bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of meningiomas involving the transverse or sigmoid sinus
Authors: Mazur Marcus D. , Cutler Aaron , Couldwell William T. , Taussky Philipp
Published: December 2013

Meningiomas that invade the transverse or sigmoid sinuses are uncommon tumors that are challenging to treat surgically. Although the risk of recurrence is associated with the extent of resection, complete removal of meningiomas in these locations must be balanced with avoidance of venous outflow obstruction, which could cause venous infarction and significant neurological consequences. When a meningioma occludes a venous sinus completely, gross-total resection of the intravascular portion is commonly performed. When the tumor invades but does not completely obliterate a major venous sinus, however, opinions differ on whether to accept a subtotal resection or to open the sinus, perform a complete resection, and reconstruct the venous outflow tract. In this paper, the authors review the different strategies used to treat these lesions and provide illustrative case examples.
Petroclival meningiomas: an update on surgical approaches, decision making, and treatment results
Authors: Xu Feng , Karampelas Ioannis , Megerian Cliff A. , Selman Warren R. , Bambakidis Nicholas C.
Published: December 2013

Object

Petroclival meningiomas remain a formidable challenge for neurosurgeons because of their location deep within the skull base and proximity to eloquent neurovascular structures. Various skull base approaches have been used in their treatment, and deciding which is the optimal one remains controversial. Attempts at achieving gross- or near-total resections are associated with an increased rate of morbidity and mortality. As adjunctive treatment options such as stereotactic radiosurgery have been developed and become widely available, there has been a trend toward accepting subtotal resections in an effort to minimize neurological morbidity. This paper reviews a recent series of patients with petroclival meningiomas and highlights current management trends and important considerations useful in surgical decision making.

Methods

The records of patients with large (> 3 cm) petroclival meningiomas surgically treated by the senior author over the past 5 years were reviewed. The clinical results are presented as examples of the surgical approaches available for approaching these tumors, and treatment options are reviewed.

Results

Of 196 meningiomas surgically treated during the study period, 8 lesions in 8 patients met the study criteria. Overall clinical results were excellent, with no death or major morbidity. Intracranial gross- or near-total resection (Simpson Grade 1, 2, or 3) was achieved in 5 patients (67%). New cranial nerve deficits occurred in 3 patients (37%) and were more common in patients in whom a subtotal resection was performed (2 of 3 cases). A variety of surgical approaches were used. Important considerations determining the best approach include the location of the tumor relative to the internal auditory canal, the presence of preoperative hearing loss, and the location of the tumor relative to the tentorium.

Conclusions

Achieving gross- or near-total resections of large petroclival meningiomas remains achievable and should be the primary goal of surgical treatment. A retrosigmoid craniotomy remains a workhorse surgical approach for most petroclival tumors of any size. Tumors that are medial to the internal auditory canal and span both middle and posterior cranial fossae are often best treated with a combined transpetrosal approach, which is especially true if there is a preoperative hearing deficit.
The treatment of cavernous sinus meningiomas: evolution of a modern approach
Authors: Klinger Daniel R. , Flores Bruno C. , Lewis Jeremy J. , Barnett Samuel L.
Published: December 2013

Cavernous sinus meningiomas (CSMs) are challenging lesions for the skull base neurosurgeon to manage given their close association with cranial nerves II–VI and the internal carotid artery. In the 1980s and early 1990s, with advancements in microsurgical techniques, increasing knowledge of the relevant microsurgical neuroanatomy, and the advent of advanced skull base surgical approaches, the treatment of CSMs involved attempts at gross-total resection (GTR). Initial fervor for a surgical cure waned, however, as skull base neurosurgeons demonstrated the limits of complete resection in this region, the ongoing issue of potential tumor recurrences, and the unacceptably high cranial nerve and vascular morbidity associated with this strategy. The advent of radiosurgery and its documented success for tumor growth control and limited morbidity in cavernous lesions has helped to shift the treatment goals for CSMs from GTR to tumor control and symptom relief while minimizing treatment- and lesion-associated morbidity. The authors review the relevant microanatomy of the cavernous sinus with anatomical and radiographic correlates, as well as the various treatment options. A modernized, multimodality treatment algorithm to guide management of these lesions is proposed.
Controversies in the role of preoperative embolization in meningioma management
Authors: Singla Amit , Deshaies Eric M. , Melnyk Vlad , Toshkezi Gentian , Swarnkar Amar , Choi Hoon , Chin Lawrence S.
Published: December 2013

The role of preoperative embolization in meningioma management remains controversial, even though 4 decades have passed since it was first described. It has been shown to offer benefits such as decreased blood loss and “softening of the tumor” during subsequent resection. However, the actual benefits remain unclear, and the potential harm of an additional procedure along with the cost of embolization have limited its use to a small proportion of the meningiomas treated.

In this article the authors retrospectively reviewed their experience with preoperative embolization of meningiomas over the previous 6 years (March 2007–March 2013). In addition, they performed a MEDLINE search using a combination of the terms “meningioma,” “preoperative,” and “embolization” to analyze the indications, embolizing agents, timing, and complications reported during preoperative embolization of meningiomas. In this retrospective review, 18 cases (female/male ratio 12:6) were identified in which endovascular embolization was used prior to resection of an intracranial meningioma. Craniotomy for tumor resection was performed within 4 days after endovascular embolization in all cases, with an average time to surgery of 1.9 days. The average duration of surgery was 4 hours and 18 minutes, and the average blood loss was 574 ml, with a range of 300–1000 ml. Complications following endovascular therapy were identified in 3 (16.7%) of 18 cases, including one each of transient hemiparesis, permanent hemiparesis, and tumor swelling.

The literature review returned 15 articles consisting of a study population greater than 25 patients. No randomized controlled study was found. The use of small polyvinyl alcohol particles (45–150 μm) is more effective in preoperative devascularization than larger particles (150–250 μm), but is criticized due to the higher risk of complications such as cranial nerve palsies and postprocedural hemorrhage. Time to surgery after embolization is inconsistently reported across the articles, and conclusions on the appropriate timing of surgery could not be drawn. The overall complication rate reported after treatment with preoperative meningioma embolization ranges from as high as 21% in some of the older literature to approximately 6% in recent literature describing treatment with newer embolization techniques. The evidence in the literature supporting the use of preoperative meningioma embolization is mainly from case series, and represents Level III evidence. Due to the lack of randomized controlled clinical trials, it is difficult to draw any significant conclusions on the overall usefulness of preoperative embolization during the management of meningiomas to consider it a standard practice.
The role of radiosurgery in the management of WHO Grade II and III intracranial meningiomas
Authors: Ding Dale , Starke Robert M. , Hantzmon John , Yen Chun-Po , Williams Brian J. , Sheehan Jason P.
Published: December 2013

Object

WHO Grade II and III intracranial meningiomas are uncommon, but they portend a significantly worse prognosis than their benign Grade I counterparts. The mainstay of current management is resection to obtain cytoreduction and histological tissue diagnosis. The timing and benefit of postoperative fractionated external beam radiation therapy and stereotactic radiosurgery remain controversial. The authors review the stereotactic radiosurgery outcomes for Grade II and III meningiomas.

Methods

A comprehensive literature search was performed using PubMed to identify all radiosurgery series reporting the treatment outcomes for Grade II and III meningiomas. Case reports and case series involving fewer than 10 patients were excluded.

Results

From 1998 to 2013, 19 radiosurgery series were published in which 647 Grade II and III meningiomas were treated. Median tumor volumes were 2.2–14.6 cm3. The median margin doses were 14–21 Gy, although generally the margin doses for Grade II meningiomas were 16–20 Gy and the margin doses for Grade III meningiomas were 18–22 Gy. The median 5-year PFS was 59% for Grade II tumors and 13% for Grade III tumors, which may have been affected by patient age, prior radiation therapy, tumor volume, and radiosurgical dose and timing. The median complication rate following radiosurgery was 8%.

Conclusions

The current data for radiosurgery suggest that it has a role in the management of residual or recurrent Grade II and III meningiomas. However, better studies are needed to fully define this role. Due to the relatively low prevalence of these tumors, it is unlikely that prospective studies will be feasible. As such, well-designed retrospective analyses may improve our understanding of the effect of radiosurgery on tumor recurrence and patient survival and the incidence and impact of treatment-induced complications.
Promoting Better Hand off and Achieving Better Patient Care in ICU
Authors: Faruq Mohammad Omar
Published: December 2013

DOI: http://dx.doi.org/10.3329/bccj.v1i2.17196 Bangladesh Crit Care J September 2013; 1 (2): 63-64
Maternal and perinatal mortality, morbidity and risk factor evaluation in ante partum hemorrhage associated with Placenta Praevia
Authors: Kalam Farhana , Faruq Mohammad Omar , Chowdhury Saleha Begum
Published: December 2013

Objective: To determine the maternal & perinatal morbidity and mortality associated with Placenta Praevia in Bangladesh. To assess the risk factors of antepartum hemorrhage associated with Placenta Praevia. Design: A cross sectional observational hospital based descriptive study. Setting: Obstetric inpatient units of two tertiary care teaching hospitals of Dhaka. Participants: One hundred pregnant mothers with diagnosis or Placenta Praevia proven by pelvic ultra sonography presenting with ante partum hemorrhage . Outcome: Incidence of maternal and fetal morbidity and mortality and risk factors of ante partum hemorrhage in Placenta Praevia. Results: 38% study mothers had no ante natal care. There was no maternal death. 96% of mothers were delivered by Caesarean Section. Incidence of primary post partum hemorrhage was 38%. There were 21% still birth and 16% neonatal death. 47% mothers had no complication after delivery. 22% mothers presented with hemorrhagic shock. 59% delivered babies had birth weight below 2.5 kg and 55% delivered babies had no complication. 57% mothers belonged to low socio economic group. Conclusion: The study reflects status of mothers presenting with Placenta Praevia with perinatal morbidity and mortality in a small urban population of Bangladesh treated at two tertiary care hospitals of Dhaka. It is recommended that mothers with Placenta Praevia need to have access to prenatal care and at the same time need to be educated about the benefit of prenatal care. Emergency management of ante partum hemorrhage with hemorrhagic shock should be widely available to improve the outcome of Placenta Praevia in our population. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17197 Bangladesh Crit Care J September 2013; 1 (2): 65-70
Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): a randomised, placebo-controlled trial
Authors: Maniruzzaman Md , Rahaman Mir Atiqur
Published: December 2013

The article is reprinted after 'Lancet 2010; 376: 23-32' by the above collaborators with written permission from Lancet Authority.Background: Tranexamic acid can reduce bleeding in patients undergoing elective surgery. We assessed the effects of early administration of a short course of tranexamic acid on death, vascular ocdusive events, and the receipt of blood transfusion in trauma patients. Methods: This randomised controlled trial was undertaken in 274 hospitals in 40 countries. In Bangladesh we have taken 12 patients for this study. 20211 adult trauma patients with, or at risk of, significant bleeding were randomly assigned within 8 h of in jury to either tranexamic acid (loading dose 1 g over 10 mm then infusion of 1 g over 8 h) or matching placebo. Randomisation was balanced by centre, with an allocation sequence based on a block size of eight, generated with a computer random number generator. Both participants and study staff (site investigators and trial coordinating centre staft) were masked to treatment allocation. The primary outcome was death in hospital within 4 weeks of injury and was described with the following categories: bleeding, vascular ocdusion (myocardial infarction, stroke and pulmonary embolism), multiorgan failure, head injury, and other. All analyses were by intention to treat. This study is registered as ISRCTN867SO1O2, Clinicaltrials.gov NCT00375258, and South African Clinical Trial Register DOH-27-0607.1919. Findings: 10096 patients were allocated to tranexamic acid and 10115 to placebo, of whom 10060 and 10067, respectively, were analysed. All-cause mortality was significantly reduced with tranexamic add (1463(14.5%] tranexamic add group vs 1613 [16.0%] placebo group; relative risk 0.91, 95% Cl 0.85-0.97; p=0.0035). The risk of death due to bleeding was significantly reduced (489 [4.9%] vs 574 [5.7%]; relative risk 0.85, 95% CI 0.76 -0.96; p=O .0077). Interpretation: Tranexamic acid safely reduced the risk of death in bleeding trauma patients in this study. On the basis of these results, tranexamic acid should be considered for use in bleeding trauma patients. Funding: UK NIHR Health Technology Assessment programme, Pfizer, BUPA Foundation, and J P Moulton Charitable Foundation. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17198 Bangladesh Crit Care J September 2013; 1 (2): 71-79
Fatal outcome related risks in severely malnourished children with pneumonia in an urban critical care ward of Bangladesh
Authors: Chisti Mohammod Jobayer , Salam Mohammed Abdus , Hossain Md Iqbal , Ashraf Hasan , Faruque Abu SG , Bardhan Pradip Kumar , Shahid Abu SMSB , Shahunja KM , Jha Simon Kumar , Ahmed Tahmeed
Published: December 2013

Background: Fatal outcome related risks are high when children with pneumonia present with severe acute malnutrition (SAM). However, data are limited on fatality related risk factors from pneumonia in Children with SAM especially those who attended in critical care ward. We evaluated clinically identifiable risks for fatal outcome in under-five Children with SAM with pneumonia at a critical care ward in an urban hospital. Methods: This study was of unmatched case-control design and Children with SAM of either sex, aged 0-59 months, admitted to the Intensive Care Unit (ICU) of Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) from April 2011 through July 2012 with radiological pneumonia were studied. The study children who had fatal outcome constituted the cases (n=35), and randomly selected children who survived constituted the controls (n=105). Results: The age (months) among the cases and the controls [median (inter-quartile range)] was comparable [8.0 (4.9, 11.0) vs. 9.7 (5.0, 18.0); p=0.210)]. In multivariate logistic regression analysis, after adjusting for potential confounders, such as abnormal mental status, vomiting, and systolic hypotension (<70 mm of Hg) in absence of dehydration, severely malnourished under-five children with pneumonia having fatal outcome more often had hypoxemia (OR=23.15, 95% CI=4.38-122.42), dehydrating (some/severe) diarrhea (OR=9.48, 95% CI=2.42-37.19), abdominal distension at admission (OR=4.41, 95% CI=1.12-16.52), and received blood transfusion (OR=5.50, 95% CI=1.21-24.99) for the management of crystalloid resistant systolic hypotension. Conclusion: The results of our data revealed hypoxemia, clinical dehydration, and abdominal distension as the independent risk factors for fatal outcome in Children with SAM with pneumonia. Severely malnourished children with pneumonia who required blood transfusion for the management of crystalloid resistant systolic hypotension were also at risk of fatal outcome. Thus, early identification and prompt management of these simple clinically recognizable risk factors for fatal outcome and avoiding the use of blood transfusion for the management of crystalloid resistant systolic hypotension may help reduce death in such population. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17199 Bangladesh Crit Care J September 2013; 1 (2): 80-85
A Controlled Trial of Noninvasive Positive Pressure Ventilation (NIPPV) in Patients of COPD with Respiratory Failure
Authors: Khanam Rawshan Arra , Haque Md Ashraful , Rahman Shah Md Saifur , Hossain Md Ali , Hassan Md Rashidul
Published: December 2013

Objective : To assess the role of noninvasive positive pressure ventilation (NIPPV) in patients of acute exacerbation of COPD with respiratory failure, also to reduce endotracheal intubation (ETI) and the frequency of complications associated with ETI. Materials and Methods : Prospective, single blind, randomized controlled trial study (RCT) comparing the effect of combined standard medical treatment and noninvasive positive pressure ventilation with standard medical treatment alone in patients admitted to National Institute of Diseases of the Chest and Hospital (NIDCH), Mohakhali, Bangladesh over a 12-month period. Results : A total number of 60 patients of acute exacerbation of COPD with type II respiratory failure were enrolled from inpatient department of Institute of Diseases of the Chest and Hospital (NIDCH), Mohakhali, Bangladesh. A total of 30 (thirty) were randomly assigned to standard therapy and 30 (thirty) to noninvasive ventilation. The two groups had similar clinical characteristics on admission to the hospital. The use of noninvasive ventilation significantly reduced the need for endotracheal intubation (which was dictated by objective criteria): 12 of 30 patients (40.0%) in the noninvasive- ventilation group were intubated, as compared with 22 of 30 patients (73.3%) in the standard-treatment group (P=0.01). In addition, the frequency of complications was significantly lower in the noninvasive-ventilation group. The mean ( ± SD) hospital stay was significantly shorter for patients receiving noninvasive ventilation. 19.2±5.7days vs. 23.5±8.3 days, (P 0.02). The in-hospital mortality rate was also significantly reduced with noninvasive ventilation, 5 of 30 patients (16.7%) in the noninvasive- ventilation group died in the hospital, as compared with13 of 30 (43.3%) in the standard-treatment group( P 0.04) Conclusions : In selected patients with acute exacerbations of chronic obstructive pulmonary disease, noninvasive ventilation can reduce the need for endotracheal intubation, complications, the length of the hospital stay, and the in-hospital mortality rate. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17201 Bangladesh Crit Care J September 2013; 1 (2): 86-92
Headache in pregnancy: Recent insight
Authors: Rahman Aminur , Islam Md Rashedul , Habib Rumana , Bhowmik Nimalendu Bikash , Haque Md Amirul
Published: December 2013

DOI: http://dx.doi.org/10.3329/bccj.v1i2.17202 Bangladesh Crit Care J September 2013; 1 (2): 93-98
HELLP syndrome: An experience of treating with plasma exchange
Authors: Nessa Shahzadi Sayeeda Tun , Polash Mohammd Mufizul Islam , Islam Md Motiul , Anam Ahmad Mursel , Bhuiyan Muhammad Mahbubul Rahman
Published: December 2013

In the spectrum of patient with severe pre-eclampsia, there is a potentially lethal complication called HELLP syndrome( haemolysis, elevated liver enzyme and low platelet count).1 The pathogenesis of HELLP syndrome is unclear. If it is a form of severe preeclampsia, it likely originates from aberrant placental development and function. As an independent entity, it has been attributed to abnormal placentation, similar to preeclampsia, but with greater hepatic inflammation and greater activation of the coagulation system than in preeclampsia.2,3,4 HELLP develops in approximately 0.5 to 0.9 percent of all pregnancies and in 10 to 20 percent of women with severe preeclampsia/eclampsia.5 Maternal mortality rate in HELLP syndrome is variable(1-23%) due to severity of disease, delayed diagnosis and presence of multi-organ involvement.6,7 So the recognition of HELLP syndrome and an aggressive multidisciplinary approach are required for the improvement of meternofoetal prognosis. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17204 Bangladesh Crit Care J September 2013; 1 (2): 102-103
Posterior Reversible Encephalopathy Syndrome (PRES): A case series in postpartum patients
Authors: Biswas Rama , Nessa Shahzadi Sayeeda Tun , Gupta Poly Sen , Biswas Shokhina
Published: December 2013

Posterior reversible encephalopathy syndrome (PRES) refers to a clinicoradiologic entity with characteristic features on neuroimaging and nonspecific symptoms comprising headache, confusion, visual disturbances and seizures. The radiological findings in PRES are thought to be due to vasogenic edema, predominantly in the posterior cerebral hemispheres and are reversible with appropriate management.We report 4 cases of PRES diagnosed by MRI scan following uneventful caesarean section in previously normotensive patients who were succesfully treated with antihypertensives, anticonvulsants and supportive treatment. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17205 Bangladesh Crit Care J September 2013; 1 (2): 104-106
Absent Appendix
Authors: Maitra Tapash Kumar , Roy Sharmistha , Mondal Samiron Kumar , Mahjabin Sahla
Published: December 2013

Congenital absence of the vermiform appendix is a rare condition in human that many well-experienced surgeons have never seen. The fact that congenital absence of the vermiform appendix has been reported on several occasions confirms its existence and should be kept in mind. A thorough and meticulous search of the entire ileocecal region and mobilization of the cecum and ascending colon should be carried out before the diagnosis is made. But, it should also be kept in mind that early cessation of appendiceal anlage can result in very tiny ones. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17207 Bangladesh Crit Care J September 2013; 1 (2): 109-110
Dense Artery Sign
Authors: Anam Ahmad Mursel , Polash Mohammd Mufizul Islam , Rabbani Raihan , Shumy Farzana
Published: December 2013

DOI: http://dx.doi.org/10.3329/bccj.v1i2.17208 Bangladesh Crit Care J September 2013; 1 (2): 111-112
Prevalence of Sedentary Behavior in Older Adults: A Systematic Review
Authors: Harvey Juliet , Chastin Sebastien , Skelton Dawn
Published: December 2013

Sedentary behavior is a cluster of behaviors adopted in a sitting or lying posture where little energy is being expended. Sedentary behavior is a risk factor for health independent to inactivity. Currently, there are no published systematic reviews on the prevalence of sedentary behavior objectively measured in, or subjectively reported by, older adults. The aim of this systematic review was to collect and analyze published literature relating to reported prevalence of sedentary behavior, written in English, on human adults, where subjects aged 60 years and over were represented in the study. 23 reports covered data from 18 surveys sourced from seven countries. It was noted that sedentary behavior is defined in different ways by each survey. The majority of surveys included used self-report as a measurement of sedentary behavior. Objective measurements were also captured with the use of body worn accelerometers. Whether measurements are subjective or objective, the majority of older adults are sedentary. Almost 60% of older adult’s reported sitting for more than 4 h per day, 65% sit in front of a screen for more than 3 h daily and over 55% report watching more than 2 h of TV. However, when measured objectively in a small survey, it was found that 67% of the older population were sedentary for more than 8.5 h daily.
Polyhydroxylated Steroids from the South China Sea Soft Coral Sarcophyton sp. and Their Cytotoxic and Antiviral Activities
Authors: Gong Kai-Kai , Tang Xu-Li , Zhang Gang , Cheng Can-Ling , Zhang Xing-Wang , Li Ping-Lin , Li Guo-Qiang
Published: December 2013

Chemical investigation on the soft coral Sarcophyton sp. collected from the South China Sea yielded three new polyhydroxylated steroids, compounds (1–3), together with seven known ones (4–10). Their structures were established by extensive spectroscopic methods and comparison of their data with those of the related known compounds. All the isolates possessed the 3β,5α,6β-trihydroxylated steroidal nucleus. The cytotoxicities against selected HL-60, HeLa and K562 tumor cell lines and anti-H1N1 (Influenza A virus (IAV)) activities for the isolates were evaluated. Compounds 2, 3 and 5–8 exhibited potent activities against K562 cell lines with IC50 values ranging from 6.4 to 10.3 μM. Compounds 1, 6–8 potently inhibited the growth of HL-60 tumor cell lines, and 6 also showed cytotoxicity towards HeLa cell lines. In addition, preliminary structure-activity relationships for the isolates are discussed. The OAc group at C-11 is proposed to be an important pharmacophore for their cytotoxicities in the 3β,5α,6β-triol steroids. Compounds 4 and 9 exhibited significant anti-H1N1 IAV activity with IC50 values of 19.6 and 36.7 μg/mL, respectively.
Exposure to the Neurotoxic Dinoflagellate, Alexandrium catenella, Induces Apoptosis of the Hemocytes of the Oyster, Crassostrea gigas
Authors: Medhioub Walid , Ramondenc Simon , Vanhove Audrey , Vergnes Agnes , Masseret Estelle , Savar Veronique , Amzil Zouher , Laabir Mohamed , Rolland Jean
Published: December 2013

This study assessed the apoptotic process occurring in the hemocytes of the Pacific oyster, Crassostrea gigas, exposed to Alexandrium catenella, a paralytic shellfish toxins (PSTs) producer. Oysters were experimentally exposed during 48 h to the toxic algae. PSTs accumulation, the expression of 12 key apoptotic-related genes, as well as the variation of the number of hemocytes in apoptosis was measured at time intervals during the experiment. Results show a significant increase of the number of hemocytes in apoptosis after 29 h of exposure. Two pro-apoptotic genes (Bax and Bax-like) implicated in the mitochondrial pathway were significantly upregulated at 21 h followed by the overexpression of two caspase executor genes (caspase-3 and caspase-7) at 29 h, suggesting that the intrinsic pathway was activated. No modulation of the expression of genes implicated in the cell signaling Fas-Associated protein with Death Domain (FADD) and initiation-phase (caspase-2) was observed, suggesting that only the extrinsic pathway was not activated. Moreover, the clear time-dependent upregulation of five (Bcl2, BI-1, IAP1, IAP7B and Hsp70) inhibitors of apoptosis-related genes associated with the return to the initial number of hemocytes in apoptosis at 48 h of exposure suggests the involvement of strong regulatory mechanisms of apoptosis occurring in the hemocytes of the Pacific oyster.
Anticancer and Cancer Preventive Properties of Marine Polysaccharides: Some Results and Prospects
Authors: Fedorov Sergey , Ermakova Svetlana , Zvyagintseva Tatyana , Stonik Valentin
Published: December 2013

Many marine-derived polysaccharides and their analogues have been reported as showing anticancer and cancer preventive properties. These compounds demonstrate interesting activities and special modes of action, differing from each other in both structure and toxicity profile. Herein, literature data concerning anticancer and cancer preventive marine polysaccharides are reviewed. The structural diversity, the biological activities, and the molecular mechanisms of their action are discussed.
Videographic Analysis of Eriophorum Vaginatum Spatial Coverage in an Ombotrophic Bog
Authors: Kalacska Margaret , Arroyo-Mora J. , De Gea Julie , Snirer Eva , Herzog Carrie , Moore Tim
Published: December 2013

The use of Remotely Piloted Aircraft Systems (RPAS) as well as newer automated unmanned aerial vehicles is becoming a standard method in remote sensing studies requiring high spatial resolution (<1 m) and very precise temporal data to capture phenological events. In this study we use a low cost rotorcraft to map Eriophorum vaginatum at Mer Bleue, an ombrotrophic bog located east of Ottawa, ON, Canada. We focus on E. vaginatum because this sedge plays an important role in methane (CH4) gas exchange in peatlands. Using the remote controlled rotorcraft we were able to record, process, and mosaic 11.1 hectares of 4.5 cm spatial resolution imagery extracted from individual frames of video recordings (post georegistration RMSE 4.90 ± 4.95 cm). Our results, based on a supervised classification (96% accuracy) of the red, green, blue image planes, indicate a total tussock cover of 2,417 m2. Because the basal area of the plant is more relevant for calculating its contribution to the CH4 flux, the tussock area was related to the basal area from field data (R2 = 0.88, p < 0.0001). Our final results indicate a total basal area of 1,786 ± 62.8 m2. Based on temporal measurements of CH4 flux from the peatland as a whole that vary over the growing season, we estimate the E. vaginatum contribution to range from 3.0% to 17.3% of that total. Overall, our low cost approach was an effective non-destructive way to derive E. vaginatum coverage and estimate CH4 exchange over the growing season.
Updated Method Guidelines for Cochrane Musculoskeletal Group Systematic Reviews and Metaanalyses
Authors: Ghogomu Elizabeth A.T. , Maxwell Lara J. , Buchbinder Rachelle , Rader Tamara , Pardo Pardo Jordi , Johnston Renea V. , Christensen Robin D.K. , Rutjes Anne W.S. , Winzenberg Tania M. , Singh Jasvinder A. , Zanoli Gustavo , Wells George A. , Tugwell Peter ,   the Editorial Board of the Cochrane Musculoskeletal Group
Published: December 2013

The Cochrane Musculoskeletal Group (CMSG), one of 53 groups of the not-for-profit, international Cochrane Collaboration, prepares, maintains, and disseminates systematic reviews of treatments for musculoskeletal diseases. It is important that authors conducting CMSG reviews and the readers of our reviews be aware of and use updated, state-of-the-art systematic review methodology. One hundred sixty reviews have been published. Previous method guidelines for systematic reviews of interventions in the musculoskeletal field published in 2006 have been substantially updated to incorporate methodological advances that are mandatory or highly desirable in Cochrane reviews and knowledge translation advances. The methodological advances include new guidance on searching, new risk-of-bias assessment, grading the quality of the evidence, the new Summary of Findings table, and comparative effectiveness using network metaanalysis. Method guidelines specific to musculoskeletal disorders are provided by CMSG editors for various aspects of undertaking a systematic review. These method guidelines will help improve the quality of reporting and ensure high standards of conduct as well as consistency across CMSG reviews.
Update of Strategies to Translate Evidence from Cochrane Musculoskeletal Group Systematic Reviews for Use by Various Audiences
Authors: Rader Tamara , Pardo Pardo Jordi , Stacey Dawn , Ghogomu Elizabeth , Maxwell Lara J. , Welch Vivian A. , Singh Jasvinder A. , Buchbinder Rachelle , Légaré France , Santesso Nancy , Toupin April Karine , O’Connor Annette M. , Wells George A. , Winzenberg Tania M. , Johnston Renea , Tugwell Peter ,   The Cochrane Musculoskeletal Group Editors
Published: December 2013

For rheumatology research to have a real influence on health and well-being, evidence must be tailored to inform the decisions of various audiences. The Cochrane Musculoskeletal Group (CMSG), one of 53 groups of the not-for-profit international Cochrane Collaboration, prepares, maintains, and disseminates systematic reviews of treatments for musculoskeletal diseases. While systematic reviews provided by the CMSG fill a major gap in meeting the need for high-quality evidence syntheses, our work does not end at the completion of a review. The term “knowledge translation” (KT) refers to the activities involved in bringing research evidence to various audiences in a useful form so it can be used to support decision making and improve practices. Systematic reviews give careful consideration to research methods and analysis. Because the review is often long and detailed, the clinically relevant results may not be apparent or in the optimal form for use by patients and their healthcare practitioners. This paper describes 10 formats, many of them new, for ways that evidence from Cochrane Reviews can be translated with the intention of meeting the needs of various audiences, including patients and their families, practitioners, policy makers, the press, and members of the public (the “5 Ps”). Current and future knowledge tools include summary of findings tables, patient decision aids, plain language summaries, press releases, clinical scenarios in general medical journals, frequently asked questions (Cochrane Clinical Answers), podcasts, Twitter messages, Journal Club materials, and the use of storytelling and narratives to support continuing medical education. Future plans are outlined to explore ways of improving the influence and usefulness of systematic reviews by providing results in formats suitable to our varied audiences.
Clinical, Functional, and Radiographic Implications of Time to Treatment Response in Patients With Early Rheumatoid Arthritis: a Posthoc Analysis of the PREMIER Study
Authors: Keystone Edward C. , Haraoui Boulos , Guérette Benoît , Mozaffarian Neelufar , Liu Shufang , Kavanaugh Arthur
Published: December 2013

Objective.

Rheumatoid arthritis (RA) treatment recommendations suggest target attainment within the first 3 months of therapy, yet delayed clinical responses can occur. This analysis assessed the longterm clinical, functional, and radiographic outcomes associated with delayed responses to methotrexate (MTX) monotherapy or to the combination of adalimumab (ADA) + MTX.

Methods.

In this posthoc analysis, patients with early RA who received MTX monotherapy or ADA + MTX in the PREMIER study were categorized based on clinical responses at 3 and 6 months [American College of Rheumatology response, 28-joint Disease Activity Score (DAS28)-C-reactive protein (CRP) improvement and targets]. “Month 3” responders met the clinical measure at both months 3 and 6, and “Month 6” responders met the clinical measure only at Month 6. The odds of achieving longterm outcomes [remission (DAS28-CRP < 2.6), normal function (Health Assessment Questionnaire-Disability Index < 0.5), or rapid radiographic progression (Δ modified total Sharp score > 3 U/yr)] were modeled using logistic regression, including treatment, response, and interaction.

Results.

A delayed or low-level response was associated with poorer longterm outcomes. Generally, MTX Month 6 responders demonstrated worse clinical, functional, and radiographic outcomes than Month 3 MTX and Month 3 or 6 ADA + MTX responders. Although similar longterm benefit was observed for ADA + MTX responders, delayed (Month 6) responders exhibited downward trends in clinical, functional, and radiographic outcomes that were comparable with those experienced by Month 3 MTX responders.

Conclusion.

Response speed and magnitude predict longterm outcomes in patients with early RA treated with MTX or ADA + MTX. MTX-treated patients failing to demonstrate a Month 3 clinical response have less-favorable outcomes than other groups, while outcomes in ADA + MTX Month 3 and Month 6 responders tended to be comparable.
Brain Death: Assessment, Controversy, and Confounding Factors
Authors: Arbour Richard B.
Published: December 2013

When brain injury is refractory to aggressive management and is considered nonsurvivable, with loss of consciousness and brain stem reflexes, a brain death protocol may be initiated to determine death according to neurological criteria. Clinical evaluation typically entails 2 consecutive formal neurological examinations to document total loss of consciousness and absence of brain stem reflexes and then apnea testing to evaluate carbon dioxide unresponsiveness within the brain stem. Confounding factors such as use of therapeutic hypothermia, high-dose metabolic suppression, and movements associated with complex spinal reflexes, fasciculations, or cardiogenic ventilator autotriggering may delay initiation or completion of brain death protocols. Neurodiagnostic studies such as 4-vessel cerebral angiography can rapidly document absence of blood flow to the brain and decrease intervals between onset of terminal brain stem herniation and formal declaration of death by neurological criteria. Intracranial pathophysiology leading to brain death must be considered along with clinical assessment, patterns of vital signs, and relevant diagnostic studies.
Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?
Authors: Gourgiotis Stavros , Gemenetzis George , Kocher Hemant M. , Aloizos Stavros , Salemis Nikolaos S. , Grammenos Stylianos
Published: December 2013

Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient’s current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary.
Extubation With or Without Spontaneous Breathing Trial
Authors: Wang Jing , Ma Yingmin , Fang Qiuhong
Published: December 2013

Purpose—

To evaluate whether spontaneous breathing trials (SBTs) are necessary when extubating critical care patients.

Methods—

A prospective, randomized, double-blind study was performed in adult patients supported by mechanical ventilation for at least 48 hours in the general intensive care unit of a teaching hospital. Patients ready for weaning were randomly assigned to either the SBT group (extubation with an SBT) or the no-SBT group (extubation without an SBT). Patients in the SBT group who tolerated SBT underwent immediate extubation. Patients in the no-SBT group who met the weaning readiness criteria underwent extubation without an SBT. The primary outcome measure was a successful extubation or the ability to maintain spontaneous breathing for 48 hours after extubation.

Results—

A total of 139 adult patients were enrolled. No significant difference in the demographic, respiratory, and hemodynamic characteristics was indicated between the groups at the end of weaning readiness assessment. Successful extubation was achieved in 56 of 61 patients (91.8%) in the SBT group and 54 of 60 patients (90.0%) in the no-SBT group. In the SBT and no-SBT groups, 5 (8.2%) and 6 (10.0%) patients, respectively, needed reintubation; 7 (11.5%) and 9 (15.0%) patients, respectively, required noninvasive ventilation after extubation. In-hospital mortality did not differ significantly between the groups.

Conclusion—

Intensive care patients can be extubated successfully without an SBT.
Effects of Depleted Uranium on Immune Parameters of Zebrafish, Danio rerio, Measured by Flow Cytometry
Authors: Gagnaire B. , Bado-Nilles A. , Betoulle S. , Sanchez W.
Published: December 2013

Uranium is ubiquitous in natural waters at concentrations ranging from a few ng/L to low μg/L depending on the composition of sur- rounding rocks and up to 1 mg/L at the vicinity of uraniferous sites. [...]
ChIP-Seq Data Mining: Remarkable Differences in NRSF/REST Target Genes between Human ESC and ESC-Derived Neurons
Authors: Satoh Jun-Ichi , Kawana Natsuki , Yamamoto Yoji
Published: December 2013

The neuron-restrictive silencer factor (NRSF) is a zinc finger transcription factor that represses neuronal gene transcription in non-neuronal cells by binding to the consensus repressor element-1 (RE1) located in regulatory regions of target genes. NRSF silences the expression of a wide range of target genes involved in neuron-specific functions. Previous studies showed that aberrant regulation of NRSF plays a key role in the pathological process of human neurodegenerative diseases. However, a comprehensive set of NRSF target genes relevant to human neuronal functions has not yet been characterized. We performed genome-wide data mining from chromatin immunoprecipitation followed by deep sequencing (ChIP-Seq) datasets of NRSF binding sites in human embryonic stem cells (ESC) and the corresponding ESC-derived neurons, retrieved from the database of the ENCODE/HAIB project. Using bioinformatics tools such as Avadis NGS and MACS, we identified 2,172 NRSF target genes in ESC and 308 genes in ESC-derived neurons based on stringent criteria. Only 40 NRSF target genes overlapped between both data sets. According to motif analysis, binding regions showed an enrichment of the consensus RE1 sites in ESC, whereas they were mainly located in poorly defined non-RE1 sites in ESC-derived neurons. Molecular pathways of NRSF target genes were linked with various neuronal functions in ESC, such as neuroactive ligand-receptor interaction, CREB signaling, and axonal guidance signaling, while they were not directed to neuron-specific functions in ESC-derived neurons. Remarkable differences in ChIP-Seq-based NRSF target genes and pathways between ESC and ESC-derived neurons suggested that NRSF-mediated silencing of target genes is highly effective in human ESC but not in ESC-derived neurons.
Are the Somatic Mutation and Tissue Organization Field Theories of Carcinogenesis Incompatible?
Authors: Rosenfeld Simon
Published: December 2013

Two drastically different approaches to understanding the forces driving carcinogenesis have crystallized through years of research. These are the somatic mutation theory (SMT) and the tissue organization field theory (TOFT). The essence of SMT is that cancer is derived from a single somatic cell that has successively accumulated multiple DNA mutations, and that those mutations occur on genes which control cell proliferation and cell cycle. Thus, according to SMT, neoplastic lesions are the results of DNA-level events. Conversely, according to TOFT, carcinogenesis is primarily a problem of tissue organization: carcinogenic agents destroy the normal tissue architecture thus disrupting cell-to-cell signaling and compromising genomic integrity. Hence, in TOFT the DNA mutations are the effect, and not the cause, of the tissue-level events. Cardinal importance of successful resolution of the TOFT versus SMT controversy dwells in the fact that, according to SMT, cancer is a unidirectional and mostly irreversible disease; whereas, according to TOFT, it is curable and reversible. In this paper, our goal is to outline a plausible scenario in which TOFT and SMT can be reconciled using the framework and concepts of the self-organized criticality (SOC), the principle proven to be extremely fruitful in a wide range of disciplines pertaining to natural phenomena, to biological communities, to large-scale social developments, to technological networks, and to many other subjects of research.
Aphakia Correction by Injection of Foldable Intra Ocular Lens in the Anterior Chamber
Authors: Giles Kagmeni , Ernest Moukouri , Christelle Domngang , Georges Nguefack-Tsague , Raoul Cheuteu , Come Ebana Mvogo , Wiedemann Peter
Published: December 2013

We assessed the outcomes of the use of anterior chamber foldable lens for unilateral aphakia correction at the University Teaching Hospital of Yaounde. In this retrospective, non-comparative, consecutive case series study, we reviewed the records of patients who underwent an operation for aphakia correction by the means of injection of an angular supported foldable lens between January 2009 and December 2011 in the University Teaching Hospital Yaounde. Student's paired t-test was carried out to compare preoperative and postoperative visual acuity (VA) and intraocular pressure (TOP). P-values less than 0.05 were considered statistically significant. Twenty-one patients were included in the study; twelve were male (57.1%) and nine were female (42.9%). The mean age was 55.38 ± 17.67 years (range 9–75 years). The mean follow-up duration was 5.95 ± 3.14 months (range 2–12 months). The mean logMAR visual acuity was 1.26 ± 0.46 pre-operatively and 0.78 ± 0.57 post-operatively ( P = 0.003). The change in intraocular pressure was not statistically significant. Complications included intraocular hypertension (over 21 mmHg) in 3 patients (14.3%) and macular edema, pupillar ovalization, and retinal detachment in one patient each. The results indicate that injection of an angular support foldable lens in the anterior chamber is a useful technique for the correction of aphakia in eyes without capsular support. More extended follow-up, however, and a larger series of patients are needed to ascertain the effectiveness and safety of this procedure.
Numerical Simulation of Unidirectional Stratified Flow by Moving Particle Semi Implicit Method
Authors: Rong Shaoshan , Li Haiwang , Skote Martin , Wong Teck Neng , Duan Fei
Published: December 2013

Numerical simulation of stratified flow of two fluids between two infinite parallel plates using the Moving Particle Semi-implicit (MPS) method is presented. The developing process from entrance to fully development flow is captured. In the simulation, the computational domain is represented by various types of particles. Governing equations are described based on particles and their interactions. Grids are not necessary in any calculation steps of the simulation. The particle number density is implicitly required to be constant to satisfy incompressibility. The weight function is used to describe the interaction between different particles. The particle is considered to constitute the free interface if the particle number density is below a set point. Results for various combinations of density, viscosity, mass flow rates, and distance between the two parallel plates are presented. The proposed procedure is validated using the derived exact solution and the earlier numerical results from the Level-Set method. Furthermore, the evolution of the interface in the developing region is captured and compares well with the derived exact solutions in the developed region.