%. The author's success rate with rigid instrumentation is nearly 100%. A detailed review of the technique of fusion is presented, as well as the indications and means of avoidance of complications, their prevention, and management.
Spinal arteriovenous fistulas in children with hereditary hemorrhagic telangiectasia
Authors: Calhoun Amy R. U. L. , Bollo Robert J. , Garber Sarah T. , McDonald Jamie , Stevenson David A. , Hung Irene H. , Brockmeyer Douglas L. , Walker Marion L.
Published: June 2012

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant angiodysplasia with high penetrance and variable expression. The manifestations of HHT are often age related, and spinal arteriovenous fistula (AVF) may be the initial presentation of HHT in young children. Because spinal AVFs are rarely reported, however, screening is not incorporated into current clinical recommendations for the treatment of patients with HHT. The authors describe 2 cases of children younger than 2 years of age with acute neurological deterioration in the context of a spinal AVF and in whom HHT was subsequently diagnosed. One patient presented with intraventricular and subarachnoid hemorrhage and the other with acute thrombosis of an intramedullary varix. These cases highlight the potential for significant neurological morbidity from a symptomatic AVF in very young children with HHT. Given the lack of data regarding the true incidence and natural history of these lesions, these cases raise the question of whether spinal cord imaging should be incorporated into screening recommendations for patients with HHT.
Long-term outcome of 114 children with cerebral aneurysms
Authors: Koroknay-Pál Päivi , Lehto Hanna , Niemelä Mika , Kivisaari Riku , Hernesniemi Juha
Published: June 2012

Object

Population-based data on pediatric patients with aneurysms are limited. The aim of this study is to clarify the characteristics and long-term outcomes of pediatric patients with aneurysms.

Methods

All pediatric patients (≤ 18 years old) with aneurysms among the 8996 aneurysm patients treated at the Department of Neurosurgery in Helsinki from 1937 to 2009 were followed from admission to the end of 2010.

Results

There were 114 pediatric patients with 130 total aneurysms during the study period. The mean patient age was 14.5 years (range 3 months to 18 years). The male:female ratio was 3:2. Eighty-nine patients (78%) presented with subarachnoid hemorrhage. The majority of the aneurysms (116 [89%]) were in the anterior circulation, and the most common location was the internal carotid artery bifurcation (36 [28%]). The average aneurysm diameter was 11 mm (range 2–55 mm) with 16 giant aneurysms (12%). Eighty aneurysms (62%) were treated microsurgically, and 37 (28%) were treated conservatively due to poor medical and neurological status of the patient or due to technical reasons during the early years of the patient series. No connective tissue disorders common to pediatric aneurysm patients were diagnosed in this series, with the exception of 1 patient with tuberous sclerosis complex. The mean follow-up duration was 24.8 years (range 0–55.8 years). At the end of follow-up, 71 patients (62%) had a good outcome, 3 (3%) were dependent, and 40 (35%) had died. Twenty-seven deaths (68%) were assessed to be aneurysm-related. Factors correlating with a favorable long-term outcome were good neurological condition of the patient on admission, aneurysm location in the anterior circulation, complete aneurysm closure, and absence of vasospasm. Six patients developed symptomatic de novo aneurysms after a median of 25 years (range 11–37 years). Fourteen patients (12%) had a family history of aneurysms. There was no increased incidence for cardiovascular diseases in long-term follow-up.

Conclusions

Most aneurysms were ruptured and of medium size. Internal carotid artery bifurcation was the most frequent location of the aneurysms. There was a male predominance of pediatric patients with aneurysms. Most patients experienced good recovery, with 91% of the long-term survivors living at home independently without assistance and meaningfully employed. Altogether, almost a third of these patients finished high school and one-fifth had a college or university degree. Pediatric patients had a tendency to develop de novo aneurysms.
Diagnosis and treatment of cerebrospinal fluid rhinorrhea following accidental traumatic anterior skull base fractures
Authors: Ziu Mateo , Savage Jennifer Gentry , Jimenez David F.
Published: June 2012

Cerebrospinal fluid rhinorrhea is a serious and potentially fatal condition because of an increased risk of meningitis and brain abscess. Approximately 80% of all cases occur in patients with head injuries and craniofacial fractures. Despite technical advances in the diagnosis and management of CSF rhinorrhea caused by craniofacial injury through the introduction of MRI and endoscopic extracranial surgical approaches, difficulties remain. The authors review here the pathophysiology, diagnosis, and management of CSF rhinorrhea relevant exclusively to traumatic anterior skull base injuries and attempt to identify areas in which further work is needed.
Surgical management of temporal meningoencephaloceles, cerebrospinal fluid leaks, and intracranial hypertension: treatment paradigm and outcomes
Authors: Kenning Tyler J. , Willcox Thomas O. , Artz Gregory J. , Schiffmacher Paul , Farrell Christopher J. , Evans James J.
Published: June 2012

Object

Thinning of the tegmen tympani and mastoideum components of the temporal bone may predispose to the development of meningoencephaloceles and spontaneous CSF leaks. Surgical repair of these bony defects and associated meningoencephaloceles aids in the prevention of progression and meningitis. Intracranial hypertension may be a contributing factor to this disorder and must be fully evaluated and treated when present. The purpose of this study was to establish a treatment paradigm for tegmen defects and elucidate causative factors.

Methods

The authors conducted a retrospective review of 23 patients undergoing a combined mastoidectomy and middle cranial fossa craniotomy for the treatment of a tegmen defect.

Results

The average body mass index (BMI) among all patients was 33.2 ± 7.2 kg/m2. Sixty-five percent of the patients (15 of 23) were obese (BMI > 30 kg/m2). Preoperative intracranial pressures (ICPs) averaged 21.8 ± 6.0 cm H2O, with 10 patients (43%) demonstrating an ICP > 20 cm H2O. Twenty-two patients (96%) had associated encephaloceles. Five patients underwent postoperative ventriculoperitoneal shunting. Twenty-two CSF leaks (96%) were successfully repaired at the first attempt (average follow-up 10.4 months).

Conclusions

Among all etiologies for CSF leaks, those occurring spontaneously have the highest rate of recurrence. The surgical treatment of temporal bone defects, as well as the recognition and treatment of accompanying intracranial hypertension, provides the greatest success rate in preventing recurrence. After tegmen dehiscence repair, ventriculoperitoneal shunting should be considered for patients with any combination of the following high-risk factors for recurrence: spontaneous CSF leak not caused by another predisposing condition (that is, trauma, chronic infections, or prior surgery), high-volume leaks, CSF opening pressure > 20 cm H2O, BMI > 30 kg/m2, preoperative imaging demonstrating additional cranial base cortical defects (that is, contralateral tegmen or anterior cranial base) and/or an empty sella turcica, and any history of an event that leads to inflammation of the arachnoid granulations and impairment of CSF absorption (that is, meningitis, intracranial hemorrhage, significant closed head injury, and so forth).
Spontaneous and medically induced cerebrospinal fluid leakage in the setting of pituitary adenomas: review of the literature
Authors: Lam Grace , Mehta Vivek , Zada Gabriel
Published: June 2012

Object

Spontaneous and medically induced CSF leaks are uncommonly associated with pituitary adenomas. The aim of this study was to further characterize the clinical scenarios most closely associated with this phenomenon.

Methods

A review of the literature was conducted to identify all cases of nonsurgical CSF leaks associated with pituitary adenomas. The authors aimed to identify associated risk factors and management strategies used to treat these tumors and repair the CSF leak site.

Results

Fifty-two patients with spontaneous or medically induced CSF leaks in the setting of a pituitary adenoma were identified from 29 articles published from 1980 through 2011. In 38 patients (73%), CSF rhinorrhea developed following initiation of medical therapy, whereas spontaneous CSF leakage developed as the presenting symptom in 14 patients (27%). The patients' mean age was 42.8 years (range 23–68 years). There were 35 males and 17 females. Forty-two patients (81%) had a prolactinoma, with the remaining patients having the following tumors: nonfunctioning pituitary adenoma (6 patients), growth hormone–secreting adenoma (2 patients), mammosomatotroph cell adenoma (1 patient), and ACTH-secreting adenoma (1 patient). Infrasellar tumor invasion into the paranasal sinuses was specifically reported in 56% of patients. The medical agents associated with CSF leakage were dopamine agonists (97%) and somatostatin analogs (3%). The average time from initialization of medical treatment to onset of rhinorrhea was 3.3 months (range 3 days–17 months). Nonsurgical management was successful in 4 patients, including 1 who had successful resolution with a temporary lumbar drain. Forty-six patients (88%) underwent surgical intervention to treat the CSF leak and/or resect the tumor. In 2 patients, surgery was not performed due to medical contraindications or patient preference.

Conclusions

Nonsurgical development of CSF rhinorrhea may occur in the setting of pituitary adenomas, especially following favorable response of invasive prolactinomas to initiation of dopamine agonist therapy. Additional cases have been reported as the presenting symptom of a pituitary adenoma and are likely to be related to decreased tumor volume due to intrinsic infarction or hemorrhage, ongoing invasion, and/or increases in intracranial pressure. Surgical repair, preferentially via a transsphenoidal approach, is the recommended initial treatment for definitive repair of the CSF leak and achievement of maximal tumor resection.
Surgical nuances for nasoseptal flap reconstruction of cranial base defects with high-flow cerebrospinal fluid leaks after endoscopic skull base surgery
Authors: Liu James K. , Schmidt Richard F. , Choudhry Osamah J. , Shukla Pratik A. , Eloy Jean Anderson
Published: June 2012

Extended endoscopic endonasal approaches have allowed for a minimally invasive solution for removal of a variety of ventral skull base lesions, including intradural tumors. Depending on the location of the pathological entity, various types of surgical corridors are used, such as transcribriform, transplanum transtuberculum, transsellar, transclival, and transodontoid approaches. Often, a large skull base dural defect with a high-flow CSF leak is created after endoscopic skull base surgery. Successful reconstruction of the cranial base defect is paramount to separate the intracranial contents from the paranasal sinus contents and to prevent postoperative CSF leakage. The vascularized pedicled nasoseptal flap (PNSF) has become the workhorse for cranial base reconstruction after endoscopic skull base surgery, dramatically reducing the rate of postoperative CSF leakage since its implementation. In this report, the authors review the surgical technique and describe the operative nuances and lessons learned for successful multilayered PNSF reconstruction of cranial base defects with high-flow CSF leaks created after endoscopic skull base surgery. The authors specifically highlight important surgical pearls that are critical for successful PNSF reconstruction, including target-specific flap design and harvesting, pedicle preservation, preparation of bony defect and graft site to optimize flap adherence, multilayered closure technique, maximization of the reach of the flap, final flap positioning, and proper bolstering and buttressing of the PNSF to prevent flap dehiscence. Using this technique in 93 patients, the authors' overall postoperative CSF leak rate was 3.2%. An illustrative intraoperative video demonstrating the reconstruction technique is also presented.
Is posttraumatic cerebrospinal fluid fistula a predictor of posttraumatic meningitis? A US Nationwide Inpatient Sample database study
Authors: Sonig Ashish , Thakur Jai Deep , Chittiboina Prashant , Khan Imad Saeed , Nanda Anil
Published: June 2012

Object

Various factors have been reported in literature to be associated with the development of posttraumatic meningitis. There is a paucity of data regarding skull fractures and facial fractures leading to CSF leaks and their association with the development of meningitis. The primary objective of this study was to analyze the US Nationwide Inpatient Sample (NIS) database to elucidate the factors associated with the development of posttraumatic meningitis. A secondary goal was to analyze the overall hospitalization cost related to posttraumatic meningitis and factors associated with that cost.

Methods

The NIS database was analyzed to identify patients admitted to hospitals with a diagnosis of head injury from 2005 through 2009. This data set was analyzed to assess the relationship of various clinical parameters that may affect the development of posttraumatic meningitis using binary logistic regression models. Additionally, the overall hospitalization cost for the head injury patients who did not undergo any neurosurgical intervention was further categorized into quartile groups, and a regression model was created to analyze various factors responsible for escalating the overall cost of the hospital stay.

Results

A total of 382,267 inpatient admissions for head injury were analyzed for the 2005–2009 period. Meningitis was reported in 0.2% of these cases (708 cases). Closed skull base fractures, open skull base fractures, cranial vault fractures, and maxillofacial fractures were reported in 20,524 (5.4%), 1089 (0.3%), 5064 (1.3%), and 88,649 (23.2%) patients, respectively. Among these patients with fractures, meningitis was noted in 0.17%, 0.18%, 0.05%, and 0.10% admissions, respectively. Cerebrospinal fluid rhinorrhea was reported in 453 head injury patients (0.1%) and CSF otorrhea in 582 (0.2%). Of the patients reported to have CSF rhinorrhea, 35 (7.7%) developed meningitis, whereas in the cohort with CSF otorrhea, 15 patients (2.6%) developed meningitis. Cerebrospinal fluid rhinorrhea (p < 0.001, OR 22.8, 95% CI 15.6–33.3), CSF otorrhea (p < 0.001, OR 9.2, 95% CI 5.2–16.09), and major neurosurgical procedures (p < 0.001, OR 5.6, 95% CI 4.8–6.5) were independent predictors of meningitis. Further, CSF rhinorrhea (p < 0.001, OR 2.0, 95% CI 1.6–2.7), CSF otorrhea (p < 0.001, OR 2.3, 95% CI 1.9–2.7), and posttraumatic meningitis (p < 0.001, OR 3.1, 95% CI 2.5–3.8) were independent factors responsible for escalating the cost of head injury in cases not requiring any major neurosurgical intervention.

Conclusions

Cerebrospinal fluid rhinorrhea and CSF otorrhea are independent predictors of posttraumatic meningitis. Furthermore, meningitis and CSF fistulas may independently lead to significantly increased cost of hospitalization in head injury patients not undergoing any major neurosurgical intervention.
Prevalence of Multiple Antibiotics Resistant (MAR) Pseudomonas Species in the Final Effluents of Three Municipal Wastewater Treatment Facilities in South Africa
Authors: Odjadjare Emmanuel E. , Igbinosa Etinosa O. , Mordi Raphael , Igere Bright , Igeleke Clara L. , Okoh Anthony I.
Published: June 2012

The final effluents of three (Alice, Dimbaza, and East London) wastewater treatment plants (WWTPs) were evaluated to determine their physicochemical quality and prevalence of multiple antibiotics resistant (MAR) Pseudomonas species, between August 2007 and July 2008. The annual mean total Pseudomonas count (TPC) was 1.20 × 104 (cfu/100 mL), 1.08 × 104 (cfu/100 mL), and 2.66 × 104 (cfu/100 mL), for the Alice, Dimbaza, and East London WWTPs respectively. The effluents were generally compliant with recommended limits for pH, temperature, TDS, DO, nitrite and nitrate; but fell short of target standards for turbidity, COD, and phosphate. The tested isolates were highly sensitive to gentamicin (100%), ofloxacin (100%), clindamycin (90%), erythromycin (90%) and nitrofurantoin (80%); whereas high resistance was observed against the penicillins (90–100%), rifampin (90%), sulphamethoxazole (90%) and the cephems (70%). MAR index ranged between 0.26 and 0.58. The study demonstrated that MAR Pseudomonas species were quite prevalent in the final effluents of WWTPs in South Africa; and this can lead to serious health risk for communities that depend on the effluent-receiving waters for sundry purposes.
Intravascular Targets for Molecular Contrast-Enhanced Ultrasound Imaging
Authors: Moestue Siver A. , Gribbestad Ingrid S. , Hansen Rune
Published: June 2012

Molecular targeting of contrast agents for ultrasound imaging is emerging as a new medical imaging modality. It combines advances in ultrasound technology with principles of molecular imaging, thereby allowing non-invasive assessment of biological processes in vivo. Preclinical studies have shown that microbubbles, which provide contrast during ultrasound imaging, can be targeted to specific molecular markers. These microbubbles accumulate in tissue with target (over) expression, thereby significantly increasing the ultrasound signal. This concept offers safe and low-cost imaging with high spatial resolution and sensitivity. It is therefore considered to have great potential in cancer imaging, and early-phase clinical trials are ongoing. In this review, we summarize the current literature on targets that have been successfully imaged in preclinical models using molecularly targeted ultrasound contrast agents. Based on preclinical experience, we discuss the potential clinical utility of targeted microbubbles.
Rapid Synthesis and Antiviral Activity of (Quinazolin-4-Ylamino)Methyl-Phosphonates Through Microwave Irradiation
Authors: Luo Hui , Hu Deyu , Wu Jian , He Ming , Jin Linhong , Yang Song , Song Baoan
Published: June 2012

This study describes the simple synthesis of new (quinazolin-4-ylamino) methylphosphonates via microwave irradiation. Substituted-2-aminobenzonitrile reacted with 1,1-dimethoxy-N,N-dimethylmethanamine at a reflux condition to obtain N'-(substituted-2-cyanophenyl)-N,N-dimethylformamidine (1). The subsequent reaction of this intermediate product with α-aminophosphonate (2) in a solution containing glacial acetic acid in 2-propanol through microwave irradiation resulted in the formation of (quinazolin-4-ylamino)methyl-phosphonate derivatives 3a to 3x, which were unequivocally characterized by the spectral data and elemental analysis. The influence of the reaction conditions on the yield of 3a was investigated to optimize the synthetic conditions. The relative optimal conditions for the synthesis of 3a include a 1:1 molar ratio of N’-(2-cyanophenyl)-N,N-dimethylformamidine to diethyl amino(phenyl)methylphosphonate and a 4:1 volume ratio of isopropanol to HOAc in the solvent mixture, at a reaction temperature of 150 °C, with a microwave power of 100 W and a corresponding pressure of 150 psi for 20 min in the microwave synthesizer. The yield of 3a was approximately 79%, whereas those of 3b to 3x were approximately 77% to 86%. Some of the synthesized compounds displayed weak to good anti-Tobacco mosaic virus (TMV) activity.
A Method for Quantitative Determination of Biofilm Viability
Authors: Welch Ken , Cai Yanling , Strømme Maria
Published: June 2012

In this study we present a scheme for quantitative determination of biofilm viability offering significant improvement over existing methods with metabolic assays. Existing metabolic assays for quantifying viable bacteria in biofilms usually utilize calibration curves derived from planktonic bacteria, which can introduce large errors due to significant differences in the metabolic and/or growth rates of biofilm bacteria in the assay media compared to their planktonic counterparts. In the presented method we derive the specific growth rate of Streptococcus mutans bacteria biofilm from a series of metabolic assays using the pH indicator phenol red, and show that this information could be used to more accurately quantify the relative number of viable bacteria in a biofilm. We found that the specific growth rate of S. mutans in biofilm mode of growth was 0.70 h−1, compared to 1.09 h−1 in planktonic growth. This method should be applicable to other bacteria types, as well as other metabolic assays, and, for example, to quantify the effect of antibacterial treatments or the performance of bactericidal implant surfaces.
Extrinsic and Intrinsic Frequency Dispersion of High-k Materials in Capacitance-Voltage Measurements
Authors: Tao J. , Zhao C. Z. , Zhao C. , Taechakumput P. , Werner M. , Taylor S. , Chalker P. R.
Published: June 2012

In capacitance-voltage (C-V) measurements, frequency dispersion in high-k dielectrics is often observed. The frequency dependence of the dielectric constant (k-value), that is the intrinsic frequency dispersion, could not be assessed before suppressing the effects of extrinsic frequency dispersion, such as the effects of the lossy interfacial layer (between the high-k thin film and silicon substrate) and the parasitic effects. The effect of the lossy interfacial layer on frequency dispersion was investigated and modeled based on a dual frequency technique. The significance of parasitic effects (including series resistance and the back metal contact of the metal-oxide-semiconductor (MOS) capacitor) on frequency dispersion was also studied. The effect of surface roughness on frequency dispersion is also discussed. After taking extrinsic frequency dispersion into account, the relaxation behavior can be modeled using the Curie-von Schweidler (CS) law, the Kohlrausch-Williams-Watts (KWW) relationship and the Havriliak-Negami (HN) relationship. Dielectric relaxation mechanisms are also discussed.