Path to the Interpeduncular Fossa: Anatomical Comparison of Endoscopic-Assisted versus Standard Subtemporal Approach

Objective The aim of this study was to assess the assumed advantage of endoscopic assistance to the standard subtemporal approach. The idea was to measure qualitatively and quantitatively visibility versus operability.Design We performed eight subtemporal dissections on four cadaver heads. Our dissections integrated an operating microscope, endoscope, and neuronavigation. Comparison was made between visibility and operability afforded by the microscope alone or by the microscope–endoscope combination. Visibility was recorded as complete or incomplete and was quantified for key structures using linear measurements taken by the navigation system. Operability was determined by whichever maneuvers could be safely and comfortably accomplished in the space afforded.Results From our survey, the structures whose visibility most benefitted from the addition of the endoscope include: contralateral third nerve, posterior perforated substance, mammillary bodies, and contralateral superior cerebellar artery. With regard to quantitative evaluation, we found increased visibility of both basilar artery and posterior cerebral artery. With regard to the operability, no objective advantage was afforded by the addition of the endoscope. Subjectively, the maneuvers were easier to perform while using the endoscope.Conclusion Using the endoscope as an assistance tool during conducting classical subtemporal approach can help in overcome a lot of the classical subtemporal approach limitations.     

Belatacept : a new biological agent for maintenance immunosuppression in kidney transplantation

INTRODUCTION: Over the past decades, calcineurin inhibitors (CNIs) have become the cornerstone of transplant immunosuppression. CNIs can exert negative effects on chronic allograft function along with cardiovascular (CV) and metabolic adverse effects. Belatacept , a selective co-stimulation blocker of T cells, is the first US FDA (06/2011) and EMEA (06/2011) approved biologic agent for maintenance immunosuppression in renal transplantation. AREAS COVERED: The authors critically reviewed the literature over the last few years comparing belatacept with current standard of maintenance immunosuppression including CNIs in kidney transplantation. EXPERT OPINION: Despite the increased incidence and severity of acute rejection with belatacept in Phase II and III studies, a better preservation of GFR and reduced incidence of chronic allograft nephropathy was observed as compared with CNIs. Patient and graft survivals were similar over 3- and 5-year follow-up post-transplantation. Incidence of adverse events were similar between the groups, but the risk of post-transplant lymphoproliferative disorder, predominantly involving CNS, was higher in Epstein-Barr virus seronegative recipients on belatacept, especially with a more intensive regimen. CV and metabolic end points were more favorable in belatacept versus CNI groups with similar incidences of diabetes after transplantation. Belatacept seems to be a promising drug for the future, but long-term outcomes are awaited.     

ZnO Films Incorporation Study on Macroporous Silicon Structure

In the present work, we developed hybrid nanostructures based on ZnO films deposited on macroporous silicon substrates using the sol–gel spin coating and ultrasonic spray pyrolysis (USP) techniques. The changes in the growth of ZnO films on macroporous silicon were studied using a UV-visible spectrometer, an X-ray diffractometer (XRD), scanning electron microscopy (SEM) and atomic force microscopy (AFM). XRD analysis revealed the beneficial influence of macroporous silicon on the structural properties of ZnO films. SEM micrographs showed the growth and coverage of ZnO granular and flake-like crystals inside the pores of the substrate. The root mean square roughness (RMS) measured by AFM in the ZnO grown on the macroporous silicon substrate was up to one order of magnitude higher than reference samples. These results prove that the methods used in this work are effective to cover porous and obtain nano-morphologies of ZnO. These morphologies could be useful for making highly sensitive gas sensors.     

Trends and Outcomes in Simultaneous Liver and Kidney Transplantation in Australia and New Zealand

AimRates of simultaneous liver and kidney transplantation (SLKT) have increased, but indications for SLKT remain poorly defined. Additional data are needed to determine which patients benefit from SLKT to best direct use of scarce donor kidneys.MethodsData were extracted from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) database for all SLKT performed until the end of 2017. Patients were divided by pretransplant dialysis status into no dialysis before SLKT (preemptive kidney transplant) and any dialysis before SLKT (nonpreemptive). Baseline characteristics and outcomes were compared.ResultsBetween 1989 and 2017, inclusive, 84 SLKT procedures were performed in Australia, of which 24% were preemptive. Preemptive and nonpreemptive SLKT recipients did not significantly differ in age (P = .267), sex (P = .526), or ethnicity (P = .870). Over a median follow-up time of 4.5 years, preemptively transplanted patients had a statistically equivalent risk of kidney graft failure (hazard ratio (HR) 1.83, 95% confidence interval [CI]: 0.36-12.86, P = .474) and all-cause mortality (HR 1.69, 95% CI: 0.51-5.6, P = .226) compared to nonpreemptive patients. Overall, 1- and 5-year survival rates for all SLKTs were 92% (95% CI: 86-96) and 60% (95% CI: 45-75), respectively.ConclusionKidney graft and overall patient survival were similar between patients with preemptive kidney transplant and those who were dialysis dependent.     

Interaction between carbon and nitrogen metabolism during akinete development in the cyanobacterium Anabaena torulosa

Nutrient enrichment with a nitrogen (as nitrate) or carbon (as fructose) source to unaerated diazo and photoautorophic cultures of the cyanobacterium Anabaena torulosa induced early development of akinetes with high frequency. When cultures under any mode of nutrition were aerated, akinetes were not differentiated. Unaerated cultures with nitrate nitrogen or fructose exhibited higher respiratory rates and nitrogen assimilation compared to aerated cultures. This was evidenced by increased respiratory O2 uptake and high activities of pyruvate kinase, malate dehydrogenase (NAD+), nitrogenase and nitrate reductase signifying that akinete forming unaerated cultures exhibited high carbon dissimilation and nitrogen assimilation resulting in high nitrogenous build up in the cells. Aerated, non-akinete cultures, on the other hand, were associated with low respiratory O2 uptake, low pyruvate kinase and malate dehydrogenase (NAD+) activities, suggesting that carbon dissimilation was not favoured either in presence of nitrate or fructose. Moreover, higher activity of NADP+ linked malate dehydrogenase and lower nitrate reductase activity in aerated cultures led to a high carbon and low nitrogen content of the cells resulting in high cellular C:N ratio. The results suggest that interaction between carbon and nitrogen metabolism regulates akinete development in A. torulosa.     

Adverse events and intravenous versus oral bisphosphonate use in patients with osteoporosis and cancer in the U.S

This observational study utilized a patient-level database of more than 55 million patients and 70 U.S.-based health plans compiled from 2000-2006. Patients diagnosed with osteoporosis or various cancers were categorized according to bisphosphonate use (via IV, oral, or none). Continuous enrollment for at least six months pre- and post-index diagnosis was required. Outcomes of adverse events were defined as inflammatory conditions of the jaw, including osteonecrosis; major jaw surgery for necrotic or inflammatory conditions; or jaw surgeries for malignancies. Propensity scores and multivariate regression analyses were used to determine adjusted odds ratios for adverse events based on IV or oral bisphosphonate use relative to no bisphosphonate use, controlling for patient demographics, co-morbidities, prior dental or oral surgery, physician likelihood of prescribing oral versus IV bisphosphonates, and antibiotic, hormonal treatment, or thalidomide use. Subgroup analyses-excluding patients using oral corticosteroids-were conducted. After controlling for numerous demographic, clinical, and instrumental variables, this study found significant relationships between IV bisphosphonate use and both inflammatory conditions of the jaw and major jaw surgery for necrotic or inflammatory conditions in patients with osteoporosis or various cancers. While no significant relationship was observed for oral bisphosphonates, continued research is warranted to assess the long-term use of the medications and adverse events in patients with osteoporosis.