bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuropathic Glenohumeral Joint Resorption
Authors: Safford Daniel W. , Shah Kshamata M.
Published: August 2020

An 81-year-old woman was evaluated by a physical therapist at a skilled nursing facility 3 days post total knee arthroplasty (TKA). Following the evaluation, the on-call physician was consulted and radiographs were ordered. Radiographs revealed a chronic neuropathic joint with complete resorption of the humeral head and heterotopic ossification at the scapula. J Orthop Sports Phys Ther 2020;50(8):466. doi:10.2519/jospt.2020.9174
Training Load and Injury Part 2: Questionable Research Practices Hijack the Truth and Mislead Well-Intentioned Clinicians
Authors: Impellizzeri Franco M. , Ward Patrick , Coutts Aaron J. , Bornn Luke , McCall Alan
Published: August 2020

Background

In this clinical commentary, we highlight issues related to conceptual foundations and methods used in training load and injury research. We focus on sources of degrees of freedom that can favor questionable research practices such as P hacking and hypothesizing after the results are known, which can undermine the trustworthiness of research findings.

Clinical Question

Is the methodological rigor of studies in the training load and injury field sufficient to inform training-related decisions in clinical practice?

Key Results

The absence of a clear conceptual framework, causal structure, and reliable methods can promote questionable research practices, selective reporting, and confirmation bias. The fact that well-accepted training principles (eg, overload progression) are in line with some study findings may simply be a consequence of confirmation bias, resulting from cherry picking and emphasizing results that align with popular beliefs. Identifying evidence-based practical applications, grounded in high-quality research, is not currently possible. The strongest recommendation we can make for the clinician is grounded in common sense: “Do not train too much, too soon”–not because it has been confirmed by studies, but because it reflects accepted generic training principles.

Clinical Application

The training load and injury research field has fundamental conceptual and methodological weaknesses. Therefore, making decisions about planning and modifying training programs for injury reduction in clinical practice, based on available studies, is premature. Clinicians should continue to rely on best practice, experience, and well-known training principles, and consider the potential influence of contextual factors when planning and monitoring training loads. J Orthop Sports Phys Ther 2020;50(10):577–584. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9211
Which Interventions Enhance Pain Self-efficacy in People With Chronic Musculoskeletal Pain? A Systematic Review With Meta-analysis of Randomized Controlled Trials, Including Over 12 000 Participants
Authors: Martinez-Calderon Javier , Flores-Cortes Mar , Morales-Asencio Jose Miguel , Fernandez-Sanchez Manuel , Luque-Suarez Alejandro
Published: August 2020

Objective

To find out which interventions enhance pain self-efficacy in people with chronic musculoskeletal pain and to evaluate the reporting of interventions designed to enhance pain self-efficacy.

Design

Intervention systematic review with meta-analysis.

Literature Search

PubMed, Embase, Scopus, PsycINFO, CINAHL, PEDro, and the Cochrane Central Register of Controlled Trials were searched from inception up to September 2019.

Study Selection Criteria

Randomized controlled trials evaluating pain self-efficacy as a primary or secondary outcome in chronic musculoskeletal pain.

Data Synthesis

We used the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the risk of bias and the certainty of the evidence, respectively.

Results

Sixty randomized controlled trials were included (12 415 participants). There was a small effect of multicomponent, psychological, and exercise interventions improving pain self-efficacy at follow-ups of 0 to 3 months, a small effect of exercise and multicomponent interventions enhancing pain self-efficacy at follow-ups of 4 to 6 months, and a small effect of multicomponent interventions improving pain self-efficacy at follow-ups of 7 to 12 months. No interventions improved pain self-efficacy after 12 months. Self-management interventions did not improve pain self-efficacy at any follow-up time. Risk of bias, the nature of the control group, and the instrument to assess pain self-efficacy moderated the effects of psychological therapies at follow-ups of 7 to 12 months. The certainty of the evidence for all included interventions was low, due to serious risk of bias and indirectness. No trial reported the intervention in sufficient detail to allow full replication.

Conclusion

There was low-quality evidence of a small effect of multicomponent exercise and psychological interventions improving pain self-efficacy in people with chronic musculoskeletal pain. J Orthop Sports Phys Ther 2020;50(8):418–430. doi:10.2519/jospt.2020.9319
Examination of Corticospinal and Spinal Reflexive Excitability During the Course of Postoperative Rehabilitation After Anterior Cruciate Ligament Reconstruction
Authors: Zarzycki Ryan , Morton Susanne M. , Charalambous Charalambos C. , Pietrosimone Brian , Williams Glenn N. , Snyder-Mackler Lynn
Published: August 2020

Objective

To investigate corticospinal and spinal reflexive excitability and quadriceps strength in healthy athletes and athletes after anterior cruciate ligament reconstruction (ACLR) over the course of rehabilitation.

Design

Prospective cohort study.

Methods

Eighteen athletes with ACLR and 18 healthy athletes, matched by sex, age, and activity, were tested at (1) 2 weeks after surgery, (2) the “quiet knee” time point, defined as full range of motion and minimal effusion, and (3) return to running, defined as achieving a quadriceps index of 80% or greater. We measured (1) corticospinal excitability, using resting motor threshold (RMT) and motor-evoked potential amplitude at a stimulator intensity of 120% of RMT (MEP120) to the vastus medialis, (2) spinal reflexive excitability, calculating the ratio of the maximal Hoffmann reflex to the maximal M-wave to the vastus medialis, and (3) isometric quadriceps strength.

Results

The ACLR group had higher RMTs in the nonsurgical limb and higher MEP120 in the surgical limb at all time points. The healthy-athlete group did not have interlimb differences. The RMT was positively associated with quadriceps strength 2 weeks after surgery; MEP120 was associated with quadriceps strength at all time points.

Conclusion

Compared to healthy athletes, athletes after ACLR had altered corticospinal excitability that did not change from 2 weeks after surgery to the time of return to running. J Orthop Sports Phys Ther 2020;50(9):516–522. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9329
A Secondary Injury Prevention Program May Decrease Contralateral Anterior Cruciate Ligament Injuries in Female Athletes: 2-Year Injury Rates in the ACL-SPORTS Randomized Controlled Trial
Authors: Johnson Jessica L. , Capin Jacob J. , Arundale Amelia J.H. , Zarzycki Ryan , Smith Angela H. , Snyder-Mackler Lynn
Published: August 2020

Objective

To determine whether the addition of perturbation training to a secondary injury prevention program reduces the rate of second anterior cruciate ligament (ACL) injury compared to the prevention program alone.

Design

Single-blinded randomized controlled trial.

Methods

Thirty-nine female athletes who intended to return to cutting/pivoting sports were enrolled 3 to 9 months after primary anterior cruciate ligament reconstruction (ACLR). Athletes were randomized to receive a training program of either progressive strengthening, agility, plyometrics, and prevention (SAPP) (n = 20) or SAPP plus perturbation training (n = 19); each had 10 sessions over 5 weeks. Occurrence and side of second ACL injury were recorded for 2 years after primary ACLR.

Results

There were 9 second ACL injuries in the 2 years after ACLR. There was no statistically significant difference in rate or side of second ACL injury between the SAPP-plus-perturbation training and SAPP groups.

Conclusion

Adding perturbation training to a secondary ACL injury prevention program did not affect the rate of second ACL injury in female athletes. J Orthop Sports Phys Ther 2020;50(9):523–530. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9407
Desmoid Tumor Causing Shoulder Pain in an Adolescent Male
Authors: Blanchard Leanna , Nicklies Emily , Motamedi Daria
Published: August 2020

A 17-year-old adolescent boy was referred by an orthopaedic physician to physical therapy for chronic left shoulder pain and a clinical diagnosis of labral tear. The physician ordered current radiographs, which were noncontributory. Findings during physical therapy examination warranted referral back to the physician, with a request for magnetic resonance imaging. Magnetic resonance imaging revealed a soft tissue abnormality in the infraclavicular and subcoracoid spaces. The patient was referred to orthopaedic oncology, where biopsy confirmed a desmoid tumor. J Orthop Sports Phys Ther 2020;50(8):467. doi:10.2519/jospt.2020.9596
Limited Support for Trunk and Hip Deficits as Risk Factors for Athletic Knee Injuries: A Systematic Review With Meta-analysis and Best-Evidence Synthesis
Authors: Chia Lionel , de Oliveira Silva Danilo , McKay Marnee J. , Sullivan Justin , Micolis de Azevedo Fabio , Pappas Evangelos
Published: August 2020

Objective

To determine whether neuromuscular deficits in trunk and hip-related function are risk factors for athletic knee injuries.

Design

Etiology systematic review with meta-analysis.

Literature Search

Six online databases (MEDLINE, Web of Science, Embase, CINAHL, Scopus, and SPORTDiscus) were searched up to April 2019.

Study Selection Criteria

Studies assessing trunk and hip neuromuscular function as risk factors for knee injuries in healthy athletic populations were included.

Data Synthesis

Outcomes were synthesized quantitatively using meta-analysis of odds ratios, and qualitatively using best-evidence synthesis.

Results

Twenty-one studies met the inclusion criteria. There was very low–certainty evidence that greater hip external rotation strength protected against knee injuries (odds ratio = 0.78; 95% confidence interval: 0.70, 0.87; P<.05). There was limited evidence that deficits in trunk proprioception and neuromuscular control, and the combination of excessive knee valgus and ipsilateral trunk angle when landing unilaterally from a jump, may be risk factors for knee injuries.

Conclusion

Most variables of trunk and hip function were not risk factors for injuries. Further research is required to confirm whether hip external rotation strength, trunk proprioception and neuromuscular control, and the combination of knee valgus angle and ipsilateral trunk control are risk factors for future knee injuries. J Orthop Sports Phys Ther 2020;50(9):476–489. Epub 1 Aug 2020. doi:10.2519/jospt.2020.9705
Ultrasonido para la valoración del contenido gástrico: revisión sistemática de la literatura
Authors: Ortega Vallejo Darío Fernando , Erazo Narvaez Andrés Felipe , Díez Chamorro León Santiago , Suárez Rodríguez Daniela , Campo Sánchez Jamer Armando , Ortega López Laura Fernanda , Velasco Villarreal Lucía Maribel , Rivera Karen Alejandra
Published: August 2020

Pneumonic aspiration of gastric contents is an important complication of anesthetic practice. : To determine the applicability of ultrasound for the assessment of the qualitative and quantitative characteristics of gastric contents. : A systematic review was carried out, based on a structured search of the literature published in the databases: Pubmed, EMBASE, SciELO, Cochrane Library, OVID and Google Scholar, from the foundation of these until December 2018 Boolean connectors were used to locate information from the terms: anesthesiology, ultrasonography, gastrointestinal Contents. The quality of the information was assessed using different tools according to each type of study. : We found 23 relevant studies for inclusion in the systematic review. The overall risk of bias was low. : Gastric ultrasound seems to correspond to a tool that is easy to perform at the patient’s bedside, but there is uncertainty about its applicability in uncontrolled settings, different from those applied in the studies described in this review. More research is needed with different populations and scenarios, in favor of establishing the behavior in these, of the variables that can be determined by ultrasound. The implications for clinical practice and long-term outcomes may have the measurements achieved by ultrasound are still uncertain.
Características de la ventilación mecánica invasiva en COVID-19 para médicos no especialistas
Authors: Abarca Rozas Bastian , Vargas Urra Jocelyn , García Garzón Javier
Published: August 2020

SARS-CoV-2 is the agent responsible for COVID-19, the current pandemic, which is characterized by developing respiratory disturbances that are associated with severe hypoxemia associated with symptoms of non-bacterial pneumonia, ARDS up to multi-organ failure. It has been characterized by presenting 2 different phenotypes (phenotype L and phenotype H), with phenotype H being a stage of progressive deterioration of phenotype L, which depends on the earliness with which ventilatory management begins and the degree of inflammatory compromise. However, since VMI can generate VILI, the use of protective ventilation has been recommended as a ventilatory strategy for COVID-19. This review aims to comment on the available evidence of the essential aspects of protective IMV in the context of ARDS associated with COVID-19, in addition to the use of neuromuscular blockade and prone strategies.
The prophylactic effect of intravenous magnesium infusion on postoperative sore throat after thyroid surgery. A randomized clinical trial
Authors: Mostafa Raham Hasan , Saleh Ashraf Nabil , Ibrahim Ibrahim Mohamed
Published: August 2020

The reported incidence of postoperative sore throat (POST) varies widely from 14.4 to 100% with maximum severity at 4 to 6 postoperative hour. Nonetheless, it has increasingly become a common clinical problem particularly in thyroid surgery. Although POST usually resolves spontaneously in few days, it is likely to be the most common complaint. Driven by the increased number of patients with post-intubation sore throat following thyroid surgery, the aim of the present study was to evaluate the effectiveness of perioperative magnesium infusion in attenuating POST after thyroidectomy.
Masas cardíacas, utilidad de la ecocardiografía transesofágica durante el intraperioperatorio
Authors: Dominella Fernando , Masco Luis , Longo Silvina
Published: August 2020

We present our experience in cardiac tumor resection surgery in adult patients: 30 subjects with sternotomy approach with later diagnosis of myxomas (12), fibroelastomas (7), sarcomas (4), cardiac methastasis of a breast cancer and cardiac invasion of renal tumor (6), and 3 with videothroacoscopic approach with diagnosis of atrial myxoma (2) and intraventricular sarcoma (1). We highlight the usefulness of TEE as an essential monitor in this subtype of cardiac surgery in allowing location confirmation and completion of resection. Likewise as anesthesiologists and active participants of the surgical team, we were able to document absence of residual heart defects, lesions or perforations or dysfunction of heart valves. Evaluation of preexisting anatomy and function and post Cardiopulmonary Bypass ventricular function and circulation were important in early diagnosis of complications.
Anesthesitic management for insulinoma resection in a patient having chronic inflammatory demyelinating neuropathy
Authors: Mostafa Raham Hasan , Rashwan Amr Amin , AboKamar Mohamed Mohamed
Published: August 2020

Chronic Inflammatory Demyelinating Polyneuropathy associated with hypoglycemia 2 to insulinoma is unusual, and to our knowledge, very few patients have been reported in literature. Despite varying presentations in these patients, the clinical characteristics are usually the same. The syndrome usually occurs after several episodes of protracted hypoglycemia. The neuropathy is nearly always symmetrical. We report anesthetic management for a young female patient presenting with CIDP & repeated hypoglycemic episodes during a 2-year period scheduled for insulinoma enucleation.
Patients Radiation Risks from Computed Tomography Lymphography
Authors: Almujally Abdullah , Sulieman Abdelmoneim , Calliada Fabrizio
Published: August 2020

Objectives:

This study aims to first measure patient doses during computed tomography (CT) chest, abdomen, and extremities procedures for evaluation lymphedema, and second to estimate the radiation dose-related risks during the procedures.

Material and Methods:

Radiation effective doses from CT lymphography procedures quantified using CT machines from different vendors. After the calibration of CT systems, the data collected for a total of 28 CT lymphography procedures. Effective and organ doses extrapolated using national radiological protection software based on Monte Carlo simulation.

Results:

The mean patient doses for chest and abdomen procedures in term of CTDIvol (mGy) and DLP (mGy.cm) are 10.0 ± 3 and 425 ± 222 and 24 ± 12 and 1118 ± 812 for CT 128 and CT 16 slice, respectively. The mean DLP (mGy.cm) for extremities was 320 ± 140 and 424 ± 212 for CT 128 and CT 16 slice, in that order.

Conclusion:

Patients’ dose showed significant differences due to variation in the scan length and clinical indication. Organs lay in the primary beam received high radiation doses especially in the chest region which increases the probability of radiation-induced cancer. The current patient’s doses are higher compared to the previous studies.
Whole-Body versus Routine Skull Base to Mid-thigh 18F-Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography in Patients with Malignant Melanoma
Authors: Ozdemir Savas , McCook Barry , Klassen Christopher
Published: August 2020

Objectives:

The objectives of this study are to assess the utility of whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) (skull vertex to toes) imaging relative to the standard field of view (skull base to mid-thigh) in patients with primary melanoma site that is not located in the lower extremities.

Material and Methods:

The primary site of the melanoma and metastatic disease was determined based on 18F-FDG PET/CT findings in 26 patients. The FDG avid sites were tabulated as the primary site, lower extremity, brain, and other sites. The hypothesis is that routine skull base to mid-thigh versus whole-body 18F-FDG PET/CT in patients with malignant melanoma will not change management.

Results:

Patients (26) were divided into those with primary melanoma site in either the lower extremities (six patients) or other site (20 patients). Four of the six patients with the primary site in the lower extremities also had positive findings in the ipsilateral inguinal lymph nodes. One of the patients with a positive inguinal lymph node had metastatic sites in the external iliac region and lungs on the initial study. On follow-up imaging, this patient also exhibited diffuse metastatic disease, including a lower extremity. None of the remaining patients in this group had positive findings other than the primary site in the lower extremity. Of the remaining 20 patients with the primary site not in the lower extremity, one had diffuse metastatic disease that included a lower extremity. However, lower extremity involvement would not change patient management in this case. A second patient in this group had diffuse metastatic disease that also involved the brain. However, no metastatic disease was present in the lower extremities in this patient. None of the remaining 18 patients in this group had metastatic disease in a lower extremity. Two patients in the entire study group of 26 had brain metastasis on contrast-enhanced head CT, with one having multiple brain metastasis. PET failed to demonstrate some of the brain lesions. In the other patient with solitary brain metastasis detected on contrast-enhanced head CT, PET was negative.

Conclusion:

18F-FDG PET/CT imaging of the lower extremity may not be justified if the primary neoplasm is not located in the lower extremities. Elimination of lower extremity imaging will reduce scanning time and additional radiation exposure. Similarly, PET/CT imaging of the brain may not be justified if contrast-enhanced CT or magnetic resonance imaging of the head is already obtained since these are more sensitive.
Symptomatic intracranial hemorrhages and frame-based stereotactic brain biopsy
Authors: Lara-Almunia Monica , Hernandez-Vicente Javier
Published: August 2020

Background:

Stereotactic biopsy is a well-established procedure in neurosurgery. Our objective is to define the clinical, radiological, and technical factors that can condition the emergence of postbiopsy symptomatic intracranial hemorrhage. Based on our findings, we suggest recommendations to improve its usual clinical practice.

Methods:

We made a retrospective study of 429 cases with stereotactic biopsies performed in the past 37 years. The surgical procedure-was adapted in terms of the stereotactic frames (Todd-Wells, CRW, Leksell), neuroimaging tests, and planning programs available in the hospital. Fifty-three variables were analyzed for each patient (SPSS.23).

Results:

The diagnostic yield was 90.7%. Forty-one patients (9.5%) suffered a symptomatic postbiopsy hemorrhage; only 17 (3.9%) had permanent morbidity. The mortality was 0.93% (n = 4). A postsurgical CT scan was requested only in 99 patients (23%) of our series. Lesion mass effect, cystic component, contrast enhancement, histological nature, or number of targets were not associated with a greater risk of symptomatic postbiopsy hemorrhage (P > 0.05). On the other hand, the biopsies made by nonexpert neurosurgeons (P = 0.01) or under general anesthesia (P = 0.02) resulted in a greater risk of symptomatic postbiopsy hemorrhage. Anesthetic type was the clearest predictive factor of bleeding with this technique (OR: 0.24).

Conclusion:

Stereotactic biopsy is a very valuable tool. To optimize its safety and minimize the risk of intracranial bleeding, it requires both a knowledge of stereotactic techniques and very careful surgical planning. While the patient’s stay in intensive vigilance units after the procedure is a useful strategy, the request for control CT scans should be conditioned by the clinical evolution of each patient.
Subdural empyema caused by Morganella morganii
Authors: Bond Evalina , Stadler James A.
Published: August 2020

Background:

Morganella morganii is a species of Gram-negative enteric rod found in normal human gut flora. Pathologically, this most often presents as urinary tract infections, wound infections, and bacteremia. It is highly uncommon for M. morganii to be implicated in a central nervous system infection, with only 12 reported cases of parenchymal abscesses or meningitis.

Case Description:

A previously healthy 13-month-old female presented with fever of unknown origin and had a witnessed seizure during evaluation. A large left subdural fluid collection was identified, and the patient underwent emergent burr hole drainage and subdural drain placement. Cultures demonstrated M. morganii empyema, and she subsequently completed a course of directed antibiotics. Six months following surgery, she has no further clinical or radiographic evidence of infection, seizures, or neurological sequelae.

Conclusion:

We describe the first reported case of isolated subdural empyema caused by M. morganii. The child was successfully treated with the evacuation of the empyema and direct antibiotics with no lasting neurological injury.
Double neurophysiological certification of the filum terminale during sectioning surgery in pediatric population
Authors: Cabrera Juan P. , Vigueras Sebastián , Muñoz Rubén , López Eduardo
Published: August 2020

Background:

Surgery of thickened-fibrolipoma filum terminale (FT) is performed routinely and without conflict but is not a risk-free surgical procedure. Intraoperative neurophysiological monitoring with mapping techniques can help to certify the FT before sectioning. However, a tailored surgical approach to cauda equina and a low threshold of surrounding nerve roots can confuse the final surgical decision. The aim is to demonstrate the usefulness of this double methodology for FT certification.

Methods:

A prospective study collected and reviewed retrospectively, from 2015 to 2018, 40 patients undergoing an FT surgery section were included in the study. After opening the dura mater and under the microscope, the cauda equina mapping is performed and the recording of muscles of the lower limbs and the external anal sphincter. In addition, a high-intensity stimulation of constant current of an isolated FT for a short period of time and in a dry surgical field, obtaining a bilateral-polyradicular-symmetrical response of cauda equina nerve roots.

Results:

Traditional motor mapping identified FT in 65% (26/40) of patients. Although, 35% (14/40) of the patients still have low-intensity stimuli response (<1 mA) of a muscle, especially anal sphincter. When this happens, the optimization of the dissection around FT is performed. After that, 25% (10/40) of the patients still having a muscle response in spite of seem isolated FT. Increasing the stimulation intensity up to 20 mA evoked a cauda equina response in all cases. No postoperative neurological impairment was observed in this series.

Conclusion:

This proposed methodology accurately confirms the FT so that it can be safely found and cut. The Double Neurophysiological Certification improves the gap of the traditional mapping techniques of cauda equina and can be used in a variety of more complex surgeries in this area.
Delayed reopening of a superficial temporal artery to middle cerebral artery bypass graft occluded by a white thrombus during surgery
Authors: Takahashi Satoshi , Yoshida Kazunari
Published: August 2020

Background:

To the authors’ knowledge, reopening of a superficial temporal artery to middle cerebral artery (STA-MCA) bypass graft occluded by a white thrombus during the procedure and was observed several months after the surgery is relatively rare.

Case Description:

The authors encountered a case of moyamoya disease in an Asian female in her third decade of life, in whom a bypass recipient vessel was occluded by a white thrombus during surgery and remained occluded on magnetic resonance angiography (MRA) performed up to 6 weeks after the procedure. However, recanalization was confirmed by MRA performed 4 months after surgery. MRA performed 10 and 19 months after surgery revealed that the bypass vessel had grown thicker, and the ischemic symptoms experienced by the patient also improved.

Conclusion:

Whether this lesion is explained by reopening or angiogenesis, its pathophysiology remains controversial. The uninterrupted connection of occluded bypass vessel in STA-MCA bypass surgery in conjunction with surgical strategy of single bypass using only parietal branch of STA as donor and preserving blood flow of frontal branch to scalp may have made a positive impact on promoting the development of extracranial-intracranial bypass anastomosis in the chronic phase and should be considered.
Evolution of patients with surgically treated drug-resistant occipital lobe epilepsy
Authors: Aznarez Pablo Barbero , Cabeza Marta Pastor , Quintana Ana Sofia Alvarez , Lara-Almunia Monica , Sanchez Julio Albisua
Published: August 2020

Background:

This study was to describe the evolution of patients who underwent surgical treatment of drug- resistant occipital lobe epilepsy (OLE) at our institution.

Methods:

We performed a retrospective analysis of data collected from electronic and paper clinical records of 20 patients who were diagnosed of OLE and underwent epilepsy surgery at our institution between 1998 and 2018. We also contacted patients by telephone and asked them to fill out a questionnaire about quality of life in epilepsy (QOLIE-10). Assembled data were analyzed using descriptive statistics.

Results:

The age at surgery ranged between 19 and 55 years. The period encompassing epilepsy onset and the date of surgery was variable. Semiology of seizures included visual symptoms in 75% of patients. In 90% of cases subdural grids, depth electrodes or a combination of both were used to plan the surgery. The most frequent neuroimaging and histopathological finding was cortical dysplasia (55%). The postoperative follow-up period was up to 15 years. The most common score on the Engel scale was I (70%). Visual deficits increased after surgery. Median score on QOLIE-10 questionnaire was 82.5 (interquartile range: 32.5).

Conclusion:

Surgical treatment of drug-resistant OLE offers hopeful results to those patients who have run out of pharmacological options and leads to postoperative deficits that are deemed expectable and occasionally acceptable.
Microsurgical embolectomy with superficial temporal artery-middle cerebral artery bypass for acute internal carotid artery dissection: A technical case report
Authors: Okada Nakao Ota Yasuaki , Noda Kosumo , Tanikawa Rokuya
Published: August 2020

Background:

Dissection of the internal carotid artery (ICA) is an important cause of stroke. Intravenous alteplase administration and mechanical thrombectomy have been strongly recommended for selected patients with acute ischemic stroke. However, the efficacy and safety of these treatments for ischemic stroke due to ICA dissection remain unclear. Here, we report a case of acute ICA dissection successfully treated by microsurgical embolectomy.

Case Description:

A 40-year-old man presented with sudden left hemiparesis and in an unconscious state, with a National Institutes of Health Stroke Scale score of 14. Preoperative radiologic findings revealed an ICA dissection from the extracranial ICA to the intracranial ICA and occlusion at the superior-most aspect of the ICA. A dissection at the superior-most aspect of the ICA occlusion could not be confirmed; therefore, a surgical embolectomy with bypass was initiated. It became apparent that the superior ICA occlusion was not due to dissection but rather to an embolic occlusion; therefore, we undertook a surgical embolectomy and cervical ICA ligation with a double superficial temporal artery-middle cerebral artery bypass. The postoperative course was uneventful and, at the 6-month follow-up, the Modified Rankin Scale score for this patient was 1.

Conclusion:

Surgical embolectomy with or without bypass can safely treat acute ischemic stroke due to an ICA dissection that cannot be distinguished between a dissecting occlusion and an embolic occlusion. Thus, it may be considered as an alternative option for patients in whom mechanical thrombectomy has failed or for those who are ineligible for mechanical thrombectomy.
Cauda equina syndrome caused by lumbar leptomeningeal metastases from lung adenocarcinoma mimicking a schwannoma
Authors: Nicoletti Giovanni Federico , Umana Giuseppe Emmanuele , Graziano Francesca , Calì Alessandro , Fricia Marco , Cicero Salvatore , Scalia Gianluca
Published: August 2020

Background:

Cauda equina syndromes (CESs) due to leptomeningeal metastases from primitive lung tumors are rare. Despite recent advancements in neuro-oncology and molecular biology, the prognosis for these patients remains poor. Here, we present a case in which a patient developed lumbar leptomeningeal metastases from lung carcinoma that contributed to a CES and reviewed the appropriate literature.

Case Description:

A 55-year-old female presented with the left lower extremity sciatica/weakness. Two years ago, a then 53-year-old female had received Gamma Knife stereotactic radiosurgery (SRS) for a cerebellopontine angle schwannoma. Recently, she underwent resection of lung carcinoma and SRS for a right hemispheric cerebellar metastasis. Now at age 55, she presented with the left lower extremity sciatica/weakness. When her new lumbar MR was interpreted as showing a L5 schwannoma, a L4-L5 laminectomy was performed at surgery, the authors encountered multifocal leptomeningeal metastases densely infiltrating the cauda equina. Although only subtotal resection/decompression of tumor was feasible, she did well for the ensuing year. The histological diagnosis confirmed the lesion to be a poorly differentiated lung adenocarcinoma.

Conclusion:

Patients with a history of prior metastatic lung cancer may present with spinal leptomeningeal metastases resulting in a CES.
Causes of hospital readmissions within 7 days from the neurosurgical service of a quaternary referral hospital
Authors: Nwachuku Enyinna L. , Patel Kevin P. , Paul Audrey L. , Friedlander Robert M. , Gerszten Peter C.
Published: August 2020

Background:

Evaluation of readmission rates as a proxy metric of health-care quality in neurological surgery has grown to become a prevalent area of investigation in the last several years. Significant attention has been paid to 30-day readmission rates due to the financial incentive to health-care providers following the enforcement of the penalties created by the Affordable Care Act. However, relatively little attention has been paid to patients readmitted within 7 days of discharge to large quaternary neurological surgery services. This study was conducted to examine the causes and unique characteristics of 7-day readmission rates from a neurosurgical service at a large quaternary referral hospital.

Methods:

A retrospective observational analysis of all 7-day readmissions to the neurosurgical surgery service of the University of Pittsburgh Medical Center, Presbyterian Hospital from August 2017 to June 2019, was performed. Patients were organized into seven categories based on their primary reason for readmission: scheduled surgeries, infection, pain, altered mental status or seizures, general postoperative complications, complications directly resulting from a neurosurgical intervention, and unrelated reasons. Demographic information, the time between initial discharge and subsequent readmission, and discharge disposition were also recorded.

Results:

Of 5274 discharges, 258 patients (4.9%) were readmitted within 7 days (55.0% male; mean age 60 years of age). Two-thirds of patients readmitted initially underwent care for cranial pathologies (57% of 258 patients) as opposed to a third for spine pathologies (33% of 258 patients). Complications that directly arose from the neurosurgical intervention (e.g., shunt infection or misplacement, and hardware misplacement) represented 18.9% of total readmission, while general postoperative complications (e.g., urinary tract infection) accounted for 15.1% of total readmission, in which all together were slightly greater than a third of readmissions. Seizures or altered mental status led to less than a fifth of readmissions (17.0%), followed by readmissions from unrelated diagnosis or miscellaneous reasons (17.0%) and scheduled surgeries (13.1%). Taken together, surgical site infections (9.7%) and postoperative pain (9.3%) accounted for 9.7% and 9.3 % of readmissions, respectively.

Conclusion:

Approximately 5% of patients discharged in a single year from our quaternary referral center were readmitted within 7-days. Approximately 90% of all 7-day readmissions were unplanned, with one-third resulting directly from perioperative complications. Further investigation to better understand this acutely vulnerable yet previously overlooked population may guide focused efforts to increase the quality of neurosurgical patient care.
A case of cerebral infarction due to pleomorphic carcinoma of the lung
Authors: Yoshikawa Shinichiro , Kamide Tomoya , Kasakura Shigen , Arai Noriko , Osada Takashi , Mouri Atsuto , Hamada Mei , Kawasaki Tomonori , Takao Masaki , Kohyama Shinya
Published: August 2020

Background:

With the increase in endovascular treatment, reports of embolism other than thrombus are scattered, but intracranial tumorigenic embolism is rare and difficult to diagnose. Here, we describe a case of a tumorigenic embolism in a patient with lung cancer whose invasion into the vascular system was not detected on preoperative whole-body imaging.

Case Description:

A 66-year-old man who was hospitalized to undergo radiotherapy for pulmonary carcinoma suddenly developed left hemiplegia. He exhibited atrial fibrillation, and emergent radiographic examination revealed a right middle cerebral artery occlusion. Urgent mechanical embolectomy was performed, with successful revascularization. The excised embolus had a unique morphology and was pathologically diagnosed as a cerebral embolism caused by pleomorphic pulmonary carcinoma.

Conclusion:

Tumor-derived cerebral embolism is extremely rare, but it is necessary to consider it as a potential source of embolism during differential diagnosis in patients with malignant tumors.
Surgical removal of a spinal intrathecal projectile led to a significant improvement of cauda equina syndrome
Authors: Aljuboori Zaid
Published: August 2020

Background:

Penetrating gunshot wounds of the spine are common and can cause severe neurological deficits. However, there are no guidelines as to their optimal treatment. Here, we present a penetrating injury to the lower thoracic spine at the T12 level that lodged within the canal at L1, resulting in a cauda equina syndrome. Notably, the patient’s deficit resolved following bullet removal.

Case Description:

A 29-year-old male sustained a gunshot injury. The bullet entered the right lower chest, went through the liver, entered the spinal canal at T12, fractured the right T12/L1 facet, and settled within the canal at the L1 level. The patient presented with severe burning pain in the right leg, and perineum. On exam, he had right-sided moderate weakness of the iliopsoas and quadriceps femoris muscles, a right-sided foot drop, decreased sensation throughout the right leg, and urinary retention. Computed tomography myelography showed the bullet located intrathecally at the L1 level causing compression of the cauda equina. The patient underwent an L1 laminectomy with durotomy for bullet removal. Immediately postoperatively, the patient improved; motor power returned to normal, the sensory exam significantly improved; and he was left with only mild residual numbness and burning pain in the right leg.

Conclusion:

With gunshot injuries, there is a direct correlation between the location/severity of the neurological injury and the potential for recovery. In patients with incomplete cauda equina syndromes, bullet extraction may prove beneficial to neurological outcomes.
Pure endoscopic transsphenoidal treatment of skull base ameloblastoma with intracranial extension: Case report and literature review
Authors: Ferreira Tiago Silva Holanda , Pimentel Isnara Mara Freitas , Albuquerque Lucas Alverne Freitas de , Gondim Jackson A.
Published: August 2020

Background:

Ameloblastoma is a benign locally invasive lesion that represents 1% of all oral tumors. Epidemiological characteristics are variable in the literature. The most common origin sites are mandible and maxilla. Rarely presents metastasis, but the skull base, lymph nodes, and the lung are described as metastatic sites. Low recurrence rates were reported by the authors when surgical treatment achieved complete resection.

Case Description:

A female patient, 19 years old presenting moderate headache associated with nausea, vomiting, left facial hypoesthesia, and low visual acuity. Resonance image showed a heterogeneous expansive solid formation in sphenoid bone and clivus with neoplastic aspect. Signs of dissemination due to contiguity and invasion of skull base structures, especially cavernous sinus and internal carotid artery, determining also compression of the brainstem. First, an endoscopic biopsy was performed with otorhinolaryngology service. The pathological study showed histological characteristics of ameloblastoma. After, the patient was submitted to endoscopic surgery for resection of tumor.

Conclusion:

Ameloblastoma is a rare tumor with benign behavior and slow growing. It arises from odontogenic epithelium and accounts 1% of all oral tumors. The mandible and maxilla are the most common sites of origin. Ameloblastoma with intracranial involvement is a rare presentation with few literature reviews. A long time illness course and multiple surgeries are characteristics present in the majority of cases described. Total resection surgery is the treatment of choice and endoscopic transnasal resection is a viable option.
Elective inferior temporal lobe resection as an adjunct to subtemporal approach for a case of tentorial meningioma arising from the middle part of the free edge of the tentorium: A case report
Authors: Gupta Sunil Kumar , Aggarwal Ashish , Wankhede Lomesh
Published: August 2020

Background:

Tentorial meningiomas attached to the inner edge of the tentorium are difficult to excise due to their deep location. Sufficient space may not be always available through a subtemporal approach. Thus, the aim of not retracting the brain is not fulfilled.

Methods:

To gain surgical corridor, we electively resected the inferior temporal lobe. This helped in greater working space, better visualization, and less chances of venous damage.

Results:

Employing this technique of elective temporal lobe resection helped us in complete tumor removal without compromising on vision or surgical corridor.

Conclusion:

A limited inferior temporal lobectomy greatly enhances the working space and vision in cases of difficult tentorial meningiomas. This translates into ease of tumor excision without compromising the patient safety.
Android skin cancer detection and classification based on MobileNet v2 model
Authors: Wibowo Adi , Adhi Hartanto Cahyo , Wisnu Wirawan Panji
Published: August 2020

The latest developments in the smartphone-based skin cancer diagnosis application allow simple ways for portable melanoma risk assessment and diagnosis for early skin cancer detection. Due to the trade-off problem (time complexity and error rate) on using a smartphone to run a machine learning algorithm for image analysis, most of the skin cancer diagnosis apps execute the image analysis on the server. In this study, we investigate the performance of skin cancer images detection and classification on android devices using the MobileNet v2 deep learning model. We compare the performance of several aspects; object detection and classification method, computer and android based image analysis, image acquisition method, and setting parameter. Skin cancer actinic Keratosis and Melanoma are used to test the performance of the proposed method. Accuracy, sensitivity, specificity, and running time of the testing methods are used for the measurement. Based on the experiment results, the best parameter for the MobileNet v2 model on android using images from the smartphone camera produces 95% accuracy for object detection and 70% accuracy for classification. The performance of the android app for object detection and classification model was feasible for the skin cancer analysis. Android-based image analysis remains within the threshold of computing time that denotes convenience for the user and has the same performance accuracy with the computer for the high-quality images. These findings motivated the development of disease detection processing on android using a smartphone camera, which aims to achieve real-time detection and classification with high accuracy.
Argumentação no Ensino de Ciências: Ponderações Analíticas a Luz da Teoria de Chaїm Perelman e Lucie Olbrechts-Tyteca
Authors: Pereira Gerlany de Fátima dos Santos , Nunes José Messildo Viana , Freitas Nadia Magalhães da Silva
Published: August 2020

Este estudo teve como objetivo analisar um Debate sobre uma controvérsia sociocientífica, referente aos alimentos transgênicos. Trata-se de uma pesquisa-ação, de natureza qualitativa, realizada junto a licenciandos de Biologia. O enredo formativo desenvolve-se a partir de um estudo de caso fictício, intitulado “O caso simulado do açaí transgênico na Amazônia”. Um conjunto de atividades suscitaram discussões e argumentações sobre o tema, levados ao Debate. Para análise e interpretação dos dados, utilizou-se como abordagem teórica a classificação dos argumentos segundo Perelman e Olbrechts-Tyteca, precisamente quanto a três grandes classes, quais sejam: argumentos quase-lógicos, argumentos baseados na estrutura do real e argumentos que fundamentam a estrutura do real. Em um plano complementar, classificamos os argumentos segundo diferentes dimensões argumentativas (científica, ambiental, social e econômica). Quanto aos resultados, em geral, podemos afirmar que os argumentos de autoridade apresentam relação quase que direta com a dimensão científica da argumentação, utilizados pelos apoiadores dos transgênicos. Já os argumentos pragmáticos foram mais utilizados pelos grupos contrários à introdução do açaí transgênico, buscando elucidar as consequências desfavoráveis decorrentes de tal empreendimento, inclusive em referência ao Princípio da Precaução e ao ambiente amazônico. A experiência propiciou aos futuros professores uma formação ambiental, que apresentou a possibilidade de abordagens complexas de objetos de estudo e de ensino, bem como chamou atenção para a necessidade de adoção de metodologias ativas de ensino, cuja centralidade está no sujeito aprendente, o que pode se constituir referência ao fazer docente.
Improved Wolf Pack Algorithm for Optimum Design of Truss Structures
Authors: Li Yan-Cang , Xu Pei-Dong
Published: August 2020

In order to find a more effective method in structural optimization, an improved wolf pack optimization algorithm was proposed. In the traditional wolf pack algorithm, the problem of falling into local optimum and low precision often occurs. Therefore, the adaptive step size search and Levy's flight strategy theory were employed to overcome the premature flaw of the basic wolf pack algorithm. Firstly, the reasonable change of the adaptive step size improved the fineness of the search and effectively accelerated the convergence speed. Secondly, the search strategy of Levy's flight was adopted to expand the search scope and improved the global search ability of the algorithm. At last, to verify the performance of improved wolf pack algorithm, it was tested through simulation experiments and actual cases, and compared with other algorithms. Experiments show that the improved wolf pack algorithm has better global optimization ability. This study provides a more effective solution to structural optimization problems.
Performance of Bio Concrete by Using Bacillus Pasteurii Bacteria
Authors: Metwally Gehad A. M. , Mahdy Mohamed , Abd El-Raheem Ahmed El-Raheem H.
Published: August 2020

In concrete, cracking is a common phenomenon due to its relatively low tensile strength‎ ‎, which occurs due to external loads and imposed deformations‎‎. The main research objective is to create a kind of self-healing concrete by employing mineral producing bacteria Bacillus pasteurii‎ to locate the rift in the most favourable circumstances for autogenous healing to take place. Self-healing concrete containing bacteria has been generated for this study through the application of bacterial self-healing elements as ‎spores ‎and nutrients with different percentages of bacteria ranging from (10% - 25%) as a replacement of mixing water is added at the time of pouring. The bacteria influence was observed by Scanning Electron Microscope (SEM) and with Energy ‎Dispersive X-ray Spectrometer. The mechanical properties and durability of a thirty-five mixture were ‎examined. The optimal blending content proportion was ‎10SF20BC, which showed an increment in compressive strength and flexural strength compared to the control mixture ‎to ‎reach 79.16%, 50% respectively and 24.38% enhancement in sulfate resistance. The highest percentage of calcium carbonate precipitations was ‎9.49% of a weight of ‎mixtures ‎elements, which, in turn, revealed the highest area repair rate, which was able to fill the ‎crack with widths leads to 0.80 mm.