A novel method in predicting immediate postoperative facial nerve function post acoustic neuroma excision.

To determine whether the percentage calculated by dividing the amplitude of postexcision direct facial nerve stimulus responses (at pontomedullary junction) by the amplitude of distal ipsilateral transcutaneous (stylomastoid region) maximal stimulus responses and response amplitude progression by increasing stimulus intensities have predictive value for determining normal or near-normal (House-Brackmann Grade 1 or 2) immediate postoperative facial nerve function. STUDY DESIGN: Intraoperative recordings of three muscle groups: 1) frontalis, 2) orbicularis oculi, and 3) orbicularis oris. Postexcision direct facial nerve stimulation at the pontomedullary junction and transcutaneous maximal facial nerve stimulation at the ipsilateral stylomastoid region and their associated response amplitudes were recorded. SETTING: Tertiary referral center. PATIENTS AND METHODS: Patients who underwent acoustic neuroma surgery from January 2004 to March 2006 with intraoperative facial nerve monitoring and an intact facial nerve after tumor excision were included. Recordings were available for 38 patients. RESULTS: With a stimulus intensity of 0.3 mA at the root exit zone, there was an 81% positive predictive value in patients that exhibited a compound action potential of greater than 20% of maximum (sensitivity, 81%). This increased to 93% when the compound action potential was greater than 50% of maximum. When the amplitude increase was greater than 5 microV, there was a 77% positive predictive value (sensitivity, 87%). CONCLUSION: The percentage of the response amplitude of direct facial nerve stimulation at the pontomedullary junction when compared with the maximum response amplitude of ipsilateral transcutaneous stimulation at the stylomastoid foramen is a good predictor of normal to near-normal immediate postoperative facial nerve function. Progression of amplitude response also seems to be a good predictor of normal to near-normal immediate postoperative facial nerve function.     

Significant decrease in plasmad‐dimer levels and mean platelet volume after a 3‐month treatment with rosuvastatin in patients with venous thromboembolism

BackgroundInflammation has been considered as a possible mechanism for the initiation and recurrence of venous thromboembolism (VTE). Statins have anti‐inflammatory and potential immune‐modulatory effects, but their effect on plasmad‐dimer levels is controversial.HypothesisIn this study, we aimed to evaluate the impact of rosuvastatin on D‐dimer and other inflammatory serum markers in VTE patients.MethodsWe conducted a prospective, randomized study on 228 patients with VTE. Control group received conventional treatment (warfarin or rivaroxaban), whereas rosuvastatin‐intervention group received rosuvastatin 10 mg daily, in addition to their conventional treatment for 3 months. Serum markers were extracted from both groups at the baseline and 3 months after the beginning of treatment.ResultsAfter 3 months, in patients of the intervention group, there was a statistically significant decrease in levels ofd‐dimer and mean platelet volume (MPV) but no significant change in neutrophil‐to‐lymphocyte ratio and platelet‐to‐lymphocyte ratio.ConclusionsOur results showed that a 3‐month treatment with 10 mg rosuvastatin daily can significantly decrease the plasma levels ofd‐dimer and MPV, which would support a potential role of statins to reduce activated systemic inflammation among VTE patients. Such effects can be used to reduce the rate of recurrent VTE in these patients.     

Effects of polyols on the quality characteristics of sucrose-free milk chocolate produced in a ball mill

Sucrose-free milk chocolates containing different types of bulk (isomalt, xylitol and maltitol) and high intensity (Stevia) sweeteners were produced by using a ball mill. The main quality characteristics of the formulated chocolates were evaluated and compared with those of the conventional sample containing sucrose. The Casson model was the best fitting model for the rheological data. Casson viscosity and Casson yield stress were significantly affected by the type of bulking agent in chocolates formulated with xylitol (p < 0.05). However xylitol notably improved the overall acceptability according to the sensory analysis results. Chocolates containing the sucrose replacers demonstrated lower T_onset values and higher enthalpy than the control sample. Sucrose-free chocolates illustrated a higher degree of particle agglomeration. Bulk sweeteners meanwhile seem to have high potential for milk chocolate production with low calorie values by using the ball mill technique. Industrial applications: the production of sucrose-free chocolates with conventional methods requires a lot of time and energy. Recently, using alternative methods for chocolate production has been raising interest in many small industries. This study proposed a ball mill method for the preparation of sucrose-free milk chocolates with physiochemical properties almost ranging in the standard limit defined for chocolate. Although using the ball mill method presents a more cost-effective technique for chocolate production and provides shorter processing times for small chocolate industries, it seems to be less efficient in evaporating moisture than the conventional processing. Challenges are still ahead for upgrading this alternative technique to be efficient in evaporating more moisture during operation ending in a high quality product.

Sucrose-free milk chocolates containing different types of bulk (isomalt, xylitol and maltitol) and high intensity (Stevia) sweeteners were produced by using a ball mill.     

CHA2DS2‐VASc and PESI scores are associated with right ventricular dysfunction on computed tomography pulmonary angiography in patients with acute pulmonary thromboembolism

BackgroundAccurate risk stratification is the most important step in the management of patients with acute pulmonary thromboembolism (PTE). Pulmonary embolism severity index (PESI) is a clinical tool for PTE risk stratification. CHA₂DS₂‐VASc score, a risk assessment tool in patients with atrial fibrillation, is recently considered for acute PTE. The presence of right ventricular (RV) dysfunction in imaging is more efficient in acute PTE risk evaluation.HypothesisThis study aims to evaluate the association between CHA₂DS₂‐VASc and PESI score and each of them with RV dysfunction on computed tomography pulmonary angiography (CTPA).MethodsOne hundred eighteen patients with a definite diagnosis of PTE were entered. The CHA₂DS₂‐VASc and PESI scores were calculated for all of them. RV dysfunction including an increase in RV to left ventricular diameter ratio, interventricular septal bowing, and reflux of contrast medium into the inferior vena cava was examined by CTPA.ResultsPESI and CHA₂DS₂‐VASc scores were significantly associated with RV dysfunction. In addition, different classes of PESI scores were correlated with RV dysfunction. Moreover, this study showed that the CHA₂DS₂‐VASc score and PESI score had a positive correlation. The area under the curve value for the CHA₂DS₂‐VASc score was 0.625 with 61.54% sensitivity and 60.0% specificity for predicting RV dysfunction while for PESI score was 0.635 with 66.7% sensitivity and 60.0% specificity.ConclusionThis study showed that not only CHA₂DS₂‐VASc and PESI scores are positively correlated, but they are both associated with RV dysfunction diagnosed by CTPA. CHA₂DS₂‐VASc and PESI scores are able to predict RV dysfunction.     

The reliability of ultrasound measurements of carotid stenosis compared to MRA and DSA

OBJECTIVE: Carotid ultrasound (US) is a screening test for patients with transient ischemic attacks (TIAs) or stroke who then undergo Digital Subtraction Angiogram (DSA) or Magnetic Resonance Angiography (MRA). Gold standard DSA is invasive with inherent risks and costs. MRA is an evolving technology. This study compares reliability of MRA and US modes with DSA in determining degree of internal carotid artery stenosis. METHODS: A five year retrospective analysis of 140 carotid arteries from patients who had carotid US and DSA, and possibly Magnetic Resonance Angiography was undertaken. Recorded US parameters were peak systolic velocity (PSV), end diastolic velocity (EDV), and ICA/CCA peak systolic velocity ratio. The MRA and DSA parameters used NASCET technique for measuring stenosis. Statistical analysis included ROC curves and Kappa computation. RESULTS: US grading of carotid stenosis can be made more reliable by choosing appropriate parameters. The best combination of sensitivity and specificity for stenosis > 70% in our hospital was seen at PSV > 173 cm/s (sensitivity 0.87, specificity 0.8, Positive Predictive Value (PPV) 0.70, Negative Predictive Value (NPV) 0.93, kappa 0.64 and weighted kappa 0.71). MRA kappa was 0.78, (sensitivity 0.75, specificity 1.0, PPV 1.0, NPV 0.85). CONCLUSIONS: US parameters should be validated in each centre. At best, US can only approximate the accuracy of DSA, probably due to inherent limitations of this modality. Magnetic Resonance Angiography has a perfect specificity and PPV but this technique needs to be standardized. Simultaneous use of MRA and US for screening increases sensitivity to over 0.9 without compromising specificity in > 70% stenosis.     

The incidence trends of primary brain tumors in Saskatchewan from 1970 to 2001

OBJECTIVE: There has been a paucity of information on the epidemiology of primary brain tumors (BTs) in Canada. This study documents epidemiology of primary BTs in Saskatchewan over three decades to define their current state, changing pattern over years and relative distribution in two geographically defined areas of the province. METHODS: Data on all primary BTs from 1970 to 2001 from the Brain Tumor Registry in Saskatchewan was collected. The aggregate data on primary BTs including the time-series for incidence, age, geographic location and sex were statistically analyzed using SPSS 13. Poisson regression was used to model the incidence as a function of decade of diagnosis and age at the time of diagnosis. RESULTS: The average annual incidence of primary BTs was 11.1 per 100,000 person-years (male 12.5 per 100.000 and female 9.8 per 100.000). Males constituted 54.5% of all these tumors. The age distribution of tumors was bimodal with peaks at 5 years and 65 years. During this time, the incidence of primary BTs has increase predominantly in non-malignant types. No difference was found in the rate of all the diagnosed primary BTs combined, meningioma and lymphoma between the northern part (Regina) and southern part (Saskatoon) of the province. CONCLUSIONS: The incidence of BTs in Saskatchewan is more than previously reported in Canada. There is a temporal trend in increasing incidence of some of the BTs predominantly in the non-malignant types. No spatial difference in the incidence of primary BTs was shown in this province. These data will provide useful information to guide the future studies on BTs changing patterns, possible etiologies and efficient resource allocation for management of these diseases.     

A survey on Hibiscus rosa—sinensis,Alcea rosea L. and Malva neglecta Wallr as antibacterial agents

ObjectiveTo guide for selection of plants with antibacterial activity for further phytochemical works on the isolation and identification of the active compounds.MethodsEthanolic extracts of 3 species from Malvaceae family were evaluated by agar disc diffusion method for antibacterial activity against some gram-positive and gram-negative bacteria (Pseudomonas aeruginosa, Listeria monocytogenes, Staphylococcus epidermidis, Staphylococcus aureus, Klebsiella pneumoniae, Salmonella typhi, Bacillus cereus, Bacillus anthracis, Escherichia coli Streptococcus pyogenes). The extracts were obtained from aerial parts of Hibiscus rosa (H. rosa)-sinensis (leaf and flower), Alcea rosea (A. rosea) L. (leaf and flower) and Malva neglecta (M. neglecta) Wallr (flower).ResultsThese extracts had inhibitory effects at different concentrations (0.05, 0.10, 0.20 and 0.40 g/mL) against above mentioned bacteria. Escherichia coli was the most resistant strain. The highest inhibitory zone was showed by ethanolic extract of M. neglecta against Staphylococcus epidermidis (22 mm) and followed by ethanolic extract from flower of H. rosa against Staphylococcus epidermidis and Staphylococcus aureus (20 mm). The Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) values against Staphylococcus epidermidis were equal (MIC=MBC=5 mg/mL for M. neglecta extract and for H. rosa extract MIC=MBC=20 mg/mL).ConclusionsThese findings suggest that these native plants have good antibacterial properties that can be used for infection control and treatment and could also be as new source for antibiotics discovery and infection treatment.