Search

Postoperative peritumoral brain edema (PTBE) is the progressively exacerbating cerebral edema following meningiomas resection.The study aims to identify the predictive factors of postoperative PTBE.A retrospective study was conducted on the 117 cases of patients who underwent meningioma. The histopathological features of the tumors were re-assessed according to WHO 2016 classification. Clinical and pathohistological features were analyzed.Thirteen patients (11.1%) were diagnosed having postoperative PTBE. Preoperative seizure (odds ratio [OR] = 6.125, P = 0.039) and histological prominent nucleoli (OR = 3.943, P = 0.039) were the independent risk factors for postoperative PTBE. Meningiomas with a parietal localization were more likely to develop postoperative PTBE (OR = 3.576, P = 0.054). Brain invasion and large tumor volume did not increase complication rate. Preoperative edema index was significantly higher in brain invasive meningiomas (3.0 ± 2.2 versus 1.8 ± 1.7, P = 0.001). Patients having moderate preoperative PTBE were prone to the complication (21.4% versus 7.9%, P = 0.100).Preoperative seizure were the predictive factors for postoperative PTBE. Careful venous protection during the operation may be helpful, especially for tumors locating in the parietal lobe. Prominent nucleoli observed in postoperative pathology should warrant surgeons' attention. Comprehensive perioperative management is essential for these patients.

Background Spontaneous intracerebral hemorrhage (SICH) is of high mortality and morbidity. SICH in the basal ganglia is usually attributed to chronic hypertension. Postoperative rehemorrhage is a severe complication, and it is relative to surgical techniques. Methods A retrospective survey was conducted on 123 patients with basal ganglia SICH who received surgery from January 2015 to January 2019. Postoperative rehemorrhage within 24 hours was recorded. Preoperative clinical parameters, surgeon experience ( 20 years), operation time, surgical approach, and hemostasis technique were recorded and analyzed. Results The total postoperative rehemorrhage rate was 12.2% (15/123). The univariable analysis showed general surgeons had a higher postoperative rehemorrhage rate than experienced surgeons (30.4% vs. 8.6%, respectively; P = 0.068). The operation time (minutes) in experienced surgeons was significantly longer (164.9 ± 53.5 vs. 137.7 ± 30.8, P = 0.016), but they had a higher chance to locate the responsible vessel (74.2% vs. 40.0%, P = 0.001), respectively. Logistic analysis indicated that experienced surgeons significantly reduced the risk of rehemorrhage (odds ratio [OR], 0.242; P = 0.021). Transsylvian approach was a protective factor for postoperative rehemorrhage (OR, 0.291; P = 0.045). Conclusions Surgeons' experience plays the most important role in postoperative rehemorrhage. Surgeons with rich experience were willing to spend more time to achieve definitive hemostasis in operation. The use of a transsylvian approach can significantly reduce the rehemorrhage rate. Packing hemostasis with gelatin sponge may increase complications.

Hydrocephalus is a common complication following decompressive craniectomy. Ventriculoperitoneal shunt (VPS) is required for some patients before receiving a cranioplasty (CP). The presence of a VPS is regarded as a risk factor for overall CP complications.A retrospective survey was conducted on 176 patients with traumatic brain injury who underwent late (3 months) titanium CP (Ti-CP) in our hospital from April 2014 to July 2018. Thirteen patients (7.4%) had preoperative VPS. Propensity score matching was performed for these 13 patients with a ratio of 1:5. A total of 78 patients were selected. Preoperative clinical parameters and postoperative complications were analyzed. The period of postoperative follow-up ranged from 3 to 63 months (mean 21.3 ± 17.0 months).The overall complication rate was greater in the VPS group (P = 0.010). These patients were more likely to develop a sunken skin flap (P0.001). The rate of postoperative cerebral hemorrhage was greater in the VPS group. Logistic analysis showed that preoperative VPS was an independent risk factor for postoperative extradural collection (odds ratio 17.714, P0.001). VPS was not related to postoperative infection and seizure. Postoperative drainage duration longer than 2.5 days significantly increased the risk of postoperative infection (odds ratio 7.715, P = 0.023).The presence of a VPS significantly increased the risk of extradural collection in patients with traumatic brain injury who underwent late Ti-CP. It also was related to postoperative hemorrhage. The sunken skin flap in patients with VPS increased surgical difficulty and the likelihood of extradural accumulation. Preoperative VPS was not related to postoperative infection and seizure in Ti-CP.

Background Cranioplasty is a routine procedure, but it carries a significantly higher complication rate over standard clean cranial surgery. Surgical site infection is the most common but severe complication. Risk factors for surgical site infection are still debated. Methods A retrospective survey of 155 patients (≥16 years old) who exclusively underwent customized titanium cranioplasty from April 2014 to January 2017 was performed. Preoperative clinical parameters, surgeon's hemostasis technique, temporalis dissection, operative time, intraoperative blood loss, postoperative catheter duration and drainage, postoperative hemorrhage and extradural fluid collection (EDFC), and prophylactic antibiotics were recorded and compared between patients with superficial surgical site infection (sSSI) and patients with non-sSSI. Results Overall sSSI rate was 10.3%. Binary logistic analysis showed excessive hemostasis on scalp (odds ratio = 10.302, P = 0.000), presence of postoperative EDFC (odds ratio = 12.740, P = 0.003), and postoperative drainage >277 mL (odds ratio = 10.302, P = 0.000) were independent risk factors for sSSI. Patients who received excessive hemostasis had a longer operative time (P = 0.000). A flaccid cranial defect was a protective factor for postoperative EDFC (odds ratio = 0.130, P = 0.044), whereas presence of ventriculoperitoneal shunt could induce EDFC formation (odds ratio = 9.598, P = 0.020). Postoperative subgaleal drainage was correlated to the size of cranial defect (standardized β = 0.347, P = 0.000). Timing of cranioplasty and use of prophylactic antibiotics were not related to sSSI. Conclusions Surgeons should lower the hemostasis standard for cranioplasty, as this would promote wound healing and reduce operative time, which subsequently decreases SSI rate.

The influence of the dynamic Stark effect on the dissociation of CsI is theoretically studied by the time-dependent wave-packet method. After a pump pulse induces a dissociating wave packet that propagates through both the ionic channel X0+(Cs +(1 S 0) + I +(1 S 0)) and the covalent channel A0+(Cs(2 S 1/2) + I(2 P 3/2)), a Stark pulse is applied to control the diabatic-dissociation dynamics. The first-order non-resonant non-perturbative dynamic Stark effect gives control over the break up, the dissociation probabilities in the two channels being controlled by the delay between the pump and Stark pulses. With a 720-fs delay, the dissociation probability through channel A is greatly enhanced.

As a major component of lignin and abundantly existing in softwood and hardwood, ferulic acid has been used as a lignin-related compound for lignin biodegradation study. Biodegradation of ferulic acid by Cupriavidus sp. B-8, a newly isolated strain, was studied. This strain is able to utilize a wide range of lignin-related aromatic compounds as the sole carbon and energy source, including guaiacol, veratric acid, vanillic acid, cinnamic acid, p-coumaric acid, ferulic acid, and sinapic acid. In addition, the effects of different concentrations of ferulic acid on growth of Cupriavidus sp. B-8 were studied. The growth of Cupriavidus sp. B-8 is better under the condition of lower concentration. High-performance liquid chromatography (HPLC) analysis reveals that above 95% of ferulic acid is degraded within 12 h by Cupriavidus sp. B-8. Based on identification of biodegradation intermediates and further metabolites, the biodegradation pathway of ferulic acid by Cupriavidus sp. B-8 was proposed. Ferulic acid is initially converted to 4-vinylguaiacol, and further oxidized to vanillic acid and protocatechuic acid.

Three hydrogen bonding complexes of the gauche-1PA dimer (GG), trans-1PA dimer (TT) and mixed dimer (GT) have been calculated for the geometry conformations and excited-state energies. The electron distribution at the site of C-O of H-donor moiety in HOMO transfers to the direction of O-H of H-acceptor moiety in LUMO. The hydrogen bond between two 1PAs is the bridge of the intermolecular charge transfer. By the Zhao and Han's excited-state hydrogen bonding dynamics rule, the first excited-state hydrogen bonding change has been discussed without optimizing the excited-state geometry conformations. According to the distinct difference between GT and GG (TT), we concluded that two gauche-1PA monomers of one dimer are transformed at the same time to two trans-1PA monomers.

The sensorless control system of permanent magnet synchronous motor is a system with an uncertainty and external disturbance. This paper uses the control law of equivalent control matched with switching control according to the theory of variable structure with sliding mode control, and achieves a robust control of the uncertainty and external disturbance. In order to eliminate the adverse effect caused by the chattering of the sliding mode, a saturation function of the quasi-sliding mode is used instead of the traditional sign function. Simulations and experiments prove that this control technology has a nicer dynamic and static performance.

Because channel quality defects of post-tensioned prestressed concrete construction cannot be discovered on time, an electric heating method is put forward to produce effective detection. The results of the numeric simulation on the temperature field of a prestressed concrete component show that the electric heating infrared detection method, for its energy consumption, efficiency and safety, is feasible for detecting the channel quality of prestressed concrete component, but the electric current needs to be controlled to avoid high temperature which affects the physical and mechanical properties of the strand and the concrete.

In this work, the femtosecond time-resolved photoelectron spectra and the coupling between the A2Σ+ and B2Π states of the NO molecule in a strong laser field have been investigated by the time-dependent wave packet method. We demonstrate that the weak coupling between the A2Σ+ and B2Π states of NO plays a key role on the peak centered at 0.37 eV of the photoelectron spectra in the 2+1’ channel.

The stereodynamics of the title reaction on the ground electronic state X2A' potential energy surface (PES)1 has been studied using the quasiclassical trajectory (QCT) method. The commonly used polarization-dependent differential cross-sections (PDDCSs) of the product and the angular momentum alignment distribution, P(θr) and P(Φr), are generated in the center-of-mass frame using QCT method to gain insight of the alignment and orientation of the product molecules. Influence of collision energy on the stereodynamics is shown and discussed. The results reveal that the distribution of P(θr) and P(Φr) is sensitive to collision energy. The PDDCSs exhibit different collision energy dependency relationship at low and high collision energy ranges.

Objective To evaluate the titanium Kirsch-Zhu microclip microsurgical reanastomoses of the fallopian tubes. Design Compare the reanastomoses of the rat uterine horn between Kirsch-Zhu clips (Cushman Engineering, Albuquerque, NM) (group A) and conventional suture microsurgical techniques (group B). Setting Microsurgery Research Laboratory, Loma Linda University Medical Center, Loma Linda, California. Patients, Participants Fifteen SD rats Harlan (Harlan Sprague-Dawley Corp., Indianapolis, IN) were done in groups A and B and six in control group (C). Main Outcome Measure Pregnancy rate, litter size, tissue of procedure, and histologic results. Results The clip technique was shorter in procedure time and resulted in equal fertility rate and litter size. Histologically, there were less granulomatous formation and histiocytic inflammation, but muscularis thinning and fibrosis were noted with the clip. Conclusions The Kirsch-Zhu clip has potential for application to human fallopian tube reanastomoses.

A new method for reconstructing rat uterine horn was developed in which nonpenetrating, arcuate-legged clips are applied in interrupted fashion to everted seromuscular edges, forming an elastomeric flanged joint. This anastomosis has unusual physical and morphologic properties, with improved tissue healing and luminal restitution. Clipping is easier than suturing, and resulted in equivalent fertility rate (50–60%) and litter size. It also is associated with less granuloma formation and hystiocytic infiltration than suture. The new technique has the potential of endoscopic translation for human tubal reconstruction.

Reconstructive challenges engendered by skull base surgery are critical determinants of outcome. A novel nonpenetrating, arcuate-legged clip has proven to be both technically and biologically effective for management of these difficult closures. Clips have facilitated reconstructions associated with the surgical management of eight skull base cases: leiomyosarcoma of the orbit, middle fossa, ptyergopalatine fossa, two meningiomas (petrotentorial, cavernous sinus), vagus nerve paraganglioma, complex traumatic orbital dural tear, and one basilar and two vertebral artery aneurysms.

To study the effects of Dihydromyricetin (DMY) on antilipid-peroxidation.The antilipid-peroxidation of DMY on heart, liver, brain tissue homogenate and mitochondria was measured by the determination of malondiadehyde (MDA) induced by Fe2+ -Vit C, Fe2+ -H2O2, Fe-Cys with TBA spectrometric method.DMY could inhibit the lipid peroxidation of homogenate and mitochondria. The inhibition exhibited concentration-dependent manner.DMY has good antilipid-peroxidation effect, which is worth studing further.

Objective Meningospinal and cranial dural adhesions were compared in a canine model, after duraplasty using nonpenetrating clips or penetrating needles and sutures. Methods Fourteen dogs underwent bilateral craniotomies and duraplasties, with implantation of dural prostheses (DuraGuard; Biovascular Corp., Minneapolis, MN), using either 6-0 silk sutures or titanium clips (DuraClose; Surgical Dynamics, Norwalk, CT). Fourteen other dogs underwent L3-L4 laminectomies; three longitudinal dural incisions were closed with 6-0 silk sutures, 6-0 polyglactin 910 (Vicryl) sutures, or clips. Groups of eight dogs (four cranially treated and four spinally treated) were killed 6, 12, 24, and 52 weeks after surgery, and specimens were collected for study after perfusion and fixation (two cranial and two spinal dural reconstructions at 52 wk). Evaluations included assessment of the appearance of approximated dural margins and responses to clips, sutures, and dural prostheses (inflammation, foreign body reaction, fibrosis, and severity of meningospinal/meningocerebral adhesions). Data were evaluated using the Wilcoxon signed-rank and McNemar tests. Results Duraplasties with clips displayed significantly less extensive acute and chronic inflammation, foreign body reaction, and meningoneural adhesions than did repairs with needles and sutures. Conclusion This report is the first long-term experimental study comparing two fundamentally different methods for dural repair in a relevant animal model.

Background . A mechanical system for facilitating vascular anastomosis (end-to-side, end-to-end) is described that enables the rapid construction of nonpenetrated, compliant junctions. The instrument (United States Surgical One-Shot system) simultaneously applies either 10 or 12 nonpenetrating, arcuate-legged titanium clips to everted vessel or prosthetic conduit edges. Methods and Results . The instrument has been tested in animals (jugular and femoral vein jump grafts in carotid and femoral arteries, interpositional grafts, 20 pigs) and human cadaveric constructs (saphenous veins to left anterior descending coronary arteries, 20 cases, 5 brachiocephalic access fistulas) as end-to-side constructs. Clipped constructs have equivalent or superior physical properties to control sutured constructs (6-0 polypropylene) as gauged by burst and tensile strength. All studies were performed under Food and Drug Administration Good Laboratory Practice standards, and the device has been approved for marketing by the Food and Drug Administration. Conclusions . The device enables rapid and reproducible vascular anastomotic constructs with vessels as small as 1.8 mm outer diameter. The constructs are flanged, interrupted, and nonpenetrated.

The surgical principles governing venous reconstruction remain uncertain in contrast to the standardized principles of arterial corrective surgery. The technical difficulties attending venous reconstructions, their potential for complicating thromboembolism, and poor surgical outcome are directly related to the biological response of veins to needle-and-suture. A new method for venous reconstruction, predicated on intimai nonpenetration and flanged eversion, exhibits technical and physiologic advantages over conventional suture.