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Connective or muscular tissue crossing the axilla is named axillary arch (of Langer). It is known to complicate axillary surgery and to compress nerves and vessels transiting from the axilla to the arm. Our study aims at systematically researching the frequency, insertions, tissue composition and dimension of axillary arches in a large cohort of individuals with regard to gender and bilaterality. In addition, it aims at evaluating the ability of axillary arches to cause compression of the axillary neurovascular bundle. Four hundred axillae from 200 unembalmed and previously unharmed cadavers were investigated by careful anatomical dissection. Identified axillary arches were examined for tissue composition and insertion. Length, width and thickness were measured. The relation of the axillary arch and the neurovascular axillary bundle was recorded after passive arm movements. Twenty‐seven axillae of 18 cadavers featured axillary arches. Macroscopically, 15 solely comprised muscular tissue, six connective tissue and six both. Their average length was 79.56 mm, width 7.44 mm and thickness 2.30 mm. One to three distinct insertions were observed. After passive abduction and external rotation of the arm, 17 arches (63%) touched the neurovascular axillary bundle. According to our results, 9% of the Central European population feature an axillary arch. Approximately 50% of it bilaterally. A total of 40.74% of the arches have a thickness of 3 mm or more and 63% bear the potential of touching or compressing the neuromuscular axillary bundle upon arm movement. [ABSTRACT FROM AUTHOR]

Objective—Direct oral anticoagulants (DOAC) are replacing vitamin K antagonists (VKA) for the prevention of ischemic stroke and venous thromboembolism. We set out to assess the effect of prior treatment with DOAC and VKA in patients with aneurysmal subarachnoid hemorrhage (SAH). Methods—Consecutive SAH patients treated at two (Aachen, Germany and Helsinki, Finland) university hospitals were considered for inclusion. To assess the association between anticoagulant treatments on SAH severity measure by modified Fisher grading (mFisher) and outcome as measured by the Glasgow outcome scale (GOS, 6 months), DOAC- and VKA-treated patients were compared against age- and sex-matched SAH controls without anticoagulants. Results—During the inclusion timeframes, 964 SAH patients were treated in both centers. At the time point of aneurysm rupture, nine patients (0.93%) were on DOAC treatment, and 15 (1.6%) patients were on VKA. These were matched to 34 and 55 SAH age- and sex-matched controls, re-spectively. Overall, 55.6% of DOAC-treated patients suffered poor-grade (WFNS4–5) SAH compared to 38.2% among their respective controls (p = 0.35); 53.3% of patients on VKA suffered poor-grade SAH compared to 36.4% in their respective controls (p = 0.23). Neither treatment with DOAC (aOR 2.70, 95%CI 0.30 to 24.23; p = 0.38), nor VKA (aOR 2.78, 95%CI 0.63 to 12.23; p = 0.18) were inde-pendently associated with unfavorable outcome (GOS1–3) after 12 months. Conclusions—Iatrogenic coagulopathy caused by DOAC or VKA was not associated with more severe radiological or clinical subarachnoid hemorrhage or worse clinical outcome in hospitalized SAH patients. [ABSTRACT FROM AUTHOR]

Background: Over the past few decades, there has been a paradigm shift in treatment strategy for cavernous sinus meningiomas (CSMs). Preserving neurological function and cranial nerve (CN) decompression have become the primary goal of cases eligible for surgical treatment. Extensive skull base dissection and drilling can be avoided by approaching these lesions through a subtemporal route. Methods: We describe the subtemporal approach in a step-by-step fashion illustrating its advantages and pitfalls through and illustrative case. Results: The subtemporal approach to CSMs is a valuable alternative for CN decompression and maximal safe resection. We describe the technique in comparison to classical skull base approaches. Although rare, recurrence after adjuvant maximal radiation is possible leaving reoperation as the only treatment option. Conclusion: The subtemporal approach offers a less invasive alternative for initial and redo CN decompression and successful symptom control in patients suffering from CSM. Keywords: Cavernous sinus, Meningioma, Skull base, Subtemporal approachBackground: Over the past few decades, there has been a paradigm shift in treatment strategy for cavernous sinus meningiomas (CSMs). Preserving neurological function and cranial nerve (CN) decompression have become the primary goal of cases eligible for surgical treatment. Extensive skull base dissection and drilling can be avoided by approaching these lesions through a subtemporal route. Methods: We describe the subtemporal approach in a step-by-step fashion illustrating its advantages and pitfalls through and illustrative case. Results: The subtemporal approach to CSMs is a valuable alternative for CN decompression and maximal safe resection. We describe the technique in comparison to classical skull base approaches. Although rare, recurrence after adjuvant maximal radiation is possible leaving reoperation as the only treatment option. Conclusion: The subtemporal approach offers a less invasive alternative for initial and redo CN decompression and successful symptom control in patients suffering from CSM. [ABSTRACT FROM AUTHOR]

We study the effects of imposing linear relations within modules of matrices on average sizes of kernels. The relations that we consider can be described combinatorially in terms of partial colourings of grids. The cells of these grids correspond to positions in matrices and each defining relation involves all cells of a given colour. We prove that imposing such relations arising from 'admissible' partial colourings has no effect on average sizes of kernels over finite quotients of discrete valuation rings. This vastly generalises the known fact that average sizes of kernels of general square and traceless matrices of the same size coincide over such rings. As a group‐theoretic application, we explicitly determine zeta functions enumerating conjugacy classes of finite p$p$‐groups derived from free class‐3$\hskip.001pt 3$‐nilpotent groups for p⩾5$p\geqslant 5$. [ABSTRACT FROM AUTHOR]

Introduction: Chronic subdural hematoma (cSDH) is becoming more prevalent due to population aging and the increasing use of antithrombotic drugs. Postoperative seizure in cSDH have a negative effect on outcome, and there currently no consensus regarding prophylactic anti-epileptic drug (AED) treatment. The objective of this study was to evaluate predisposing and triggering factors associated with postoperative epileptic seizure in patients with cSDH. Methods: All patients, who were surgically treated for cSDH in a single tertiary care center between 2015 and 2019, were considered for inclusion. Relevant patient- and hematoma-specific characteristics were retrospectively extracted fromhospital records. Paroxysmal events categorized by the treating physician as suspected postoperative seizures were noted. The clinical outcome was extracted from the last available follow-up visit and classified according to the Glasgow outcome scale (GOS). Results: Of the included 349 patients, 54 (15.5%) developed suspected postoperative epileptic complications in the form of early seizure (≤7 days) in 11 patients (3.2%) and late seizure (>7 days) in 43 patients (12.3%). In the logistic regression analysis, solely depressed brain volume (supratentorial volume (ml) not filled with re-expanded brain) was independently associated with postoperative seizure (odds ratio [OR] 1.006, 95% CI: 1.001-1.011; p = 0.034). The occurrence of postoperative seizure (OR 6.210, 95% CI: 2.704-14.258; p < 0.001) and preoperative Markwalder grading (OR 2.919, 95% CI: 1.538-5.543; p = 0.001) were independently associated with unfavorable (GOS1-3) outcome. Conclusion: Larger postoperative depressed brain volume was the only factor independently associated with suspected postoperative seizure, and it could help identify a subgroup of patients with higher susceptibility to epileptic events. Based on our data, no formal recommendation can bemade regarding the prophylactic use of anti-epileptic drugs. Nevertheless, the relative safety of new generation AEDs and the detrimental effect of postoperative seizure on outcome may justify its use in a selected patient population. [ABSTRACT FROM AUTHOR]

The scalar-field imaging of a hypersonic mixing flow is performed in a mixing facility that is shock tunnel driven. The instantaneous mixture-fraction field of a hypersonic two-dimensional mixing layer ([M.sub.1] = 5.1, [M.sub.2] = 0.3) is determined with a temperature-insensitive planar laser-induced fluorescence technique with nitric oxide (NO) as the tracer species. Single-shot images are obtained with the broadband excitation of a reduced temperature-sensitivity transition in the [A.sup.2][[summation over].sup.+] [left arrow] [X.sup.2][PI.sup.1/2] (0, 0) band of NO near 226 nm. The instantaneous mixture-fraction field at a convective Mach number of 2.64 is shown to be nearly identical to a typical diffusive process, supporting the notion of gradient-transport mixing models for highly compressible mixing layers. OCIS codes: 260.2510, 280.2490, 300.2530, 300.6280.

Introduction/Aims: For cubital tunnel syndrome, the avoidance of predisposing arm positions and the use of elbow splints are common conservative treatment options. The rationale is to prevent excessive stretching and compression of the nerve in the cubital tunnel, as this mechanical stress impedes intraneural perfusion. Data regarding those upper extremity postures to avoid, or whether elbow flexion alone is detrimental, are inconsistent. This study aimed to assess perfusion and size changes of the cubital tunnel during different postures in an experimental cadaver setup. Methods: Axillary arteries in 30 upper extremities of fresh cadavers were injected with ultrasound contrast agent. High‐resolution ultrasound of the cubital tunnel was performed during five different arm postures that gradually increased tension on the ulnar nerve and caused cubital tunnel narrowing. Contrast enhancement within the tunnel was measured to quantify perfusion. Cubital tunnel cross‐sectional area was measured to detect compression. Results: Increasing tension significantly reduced perfusion. When isolated, neither shoulder elevation, elbow flexion, pronation, nor extension of wrist and fingers impaired perfusion. However, combining two or more of these postures led to significant decreases. Significant narrowing of the cubital tunnel was seen in full elbow flexion and shoulder elevation. Discussion: Combinations of some upper extremity joint positions reduce nerve perfusion, but isolated elbow flexion does not have a significant impact. We hypothesize that elbow splints alone may not influence cubital tunnel perfusion but may only prevent direct compression of the ulnar nerve. Advising patients about upper extremity postures that should be avoided may be more effective. [ABSTRACT FROM AUTHOR]

Various types of local zeta functions studied in asymptotic group theory admit two natural operations: (1) change the prime and (2) perform local base extensions. Often, the effects of both of the preceding operations can be expressed simultaneously in terms of a single formula, a statement made precise using what we call local maps of Denef type. We show that assuming the existence of such formulae, the behaviour of local zeta functions under variation of the prime in a set of density 1 in fact completely determines these functions for almost all primes and, moreover, it also determines their behaviour under local base extensions. We discuss applications to topological zeta functions, functional equations, and questions of uniformity. [ABSTRACT FROM AUTHOR]

Abstract: Let O be a compact discrete valuation ring of characteristic 0. Given a module M of matrices over O, we study the generating function encoding the average sizes of the kernels of the elements of M over finite quotients of O. We prove rationality and establish fundamental properties of these generating functions and determine them explicitly for various natural families of modules M. Using p‐adic Lie theory, we then show that special cases of these generating functions enumerate orbits and conjugacy classes of suitable linear pro‐ p groups. [ABSTRACT FROM AUTHOR]

We describe a practical algorithm for primitivity testing of finite nilpotent linear groups over various fields of characteristic zero, including number fields and rational function fields over number fields. For an imprimitive group, a system of imprimitivity can be constructed. An implementation of the algorithm in Magma is publicly available. [ABSTRACT FROM PUBLISHER]

Abstract: An experimental study of the flammability properties of PMMA at low pressures and oxygen concentrations was performed. The work was motivated by the importance of these effects on fire safety in the aviation industry. Measurements were obtained in a mass loss calorimeter inside a large 10m3 pressure vessel capable of reaching pressures as low as 0.1atm. The PMMA flammability was characterized by measuring the burning rate and the time to ignition of small test samples. These were ignited and burned under different external heat fluxes, total pressures and oxygen concentrations. The combined effects of pressure and oxygen concentration on the burning rate, combustion flow field, and ignition were evaluated. Results showed that at low pressure, the burning rate was less intense with a decrease in the mass loss rate. However, the reduction in pressure caused a shortened ignition delay time. Experimental measurements were compared with a simple analytical model showing good agreement. The results also show how pressure and oxygen concentration contributed to the heat transfer from the flame. The model revealed that a single function in oxygen and pressure could account for both flame radiative and convective effects. As a result, a power law fit was obtained for the relation of the combined pressure and oxygen effect on the burning rate. This correlation shows a good agreement with the measurements and predicts the burning rate behavior for the full range of pressure and oxygen tests. [Copyright &y& Elsevier]

Background: Reduced longitudinal median nerve gliding is a new promising diagnostic feature in carpal tunnel syndrome (CTS). However, the complexity of existing ultrasound analysis protocols undermines the application in routine clinical practice., Aim: To provide a simple method for assessing longitudinal gliding with ultrasound, without the need for post-hoc image analysis., Design: 1) Retrospective cohort study, validation by external blinded reviewers; 2) proof of concept in body donors., Setting: 1) Outpatient clinic; 2) anatomy department., Population: The population included 48 patients with idiopathic CTS diagnosed by electrodiagnostic testing and ultrasound, as well as 15 healthy controls. Twelve, non-frozen, non-embalmed body donors were enrolled., Methods: Longitudinal gliding of the median nerve in the carpal tunnel was visualized in all patients with idiopathic CTS and healthy controls. All ultrasound videos were pseudonymized, equipped with a scale, and randomized. Videos were analyzed by four independent radiologists, all blinded to clinical characteristics. The endpoint was gliding rated as millimeters. Validity of the technique was tested by using speckle tracking software, and in body donors, directly measuring nerve excursion in situ, simultaneously to ultrasound., Results: Gliding differed significantly between controls and patients with CTS, decreasing with incremental CTS severity. A cut-off value of 3.5 mm to identify patients with CTS, yielded 93.8% sensitivity and 93.3% specificity. Intraclass correlation coefficient among senior author and raters was 0.798 (95% CI 0.513 to 0.900, P<0.001), indicating good reliability. Speckle tracking and especially direct validation in body donors correlated well with ultrasound findings., Conclusions: First, longitudinal median nerve gliding can reliably be assessed using this simple technique without the need for complicated procedures. Second, a decrease in gliding was found with progressive severity of CTS. Reproducibility for measured distances is good among raters., Clinical Rehabilitation Impact: An easy to apply sonography parameter would bolster the diagnostic ability of specialists in physical medicine and rehabilitation in daily routine.

Background: Despite recent multi-institutional efforts, long-term data on clinical and radiological outcomes after treatment of high-grade dural arteriovenous fistulas (dAVFs) remain scarce. This study aimed to evaluate the long-term risk of hemorrhage and fistula-related mortality after treatment., Methods: Retrospective analysis of all consecutive patients primarily diagnosed with a high-grade dAVF (Cognard grade 2b, 2a+b, 3, 4) between January 2012 and September 2022 at a large neurovascular center. Primary endpoints were intracranial hemorrhage (ICH) and all-cause mortality after treatment; secondary endpoints were angiographic occlusion, complication rate and neurological deficits., Results: A total of 121 patients underwent 141 treatments (122 endovascular therapy (EVT), 5 radiotherapy, 14 surgery) of which 12 patients (10%) underwent retreatment. Follow-up was available in all patients for a median of 4.2 (IQR 2.5 to 6.6) years. Eleven patients (9%) died during the follow-up period, of which three deaths (2%) occurred after hemorrhagic presentation, one of them attributable to treatment. One death (0.8%) was due to delayed hemorrhage after partial occlusion from EVT. No other post-treatment bleedings occurred. Angiographic follow-up after multimodality treatment was available in 93% of patients after a median of 6 months; the overall occlusion rate was 90%. The overall rate of complications was 25% after EVT and 14% after surgery. The rates of new transient and permanent neurological deficits after EVT were 9% and 3%, respectively., Conclusions: The long-term rate of re-bleeding or dAVF-related mortality was low when high rates of angiographic occlusion were achieved. The risk for treatment-related complications leading to neurological sequela was low., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)