bluuebunny/crossref_metadata_2025 huggingface dataset:
Management and Long-Term Outcomes of Patients With Infectious Intracranial Aneurysms
Authors: Alawieh Ali M. , Dimisko Laurie , Newman Sarah , Grossberg Jonathan A. , Cawley C. Michael , Pradilla Gustavo , Samuels Owen , Barrow Daniel L. , Howard Brian M.
Published: January 2023

BACKGROUND:

Infectious intracranial aneurysms (IIAs) are rare complications of infective endocarditis (IE). Data on management and long-term outcomes remain limited.

OBJECTIVE:

To retrospectively study long-term outcomes of IIAs in patients treated medically or surgically.

METHODS:

Adult cases of IE and/or IIAs admitted to Emory or Grady Healthcare Systems between May 2015 and May 2020 were reviewed for demographic, clinical, and radiographic variables for up to 2 years. Primary outcome measure was 2-year survival.

RESULTS:

Among 1714 cases of IE, intracerebral hemorrhage occurred in 322 patients and IIAs in 17 patients. The presence of IIAs in IE was associated with higher odds of disposition to hospice/death (odds ratio = 6.9). Including non-IE patients, 24 patients had 38 IIAs mainly involving the distal middle cerebral artery and 16 were ruptured on admission. IIAs were predominantly treated with antibiotics as the primary approach. Open microsurgery was the primary approach for 5 aneurysms and was used as salvage in 7 IIAs. Endovascular management was the primary approach for 2 IIAs and used as salvage for 5 IIAs with antibiotic failure. Medical management had high rate of treatment failure (15/31) which predominantly occurred within 2 weeks of onset. The 2-year survival in this cohort was 70% (17/24).

CONCLUSION:

IIAs are rare complications of IE with a poor prognosis. Patients treated with antibiotics have higher risk of treatment failure requiring salvage surgical or endovascular intervention. Medical treatment failure occurred mostly within 2 weeks of onset and had a negative prognostic value emphasizing the need for close follow-up and early surgical or endovascular management.
“July Effect” in Spinal Fusions: A Coarsened Exact-Matched Analysis
Authors: Borja Austin J. , Ahmad Hasan S. , Tomlinson Samuel B. , Na Jianbo , McClintock Scott D. , Welch William C. , Marcotte Paul J. , Ozturk Ali K. , Malhotra Neil R.
Published: January 2023

BACKGROUND:

Few neurosurgical studies examine the July Effect within elective spinal procedures, and none uses an exact-matched protocol to rigorously account for confounders.

OBJECTIVE:

To evaluate the July Effect in single-level spinal fusions, after coarsened exact matching of the patient cohort on key patient characteristics (including race and comorbid status) known to independently affect neurosurgical outcomes.

METHODS:

Two thousand three hundred thirty-eight adult patients who underwent single-level, posterior-only lumbar fusion at a single, multicenter university hospital system were retrospectively enrolled. Primary outcomes included readmissions, emergency department visits, reoperation, surgical complications, and mortality within 30 days of surgery. Logistic regression was used to analyze month as an ordinal variable. Subsequently, outcomes were compared between patients with surgery at the beginning vs end of the academic year (ie, July vs April–June), before and after coarsened exact matching on key characteristics. After exact matching, 99 exactly matched pairs of patients (total n = 198) were included for analysis.

RESULTS:

Among all patients, operative month was not associated with adverse postoperative events within 30 days of the index operation. Furthermore, patients with surgeries in July had no significant difference in adverse outcomes. Similarly, between exact-matched cohorts, patients in July were observed to have noninferior adverse postoperative events.

CONCLUSION:

There was no evidence suggestive of a July Effect after single-level, posterior approach spinal fusions in our cohort. These findings align with the previous literature to imply that teaching hospitals provide adequate patient care throughout the academic year, regardless of how long individual resident physician assistants have been in their particular role.
Exploring the Pathogenesis of Atlanto-Occipital Instability in Chiari Malformation With Type II Basilar Invagination: A Systematic Morphological Study
Authors: Huang Qinguo , Yang Xiaoyu , Zheng Dongying , Zhou Qiang , Li Hong , Peng Lin , Ye Junhua , Qi Songtao , Lu Yuntao
Published: January 2023

BACKGROUND:

Our previous study suggested that atlanto-occipital instability (AOI) is common in patients with type II basilar invagination (II-BI).

OBJECTIVE:

To further understand the pathogenesis of AOI in Chiari malformations (CM) and CM + II-BI through systematic measurements of the bone structure surrounding the craniocervical junction.

METHODS:

Computed tomography data from 185 adults (80 controls, 63 CM, and 42 CM + II-BI) were collected, and geometric models were established for parameter measurement. Canonical correlation analysis was used to evaluate the morphological and positional relationships of the atlanto-occipital joint (AOJ).

RESULTS:

Among the 3 groups, the length and height of the condyle and superior portion of the lateral masses of the atlas (C1-LM) were smallest in CM + II-BI cases; the AOJ had the shallowest depth and the lowest curvature in the same group. AOJs were divided into 3 morphological types: type I, the typical ball-and-socket joint, mainly in the control group (100%); type II, the shallower joint, mainly in the CM group (92.9%); and type III, the abnormal flat-tilt joint, mainly in the CM + II-BI group (89.3%). Kinematic computed tomography revealed AOI in all III-AOJs (100%) and some II-AOJs (1.5%) but not in type I-AOJs (0%). Morphological parameters of the superior portion of C1-LM positively correlated with those of C0 and the clivus and significantly correlated with AOI.

CONCLUSION:

Dysplasia of the condyle and superior portion of C1-LM exists in both CM and II-BI cases yet is more obvious in type II-BI. Unstable movement caused by AOJ deformation is another pathogenic factor in patients with CM + II-BI.
Six-Year Follow-up of a Randomized Controlled Trial of i-FACTOR Peptide-Enhanced Bone Graft Versus Local Autograft in Single-Level Anterior Cervical Discectomy and Fusion
Authors: Arnold Paul M. , Vaccaro Alexander R. , Sasso Rick C. , Goulet Benoit , Fehlings Michael G. , Heary Robert F. , Janssen Michael E. , Kopjar Branko
Published: January 2023

BACKGROUND:

Previous analyses of the US Food and Drug Administration (FDA) Investigational Device Exemption study demonstrated the superiority of i-FACTOR compared with local autograft bone in single-level anterior cervical discectomy and fusion (ACDF) at 12 and 24 months postoperatively in a composite end point of overall success.

OBJECTIVE:

To report the final, 6-year clinical and radiological outcomes of the FDA postapproval study.

METHODS:

Of the original 319 subjects enrolled in the Investigational Device Exemption study, 220 participated in the postapproval study (106 i-FACTOR and 114 control).

RESULTS:

The study met statistical noninferiority success for all 4 coprimary end points. Radiographic fusion was achieved in 99% (103/104) and 98.2% (109/111) in i-FACTOR and local autograft subjects, mean Neck Disability Index improvement from baseline was 28.6 (24.8, 32.3) in the i-FACTOR and 29.2 (25.6, 32.9) in the control group, respectively (noninferiority P < .0001). The neurological success rate at 6 years was 95.9% (70/73) in i-FACTOR subjects and 93.7% (70/75) in local autograft subjects (noninferiority P < .0001). Safety outcomes were similar between the 2 groups. Secondary surgery on the same or different cervical levels occurred in 20/106 (18.9%) i-FACTOR subjects and 23/114 (20.2%) local autograft subjects (P = .866). Secondary outcomes (pain, SF-36 physical component score and mental component score) in i-FACTOR subjects were similar to those in local autograft subjects.

CONCLUSION:

i-FACTOR met all 4 FDA-mandated noninferiority success criteria and demonstrated safety and efficacy in single-level anterior cervical discectomy and fusion for cervical radiculopathy through 6 years postoperatively. Safety outcomes are acceptable, and the clinical and functional outcomes observed at 12 and 24 months remained at 72 months.
Onyx Versus Particles for Middle Meningeal Artery Embolization in Chronic Subdural Hematoma
Authors: Shehabeldin Mohamed , Amllay Abdelaziz , Jabre Roland , Chen Ching-Jen , Schunemann Victoria , Herial Nabeel A. , Gooch M. Reid , Mackenzie Larami , Choe Hana , Tjoumakaris Stavropoula , Rosenwasser Robert H. , Jabbour Pascal , Kozak Osman
Published: January 2023

BACKGROUND:

Middle meningeal artery (MMA) embolization has recently emerged as a treatment option for chronic subdural hematoma (cSDH). It is considered a simple and potentially safe endovascular procedure.

OBJECTIVE:

To compare between 2 different embolic agents; onyx (ethylene vinyl alcohol) and emboparticles (polyvinyl alcohol particles—PVA) for endovascular treatment of cSDH.

METHODS:

A retrospective analysis of all patients who underwent MMA embolization for cSDH treatment in 2 comprehensive centers between August 2018 and December 2021. Primary outcomes were failure of embolization and need for rescue surgical evacuation.

RESULTS:

Among 97 MMA embolizations, 49 (50.5%) received onyx and 48 (49.5%) received PVA. The presence of acute or subacute on cSDH was higher in the PVA group 11/49 (22.5%) vs 30/48 (62.5%), respectively,P< .001. There were no significant differences between both groups regarding failure of embolization 6/49 (12.2%) vs 12/48 (25.0%), respectively,P= .112, and need of unplanned rescue surgical evacuation 5/49 (10.2%) vs 8/48 (16.7%), respectively,P= .354. Hematoma thickness at late follow-up was significantly smaller in the PVA group 7.8 mm vs 4.6 mm, respectively;P= .017.

CONCLUSION:

Both onyx and PVA as embolic agents for cSDH can be used safely and have comparable clinical and surgical outcomes.
Preoperative Detection of Subtle Focal Cortical Dysplasia in Children by Combined Arterial Spin Labeling, Voxel-Based Morphometry, Electroencephalography-Synchronized Functional MRI, Resting-State Regional Homogeneity, and 18F-fluorodeoxyglucose Positron Emission Tomography
Authors: Dangouloff-Ros Volodia , Fillon Ludovic , Eisermann Monika , Losito Emma , Boisgontier Jennifer , Charpy Sarah , Saitovitch Ana , Levy Raphael , Roux Charles-Joris , Varlet Pascale , Chiron Catherine , Bourgeois Marie , Kaminska Anna , Blauwblomme Thomas , Nabbout Rima , Boddaert Nathalie
Published: January 2023

BACKGROUND:

Focal cortical dysplasia (FCD) causes drug-resistant epilepsy in children that can be cured surgically, but the lesions are often unseen by imaging.

OBJECTIVE:

To assess the efficiency of arterial spin labeling (ASL), voxel-based-morphometry (VBM), fMRI electroencephalography (EEG), resting-state regional homogeneity (ReHo), 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET), and their combination in detecting pediatric FCD.

METHODS:

We prospectively included 10 children for whom FCD was localized by surgical resection. They underwent 3T MR acquisition with concurrent EEG, including ASL perfusion, resting-state BOLD fMRI (allowing the processing of EEG-fMRI and ReHo), 3D T1-weighted images processed using VBM, and FDG PET-CT coregistered with MRI. Detection was assessed visually and by comparison with healthy controls (for ASL and VBM).

RESULTS:

Eight children had normal MRI, and 2 had asymmetric sulci. Using MR techniques, FCD was accurately detected by ASL for 6/10, VBM for 5/10, EEG-fMRI for 5/8 (excluding 2 with uninterpretable results), and ReHo for 4/10 patients. The combination of ASL, VBM, and ReHo allowed correct FCD detection for 9/10 patients. FDG PET alone showed higher accuracy than the other techniques (7/9), and its combination with VBM allowed correct FCD detection for 8/9 patients. The detection efficiency was better for patients with asymmetric sulci (2/2 for all techniques), but advanced MR techniques and PET were useful for MR-negative patients (7/8).

CONCLUSION:

A combination of multiple imaging techniques, including PET, ASL, and VBM analysis of T1-weighted images, is effective in detecting subtle FCD in children.
Lumbar Synovial Cysts—Should You Fuse or Not?
Authors: Gonzalez Glenn A. , Corso Katherine , Kothari Prerna , Franco Daniel , Porto Guilherme , Miao Jingya , Wainwright John V. , O'Leary Matthew , Hines Kevin , Mahtabfar Aria , Vanderkarr Mari , Thalheimer Sara , Sharan Ashwini , Jallo Jack , Harrop James
Published: January 2023

BACKGROUND:

Spinal synovial cysts are lesions that most commonly occur in the lumbar region. The need for an instrumented spinal fusion in addition to lumbar decompression with removal of the synovial cyst is unknown.

OBJECTIVE:

To test the hypothesis that select patients who underwent decompression with instrumented fusion for lumbar synovial cysts would be less likely to have subsequent surgery (SS) in a 2-year period than patients treated with laminectomy alone.

METHODS:

This retrospective cohort study was performed using IBM MarketScan Commercial Claims and Encounters Database. Patients who had a lumbar synovial cyst diagnosis and laminectomy surgery with or without fusion surgery were included in this study. Patients were tracked for SS 2 years after surgery. Laminectomy patients were propensity score–matched to laminectomy with fusion (LF) patients using a 2:1 ratio. The log-rank test and Cox regression were used to compare the cumulative incidence of SS between groups.

RESULTS:

There were 7664 and 1631 patients treated with laminectomy and LF before matching. After matching, there were 2212 laminectomy and 1631 LF patients and patient characteristics were balanced. The 2-year incidence of recurrent SS was 3.1% ([CI]: 2.2%, 4.0%) and 1.7% (95% CI: 0.9%, 2.5%) laminectomy and LF, respectively. Compared with laminectomy, LF had a statistically significant lower risk of recurrent SS (hazard ratio: 0.56 [95% CI: 0.32-0.97];P-value: .04).

CONCLUSION:

All patients who had concomitant lumbar fusion showed decreased chance of having a cyst- or noncyst-related recurrence SS when compared with all patients undergoing laminectomy alone, regardless of diagnosis at the time of SS.
Pediatric Vagus Nerve Stimulation: Case Series Outcomes and Future Directions
Authors: LoPresti Melissa A. , Katlowitz Kalman A. , Sharma Himanshu , McGinnis John P. , Weiner Howard L.
Published: January 2023

BACKGROUND:

Vagus nerve stimulation (VNS) is a neuromodulatory procedure most extensively studied as an adjunct to medically refractory epilepsy. Despite widespread adoption and decades of clinical experience, clinical predictors of response to VNS remain unclear.

OBJECTIVE:

To evaluate a retrospective cohort of pediatric patients undergoing VNS at our institution to better understand who may benefit from VNS and identify factors which may predict response to VNS.

METHODS:

We conducted a retrospective cohort study examining pediatric patients undergoing VNS over nearly a 20-year span at a single institution. Presurgical evaluation, including demographics, clinical history, and diagnostic electroencephalogram, and imaging findings were examined. Primary outcomes included VNS response.

RESULTS:

Two hundred ninety-seven subjects were studied. The mean age at surgery was 10.1 (SD = 4.9, range = 0.8-25.3) years; length of follow-up was a mean of 4.6 years (SD = 3.5, median = 3.9 years, range 1 day-16.1 years). There was no association between demographic factors, epilepsy etiology, or genetic basis and VNS outcomes. There was an association between reduction in main seizure type with positive MRI finding. Of all MRI findings analyzed, brain atrophy was significantly associated with worse VNS outcomes, whereas dysplastic hippocampus and chronic periventricular leukomalacia findings were found to be associated with improved outcomes. Increased seizure semiology variability and seizure type were also associated with improved seizure outcomes.

CONCLUSION:

Predicting response to VNS remains difficult, leading to incompletely realized benefits and suboptimal resource utilization. Specific MRI findings and increased seizure semiology variability and type can help guide clinical decision making and patient counseling.
Two Practices to Improve Informed Consent for Intraoperative Brain Research
Authors: Peabody Smith Ally , Pouratian Nader , Feinsinger Ashley
Published: January 2023

As the clinical applications of neurologically implanted devices increase, so do opportunities for intracranial investigations in human patients. In some of these studies, patients participate in research during their awake brain surgery, performing additional tasks without the prospect of personal therapeutic benefit. These intraoperative studies raise persistent ethical challenges because they are conducted during a clinical intervention, in a clinical space, and often by the treating clinician. Whether intraoperative research necessitates innovative informed consent methods has become a pressing conversation. Familiar worries about inadequate participant understanding and undue influence dominate these discussions, as do calls for increasing information retention (e.g., using methods such as “teach-back”) and minimizing enrollment pressures (e.g., preventing surgeons from consenting their own patients). However, efforts have yet to inspire widespread consent practices that mirror the scope of ethical concern. Focusing on awake, intraoperative intracranial research, we identify 2 underappreciated problems in approaches to informed consent. The first is epistemic: Many practices do not fully consider when and under which conditions participants are adequately informed. The second is relational: Many practices do not fully consider the effects of trust between patient-participants and surgeon-researchers. In exploring these concerns, we also raise questions about whether additional steps beyond preoperative consent may improve the process because decisions at this time are decoupled from both the experiences and vulnerability of awake brain surgery. Motivated by these considerations, we propose 2 practices: first, requiring a third-party patient advocate in initial consent and second, requiring verbal intraoperative reconsent before initiating research.
A Second Prone Dose Algorithm for Patients Undergoing Spinal Anesthesia During Thoracolumbar Surgeries
Authors: Wang Andy Y. , Olmos Michelle , Ahsan Tameem , Kanter Matthew , Liu Penny , Balonov Konstantin , Riesenburger Ron I. , Kryzanski James
Published: January 2023

BACKGROUND:

Spinal anesthesia is safe and effective in lumbar surgeries, with numerous advantages over general anesthesia (GA). Nevertheless, 1 major concern preventing the widespread adoption of this anesthetic modality in spine surgeries is the potential for intraprocedural anesthetic failure, resulting in the need to convert to GA intraoperatively.

OBJECTIVE:

To present a novel additional prone dose algorithm for when a first spinal dose fails to achieve the necessary effect.

METHODS:

A total of 422 consecutive patients undergoing simple and complex thoracolumbar surgeries under spinal anesthesia were prospectively enrolled into our database. Data were retrospectively collected through extraction of electronic health records.

RESULTS:

Sixteen of 422 required a second prone dose, of whom 1 refused and was converted to GA preoperatively. After 15 were given a prone dose, only 2 required preoperative conversion to GA. There were no instances of intraoperative conversion to GA. The success rate for spinal anesthesia without the need for conversion rose from 96.4% to 99.5%. In patients who required a second prone dose, there were no instances of spinal headache, deep vein thrombosis, pneumonia, urinary tract infection, urinary retention, readmission within 30 days, acute pain service consult, return to operating room, durotomy, or cerebrospinal fluid on puncture.

CONCLUSION:

Use of an additional prone dose algorithm was able to achieve a 99.5% success rate, and those who received this second dose did not experience any complications or negative operative disadvantages. Further research is needed to investigate which patients are at increased risk of inadequate analgesia with spinal anesthesia.
Pituitary Stalk Stretch Predicts Postoperative Diabetes Insipidus After Pituitary Macroadenoma Transsphenoidal Resection
Authors: Hoang Alex Nguyen , McGahan Benjamin G. , Cua Santino , Magill Stephen T. , Nayak Pratima , Montaser Alaa S. , Ghalib Luma , Prevedello Luciano M. , Hardesty Douglas A. , Carrau Ricardo L. , Prevedello Daniel M.
Published: January 2023

BACKGROUND:

Manipulation of the pituitary stalk, posterior pituitary gland, and hypothalamus during transsphenoidal pituitary adenoma resection can cause disruption of water electrolyte regulation leading to diabetes insipidus (DI).

OBJECTIVE:

To determine whether pituitary stalk stretch is an independent risk factor for postoperative DI after pituitary adenoma resection.

METHODS:

A retrospective review was performed of patients undergoing endoscopic endonasal resection of pituitary macroadenoma between July 2010 and December 2016 by a single neurosurgeon. We analyzed preoperative and postoperative imaging metrics to assess predictors for postoperative DI.

RESULTS:

Of the 234 patients undergoing resection, 41 (17.5%) developed postoperative DI. DI was permanent in 10 (4.3%) and transient in 31 (13.2%). The pituitary stalk stretch, measured as the change in stalk length from preoperative to postoperative imaging, was greater in the DI compared with the non-DI group (10.1 mm vs 5.9 mm, P < .0001). The pituitary stalk stretch was associated with DI with significant difference in mean pituitary stalk stretch between non-DI group vs DI group (5.9 mm vs 10.1 mm, P < .0001). Multivariate analysis revealed that pituitary stalk stretch >10 mm was a significant independent predictor of postoperative DI [odds ratios = 2.56 (1.10-5.96), P = .029]. When stratified into transient and permanent DI, multivariable analysis showed that pituitary stalk stretch >10 mm was a significant independent predictor of transient DI [odds ratios = 2.71 (1.0-7.1), P = .046] but not permanent DI.

CONCLUSION:

Postoperative pituitary stalk stretch after transsphenoidal pituitary adenoma surgery is an important factor for postoperative DI. We propose a reconstruction strategy to mitigate stalk stretch.
Does High-Definition 3-Dimensional Imaging Improve Orientation During Endoscopic Transsphenoidal Surgery? A Prospective Trial
Authors: Micko Alexander S. G. , Cho Anna , Heck Simon , Marik Wolfgang , Wolfsberger Stefan
Published: January 2023

BACKGROUND:

Endoscopy has evolved as the standard visualization tool for endonasal transsphenoidal resection of sellar lesions. The most widely used 2-dimensional (2D) endoscopes harbor the problem of limited depth perception. Therefore, 3-dimensional (3D) endoscopes have been developed to enable depth perception through a stereoscopic view.

OBJECTIVE:

To evaluate the impact of high-definition (HD) 2D vs 3D HD endoscopes on spatial orientation within the sphenoid sinus.

METHODS:

In this prospective single-center study, 21 patients have been investigated (2021-2022). Eleven standardized anatomic landmarks, which were preoperatively defined on neuronavigation imaging, were intraoperatively targeted with a navigation probe using either 2D HD or 3D HD endoscopes for visualization.

RESULTS:

Overall, 3D HD endoscopes provided a statistically significant higher accuracy of identification of sphenoid sinus landmarks (median deviation: 5.2 mm vs 4.2 mm,P< .001). In detail: tuberculum sellae (3.0 mm vs 4.3 mm,P= .047), most anterior point of sella (3.3 mm vs 4.8 mm,P= .049), and clivus indentation (3.8 mm vs 5.3 mm,P= .035). Anatomic variations such as a complex sphenoid sinus configuration had no influence on identifying sphenoid sinus landmarks.

CONCLUSION:

According to our data, stereoscopic 3D HD endoscopy enhances intraoperative orientation by improved depth perception within the sphenoid sinus. This may add to the safety of endoscopic skull base procedures, especially in extended approaches and cases with distorted anatomy.
Why don't horseflies land on zebras?
Authors: Caro Tim , Fogg Eva , Stephens-Collins Tamasin , Santon Matteo , How Martin J.
Published: January 2023

Stripes deter horseflies (tabanids) from landing on zebras and, while several mechanisms have been proposed, these hypotheses have yet to be tested satisfactorily. Here, we investigated three possible visual mechanisms that could impede successful tabanid landings (aliasing, contrast and polarization) but additionally explored pattern element size employing video footage of horseflies around differently patterned coats placed on domestic horses. We found that horseflies are averse to landing on highly but not on lightly contrasting stripes printed on horse coats. We could find no evidence for horseflies being attracted to coats that better reflected polarized light. Horseflies were somewhat less attracted to regular than to irregular check patterns, but this effect was not large enough to support the hypothesis of disrupting optic flow through aliasing. More likely it is due to attraction towards larger dark patches present in the irregular check patterns, an idea bolstered by comparing landings to the size of dark patterns present on the different coats. Our working hypothesis for the principal anti-parasite features of zebra pelage are that their stripes are sharply outlined and thin because these features specifically eliminate the occurrence of large monochrome dark patches that are highly attractive to horseflies at close distances.
Copper-Catalyzed Electrophilic Amination: An Umpolung Strategy for New C–N Bond Formations
Authors: Hirano Koji
Published: January 2023

The nitrogen atom is ubiquitous in bioactive molecules and functional materials, and the development of new C–N bond forming strategies is thus one of the long-standing research subjects in the synthetic community. This account describes the nitrogen-umpolung-enabled copper-catalyzed highly chemo- and stereoselective amination protocols developed by the author’s research group. Starting from the C–H amination, electrophilic amination of stable organoboron and organosilicon compounds, aminoboration/hydroamination of alkenes, and their applications to the synthesis of functionality-rich alkylamines are shown. The reaction design, concept, and substrate scope are briefly summarized.
Factors associated with lack of tracheal sealing by a cuff inflated to more than 30 cmH2O during mechanical ventilation: A cross-sectional study
Authors: Wu Hong-Lei , Shi Hai-Yan , Shi Jia-hai , Shen Wang-Qin
Published: January 2023

Objectives: The cuff pressures > 30 cmH2O may create a seal in the trachea. The objective of this study was to identify risk factors associated with lack of tracheal sealing by an endotracheal cuff inflated to > 30 cmH2O in patients undergoing mechanical ventilation.

Methods: This prospective cross-sectional study was conducted from 2019 to 2020 in the cardiothoracic intensive care unit and respiratory medical care unit of a Hospital in Nantong, China. Patients aged >16 years undergoing cardiothoracic surgery with mechanical ventilation using endotracheal intubation were included. Patient characteristics and ventilator parameters were analyzed. Cuff pressure was maintained with the minimum leak technique (MLT) and measured with a cuff pressure gauge. Cuff pressure was measured for 30 seconds when ventilation was accompanied by no leak, simultaneously detected by the ventilator or auscultation with a stethoscope.

Results: Of 352 patients undergoing mechanical ventilation, 51 patients (14.5%) had a cuff pressure of >30 cmH2O. Multivariable analysis showed that cuff manufacturer (Guangzhou Weili) and nasal endotracheal intubation significantly increased the risk of an unsealed trachea. Peak inspiratory pressure, cuff diameter and male sex had a strong inverse association with an unsealed trachea.

Conclusions: These findings suggest that an endotracheal cuff pressure of 20 to 30 cmH2O is adequate for most patients, but lack of a tracheal seal still occurs in a small number of people. An unsealed trachea is most likely because cuff and tracheal diameters do not match.

Clinical Trial Registration: http://www.chictr.org.cn/index.aspx Unique identifier: ChiCTR-COC-15006459.

doi: https://doi.org/10.12669/pjms.39.2.5672

How to cite this: Wu H, Shi H, Shi J, Shen W. Factors associated with lack of tracheal sealing by a cuff inflated to more than 30 cmH2O during mechanical ventilation: A cross-sectional study. Pak J Med Sci. 2023;39(2):---------.  doi: https://doi.org/10.12669/pjms.39.2.5672

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Comparison of residual silicone oil index after removal of silicone oil with fluid-air versus oil-fluid exchange
Authors: Rizwan Amna , Rana Muhammad Mohsin Javaid  , Sidrah Latif  , Muhammad Suhail Sarwar  , Khan Asad Aslam
Published: January 2023

Objectives: To compare the effectiveness of fluid-air exchange with silicone oil-fluid exchange in reducing the residual silicone oil (SO) droplets after the removal of SO.

Methods: This was a prospective, quasi-experimental study conducted from October 2021 to February 2022 at Eye Unit-III, COAVS, Mayo Hospital, Lahore. Sixty-one patients with siliconized eyes underwent removal of SO with two different techniques and were divided into fluid-air exchange and oil-fluid exchange groups. To quantify the residual silicone droplets objectively, B-scan echographic images were analyzed within seven days of surgery. Silicone oil index (SOI) which is the amount of residual SO droplets/vitreal area in the images was calculated with the help of imagej software.

Results: The residual SOI of the fluid-air exchange group (0.99 ± 1.76%) was significantly lower than the oil-fluid exchange group (3.25 ± 3.85%). The SOI is positively correlated with the duration of tamponade, preoperative intraocular- pressure and axial length. Persistent IOP elevation post-operatively was seen in 16.67% individuals in the fluid-air exchange group and 54.8% individuals in the oil-fluid exchange group.

Conclusion: Fluid-air exchange group was found to be superior in reducing residual SO droplets than the oil-fluid exchange group.

doi: https://doi.org/10.12669/pjms.39.2.6243

How to cite this: Rizwan A, Javaid RMM, Latif S, Sarwar MS, Khan AA. Comparison of residual silicone oil index after removal of silicone oil with fluid-air versus oil-fluid exchange. Pak J Med Sci. 2023;39(2):---------. doi: https://doi.org/10.12669/pjms.39.2.6243

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ALGORITHMS FOR DIAGNOSIS AND THERAPY MENTAL DISORDERS IN GENERAL MEDICAL PRACTICE
Authors:   Sechenov University, Volel Beatrice , Petelin Dmitry ,   Sechenov University, Romanov Dmitry ,   Sechenov University, Voronova Evgeniya ,   Sechenov University, Kopylov Philipp ,   Sechenov University, Beketov Vladimir ,   Sechenov University
Published: January 2023

This tutorial is devoted to diagnostic algorithms and curation of the main forms of mental pathology encountered in the practice of therapists and general practitioners. Presented modern scientific and practical information concerning clinical manifestations of depression, anxiety and somatoform disorders, chronic fatigue syndrome, adjustment disorders and chronic delusional disorders in the general medical network. Algorithms for the treatment of the described mental disorders are outlined in the form of visual flowcharts, which increases the availability of material for practical doctor. Significant emphasis is placed on the description of situations in which the patient must be referred to a psychiatrist for consultation. Special attention is paid to the legislative framework for assistance patients with borderline psychiatric disorders in the primary medical network. This training manual is intended for general practitioners and general practitioners. Can be used as educational benefits in the process of continuous postgraduate professional education of doctors.
THE ROLE OF AUTHORIZED AGENCY IN DETECTING AND PREVENTING THE CONSEQUENCES OF DISFUGE ACTIONS OF THE SUBJECTS OF INSOLVENCY RELATIONS
Authors: Akulov Andrey , Ryakhovsky Dmitriy , Klychova Guzaliya
Published: January 2023

The Federal Tax Service of Russia, within the framework of performing the functions of an authorized body in cases of bankruptcy of legal entities, is vested with certain powers to protect the interests of the Russian Federation as a creditor. High requirements for high-quality support of bankruptcy procedures increase the attention of the scientific community to the problem of improving the activities of the authorized body to identify and prevent the consequences of dishonest actions of insolvency entities. The purpose of the study is to summarize the experience of the authorized body in identifying dishonest actions of the debtor and its controlling persons, preventing their consequences in the framework of a bankruptcy case, as well as developing methodological recommendations for improving the preparation of a package of evidence confirming the grounds for bringing the persons controlling the debtor to subsidiary liability. Based on the results of the analysis of arbitration practice, typical dishonest actions of the beneficiaries of the debtor's bankruptcy were identified and systematized (withdrawal of the debtor's assets, encumbrance of the debtor's obligations with artificial accounts payable of affiliated persons, implementation of various schemes (transactions) aimed at evading payment of accounts payable, etc.), methods of preventing body of the consequences of bad faith actions of the subjects of insolvency relations, as well as a methodological approach to justifying the holding of the controlling debtor of persons to subsidiary liability for bad faith actions against the debtor and independent creditors. The role of the authorized body in accompanying bankruptcy procedures is much broader than ensuring the interests of the state as a creditor, therefore, the implementation of the proposed methodological approach to the economic justification of the reasons (grounds) for bringing the persons controlling the debtor to subsidiary liability, which includes several successive stages, will improve the standards of proof in cases of bankruptcy, reduce errors of justice and, ultimately, improve the effectiveness and efficiency of the institution of bankruptcy.
RELATIONSHIP OF YIELD OF VARIETIES OF COMPETITIVE VARIETY TESTING OF SPRING SOFT WHEAT WITH ELEMENTS OF ITS STRUCTURE IN THE MIDDLE VOLGA REGION
Authors: Menibayev Ashat
Published: January 2023

The research was carried out in order to find the optimal combination of elements of the crop structure, based on the parameters of released and promising varieties of spring soft wheat of the competitive variety testing of Samara Research Institute of Agriculture. The work was carried out in 2016-2018 in Samara region. The object of research in 2016 were 8 varieties, in 2017 - 16 varieties, in 2018 - 13 varieties of spring soft wheat of competitive variety testing of Samara Research Institute of Agriculture. The area of the plot is 20 m2, the repetition is four times, the placement of the plots is randomized. The variety Tulaykovskaya Nadezhda served as the standard. In the studied set of genotypes, productivity was most often included in one component with adaptability traits and morphological traits with a positive relationship. In 2017, it was in one component (the absolute value of the load of the trait in the component +0.547) with the mass of the ear (+0.988), the mass of grain per ear (+0.766), and the mass of the shoot (+0.932). In 2016, the yield (+0.534) was in one component and was positively related to the number of grains per ear (+0.861) and the weight of grain per ear (+0.880). In 2018, being in one component, the yield (-0.664) positively correlated with the length of the upper internode (-0.592). The presented combinations can be considered as one of the optimal options for the formation of the structure of spring soft wheat in the Middle Volga region to its full ripeness. At the same time, it is necessary to pay attention to the features that ensure the redistribution of biomass between the vegetative part and the grain, as a reserve for increasing productivity and further optimizing the elements of the yield structure of spring soft wheat.
EFFICIENCY OF CULTIVATION OF GRAPEVINE IN VITRO*
Authors: Puzyrnova Valentina , Doroshenko Natalya
Published: January 2023

The paper is devoted to improving the elements of the technology of clonal micropropagation of Pukhlyakovsky grapevine variety in order to increase the efficiency of its content in the in vitro collection. The introduction of an osmotically active substance ‒ sorbitol into the culture medium in the concentration range of 5-30 g/l in comparison with sucrose of 10 g/l was studied. The research was carried out in 2021-2022 on the collection of grapevine plants in vitro of the All-Russian Research Institute for Viticulture and Winemaking named after Ya.I. Potapenko in Novocherkassk (Rostov region). Cultivation was carried out in conditions of illumination of 3.0 thousand lux, temperature +25 ° C, photoperiod of 16/8 hours, air humidity 60 %. Morphometric parameters of shoots were evaluated: the number and length of shoots, shoot height, number of leaves, inhibition of growth processes was noted in all experimental variants in comparison with the control. The maximum safety indicators were recorded in the variant with a sorbitol concentration of 10 g/l. The minimum safety was observed in the control (43.3 %) and the variant with the maximum sorbitol content ‒ 30 g/l (36.7 %). The calculation of the economic efficiency of keeping plants in the collection in vitro on a medium with sucrose and sorbitol was carried out. Depositing on a medium with sorbitol is 17 % more economical due to an increase in the interval between subcultivations from 6 months to 12. The positive effect of the drug sorbitol on the safety and quality characteristics of plants was established, the maximum safety (86.7 %) and moderate inhibition of growth were recorded in the variant with a concentration of the drug 10 g/l. We consider this concentration to be optimal for use when depositing Puhlyakovsky grape plants in the in vitro collection under conditions of slow growth.
EL YOUTUBER COMO REFERENTE EN LA ADOLESCENCIA: REFLEXIONES DESDE UNA PERSPECTIVA ANTROPOLÓGICA.
Authors: Muñiz María
Published: January 2023

Los youtubers son percibidos por adolescentes y jóvenes como personas cercanas que comparten rasgos similares a los suyos. Este elemento facilita la rápida identificación con ellos, a su vez gozan de una popularidad y capacidad de influencia que los convierte en figuras influyentes. El presente artículo tiene como objetivo realizar una aproximación teórica a la adolescencia y la socialización online para tratar de entender cómo y porqué los youtubers a través de una producción discursiva basada en elementos identitarios, el manejo de diferentes escenarios o el diálogo con los seguidores entre otros aspectos, se erigen como figuras de referencia. Para ello se tiene en cuenta el tipo de contenido que crean y el discurso producido en sus canales principales y secundarios y, en consecuencia, cómo contribuyen al desarrollo de nuevos modelos influyentes para la juventud.
¿CÓMO LOS ADOLESCENTES DE CASTRO URDIALES (CANTABRIA) APRENDEN A SER ADULTOS?.
Authors: Tahull Fort Joan
Published: January 2023

Los adolescentes de Castro Urdiales se tiran al mar desde diferentes lugares de la zona de San Guillén, el más conocido y popular es el puente Medieval. Se desconocen los orígenes, pero los vecinos lo sitúan entre finales del siglo XIX y principios del XX, aunque piensan que los mozos se tiraban desde la misma construcción del puente. Los chicos se lanzaban hasta la mayoría de edad, a los 18 años dejaban de tirarse y se ocupaban de las tareas adultas. En la actualidad, los adolescentes castreños siguen tirándose con más observadores y las redes sociales han amplificado el hecho social. Se presenta información obtenida mediante observación participante y se han realizado diez entrevistas a vecinos conocedores de la temática. Para los adolescentes realizar saltos arriesgados está más allá de simples momentos de ocio y constituye un ritual social de su presentación en sociedad y configuración de la identidad adulta.
Funkcjonowanie persjarni słuckiej prowadzonej przez Jana i Leona Madżarskich w świetle dokumentacji ekonomiczno-gospodarczej z Narodowego Historycznego Archiwum Białorusi w Mińsku
Authors: Siwek Wojciech Aleksander
Published: January 2023

OPERATING OF THE SŁUCK SASH MANUFACTORY RUN BY JAN AND LEON MADŻARSKI IN THE LIGHT OF ECONOMIC DOCUMENTATION FROM THE NATIONAL HISTORICAL ARCHIVE OF BELARUS IN MINSK

The noble outfit was one of the most popular and characteristic symbols of the old Polish Sarmatist culture. Kontush belts made from valuable fabrics belonged to its elements. The name “Słuck belts” is connected with a persjarnia [manufactory producing fabrics] in Słuck – the domain of the Radziwiłł family. It was in its heyday during the second half of the 18th century, when it was run by the Armenian Madżarski family. The article analyses documentation which concerns this issue and is kept in the National Historical Archive of Belarus in Minsk. This material is scrutinised in the context of economic activity of the princes Michał Kazimierz and Karol Stanisław Radziwiłł, orientalisation of noble tastes as well as the history of the Madżarski family.
Starodruki z kolekcji arcybiskupa Józefa Teodorowicza: przyczynek do badań bibliofilstwa w środowisku Ormian polskich
Authors: Krzyżowski Tomasz
Published: January 2023

ANTIQUE BOOKS FROM THE COLLECTION OF ARCHBISHOP JÓZEF TEODOROWICZ: A MINOR CONTRIBUTION TO THE RESEARCH OF BIBLIOPHILISM IN THE ENVIRONMENT OF THE POLISH ARMENIANS

Armenian Archbishop Józef Teodorowicz (1864-1938) had a collection of antique books, comprising at least 145 titles in a few languages: Latin, Polish, German, and French. Armenian antique books, published with great artistry in Venice and Constantinople, were especially interesting among these works. It was determined that over 80 percent of collection concerned different branches of theology. The rest, i.e. 20 percent, included works of philosophy, ethics, canon law, rhetoric, literature, and linguistics. During the Second World War, after the capture of Lwów by Soviet troops, the collection was partially destroyed and dispersed. In August 1940, preserved fragments were included into the collections belonging to the Library of the Academy of Sciences of the Ukrainian Socialistic Soviet Republic (Lviv Branch). Today, the preserved fragments of the collection from the library of Archbishop Teodorowicz are kept in two institutions: the Division of Antique Books of the Wasyl Stefanyk National Scientific Library in Lviv and the Unit of Antique Books of the Ossoliński National Institute in Wrocław.
Diferencias, traducciones y metodologías en investigaciones sobre ciudades: miradas desde Brasil, España y el País Vasco
Authors: Silva Saraiva Luiz Alex , Cordeiro de Campos Clarissa
Published: January 2023

En este artículo se pretende problematizar las prácticas de investigación en el ámbito de los estudios organizativos sobre las ciudades, especialmente en lo que se refiere a la aplicación de métodos cualitativos y comparativos, que implican la comprensión, traducción y análisis de la información en diferentes idiomas. Los datos examinados se refieren a tres investigaciones realizadas en la región metropolitana de Belo Horizonte, en Brasil, en Madrid y en el País Vasco, en el territorio español. El recorrido teórico y metodológico sugiere que las asimetrías entre investigadores e investigados exigen reflexiones éticas sobre qué, para qué y por qué se hacen investigaciones que aportan tan poco a los no investigadores. Independientemente de que la investigación se lleve a cabo en Europa o en Sudamérica, los datos apuntan a la traducción como un elemento importante de la investigación porque implica reconocer las diferencias entre los distintos agentes, lo que sugiere metodologías de humanización no solo para desinstru­mentalizar la investigación, sino para reconocer la humanidad de los implicados en la misma.
What Constitutes a ‘Classroom Problem’ for Today's Teacher?: An Exploratory Study
Authors: Vallejos Sergio Sepúlveda- , Muñoz Carla , Contreras Claudia , Monzalve Manuel
Published: January 2023

Teachers face situations that are difficult to solve, which affect their practices in the classroom. Teachers´ability to face problematic situations been related to educators' adaptive and metacognitive capacity. This study aimed to contrast the recent literature on classroom problems with reports from Chilean teachers regarding what they mean today as critical situations in the classroom. The major problems with the highest prevalence were categorized based on a literature review. Subsequently, teachers from three educational levels (pre-school, primary and secondary) were asked to relate situations in which they had experienced a crisis in their profession. After a filtering based on the relevance and textual richness present, the stories (n=145) were subjected to a thematic analysis and contrasted with the categories obtained from the reviewed literature. The results show a low proportion of problems associated with learning management in the classroom and, on the other hand, a high proportion of behavioral problems in students focused on situations of aggression towards the teacher. These conclusions are discussed to reconsider the concept of "classroom problem situations" and, based on this, questioning the role of teacher training in the development of skills for the management of authentic problem situations.