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Olfactory groove meningiomas (OGMs) are commonly treated with open craniotomy. Endonasal approaches have also been described. To present clinical and radiographic outcomes for the minimally invasive eyebrow incision supraorbital keyhole approach with endoscopic assistance for OGMs. We performed a retrospective single-center cohort study and a systematic literature review. Fifteen patients were identified, all with Grade I meningiomas. Radiographic gross total resection of enhancing tumor was achieved in all patients. Mean frontal lobe fluid-attenuated inversion recovery volume decreased from 11.1 ± 18.3 cm3 preoperatively to 9.9 ± 11.4 cm3 immediately postoperatively, and there was minimal new restricted diffusion (3.2 ± 2.2 cm3; max 7.5 cm3). Median length of stay was 3 days (range 2–8). Vision was improved in 4 (80%) and stable in 1 (20%) of 5 patients with a preoperative deficit. New postoperative anosmia occurred in 3 (23%) of 13 patients with any preoperative olfaction. All patients were satisfied with their cosmetic result at 3 months. After a median follow-up of 32.2 months, there were 2 (13.3%) asymptomatic radiographic recurrences, 1 treated with radiosurgery and the other with endoscopic endonasal approach (EEA). No patients required further craniotomy. Systematic review revealed the present series to be the largest to date reporting disaggregated outcomes for the eyebrow approach to OGM. The eyebrow incision supraorbital keyhole craniotomy with endoscopic assistance is a safe and effective approach to OGM with tumor control rates similar to more invasive open approaches and better than the endonasal approach. Rates of frontal lobe injury, CSF leak and anosmia are comparatively low.

OBJECTIVEPostoperative sellar hematoma is an uncommon complication of endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma that often requires emergency surgical evacuation. Sellar hematomas can cause mass effect and compress parasellar structures, leading to clinically significant symptoms such as visual impairment and severe headache. The objective of this study was to determine the incidence and risk factors associated with reoperation for postoperative hematoma after EETS for pituitary adenoma.METHODSThe authors reviewed a prospectively acquired database of EETS for pituitary adenoma over 13 years at Weill Cornell Medicine, NewYork-Presbyterian Hospital and identified cases that required reoperation for confirmed hematoma. They also reviewed clinical and radiographic data of a consecutive series of patients undergoing EETS for pituitary adenoma who did not have postoperative hematoma, which served as the control group. Demographic data and risk factors were compared between the groups using univariate and multivariate analyses via binary logistic regression.RESULTSAmong a cohort of 583 patients undergoing EETS for pituitary adenoma, 9 patients (1.5%) required operation for sellar hematoma evacuation. All 9 patients with reoperation for sellar hematoma presented with worsening in their vision, and severe headache was present in 67%. New postoperative endocrine dysfunction developed in 78%. Clot evacuation improved vision in 88%. The mean time to hematoma evacuation was 4.5 days. The median length of stay for patients with sellar hematoma was 8 days (range 4–210 days) compared with a median length of stay of 3 days (range 1–32 days) for the control patients (p < 0.005). Significant risk factors in univariate analysis were tumor diameter ≥ 30 mm (p < 0.005), suprasellar extension (p < 0.005), tumor volume (p < 0.005), cavernous sinus invasion (p < 0.05), gonadotroph histology (p < 0.05), antiplatelet use (p < 0.05), and elevated BMI (p < 0.05). On multivariate analysis, tumor diameter ≥ 30 mm (OR 4.555, CI 1.30–28.90; p < 0.05) and suprasellar extension (OR 1.048, CI 1.01–1.10; p < 0.05) were found to be the only independent predictors of sellar hematoma. The incidence of hematoma in tumors ≥ 30 mm was 5% (7/139).CONCLUSIONSPostoperative sellar hematoma requiring reoperation is a rare phenomenon after transsphenoidal surgery, often presenting with visual loss and headache. Clot evacuation results in improvement in vision, but long-term endocrinopathy often ensues. Tumor diameter ≥ 30 mm and suprasellar extent are the most reliable risk factors. Close postoperative scrutiny should be given to patients at high risk.

Depression and anxiety in patients with heart disease and/or cancer have been shown to affect quality of life, adherence with medical management, and prognosis. We investigated the association of the diagnoses of cancer, heart disease, or both with self-reported symptoms consistent with serious mental illness (SMI). We used the K6 score to identify self-reported symptoms consistent with SMI from patients’ responses to the 2017 National Health Interview Survey. Our final cohort included 24,777 individual surveys. Of those respondents, 1509 reported cancer, 2639 reported heart disease, and 534 reported both. About 96% of patients reported a K6 score

Background Smaller hippocampal volumes are reported in adults with major depressive disorder (MDD) and in reported childhood abuse. The hippocampus is a complex structure with distinct functional subfields. We sought to examine the effect of MDD diagnosis and childhood abuse on hippocampal subfields. Methods Forty-one MDD participants (17 reported abuse and 24 did not) and 46 healthy volunteers (HV) (2 reported abuse) underwent T1- weighted structural magnetic resonance imaging (MRI) and clinical characterization in a retrospective design. A subfield segmentation program was used to measure the whole and subfield hippocampal volumes. Linear mixed-effects models were fitted for group comparisons. Results No main effect of diagnosis interaction effect between diagnosis and subfield region was observed. However, a comparison of abused MDD vs. HVs showed a group by region interaction. A significant interaction between childhood abuse and region was observed. Effects were confined to the left side of the brain, and post hoc, exploratory region-specific tests indicated smaller left CA1 volume in abused MDD compared with non-abused MDD. In addition, smaller amygdala volume was found in all MDD compared with HVs. Limitations We did not have a sample of healthy volunteers with reported childhood abuse. Conclusions The diagnosis of pure MDD may not be sufficient to exert effects on hippocampal volumes, indicating the importance of taking into account childhood trauma in studies on psychopathological mechanisms. Left CA1 might be the hippocampal subfield most relevant to reported childhood abuse. Smaller amygdala volume may be related to MDD diagnosis independent of childhood abuse.

Endonasal endoscopic transsphenoidal surgery (EETS) for pituitary adenoma has become a mainstay of treatment over the last two decades and it is generally accepted that once this learning curve is achieved, a plateau is reached with little incremental improvement. The objective of this study was to assess the slope of the learning curve over a long period of time for a variety of outcomes measures. We examined outcomes and complications in a consecutive series of 600 EETS for pituitary adenoma grouped into quartiles based on date of surgery. GTR significantly increased across quartiles from 55 to 79% in the last quartile (p

Introdução: A enxaqueca é uma cefaleia primária comum, que pode ter início em idade pediátrica. Não existem dados concretos nos cuidados de saúde primários (CSP) em Portugal. Foi objetivo deste estudo caracterizar uma população pediátrica com diagnóstico de enxaqueca em seguimento nos CSP da região Centro de Portugal, abordando aspetos demográficos, epidemiológicos e clínicos. Métodos: No primeiro trimestre de 2018, a partir de dados retrospetivos colhidos exclusivamente em ambiente de CSP, selecionámos uma amostra de indivíduos em idade pediátrica de 11 unidades de saúde, com diagnóstico de enxaqueca codificado nos problemas ativos do sistema informático. Foram recrutados sequencialmente e entrevistados de acordo com um guião pré-definido, baseado nos critérios da Classificação Internacional de Cefaleias. Realizámos a análise estatística descritiva das variáveis recolhidas. Resultados: Recrutámos 117 indivíduos e, após entrevista, apenas 72 foram incluídos. Estimámos uma prevalência de enxaqueca pediátrica de 0,35% nessas unidades, afetando predominantemente adolescentes do sexo feminino. O intervalo de tempo decorrido entre o início dos sintomas e o diagnóstico teve uma mediana de 1,3 anos (0-3 anos). Confirmámos que faziam terapêutica profilática 22,2% dos casos e terapêutica abortiva de crise 97,2% deles, sendo as classes mais utilizadas os analgésicos simples (65,7%) e anti-inflamatórios não esteróides (50,0%). Apenas uma minoria utilizava triptanos (2,9%). A automedicação foi reportada em 12,5% dos casos. Recorriam à terapêutica não farmacológica 66,7% dos doentes. Discussão: O diagnóstico e prevalência estimada de enxaqueca pediátrica nos CSP ficaram aquém dos valores descritos na literatura. O tratamento implementado nas crises é adequado, mas a utilização de terapêutica não farmacológica e profilática poderão ser otimizadas, nesta população particular. Salvaguarda-se, no entanto, que este foi um estudo preliminar de natureza retrospetiva realizado numa população de uma zona geográfica específica do país, carecendo naturalmente de confirmação posterior. Introduction: Migraine is a common primary headache, which can begin in the pediatric age. There are no concrete data on primary health care (PHC) in Portugal. This study aimed to characterize a pediatric population with migraine followed at PHC in the central region of Portugal, addressing demographic, epidemiological and clinical aspects. Methods: In the first trimester of 2018, from retrospective data collected exclusively in a PHC environment, we selected a sample of pediatric individuals of 11 health units with a diagnosis of migraine encoded in the active problems of units’ informatics system. They were sequentially recruited and interviewed according to a pre-defined guide, based on the International Classification of Headache Disorders criteria. A descriptive analysis of collected variables was conducted. Results: We recruited 117 individuals and, after interview, only 72 were included. We estimated a prevalence of pediatric migraine of 0.35% in these units, affecting predominantly female adolescents. The time elapsed between the onset of symptoms and the diagnosis had a median of 1.3 years (0-3 years). We confimed that prophylactic therapy was used by 22.2% of cases and abortive therapy by 97.2%, with the most commonly used classes being simple analgesics (65.7%) and non-steroidal anti-inflmmatory drugs (50.0%). A minority used triptans (2.9%). Self-medication was reported in 12.5% of cases; 66.7% referred the usage of non-pharmacological therapy. Discussion: The diagnosis and estimated prevalence of pediatric migraine in PHC units fell short of the values described in the literature. The abortive treatment was considered adequate, but the use of non-pharmacological and prophylactic therapies may be optimized in this particular population. However, this was a preliminary study of a retrospective nature carried out in a population of a specific geographic area of the country, naturally requiring further confimation. info:eu-repo/semantics/publishedVersion

Controversy surrounds utilization of induced hypothermia (IHT) in comatose cardiac arrest (CA) survivors with a non-shockable rhythm. We conducted a meta-analysis and trial sequential analysis (TSA) comparing IHT with no IHT approaches in patients with CA and a non-shockable rhythm. The primary outcome of interest was favorable neurological outcomes (FNO) defined using the Cerebral Performance Category (CPC) score of 1 or 2. Secondary endpoints were survival at discharge and survival beyond 90 days. A total of 9 studies with 10,386 patients were included. There was no difference between both groups in terms of FNO (13% vs. 13%, RR 1.34, 95% CI 0.96–1.89, p = 0.09, I2 = 88%), survival at discharge (20% vs. 22%, RR 1.09, 95% CI 0.88–1.36, p = 0.42, I2 = 76%), or survival beyond 90 days (16% vs. 15%, RR 0.92, 95% CI 0.61–1.40, p = 0.69, I2 = 83%). The TSA showed firm evidence supporting the lack of benefit of IHT in terms of survival at discharge. However, the Z-curves failed to cross the conventional and TSA (futility) boundaries for FNO and survival beyond 90 days, indicating lack of sufficient evidence to draw firm conclusions regarding these outcomes. In this meta-analysis of 9 studies, the utilization of IHT was not associated with a survival benefit at discharge. Although the meta-analysis showed lack of benefit of IHT in terms of FNO and survivals beyond 90 days, the corresponding TSA showed high probability of type-II statistical error, and therefore more randomized controlled trials powered for these outcomes are needed.

Aims Lung Doppler signals (LDS) represent the radial movement of small pulmonary blood vessel walls, caused by pulse waves of cardiac origin. We sought to investigate the accuracy and prognostic value of LDS as a predictor of mitral valve early diastolic flow to annular velocity ratio (E/e′), in patients with acute decompensated heart failure (ADHF). Methods and results We prospectively enrolled patients with ADHF (n = 99, mean age 65 ± 15 years, 61% males) who underwent echocardiographic and simultaneous LDS evaluation at hospital admission. Patients with hospital stay over 72 h underwent a repeat echocardiogram and LDS assessment before discharge. Patients were followed for the occurrence of short-term all-cause mortality and heart failure (HF) hospitalization. Predicted E/e′ from LDS correlated with echocardiographic E/e′ at admission and discharge (r = 0.67 and 0.83; P Conclusion In this single-centre prospective study of patients with ADHF, LDS predicted echocardiographic E/e′ measurements and showed prognostic value in predicting all-cause mortality in HF patients with a reduced EF.

Objective Patients who undergo decompression surgery for Chiari malformation frequently require occipitocervical fixation. This is typically performed with occipital plates, which may cause intracranial injuries due to multiple fixation points. We undertook this study to assess the feasibility of occipital condyle (OC) screw placement as an alternative method of occipitocervical fixation in this patient population. Methods Using a cadaveric model with navigational assistance, we performed the complete surgical procedure for occipitocervical fixation with OC screws. We then performed a morphometric analysis using measurements from computed tomography scans of 49 patients (32 adult, 17 pediatric) who had undergone occipitocervical fusion with instrumentation following decompression surgery for Chiari malformation. Bilateral morphometric data were analyzed for the adult and pediatric subgroups separately, as well as for the overall group. Results The surgical procedure was successfully performed in the cadaveric model, demonstrating the feasibility of the proposed method. Ninety-eight OCs were studied in the morphometric analysis, and 80 (81.6%) met our eligibility criteria for OC screw placement. However, in 14.1% of adult OCs and 26.5% of pediatric OCs studied, placement of condylar screws would have been challenging or unsafe, according to our criteria. Conclusions Our findings suggest that OC screws provide a useful option for occipitocervical fixation in a substantial proportion of patients with Chiari malformation. However, rigorous preoperative analysis would be essential to identify appropriate candidates for this technique and exclude those in whom it should not be attempted. Additional study is warranted.

Background Multiparametric magnetic resonance imaging (mpMRI) may improve prostate cancer risk stratification and decrease the need for repeat biopsies in men on prostate cancer active surveillance (AS). However, the impact of mpMRI on AS-related healthcare spending has not been established. Objective To characterize the impact of mpMRI on AS-related Medicare expenditures. Design, setting, and participants Using Surveillance, Epidemiology, and End Results (SEER)-Medicare files, we identified men ≥66 yr old with localized prostate cancer diagnosed during 2008–2013. Outcome measures and statistical analysis With a validated algorithm, we classified men into AS with and without mpMRI groups. We then determined Medicare spending on AS in each group using inflation-adjusted, price-standardized Medicare payments for AS-related procedures (ie, prostate-specific antigen [PSA] tests, prostate biopsies, biopsy complications, and mpMRI). Multivariable median regression compared Medicare spending on AS for men who received mpMRI and those who did not. Results and limitations We identified 9081 men on AS with a median follow-up of 45 mo (interquartile range 29–64 mo). Thirteen percent (N = 1225) received mpMRI. On multivariable median regression, receipt of mpMRI was associated with an additional $447 (95% confidence interval $409–487) in Medicare spending per year. We observed greater frequency of AS-related procedures and higher spending for identical procedures (eg, PSA or prostate biopsy) in the mpMRI group than in the non-mpMRI group (all p Conclusions Among Medicare beneficiaries on AS, mpMRI is associated with additional annual Medicare spending. Future studies are needed to determine optimal use of mpMRI during AS to maximize value. Patient summary Prostate magnetic resonance imaging (MRI) helps physicians determine which prostate cancers are aggressive and which can be monitored safely. We studied whether using MRI during prostate cancer monitoring (also called active surveillance) resulted in increased healthcare spending. There was a modest increase in spending, but this may be worthwhile if the use of MRI allows physicians to monitor prostate cancer more accurately.

In this paper, a two degree of freedom linear vehicle model is proposed to investigate dynamic vehicle stability under varies vehicle maneuvers. The simulation is developed using MATLAB/Simulink application program to predict the vehicle dynamic stability under different maneuvers. To investigate vehicle stability, the Steering wheel angle is chosen to be the primary model input for the analysis procedures. The developed model is validated via Step steer input. Moreover, a new typical steer wheel angle is developed to examine highway predicted vehicle output within its maneuver. The vehicle dynamic outputs, namely, yaw rate and lateral acceleration are adopted for all the investigated maneuvers. It is found that the vehicle design parameters such as changing the vehicle center of gravity (CG) position, vehicle mass, tire cornering stiffness and vehicle speed have a significant influence on the vehicle dynamic stability. Change in vehicle center of gravity position is the most parameter has an influence in vehicle stability dynamics. 10% forward and reward in the C.G position change in under steering gradient, it changes steering in vehicle model from under steering type to over steering type, on the other hand, vehicle mass change ±10% change in vehicle mass has the latest influence in vehicle stability dynamic. Others have a different rate effect on vehicle dynamic stability.

Skull base reconstruction after extended endoscopic endonasal approaches (EEAs) can be challenging. In addition to the nasoseptal flap, which has been adopted by most centers, autologous fascia lata is also often utilized. Harvesting of fascia lata requires a separate thigh incision, may prolong recovery, and results in a visible scar. In principal, the use of non-autologous materials would be preferable to avoid a second incision and maintain the minimally invasive nature of the approach, assuming the CSF leak rate is not compromised. To assess the efficacy of acellular dermal matrix (ADM) as a non-autologous alternative to autologous fascia lata graft for watertight closure of the cranial base following EEAs. A retrospective chart review of extended EEAs performed before and after the transition from fascia lata to ADM was performed. Cases were frequency matched for approach, pathology, BMI, use of lumbar drainage, and tumor volume. Power analysis was performed to estimate the sample size needed to demonstrate non-inferiority. ADM was used for watertight closure of the cranial base in 19 consecutive extended endoscopic endonasal approaches (16 gasket-seals and 3 buttons) with 1 postoperative CSF leak at the last follow-up (median 5.3, range 1.0–12.6 months). All patients had high-flow intraoperative leaks. The cohort included 8 meningiomas, 8 craniopharyngiomas, 2 chordomas, and 1 pituicytoma ranging in size from 0.2 to 37.2cm3 (median 5.5, IQR 2.8–13.3 cm3). In 19 historical controls who received fascia lata, there were 2 postoperative CSF leaks. Preliminary results suggest that ADM provides a non-inferior non-autologous alternative to fascia lata for watertight gasket-seal and button closures following extended EEAs, potentially reducing or eliminating the need to harvest autologous tissue.

Long non-coding RNAs (lncRNAs) are involved in many normal and oncogenic pathways through a diverse repertoire of transcriptional and posttranscriptional regulatory mechanisms. LncRNAs that are under tight regulation of well-known oncogenic transcription factors such as c-Myc (Myc) are likely to be functionally involved in their disease-promoting mechanisms. Myc is a major driver of many subsets of B cell lymphoma and to date remains an undruggable target. We identified three Myc-induced and four Myc-repressed lncRNAs by use of multiple in vitro models of Myc-driven Burkitt lymphoma and detailed analysis of Myc binding profiles. We show that the top Myc-induced lncRNA KTN1-AS1 is strongly upregulated in different types of B cell lymphoma compared with their normal counterparts. We used CRISPR-mediated genome editing to confirm that the direct induction of KTN1-AS1 by Myc is dependent on the presence of a Myc E-box-binding motif. Knockdown of KTN1-AS1 revealed a strong negative effect on the growth of three BL cell lines. Global gene expression analysis upon KTN1-AS1 depletion shows a strong enrichment of key genes in the cholesterol biosynthesis pathway as well as co-regulation of many Myc-target genes, including a moderate negative effect on the levels of Myc itself. Our study suggests a critical role for KTN1-AS1 in supporting BL cell growth by mediating co-regulation of a variety of Myc-target genes and co-activating key genes involved in cholesterol biosynthesis. Therefore, KTN1-AS1 may represent a putative novel therapeutic target in lymphoma.

Information about essential trace elements among children in many African countries, including the Democratic Republic of Congo (DRC), is limited. We aimed to measure the distribution and determinants of serum zinc (Zn), copper (Cu), and selenium (Se) concentrations in a representative sample of children under five years old. We conducted a community-based cross-sectional study in Popokabaka, DRC. Blood samples were drawn from 412 children. The serum concentrations of minerals were measured using inductively coupled plasma–mass spectrometry. The median concentrations (P25–P75) of Zn, Cu, and Se were 61.9 µg/dL (52.8–70.2), 145.5 (120.0–167.0) µg/dL and 5.3 (4.3–6.3) µg/dL. The CRP-adjusted prevalence of serum Se deficiency was 84.1% (95% confidence interval [CI] 81.4–87.0) and of Zn deficiency was 64.6% (95% CI 59.8–69.1%). Only a few children were Cu deficient [1.5% (0.6–3.2)]. Evidence of inflammation (C-reactive protein, >5 mg/L) was associated with a lower Se concentration and higher Cu concentration. Furthermore, serum Se concentration was positively associated with linear growth. The average Cu/Zn molar ratio (2:1) was twice that recommended. Children in western Popokabaka had higher Zn and Se levels than their eastern neighbors. Zinc and selenium deficiencies are common among children in Popokabaka and require attention and prioritization.