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The objective of this study is to provide an update on endovascular treatments for iatrogenic internal carotid artery (ICA) injuries following endonasal surgery. A systematic review of the literature was performed by using Medline, Cochrane library, and Scopus from 1999 to 2019. We used a combination of the MeSH terms “internal carotid artery,” “iatrogenic disease,” and “endovascular procedure.” Twenty-six articles including 46 patients were identified for in this systematic review. The mean age of the patients was 49 years (CI: ± 4.2). The most common site of ICA injury was in cavernous segment (18 patients; 39%). The most common type of iatrogenic ICA injury was a traumatic pseudoaneurysm documented in 28 patients (60%). Endoluminal reconstruction was performed using covered stents in 28 patients, the Pipeline embolization device (PED) in 13 patients, the Surpass flow diverter device in three, the SILK flow diverter in one, and one case was treated using a combined approach of a covered stent and a PED. Flow diversion and covered stents resulted in a good clinical outcome in 94% and 89% of patients, respectively. This difference did not reach statistical significance (p = 1.0). Even though this systematic review was limited due to articles of small sample sizes and considerable heterogeneity, the results indicate that flow diverting devices and covered stents are good therapeutic options for endoluminal reconstruction of iatrogenic ICA injuries following endonasal surgery.

Vertebral body compression fractures are one of the most common causes of disability and morbidity, especially among the elderly population. The present study was performed in order to evaluate the effect of percutaneous balloon kyphoplasty (BKP) on patients' pain and quality of life (QOL) in Iran.The study was conducted on a consecutive series of 54 patients with symptomatic vertebral compression fractures who failed conservative management between 2014 and 2017. A quasi-experimental design was employed in which the pain severity, quality of life, and kyphotic angle were measured before and 3 and 12 months after the PBK procedure. Pain and quality of life outcomes were determined using a Visual Analogue Scale (VAS) for Pain and the 12-Item Short Form Health Survey (SF-12) for QOL.Excellent improvement in VAS was documented at 3 and 12 months after the BKP procedure (Balloon kyphoplasty was determined to be a safe and successful method for treating symptomatic vertebral compression fractures. It leads to significant pain relief, an improvement in self-reported QOL measures, and correction in kyphotic deformity.

We report a rare case of cervical epidural abscess at the C5-C6 levels. The patient underwent surgery with complete abscess removal through C6 vertebral body corpectomy. The result of bacteriological culture was Brucella melitensis. Brucellosis must be considered as a possible cause of epidural abscess in patients from endemic area.

We report three patients who deteriorated after lumbar puncture (LP). Two patients were later found to have type іі (a + b) dural arteriovenous fistulas (DAVF) with high flow retrograde venous drainage on cerebral angiography. The third had a type II (a) DAVF. All patients recovered at least partially after DAVF treatment. In patients with signs and symptoms of increased intracranial pressure (ICP) but no evidence of focal mass lesion on cranial imaging, we suggest an evaluation for a DAVF before performing an LP.

Background and Objectives: Professionalism includes behaviors, actions, and goals that determine the professional level of an individual. The assessment of the professionalism of learners can help to estimate and determine educational needs and priorities, as well as further interventions. As future faculty members and experts, residents play an important role in the practical education of behavior and scientific commitment of medical students. Therefore, for the first time, this study aimed to evaluate the professionalism of residents from the perspective of interns. Methods: This cross-sectional study was performed on 138 interns at Kashan University of Medical Sciences in 2017. The research tool was the Persian and edited version of the 15-item questionnaire designed by the American Board of Internal Medicine for the evaluation of professionalism. The mean and standard deviation were estimated related to total scores of professionalism and three domains of excellence, honor/integrity, as well as altruism/respect. Moreover, the relationship between reported scores and demographic characteristics was determined. Results: Out of 150 distributed questionnaires, 138 questionnaires were analyzed in this study. The total score and three domains of excellence, honor/integrity, and altruism/respect were estimated at 6.07±1.53, 4.24±1.87, 6.56±2.03, and 6.83±1.73, respectively. Conclusion: In total, the professionalism of residents was moderate from the perspective of interns. Among the three assessed domains, the lowest and highest scores were related to the domains of excellence and altruism/respect, respectively. The low score of excellence reminded the absence of residents as role models. With respect to the hidden educational curriculum and its impact on the formation of professional behavior of students, it seems crucial to plan in this regard.

This chapter presents a mathematical formulation for the translocation process of a vesicle through a narrow pore. The effect of the deformation of the vesicle while passing through the pore causes a penalty in the free energy, while the existence of an external driving force assists. We formulate the free energy landscape of the vesicle in terms of bending and stretching energy and use Fokker-Plank formalism to calculate the first-passage translocation time. We also address various modifications that can be done to this approach to make it work for different systems.

The objective of this study is to provide an update on endovascular treatments for iatrogenic internal carotid artery (ICA) injuries following endonasal surgery. A systematic review of the literature was performed by using Medline, Cochrane library, and Scopus from 1999 to 2019. We used a combination of the MeSH terms "internal carotid artery," "iatrogenic disease," and "endovascular procedure." Twenty-six articles including 46 patients were identified for in this systematic review. The mean age of the patients was 49 years (CI: ± 4.2). The most common site of ICA injury was in cavernous segment (18 patients; 39%). The most common type of iatrogenic ICA injury was a traumatic pseudoaneurysm documented in 28 patients (60%). Endoluminal reconstruction was performed using covered stents in 28 patients, the Pipeline embolization device (PED) in 13 patients, the Surpass flow diverter device in three, the SILK flow diverter in one, and one case was treated using a combined approach of a covered stent and a PED. Flow diversion and covered stents resulted in a good clinical outcome in 94% and 89% of patients, respectively. This difference did not reach statistical significance (p = 1.0). Even though this systematic review was limited due to articles of small sample sizes and considerable heterogeneity, the results indicate that flow diverting devices and covered stents are good therapeutic options for endoluminal reconstruction of iatrogenic ICA injuries following endonasal surgery.

Iatrogenic and traumatic cerebral internal carotid artery injuries are uncommon but potentially lethal complications. Direct surgical repair of ICA injuries may be difficult in an acute setting. However, endovascular treatment with a flow-diverter embolization device is a feasible alternative technique that we experienced. In this clinical report, we describe demographic data, radiographic images, lesion characteristics, endovascular procedure notes, postprocedural hospital course, and follow-up digital subtraction angiography of 5 patients. At least 6-month follow-up was available in all patients without occurrence of rebleeding and other complications.

This paper details a method for residential water consumption modeling within the Integrated Urban Metabolism Analysis Tool (IUMAT), a computational modeling platform for evaluating environmental performance of urban communities under alternative growth scenarios. A bottom-up approach is introduced to generate end-use indoor and outdoor water profiles by applying GLM and Ridge regression methods to Residential End Uses of Water, Version 2 (REU II-2016) dataset and investigating the influence of demographic and climate factors, as well as utility rate structures on patterns of consumption. The data is collected from 2010 through 2013 by nine utilities that operate in North America on 771 and 838 single family units for indoor and outdoor water use respectively. Potential advances to surveying methods as well as the need for tools that allow simultaneous, isolated assessment of educational and technological conservation measures are explained.

Hypersomnia is a condition in which a person has trouble staying awake during the day. There are several potential causes of it, including sleep apnea and sleep disorders.A 43 year old male was referred to our practice with complaints of hypersomnia, snoring, slurred speech and sleep apnea for more diagnostic and therapeutic interventions. His brain MRI was significant for a vascular loop compression on medulla oblongata. The patient underwent microvascular decompression surgery subsequently and showed improvement in all of his symptoms.One of the rare causes of sleep apnea is medulla oblongata compression by a vascular loop. Vertebrobasilar dolichoectasia may cause this phenomenon probably and should be reviewed in imaging examinations more precisely. Microvascular decompression by using a synthetic Teflon patch may be helpful in management of these patients.

Saffron is regarded as an important crop in Iranian agricultural economics that needs to be investigated to produce the environmentally friendlier product. In the present study, saffron production as an important agricultural production system in Iran was evaluated thoroughly from an environmental point of view. Data were collected from saffron farmers in Southern Khorasan province of the country with face-to-face questionnaire method during cropping period of 2013-2014. The system boundary was considered from the production of raw input materials to the harvested saffron. In order to identify the main hotspot during cultivation, impact categories were considered using CML methodology and cumulative exergy demand (CExD) indicator. Based on the results, chemical fertilizers N and P were the main hotspots in abiotic depletion (AD), acidification (AC), global warming (GWP), and photochemical oxidation (PO) impact categories, while diesel fuel was the main hotspot in fresh water aquatic ecotoxicity (FE), marine aquatic ecotoxicity (ME), and terrestrial ecotoxicity (TE). Direct emission from diesel fuel combustion (saffron) was the main hotspot only in human toxicity (HT). The small farms had the highest amounts of AD, AC, EP, GWP, and PO indicators in comparison with the medium and large farms. Total CExD indicator for production of 1 kg saffron was 1894.23 MJ eq. Totally, large farms (bigger than 1 ha) had better environmental performance considering all the impact categories.

Cystoventriculostomy is a surgical treatment for arachnoid cysts. We present a case using a neuroendovascular stent to maintain ostomy patency.A 6½-year-old male with symptomatic arachnoid cyst underwent endoscopic fenestration and Wingspan stent insertion.Neuroendovascular stent placement may be an adjunct to maintain patency in cystoventriculostomy.

Purpose Ruptured blood blisters (BBA) and very small, wide necked aneurysms (VSA) remain challenging lesions to treat due to their small size, wide necks, and thin, fragile walls. In the present study, we reviewed our experience with these aneurysms treated by flow diversion. Methods A total of 18 patients with hemorrhage due to a ruptured BBAs and VSAs, treated with flow diversion between July 2014 and March 2016 were included in this study. We analyzed clinical and radiographic outcomes. Results A total of 12 (66.7%) VSAs and 6 (33.3%) BBAs were treated with flow diversion. Fifteen (83.3%) and three (16.7%) aneurysms were located on the internal carotid artery and the basilar artery, respectively. On admission, a GCS score of 15 and WFNS grade 1 were found in 14 (77.7%) patients, 3 patients had an admission GCS of 13 and WFNS grade 2, one had an admission GCS of 8 and WFNS of 4. Fisher CT grades 2, 3, and 4 were observed in 11 (61.1%), 1 (5.6%), and 6 (33.3%) patients, respectively. Flow diversion was performed on average 5.6 days after onset of hemorrhage. 6 months post-intervention angiography showed complete obliteration of the aneurysms in all patients. Conclusion Our findings indicate that flow diversion in the acute and subacute phase of hemorrhage is a reliable treatment for reducing complications in patients with BBAs and VSAs. In patients with poor clinical presentation it might be reasonable to delay treatment until the first signs of recovery become apparent.

Background: Posterior fossa decompression both with and without duraplasty are accepted treatments for symptomatic adult patients with Chiari Malformations Type 1 (CM-1). There is still deb...

Intracranial chondromas are unusual benign tumors. They commonly occur at the base of the skull, whereas an intraventricular type is very rare. We present the case of a 19-year-old female patient with a giant intraventricular chondroma detected incidentally by imaging after a car accident. The spiral head CT scan and MRI findings revealed a large solid mass with a lobular border and coarse calcified components. A wide craniotomy was performed, and a very firm tumor was observed with no internal debulking capacity. The tumor was completely removed in one piece. Differentiation of an intraventricular chondroma from other intraventricular lesions, such as choroid plexus carcinoma, meningioma, and cavernoma, is of great importance in neuroimaging and surgical planning.

We have derived the free energy landscape for the translocation of a single vesicle through a narrow pore by accounting for bending and stretching of the vesicle, and the deformation of the vesicle by the pore. Emergence of a free energy barrier for translocation is a general result, and the magnitude of the barrier is calculated in terms of the various material parameters. The extent of the reduction in the barrier by the presence of an external constant force is calculated. Using the Fokker–Planck formalism, we have calculated the average translocation time corresponding to the various free energy landscapes representing different parameter sets. The dependencies of the average translocation time on the strength of the external force, vesicle size, bending and stretching moduli of the vesicle, and radius and length of the pore are derived, and the computed results are discussed.

Traumatic penetrating injuries to the internal carotid artery (ICA) resulting in the formation of a traumatic pseudoaneurysm are potentially devastating injuries. Previously treatment included, open surgical occlusion of the affected vessel or endovascular embolization. However, with the advent of flow diverter stents, endoluminal reconstruction has become a viable treatment option. In this case report we describe the successful managment of an ICA pseudoaneurysm due to a transorbital stab injury. Endoluminal reconstruction in a traumatic aneurysm is a feasible option. Considering the risk of hemorrhagic complications due to dual antiplatelet therapy required after flow diverter placement, this treatment should only be chosen if insufficient collateral supply is found and occlusion of the affected vessel is not a viable option.

We formulate a theory of the effects of long-range interactions on the surface tension and spontaneous curvature of proteinaceous shells based on the general Deryaguin-Landau-Verwey-Overbeek mesoscale approach to colloid stability. We derive the full renormalization formulas for the elastic properties of the shell and consider in detail the renormalization of the spontaneous curvature as a function of the corresponding Hamaker coefficient, inner and outer capsid charges, and bathing solution properties. The renormalized spontaneous curvature is found to be a nonmonotonic function of several parameters describing the system.

We present a theory of adsorption of flexible polyelectrolytes on the interior and exterior surfaces of a charged vesicle in an electrolyte solution. The criteria for adsorption and the density profiles of the adsorbed polymer chain are derived in terms of various characteristics of the polymer, vesicle, and medium, such as the charge density and length of the polymer, charge density and size of the vesicle, electrolyte concentration and dielectric constant of the medium. For adsorption inside the vesicle, the competition between the loss of conformational entropy and gain in adsorption energy results in two kinds of encapsulated states, depending on the strength of the polymer-vesicle interaction. By considering also the adsorption from outside the vesicle, we derive the entropic and energy contributions to the free energy change to transfer an adsorbed chain in the interior to an adsorbed chain on the exterior. In this paper, we have used the Wentzel-Kramers-Brillouin (WKB) method to solve the equation for the probability distribution function of the chain. The present WKB results are compared with the previous results based on variational methods. The WKB and variational results are in good agreement for both the interior and exterior states of adsorption, except in the zero-salt limit for adsorption in the exterior region. The adsorption criteria and density profiles for both the interior and exterior states are presented in terms of various experimentally controllable variables. Calculation of the dependencies of free energy change to transfer an adsorbed chain from the interior to the exterior surface on salt concentration and vesicle radius shows that the free energy penalty to expel a chain from a vesicle is only of the order of thermal energy.