Tag: nevin manimala

J Surg Oncol. 2021 Aug 20. doi: 10.1002/jso.26655. Online ahead of print.

ABSTRACT

BACKGROUND: Guidelines recommended for resection of oral cancer define a free margin of ≥5 mm as clear and safe (R0). This statement was questioned recently based on the assumption that different surgical margins may hold different risk categories. The aim of this study was to investigate the impact of stratification of the surgical margins on the survival outcome of patients with oral cancer.

METHODS: In a cohort of 753 patients, the hazard ratio for local recurrence-free survival (LRFS), overall survival (OS), and oral cancer-specific survival (OCSS) were estimated for R0 resection, the close margin of 1-4 mm, involved resection borders but with free frozen sections. Competing risk factors were considered in the statistical regression model.

RESULTS: One hundred seventy-three (23%) patients developed local recurrence and 316 (42%) died in the 5 follow-up years. There was a gradual improvement in the LRFS, OCSS, OS with the increase of clear margin. OS showed a similar tendency.

CONCLUSION: Not all patients with an R0cm status carry the same risk for impaired LRFS, OCSS, and OS. Their risk to develop recurrence is higher than those patients with R0 ≥5 mm but stratified risk management can be recommended according to the presented results.

PMID:34416792 | DOI:10.1002/jso.26655

Biol Reprod. 2021 Aug 20:ioab158. doi: 10.1093/biolre/ioab158. Online ahead of print.

ABSTRACT

Emerging evidence suggests that exposures in pre-puberty, particularly in fathers-to-be, may impact the phenotype of future offspring. Analyses of the RHINESSA cohort find that offspring of father’s exposed to tobacco smoking or overweight that started in pre-puberty demonstrate poorer respiratory health in terms of more asthma and lower lung function. A role of pre-puberty onset smoking for offspring fat mass is suggested in the RHINESSA and ALSPAC cohorts, and historic studies suggest that ancestral nutrition during pre-puberty play a role for grand-offspring health and morbidity. Support for causal relationships between ancestral exposures and (grand-)offspring health in humans has been enhanced by advancements in statistical analyses that optimize the gain while accounting for the many complexities and deficiencies in human multi-generation data. The biological mechanisms underlying such observations have been explored in experimental models. A role of sperm small RNA in the transmission of paternal exposures to offspring phenotypes has been established, and chemical exposures and overweight have been shown to influence epigenetic programming in germ cells. For example, exposure of adolescent male mice to smoking led to differences in offspring weight and alterations in small RNAs in the spermatozoa of the exposed fathers. It is plausible that male pre-puberty may be a time window of particular susceptibility, given the extensive epigenetic reprogramming taking place in the spermatocyte precursors at this age. In conclusion, epidemiological studies in humans, mechanistic research and biological plausibility, all support the notion that exposures in the pre-puberty of males may influence the phenotype of future offspring.

PMID:34416759 | DOI:10.1093/biolre/ioab158

J Neurosurg. 2021 Aug 20:1-10. doi: 10.3171/2021.2.JNS204333. Online ahead of print.

ABSTRACT

OBJECTIVE: Cerebral extracranial-intracranial (EC-IC) direct bypass is a commonly used procedure for ischemic vasculopathy. A previously described variation of this technique is to utilize one donor artery to supply two recipient arteries, which the authors designate as 1D2R. The purpose of this study is to present a single surgeon’s series of 1D2R direct bypasses for moyamoya and ischemia using detailed clinical, angiographic, and intraoperative blood flow measurement data. To the authors’ knowledge, this is the largest series reported to date.

METHODS: Hospital, office, and radiographic imaging records for all patients who underwent cerebral revascularization using a 1D2R bypass by the senior author were reviewed. The patients’ demographic information, clinical presentation, associated medical conditions, intraoperative information, and postoperative course were obtained from reviewing the medical records.

RESULTS: A total of 21 1D2R bypasses were performed in 19 patients during the study period. Immediate bypass patency was 100% and was 90% on delayed follow-up. The mean initial cut flow index (CFI(i)) was 0.64 ± 0.33 prior to the second anastomosis and the mean final value (CFI(f)) was 0.94 ± 0.38 after the second anastomosis (p < 0.001). The overall bypass flow increased on average by 50% (mean 17.9 ml/min, range -10 to 40 ml/min) with the addition of the second anastomosis. There was no significant difference in the overall flow measurements when the end-to-side anastomosis or side-to-side anastomosis was performed first. There was a statistically significant difference in the proportion of patients with a modified Rankin Scale (mRS) score of 0 or 1 postoperatively compared to preoperatively (p < 0.01). Through the application of Poiseuille’s law, the authors analyzed flow dynamics, deduced the component vascular resistances based on an analogy to electrical circuits and Ohm’s law, and introduced the new concepts of “second anastomosis relative augmentation” and “second anastomosis sink index” in the evaluation of 1D2R bypasses.

CONCLUSIONS: The application of the 1D2R technique in a series of 19 consecutive patients undergoing direct EC-IC bypass for flow augmentation demonstrated high patency rates, statistically significantly higher CFIs compared to 1D1R, and improved mRS scores at last clinical follow-up. Additionally, the technique allows a shorter dissection time and preserves blood flow to the scalp. The routine utilization of intraoperative volumetric flow measurements in such surgeries allows a deeper understanding of the hemodynamic impact on individual patients.

PMID:34416732 | DOI:10.3171/2021.2.JNS204333

Biomed Mater. 2021 Aug 20. doi: 10.1088/1748-605X/ac1f9e. Online ahead of print.

ABSTRACT

The development of “smart” scaffolds has achieved notoriety among current prospects for bone repair, especially for chronic osteopathies, such as osteoporosis. Millions of individuals in the world suffer from poor bone healing due to osteoporosis. The objective of this work was to produce and characterize castor polyurethane scaffolds (Ricinus communis L.), as well as to evaluate its in vitro biocompatibility with stem cells and osteoinductive effect in vivo on bone failures in a leporid model of osteoporosis. The material was characterized using Fourier-transform infrared spectroscopy, thermogravimetric analysis, scanning electron microscopy and porosity analysis. Then, biocompatibility was assessed by adhesion using scanning electron microscopy and cytotoxicity in a 3- (4, 5-dimethyl-2-thiazolyl) -2, 5-diphenyl-2H-tetrazolium assay. The osteoinductive effect in vivo was determined in bone defects in rabbit tibias (Oryctolagus cuniculus) submitted to castor bean scaffold, castor bean scaffold associated with stem cells and negative control, after four and eight weeks, evaluated by computed microtomography and histopathology. The scaffolds were porous, with an average pore size of 209.5 ± 98.2 µm, absence of cytotoxicity and positive cell adhesiveness in vitro. All the animals presented osteoporosis, characterized by multifocal osteoblastic inactivity and areas of mild fibrosis. There were no statistical differences between these treatments in the fourth week of treatment. In the eighth week, the treatment with castor bean scaffold alone induced greater bone formation when compared to the other groups, followed by treatment with an association between castor bean scaffold and stem cells. The castor bean scaffold was harmless to cell culture, favoring cell adhesiveness and proliferation, in addition to inducing bone neoformation in osteoporotic rabbits.

PMID:34416741 | DOI:10.1088/1748-605X/ac1f9e

J Neurosurg Spine. 2021 Aug 20:1-7. doi: 10.3171/2021.2.SPINE202133. Online ahead of print.

ABSTRACT

OBJECTIVE: Postoperative infection remains prevalent after spinal surgical procedures. Institutional protocols for infection prevention have improved rates of infection after spine surgery. However, prior studies have focused on only elective surgical patients. The aim of this study was to determine the efficacy of a multiinstitutional intraoperative sodium oxychlorosene-based infection prevention protocol for decreasing rate of infection after instrumented spinal surgery.

METHODS: A retrospective analysis was performed at two tertiary care institutions with level I trauma programs, and patients who underwent posterior instrumented spinal fusion between January 1, 2011, and May 31, 2019, were included. Postoperative deep wound infection rates were captured before and after implementation of a multiinstitutional infection prevention protocol. Possible adverse outcomes related to infection prevention techniques were also examined. In addition, consecutive patients treated from January 1, 2018, to May 31, 2019, were prospectively included in a database to collect preoperative and postoperative spine-specific quality of life measures and to assess the impact of postoperative infection on quality of life.

RESULTS: A total of 5047 patients fit the inclusion criteria. Of these, 1043 patients underwent surgery prior to protocol implementation. The infection rate of this cohort (3.5%) decreased significantly after protocol implementation (1.2%, p < 0.001). Postoperative sterile seroma rates did not differ between the preprotocol and postprotocol groups (0.7% vs 0.7%, p = 0.5). In the 1031 patients who underwent surgery between January 2018 and May 2019, the fusion rate was 89.2%. Quality of life outcomes between patients with infection and those without infection were similar, although statistical power was limited owing to the low rate of infection. Notably, 2 of 10 patients who developed deep wound infection died of infection-related complications.

CONCLUSIONS: An intraoperative sodium oxychlorosene-based infection prevention protocol helped to significantly decrease the rate of infection after spine surgery without negatively impacting other postoperative procedure-related metrics. Postoperative wound infection may be associated with higher-than-expected rate of postoperative mortality.

PMID:34416716 | DOI:10.3171/2021.2.SPINE202133

J Neurosurg. 2021 Aug 20:1-11. doi: 10.3171/2021.2.JNS203463. Online ahead of print.

ABSTRACT

OBJECTIVE: Femoral nerve palsy results in significant impairment of lower extremity function due to the loss of quadriceps muscle function. The authors have previously described their techniques utilizing the anterior obturator and sartorius nerves for transfer in cases of femoral nerve palsy presenting within 1 year of injury. In the current study, the authors discuss their updated techniques, results, and approach to partial and complete femoral nerve palsies using femoral nerve decompression and nerve transfers.

METHODS: They conducted a retrospective review of patients with femoral nerve palsies treated with their technique at the Washington University School of Medicine in 2008-2019. Primary outcomes were active knee extension Medical Research Council (MRC) grades and visual analog scale (VAS) pain scores.

RESULTS: Fourteen patients with femoral nerve palsy were treated with femoral nerve decompression and nerve transfer: 4 with end-to-end (ETE) nerve transfers, 6 with supercharged end-to-side (SETS) transfers, and 4 with ETE and SETS transfers, using the anterior branch of the obturator nerve, the sartorius branches, or a combination of both. The median preoperative knee extension MRC grade was 2 (range 0-3). The average preoperative VAS pain score was 5.2 (range 1-9). Postoperatively, all patients attained an MRC grade 4 or greater and subjectively noted improved strength and muscle bulk and more natural gait. The average postoperative pain score was 2.3 (range 0-6), a statistically significant improvement (p = 0.001).

CONCLUSIONS: Until recently, few treatments were available for high femoral nerve palsy. A treatment strategy involving femoral nerve decompression and nerve transfers allows for meaningful functional recovery and pain relief in cases of partial and total femoral nerve palsy. An algorithm for the management of partial and complete femoral nerve palsies and a detailed description of surgical techniques are presented.

PMID:34416726 | DOI:10.3171/2021.2.JNS203463

J Neurosurg Pediatr. 2021 Aug 20:1-6. doi: 10.3171/2021.5.PEDS20929. Online ahead of print.

ABSTRACT

OBJECTIVE: Amid national and local budget crises, cutting costs while maintaining quality care is a top priority. Chiari malformation is a relatively common pediatric neurosurgical pathology, and postoperative care varies widely. The postoperative course can be complicated by pain and nausea, which can extend the hospital stay. In this study, the authors aimed to examine whether instituting a standardized postoperative care protocol would decrease overall patient hospital length of stay (LOS) as well as cost to families and the hospital system.

METHODS: A retrospective study of pediatric patients who underwent an intradural Chiari decompression with expansile duraplasty at a single institution from January 2016 to September 2019 was performed. A standardized postoperative care protocol was instituted on May 17, 2018. Pre- and postprotocol groups were primarily analyzed for demographics, LOS, and the estimated financial expense of the hospital stay. Secondary analysis included readmissions, opioid consumption, and follow-up.

RESULTS: The analysis included 132 pediatric patients who underwent an intradural Chiari decompression with expansile duraplasty. The preprotocol group included 97 patients and the postprotocol group included 35 patients. Patient age ranged from 0.5 to 26 years (mean 9.5 years). The mean LOS preprotocol was 55.48 hours (range 25.90-127.77 hours), and the mean postprotocol LOS was 46.39 hours (range 27.58-77.38 hours). The comparison between means showed a statistically significant decrease following protocol initiation (95% CI 1.87-16.31 hours, p = 0.014). In the preprotocol group, 21 of 97 patients (22%) were discharged the first day after surgery compared with 14 of 35 patients (40%) in the postprotocol group (p = 0.045). The estimated cost of one night on the pediatric neurosurgical intermediate ward was approximately $4500, which gives overall cost estimates for 100 theoretical cases of $927,800 for the preprotocol group and $732,900 for the postprotocol group.

CONCLUSIONS: By instituting a Chiari protocol, postoperative LOS was significantly decreased, which resulted in decreased healthcare costs while maintaining high-quality and safe care.

PMID:34416728 | DOI:10.3171/2021.5.PEDS20929

Waste Manag. 2021 Aug 17;134:52-56. doi: 10.1016/j.wasman.2021.08.010. Online ahead of print.

ABSTRACT

For minor metal recycling from electric parts, detachment without breakage (non-destructive detachment) of the electric parts from printed circuit boards (PCBs) is required. A cross-flow shredder (CFS), a drum-type chain mill, is often used in PCB recycling, but the effects of its individual features (e.g., chain thickness) on the non-destructive detachment of the PCB parts have yet to be understood. In this study, a CFS suited to the design-of-experiment (DoE) approach was developed; 27 different experimental conditions were evaluated, with three repetitions under each condition for a single PCB crushing, and the effect of nine CFS factors on the non-destructive detachment of parts from the PCBs of mobile phones was investigated. It was revealed that two factors (rotation rate and vent screen) have a statistically significant influence on such non-destructive detachment, and two other factors (chain-wall distance and crushing time) have a significant influence on related results such as the overcrushing of boards (PCBs after parts detachment) and powder generation. Based on these results, a future perspective on CFS improvement is presented.

PMID:34416670 | DOI:10.1016/j.wasman.2021.08.010

J Hazard Mater. 2021 Aug 8;422:126849. doi: 10.1016/j.jhazmat.2021.126849. Online ahead of print.

ABSTRACT

Dichlorvos (DDVP) is an insecticide with neurotoxicity that is widely used in agricultural production and life. However, the effects of acute DDVP poisoning on brain tissue remain underinvestigated. The purpose of this study was to evaluate the differences within 15 min-6 h in plasma biochemical indexes, brain histology and metabolites among three groups of commercial broilers orally administered different dosages of DDVP one time: (1) high-dose group (11.3 mg/kg), (2) low-dose group (2.48 mg/kg) and (3) control group (0 mg/kg). The results of biochemical indexes showed that acute DDVP poisoning could cause hyperglycemia and oxidative stress in poisoned broilers. Histological examination showed that DDVP could induce brain edema, abnormal expression of glial fibrillary acidic protein (GFAP) and neuronal mitochondrial damage in broilers. Whole-brain metabolism showed that DDVP could significantly change the secretion of neurotransmitters, energy metabolism, amino acid metabolism and nucleotide metabolism. Correlation analysis showed that metabolites such as hypoxanthine, acetylcarnitine and glucose 6-phosphate were significantly correlated with blood glucose, biomarkers of oxidative stress and brain injury pathology. The results of this study provide new insights into the molecular mechanism of brain tissue responses to acute DDVP exposure in broilers and deliver important information for clinical research on neurodegenerative diseases caused by acute DDVP poisoning.

PMID:34416688 | DOI:10.1016/j.jhazmat.2021.126849

Prev Vet Med. 2021 Aug 17;195:105467. doi: 10.1016/j.prevetmed.2021.105467. Online ahead of print.

ABSTRACT

Equine leishmaniasis is a neglected tropical disease caused by the protozoan of the Leishmania genus, and it has been reported in several countries around the world, especially Brazil. Therefore, the present investigation aims to conduct a cross-sectional study to determine the prevalence, spatial distribution, and associated factors with seropositivity for Leishmania spp. in draft horses from the Distrito Federal, Brazil. The serological survey was conducted on 411 animals, employing the Indirect Immunofluorescence Test (IFA) and Enzyme-Linked Immunosorbent Assay (ELISA). The Kappa (κ) and gross agreement indexes evaluated the Leishmania spp. seropositivity by IFA and ELISA test. The statistical analysis was performed using the Chi-square test and logistic regression. The spatial analysis showed the areas with the highest number of seropositive and the Moran autocorrelation analyses between the spatial distribution and the epidemiological model’s explanatory variables. A 27.01 % co-positivity was observed with a κ index of 52.64 %. The final model considered the variables: access to water bodies (p-value = 0.008, Odds Ratio (OR) = 2.26, Confidence Interval (CI) = 1.24-4.13), the absence of the use of ectoparasiticide (p-value = 0.008, OR = 1.93 CI = 1.18-3.15) and traveling animal (p-value = 0.059, OR = 1.54, CI = 0.98-2.41). The Kernel map showed hot areas with a high concentration of nine positive animals per area and some lighter areas ranging from five to seven positive animals per area where control measures should be performed. The Moran autocorrelation analysis was significant for the variables: traveling animal (Moran’s I = 0.540 and pseudo-p-value = 0.001) and the absence of use ectoparasiticide (Moran’s I = 0.259 and pseudo-p-value = 0.005). The current study exposes a high seroprevalence of Leishmania spp. in horses in the Distrito Federal, Brazil. Moreover, it proposes that traveling animal, the access to water bodies and the absence of the use of ectoparasiticide are significantly associated with seropositivity for Leishmania spp. in draft horses, which may contribute to the implementation of prophylactic and controls measures where leishmaniasis is already stalled.

PMID:34416652 | DOI:10.1016/j.prevetmed.2021.105467