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Objective Stereoelectroencephalography (SEEG) consists of the implantation of microelectrodes for the electrophysiological characterization of epileptogenic networks. To reduce a possible risk of intracranial bleeding by vessel rupture during the electrode implantation, the stereotactic trajectories must follow avascular corridors. The use of digital subtraction angiography (DSA) for vascular visualization during planning is controversial due to the additional risk related to this procedure. Here we evaluate the utility of this technique for planning when the neurosurgeon has it available together with gadolinium-enhanced T1-weighted magnetic resonance sequence (T1-Gd) and computed tomography angiography (CTA). Methods Twenty-two implantation plans for SEEG were initially done using T1-Gd imaging (251 trajectories). DSA was only used later during the revision process. In 6 patients CTA was available at this point as well. We quantified the position of the closest vessel to the trajectory in each of the imaging modalities. Results Two thirds of the trajectories that appeared vessel free in the T1-Gd or CTA presented vessels in their proximity, as shown by DSA. Those modifications only required small shifts of both the entry and target point, so the diagnostic aims were preserved. Conclusions T1-Gd and CTA, despite being the most commonly used techniques for SEEG planning, frequently fail to reveal vessels that are dangerously close to the trajectories. Higher-resolution vascular imaging techniques, such as DSA, can provide the neurosurgeon with crucial information about vascular anatomy, resulting in safer plans.

The sharing economy platforms for accommodation have emerged as a disruptive model that has revolutionized the tourist lodging sector and modified tourist consumption patterns. Airbnb is the paradi...

INTRODUCTION Goiter is very common in patients with acromegaly; its development is correlated to the duration of the disease. Thyroid cells express the IGF-1 receptor and the TSH/IGF-1 interaction has been demonstrated to have a synergistic effect in thyroid cell growth. There is a correlation between IGF-1 levels and the thyroid volume of patients with acromegaly. The aim of this study was to evaluate, in a retrospective case-cohort study of patients with acromegaly, the associated risk factors for thyroid nodules disease in this population. METHODS This was a case-cohort study matched by age, gender, and growth hormone at diagnosis. Cases consisted of acromegalic patients that developed thyroid nodules during the follow up, and controls consisted in acromegalic patients without thyroid nodules. A Cox proportional hazard estimation was carried out for measure the associated risk factors for thyroid nodules disease in acromegalic patients. A nodular thyroid disease-free survival analysis was estimated using the Kaplan-Meier analysis. RESULTS We recruited 49 cases and 56 controls. In a multivariate Cox proportional hazard analysis age and IGF-1 ≥ 2.2 x ULN were significantly related with the presence of thyroid nodules [HR of 2.21 (95% CI; 1.15-4.25, p = 0.01)]. Nodularity-free survival rates in patients who had an IGF-1 X ULN ≥ 2.2 was found to be lower in comparison to those who had IGF-1 X ULN

Introduction: Osteotomy of the greater trochanter is a commonly used procedure in complex revision hip arthroplasty in order to achieve a wide exposure to the femoral stem and acetabular components. There is no clinical evidence in favour of a specific fixation method. The aim of this study was to compare cable-plate with figure-of-eight cerclage wire fixation in patients requiring a trochanteric “slide” osteotomy. Material and methods: In a retrospective study, 51 greater trochanteric “slide” osteotomies in complex acetabular revision arthroplasties were included. Patients were divided into 2 groups: 28 hips were fixed with 1 of 2 cable-plate systems (Dall-Miles staple, Stryker or Cable-Ready plate, Zimmer) and 23 with a figure-of-eight cerclage wire. Consolidation, osteolysis, migration of greater trochanter, bursitis of the trochanteric area, Trendelenburg gait and removal of osteosynthesis material were studied at 6 months follow-up. Results: Both groups showed good union rates. The lysis rate was similar with 32% in the cable-plate group versus 29% in the cerclage wire group ( p = 0.084). 43% of the hips with cable-plate and 22% of the cerclage wire had trochanteric migration ( p = 0.297). Pain at the greater trochanter was less frequent in the cerclage wire group (9%) as compared to the cable-plate group (43%) ( p = 0.007). Implant removal was more frequent in the cable-plate group (4 vs. 0 patients). Trendelenburg gait was found in 3 patients in the cerclage wire group as compared to 10 in the cable-plate group ( p = 0.054). Conclusions: The cerclage wiring had superior clinical outcomes with similar radiographic results. The authors recommend the use of figure-of-eight cerclage wire when fixing a greater trochanteric “slide” osteotomy in complex revision hip arthroplasty.

Background and purpose Magnetic resonance imaging (MRI) is essential in the diagnosis of pharmacoresistant epilepsy (PRE), because patients with lesions detected by MRI have a better prognosis after surgery. Focal cortical dysplasia (FCD) is one of the most frequent etiologies of PRE but can be difficult to identify by MRI. Voxel-based morphometric analysis programs, like the Morphometric Analysis Program (MAP), have been developed to help improve MRI detection. Our objective was to evaluate the clinical usefulness of MAP in patients with PRE and an apparently normal MRI. Methods We studied 70 patients with focal PRE and a nonlesional MRI. The 3DT1 sequence was processed with MAP, obtaining three z-score maps. Patients were classified as MAP+ if one or more z-score maps showed a suspicious area of brightness, and MAP- if the z-score maps did not show any suspicious areas. For MAP+ cases, a second-look MRI was performed with a dedicated inspection based on the MAP findings. The MAP results were correlated with the epileptogenic zone. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Results Thirty-one percent of patients were classified as MAP+ and 69% were MAP-. Results showed a sensitivity of 0.57, specificity of 0.8, PPV of 0.91, and NPV of 0.35. In 19% of patients, an FCD was found in the second-look MRI after MAP. Conclusions MAP was helpful in the detection of lesions in PRE patients with a nonlesional MRI, which could have important repercussions for the clinical management and postoperative prognosis of these patients.

Surgical planning is crucial to Stereoelectroencephalography (SEEG), a minimally invasive procedure that requires clinicians to operate with no direct view of the brain. Decisions making involves different clinical specialties and requires analysis of multiple multimodal datasets. We present a DepthMap tool designed to localize, measure, and visualize surgical risk, and an AlternativeFinder tool, designed to search for alternative trajectories maintaining adherence to the initial trajectory with three different re-planning strategies: similar entry, similar target, or parallel trajectory. The two tools transform the 3D problem into the 2D domain using projective geometry and distance mapping. Both use the graphics processing unit (GPU) to create a 2D depth image used by DepthMap for measurement and visualization, and by AlternativeFinder to find alternative trajectories. Tools were tested with 12 SEEG cases using digital subtraction angiography. DepthMap was used to measure vessel distance. AlternativeFinder was then used to search for alternatives. Computation time and displacements of the entry and target points for each trajectory and adherence strategy were recorded. The DepthMap tool found vessels in 118 initial trajectories (out of 145). Ninety alternative trajectories were found to meet the required avascular constraints (average 820K alternatives evaluated per initial trajectory). The average computation time was 449 ms per initial trajectory (77 ms when alternatives were found). The tools presented helped clinicians examine and re-plan SEEG trajectories to avoid vascular risks using three adherence strategies. Quantitative measurement of the adherence shows the potential of this tool for clinical use.

The sharing economy has experienced exponential growth in recent years, especially in the short-term rentals (STRs) tourist accommodation sector. This growth has caused disruptive effects in rural and urban contexts, especially in highly touristic cities. These effects can be both positive and negative, revitalizing certain areas and bringing about tension in the socioeconomic fabric. Today, Airbnb is considered the paradigm of this sharing economy model and the STR industry leader. However, as this study suggests, on many occasions the implementation of Airbnb exhibits more of a traditional economic business model than a collaborative economic business model. Through hierarchical cluster analysis, this study identifies different groups of European cities according to the degree of professionalization of Airbnb implementation in their territory. The goal is to find similar patterns in the Airbnbisation process in major European cities, as the social, economic, and spatial impacts of various typologies are very different and even contrary. By understanding and identifying such different models implemented in each territory, better policies can be informed, and more adapted strategies can be pursued by local governments and the tourism industry.

Background and objective: We present SYLVIUS, a software platform intended to facilitate and improve the complex workflow required to diagnose and surgically treat drug-resistant epilepsies. In complex epilepsies, additional invasive information from exploration with stereoencephalography (SEEG) with deep electrodes may be needed, for which the input from different diagnostic methods and clinicians from several specialties is required to ensure diagnostic efficacy and surgical safety. We aim to provide a software platform with optimal data flow among the different stages of epilepsy surgery to provide smooth and integrated decision making. Methods: The SYLVIUS platform provides a clinical workflow designed to ensure seamless and safe patient data sharing across specialities. It integrates tools for stereo visualization, data registration, transfer of electrode plans referred to distinct datasets, automated postoperative contact segmentation, and novel DWI tractography analysis. Nineteen cases were retrospectively evaluated to track modifications from an initial plan to obtain a final surgical plan, using SYLVIUS. Results: The software was used to modify trajectories in all 19 consulted cases, which were then imported into the robotic system for the surgical intervention. When available, SYLVIUS provided extra multimodal information, which resulted in a greater number of trajectory modifications. Conclusions: The architecture presented in this paper streamlines epilepsy surgery allowing clinicians to have a digital clinical tool that allows recording of the different stages of the procedure, in a common multimodal 2D/3D setting for participation of different clinicians in defining and validating surgical plans for SEEG cases. We would like to thank “la Caixa” Banking Foundation for supporting the project. We would also like to thank the epilepsy clinical staff of the Hospital del Mar (Barcelona, Spain) for their guidance and collaboration throughout the project.

A tracheostomy performed on patients infected with SARS CoV-2 is one of the procedures with the highest risks of aerosolization. Safety recommendations for carrying out this procedure are not suitable for implementation in every hospital. Despite the use of Personal Protection Equipment (PPE), the suit leaves the submental area unprotected, and even the face mask may not provide a full seal. The use of additional biosafety isolation equipment increases safety, thus preventing exposure to infecting particles and allowing the surgeon to perform the technique with the use of the available equipment; it reduces the risks of further trans-surgical complications and increases the possibilities of handling them in case they arise.

During the first days of life, premature infants have physiological difficulties swallowing, thereby missing out on the benefits of breastfeeding. The aim of this study is to assess the effects of oropharyngeal mother&rsquo, s milk administration in the inflammatory signaling of extremely premature infants. Neonates (n = 100) (&lt, 32 week&rsquo, s gestation and/or &lt, 1500 g) were divided into two groups: mother&rsquo, s milk group (n = 48), receiving 0.2 mL of oropharyngeal mother&rsquo, s milk every 4 h for the first 15 days of life, and a control group (n = 52), not receiving oropharyngeal mother&rsquo, s milk. Serum concentrations of interleukin (IL) IL-6, IL-8, IL-10, IL-1ra, tumor necrosis factor alpha (TNF-&alpha, ), and interfer&oacute, n gamma (IFN-&gamma, ) were assessed at 1, 3, 15, and 30 days of postnatal life. Maternal and neonatal outcomes were collected. The rate of common neonatal morbidities in both groups was similar. The mother&rsquo, s milk group achieved full enteral feeding earlier, and showed a decrease in Il-6 on days 15 and 30, in IL-8 on day 30, and in TNF-&alpha, and INF-&gamma, on day 15, as well as an increase in IL-1ra on days 3 and 15 and in IL-10 on day 30. Oropharyngeal mother&rsquo, s milk administration for 15 days decreases the pro-inflammatory state of preterm neonates and provides full enteral nutrition earlier, which could have a positive influence on the development of the immune system and inflammatory response, thereby positively influencing other developmental outcomes.

Understanding the extent of management required by integrated multitrophic aquaculture (IMTA) is essential to foster sustainable aquaculture practices at a commercial scale. The aquaculture farm-wetland complex of Veta la Palma (SW Spain) is an example of a currently viable land-based IMTA system that produced 657 t of European sea bass ( Dicentrarchus labrax ) in 2010. This farm combined the semi-intensive production of D. labrax in grow-out fish ponds with the extensive production of Mugilidae and Palaemonidae naturally recruited in multitrophic polyculture lagoons. Two sets of polyculture lagoons and their respective adjacent fish ponds were studied biweekly in 2009–2010. The polyculture lagoons promoted an extensive natural food web and removed an estimated 91% of the total incoming dissolved inorganic nitrogen discharged by the fish ponds. Water recirculation across the farm supplied the fish ponds with natural food from the polyculture lagoons and thus the feed conversion ratio (FCR) of D. labrax was −3 ) and an external aquafeed supply limited to warmer months in the grow-out fish ponds.

The incidence and causes that may lead to an early end (unfinished cortical/subcortical mapping) of awake surgery for language mapping are little known. A study was conducted on 41 patients with brain glioma located in the language area that had awake surgery under conscious sedation. Surgery was ended early in 6 patients. The causes were: tonic-clonic seizure (1), lack of cooperation due to fatigue/sleep (4), whether or not word articulation was involved, a decreased level of consciousness for ammonia encephalopathy that required endotracheal intubation (1). There are causes that could be expected and in some cases avoided. Tumour size, preoperative aphasia, valproate treatment, and type of anaesthesia used are variables to consider to avoid failure in awake surgery for language mapping. With these results, the following measures are proposed: l) If the tumour is large, perform surgery in two times to avoid fatigue, 2) if patient has a preoperative aphasia, do not use sedation during surgery to ensure that sleepiness does not cause worse word articulation, 3) if the patient is on valproate treatment, it is necessary to rule out the pre-operative symptoms that are not due to ammonia encephalopathy.

Purpose Sunitinib is a tyrosine kinase inhibitor indicated for the treatment of gastrointestinal stromal tumor, advanced renal cell carcinoma, and pancreatic neuroendocrine tumors. The aim of this article is to describe the pharmacological interactions between sunitinib and commonly prescribed drugs. Method We reviewed available information on pharmacological interactions between sunitinib and concomitantly prescribed drugs. Drugs were grouped into different therapeutic groups according to the Anatomical Therapeutic Chemical (ATC) classification. Results Sunitinib interacts with CYP3A4 inducers or inhibitors and with P-glycoprotein and ABCG2 substrates. Pharmacodynamic interactions with drugs have also been found. Conclusion Current information on drug interactions between sunitinib and other drugs is scarce and most of the times it is difficult to apply to clinical practice. Even so, this difficulty in managing drug interactions should not be a reason to ignore them as they can help to explain intolerances and treatment failures.

Femoral stem fracture following total hip arthroplasty is an uncommon event that requires immediate revision surgery.We report on four patients who experienced stem fractures of one design and a review of the US Food and Drug Administration adverse event reports on this design.Fracture surfaces of four EMPERION™ (SmithNephew, Memphis, TN) femoral stems were analyzed under optical and scanning electron microscopy. A search of the FDA's Manufacturer and User Facility Device Experience (MAUDE) that reports on all EMPERION™ adverse events was completed.Fracture surfaces exhibited characteristics consistent with a fatigue fracture mechanism. Sixteen MAUDE reports claimed stem fracture or breakage of EMPERION™ stems.The four cases of EMPERION™ stem fractures were likely driven by small stem diameter, high offset, and high patient weight. Modular stem-sleeve femoral systems are susceptible to fatigue failure under high stress and should only be used in appropriate patients, whom are not considered obese.

OBJECTIVES The purposes of this study were to investigate interobserver reproducibility using acoustic radiation force impulse imaging and to develop an acoustic radiation force impulse scoring system. METHODS Fifty healthy volunteers with normal liver function test values were selected for the study. Shear wave velocity measurements, expressed in meters per second, were taken in a deep portion of liver segment 6. Two observers with different levels of experience performed the measurements independently and blindly. RESULTS All of the measurements taken by the 2 observers were valid, even in volunteers with a body mass index of greater than 28 kg/m(2). The results point to very good interobserver reproducibility of shear wave velocity measurements, with an intraclass coefficient correlation of 0.86 (P < .001). CONCLUSIONS The results of this study show that shear wave velocity measurements using the acoustic radiation force impulse technique and a standardized protocol are accurate and reproducible.

The use of tranexamic acid (TXA) reduces postoperative anemia and blood transfusion requirements. We investigated if these beneficial effects improve the early outcomes of primary total knee arthroplasty (TKA).We retrospectively studied 166 consecutive patients (179 TKAs) who received topical TXA (3 g before tourniquet deflation). This "study group" was compared with a "control group" of 197 consecutive patients (209 TKAs) in whom no TXA was used. We captured outcomes during the first 4 postoperative months. Knee Society score (KSS) was determined preoperatively, 6 weeks, and 4 months postoperatively. The outcomes were compared using univariate analysis. Multiple logistic regressions were calculated to assess differences between groups in KSS at 6 weeks and 4 months, controlling for age, sex, body mass index, and preoperative KSS.Postoperative hemoglobin was significantly higher in the study than that in the control group on day 1, day 2, and at discharge (P.0001). Blood transfusions were required in 5% and 22% of patients (P.001), respectively. Six weeks postoperatively, the functional KSS and its 5 categories (ability to walk, negotiate stairs up and down, stand up from a chair, and the use of support) were significantly higher in the study than those in the control group (P ≤ .001). Four months postoperatively, there was no difference in the KSS between the groups.Our study suggests that the clinical benefit of topical TXA administration extends beyond the hospitalization period. Its use may improve knee function during the first 6 postoperative weeks. This beneficial clinical effect seems to be negligible afterward.

The purpose of this study was to analyse the incidence of interprosthetic femoral fractures and describe risk factors for them. Between 2009 and 2015, we selected patients who were carrying two implants (hip and knee) in the same femur. We collected demographic and clinical data and performed a radiological evaluation to analyse the gap between implants—the femoral canal area and total femoral area—in the axial plane. We defined interprosthetic fracture as that corresponding to a Vancouver type C fracture and types 1 and 2 according to the Su classification. We studied 68 patients who had total knee arthroplasty (TKA), and 44 patients who had total hip arthroplasty (THA); 24 patients an intramedullary nail. We found six interprosthetic fractures (8.8 %), all in patients with a non-cemented THA. There was a tendency towards statistical difference (p = 0.08). Patients with an additional implant at the proximal femur were statistically less likely to have an interprosthetic fracture (p = 0.04). In radiological results, we found more interprosthetic fractures in patients who had an increased femoral canal area in the axial plane just distal to the tip of the hip implant. Identifying risk factors for this specific type of fracture may facilitate their prevention. Better implant stability and the presence of a gap between stems in a lower canal zone appear to hinder the occurrence of interprosthetic fractures.

Dissection of the internal carotid artery is a rare cause of stroke overall, but causes 22% of strokes in younger patients. A common clinical presentation is as Claude Bernard Horner syndrome. We report a craniotomy with 30 degrees rotation of the neck (standard position) in a patient with no major risk factors for carotid dissection, who showed a Pourfour du Petit syndrome due to a dissection of the internal carotid artery. To the best of our knowledge, this is the first reported case in which a common surgical position causes an internal carotid artery dissection in a patient without relevant risk factors. The presentation with Pourfour du Petit syndrome is extremely unusual.

Pathological fractures of the long bones are common complications of metastatic disease; however, the outcome of different surgical techniques for the treatment of these fractures has not been clearly defined. The aim of this study was to evaluate differences in prophylactic and therapeutic intramedullary nailing in femoral metastasic implants.Sixty-five patients with metastasis of the femur were analysed retrospectively (37 females; 28 males) between 1995 and 2011 (follow-up 15 months). Forty-four presented with pathological fractures and 21 impending fractures (Mirel ≥7). The operative treatments used were intramedullary fixation with reamed long Gamma nails. The studied parameters were survival, radiological and analytical findings, and functional outcomes.Prophylactic nailing resulted in immediate postoperative deaths in 5% vs. 11.4% in therapeutic, and one technical complication was detected in each group. Among the surviving patients 75.9% of the fractures and 100 % of impending lesions were able to walk after the operation. The mean survival time was 11 months in the therapeutic (range 1-49) and 14 in the prophylactic group (1-34). The prophylactic intramedullary nails required a lower transfusion rate (1.4 concentrates vs. 3.0), mobilised earlier (day 4.0 vs. 9.7) and needed a shorter hospital stay (eight days vs. 16 days) compared to therapeutic nails (p 0.05).Femoral intramedullary nailing of metastasic lesions provides satisfactory results both clinically and radiologically. Early treatment of the metastases prevents fractures and gives better results, improving life quality of these patients.

To evaluate acoustic radiation force impulse (ARFI) imaging as a non-invasive tool for quantification of the grades of liver steatosis in chickens.We used two different diets: a standard diet (SD group) and a hyperlipidaemic diet (HD group). The ARFI technique was performed in all the animals in the right hepatic lobe and shear wave velocity (SWV) was measured and expressed in metres per second (m/s). Plasma lipid levels were analysed. Steatosis was quantified by using semiquantitative analysis. Statistical analysis was used and Pearson's correlation coefficient was calculated.Mean SWV was 0.94 ± 0.16 m/s (range 0.8-1.3 m/s) in the SD group and 1.91 ± 0.25 m/s (range 1.3-2.2 m/s) in the HD group (p 0.001). The lowest SWVs (≤1.3 m/s) corresponded to the chickens in the SD group, with 100% of the animals returning a score of 0, whereas the range of SWV in the HD group chickens was between 1.6 and 2.2 m/s. A substantial correlation was observed between SWVs with histological semiquantitative analysis of steatosis (r = 0.85, p 0.001).ARFI imaging is a non-invasive diagnostic tool that allows discrimination between the grades of liver steatosis in chickens.

A 51-year-old patient, treated for dental abscess 3 months ago, was admitted for an acute coronary syndrome and fever. He had a fever of 38.5°C and a diastolic murmur. Blood cultures were positive for Streptococcus anginosus . Echocardiography confirmed an aortic valvular endocarditis with severe aortic regurgitation and highly mobile vegetations. Because of the vegetations, non-invasive coronary angiography using ECG-gated 64-multislice computed tomography (MSCT) was performed instead of conventional angiography. MSCT demonstrated two mobile …

The main objective of emergent standard Virtual Private LAN Service (VPLS) is the interconnection of users located at different geographic locations as if they were in the same local area network. In this sense, the investigations and tests that have been done are mainly focused on point-to-point interconnection scenarios using Virtual Private Networks (VPNs), as there have been few tests done up until now in academic and research networks with multipoint scenarios and they have been done mainly within the same domain, but not between different domains. In this paper, we describe the process to put in production VPLS service for testing purposes in an interprovider environment, doing initial tests on a real scenario. With it, one hopes to verify its behaviour in a real production network, analysing the benefits that can be provided to the customers, especially with respect to advanced applications and distributed computing, as it is the case in Grid applications.