High Risk of New Episode of Symptomatic Vasospasm in Unaffected Arteries in Subarachnoid Hemorrhage Patients Receiving Targeted Endovascular Treatment for Symptomatic Focal Vasospasm

Background

There is controversy whether asymptomatic vasospasm in other arteries should be concurrently treated (global treatment) in patients receiving targeted endovascular treatment [percutaneous-transluminal-angioplasty (PTA) and/or intra-arterial (IA) vasodilators] for focal symptomatic vasospasm.

Objective

To determine the rates of occurrence of new symptomatic vasospasm in previously asymptomatic arterial distributions among patients with aneurysmal subarachnoid hemorrhage (SAH) who underwent targeted endovascular treatment for focal symptomatic vasospasm.

Methods

We identified all patients with SAH who had received targeted endovascular treatment during a 4-year period. We ascertained any new occurrence of symptomatic vasosopasm requiring endovascular treatment in previously unaffected (and untreated) arterial distributions within the same hospitalization. Blinded reviewers quantitatively graded angiographic vasospasm (<25, 26–49, ≥50 %) in all major arteries for each patient at the time of targeted treatment.

Results

Of the 41 patients who received targeted endovascular treatment (PTA in 41 % and vasodilators in 59 %), 11 (27 %) developed new symptomatic vasospasm in previously asymptomatic vascular distributions requiring endovascular treatment. Moderate severity of angiographic vasospasm in asymptomatic arteries at the time of targeted treatment tended to predict the occurrence of new symptomatic vasospasm. The rate of death and disability at discharge [modified Rankin scale (mRS) of 3–6] was 82 % (9/11) among those who developed a new episode of symptomatic vasospasm compared with 70 % (21/30) in those who did not (P = 0.58).

Conclusions

High risk of new occurrence of ischemic symptoms in previously asymptomatic (and untreated) arterial distributions among patients receiving targeted treatment should be recognized. Further studies should evaluate the benefit of performing global endovascular treatment during the initial targeted endovascular treatment session.     

Predictors of poor outcome of decompressive craniectomy in pediatric patients with severe traumatic brain injury: a retrospective single center study from Pakistan

Objective

This study aimed to determine the risk factors associated with poor outcome of decompressive craniectomy (DC) for severe traumatic brain injury (TBI) in pediatric patients.

Methods

This retrospective study is conducted on pediatric population (age 1–15 years) presenting with TBI who underwent DC at our institute between January 2000 and 2010. Based on Glasgow outcome score (GOS) at a minimum follow-up of 5 months, patients were divided into two groups, namely poor outcome (GOS 1, 2, and 3) and good outcome (GOS 4 and 5). Records were reviewed and analyzed for preoperative and intraoperative predictors.

Results

We found 25 patients who were eligible as per selection criteria. Mean age at presentation was 6?±?4 years and there was male preponderance (84 %). Fall (60 %) was the most common mechanism of injury followed by gunshots and road traffic accident. On univariate analysis, presenting GCS ≤5 (p value?=?0.009), delay in presentation of more than 150 min (p value?=?0.010), DC performed after more than 4 h of arrival in hospital (p value?=?0.042), and intraoperative blood loss exceeding 300 ml (p value?=?0.001) were significant predictors of poor outcome.

Conclusion

Our study suggests that DC in children is not only a life-saving procedure, but also leads to a good functional outcome after severe injury. However, patient selection still remains an important aspect, and the above-mentioned factors should be considered while deciding for DC to improve survival. Further prospective studies on larger sample size are warranted to validate our results.     

A systematic review and meta-analysis evaluating the role of laparoscopic surgical resection of transverse colon tumours

Objectives

A meta-analysis of published literature comparing outcomes after laparoscopic resection (LR) with open resection (OR) for transverse colon tumours.

Methods

Medline, PubMed, CINAHL, EMBASE and Cochrane were searched from inception to October 2013. The text words “minimally invasive”, “keyhole surgery” and “transverse colon” were used in combination with the medical subject headings “laparoscopy” and “colon cancer”. Outcome variables were chosen based upon whether the included articles reported results. A meta-analysis was performed to obtain a summative outcome.

Results

Six comparatives involving 444 patients were analysed. Of them 245 patients were in the LR group and 199 in the OR group. There was a significant increase in operative time in the LR group compared with the OR group [random effects model: SMD = ?0.65, 95 % CI (?1.01, ?0.30), z = ?3.60, p < 0.001] but there was significant heterogeneity amongst trials (Q = 15.51, df = 5, p = 0.008, I ² = 68). There was less blood loss in the LR group [fixed effects model: SMD = 0.70, 95 % CI (0.47, 0.93), z = 6.01, p < 0.001] and patients returned to oral diet earlier [random effects model: SMD = 0.78, 95 % CI (0.40, 1.16), z = 4.01, p < 0.001] and had a reduced time to functioning bowel [fixed effects model: SMD = 0.86, 95 % CI (0.60, 1.11), z = 6.63, p < 0.001]. No difference was seen for overall morbidity (p = 0.76) or mortality (p = 0.58).

Conclusions

LR of transverse colon tumours is a safe and effective technique. Although there is an increase in operating time, operative and clinical outcomes of intraoperative blood loss and faster recovery are seen with laparoscopic procedures.     

Tribological Characterization of Electrical Discharge Machined Surfaces for AISI 304L

Surface treatments are normally carried out after machining. Surface treatment is a costly and time-consuming process. Hence, it makes sense to reduce the requirement of surface treatment as much as possible. Electrical Discharge Machining (EDM) is a frequently used machining process. EDM produces a recast layer on the surface of machined components. The tribological performance of this recast layer is not very well understood. The properties of the recast layer formed as a result of EDM depend upon the discharge current, electrodes and dielectrics. This work aims to study the effects of each on the tribological performance — in terms of the wear depth, friction coefficient, friction force and contact surface temperature of recast layers. Subsequent improvement in the quality of surfaces will significantly reduce the cost and time required to treat surfaces after machining. Hence, various combinations of discharge current, dielectrics and electrodes have been used to characterize and deduce their effects. The tribo-tests are performed in the boundary lubrication regime under pin-on-disc configuration to analyze sliding friction, contact surface temperature and the wear of the recast layers formed on AISI 304L. The surface morphology of the test pins has been performed by Scanning Electron Microscopy (SEM) before and after the tests. The results show that indeed it is possible to control the tribological performance of the recast layers by varying EDM parameters. This approach promises to be a useful methodology to improve the tribological performance of the layers formed after EDM and reduce the time and costs required for surface treatments post machining.     

Cardiac tamponade following varicella

An 18-month-old girl presented with cardiac tamponade five weeks after varicella. An emergency pericardiocentesis was performed and, subsequently, an anterior pericardiectomy. She eventually made a complete recovery following corticosteroid treatment.     

Alcohol intake and risk of nonmelanoma skin cancer: a systematic review and dose–response meta‐analysis

Nonmelanoma skin cancer (NMSC) comprises mainly basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC). The association between alcohol intake and NMSC has been inconclusive; therefore the objective of this study is to quantify the relationship between alcohol intake and NMSC using meta‐analyses. A systematic literature search of PubMed and Embase was performed on 30 October 2016. Eligible articles were case–control or cohort studies that examined alcohol intake and risk of BCC or cSCC and reported relative risks (RRs) with 95% confidence intervals (CIs). Of the 307 articles identified, 13 case–control and cohort studies were included in the systematic review, including 95 241 NMSC cases (91 942 BCC and 3299 cSCC cases). A random‐effects model was used to obtain summary RRs and 95% CIs for dose–response meta‐analyses. For every 10‐gram increase in ethanol intake per day, a positive association was found for both BCC (summary RR of 1·07; 95% CI 1·04–1·09) and cSCC (summary RR of 1·11; 95% CI 1·06–1·16). While there was evidence suggesting a nonlinear association for BCC, it may be due to the sparse data at higher alcohol intake levels. This meta‐analysis found evidence that alcohol drinking is positively associated with both BCC and cSCC risk in a dose‐dependent manner. These results should be interpreted with caution due to potential residual confounding. Nonetheless, because alcohol drinking is a prevalent and modifiable behaviour, it could serve as an important public health target to reduce the global health burden of NMSC.     

Deep learning in hepatocellular carcinoma: Current status and future perspectives

Hepatocellular carcinoma (HCC) is among the leading causes of cancer incidence and death. Despite decades of research and development of new treatment options, the overall outcomes of patients with HCC continue to remain poor. There are areas of unmet need in risk prediction, early diagnosis, accurate prognostication, and individualized treatments for patients with HCC. Recent years have seen an explosive growth in the application of artificial intelligence (AI) technology in medical research, with the field of HCC being no exception. Among the various AI-based machine learning algorithms, deep learning algorithms are considered state-of-the-art techniques for handling and processing complex multimodal data ranging from routine clinical variables to high-resolution medical images. This article will provide a comprehensive review of the recently published studies that have applied deep learning for risk prediction, diagnosis, prognostication, and treatment planning for patients with HCC.