Notes

A static correction: What makes audience often (however, not often) egocentric? Creating implications about utilizing other peoples' viewpoint throughout referential communication.
5% in the robot-assisted groups and 26.3% in group 5. CONCLUSIONS The puncture accuracy of robot-assisted PKP for treating OVCF does not change with the increase in the number of operations. The total operation time and robotic-assisted operation time decreases with the increase in the number of cases. BACKGROUND The safety of CAS in elderly patients remains controversial. And the aims of this study were to evaluate 30-day outcomes after CAS in elderly patients (≥70 years) and to investigate the risk factors for the postoperative incidence of major adverse clinical events (MACEs) for providing clinical evidence to improve CAS safety in this specific subgroup of patients. METHODS Our data set included patients who underwent CAS between 2001 and 2017 at Xuanwu Hospital, Capital Medical University. The primary outcome variable was 30-day postoperative incidence of MACEs death, myocardial infarction (MI), and ipsilateral stroke. Univariable and multivariable analyses were performed to identify high-risk patients and procedural characteristics associated with MACEs. RESULTS A total of 1029 elderly patients who underwent CAS for carotid artery stenosis were identified and analyzed. The incidence of postoperative MACEs was 3.01% (31 cases 5 deaths, 24 strokes, and 2 MIs) for these patients. After multivariable analysis, the independent predictors of MACEs included a family history of stroke, (odds ratio [OR]=3.817; 95% confidence interval [CI]=1.227-11.876; P=0.021), symptoms (OR=2.650; 95% CI=1.210-5.806; P=0.015), and modified Rankin Scale (mRS) ≥3 (OR=4.594; 95% CI=1.708-12.352; P=0.003). Hyperlipidemia was not an independent risk factor (OR=1.597; 95% CI=0.745-3.425; P=0.229). CONCLUSION According to our single-center experience, CAS was safely performed in elderly patients. Being symptomatic, having a family history of stroke, and presence of a neurological deficit (mRS ≥3) increased the risk of 30-day postoperative MACEs. BACKGROUND Spinal epidural abscess is a rare pathology with an incidence that has tripled in the past 2 decades. Ventral cervical epidural abscesses (vCEA) of the cervical spine pose particular treatment challenges because of the anatomical location. The aim of this report is to identify trends in the surgical management of these patients and to determine whether concomitant spondylodiscitis warrants fusion at the index surgery. METHODS Patients presenting to a quaternary care institution from January 2009 to December 2018 with isolated vCEA were identified. Patients were excluded if they had dorsal or circumferential epidural abscesses. Clinical and radiographic data were collected. Patients with vCEA were stratified by the presence or absence of spondylodiscitis upon presentation. Clinical outcomes analyzed included neurological sequelae and the need for revision surgery. RESULTS During the 10-year study period, 36 patients presented with symptomatic isolated vCEA and constituted the study cohort; 16 (44%) had concurrent spondylodiscitis. All 36 patients underwent surgical decompression; the initial surgical approach was anterior-only for 7 patients (19%), posterior-only for 27 patients (75%), and and a combined approach for 2 patients (6%). Four patients from the total cohort (11%) ultimately required a revision operation; all 4 were from the subset with concurrent spondylodiscitis (25% vs. 0%, P = 0.03). CONCLUSIONS vCEA can be evacuated safely and effectively by a variety of strategies in patients with neurologic deficits. Concomitant spondylodiscitis with cervical epidural abscess may warrant instrumented fusion as part of the initial surgical strategy. BACKGROUND An epidural nerve block injection is the most common modality of treatment for control of low backache associated with radiating pain. Epidural catheter injections are also widely used by pain physicians to control cancer pain. Epidural catheters could be associated with procedure-related complications, such as epidural hematoma, epidural abscess, and post-dural puncture headache, and rare complications, such as shearing or breakage of the catheter tip. In this report, we describe the full-endoscopic removal of a sheared epidural catheter fragment. CASE DESCRIPTION A man aged 24 years presented with low backache radiating to his left leg with numbness and weakness. Left-sided L4-L5 disc herniation was diagnosed on magnetic resonance imaging, and the patient was posted for an epidural nerve block. The epidural catheter broke during removal, and a 4-cm fragment was retained in the epidural space. We performed an interlaminar full-endoscopic removal of the sheared epidural catheter. Postoperatively, the patient reported excellent clinical outcome. CONCLUSIONS Interlaminar full-endoscopic procedure could be used for the removal of the retained epidural catheter as a practical option. OBJECTIVE The relationship between neutrophil-lymphocyte ratio (NLR) and the occurrence of rebleeding in aneurysmal subarachnoid hemorrhage (aSAH) is poorly understood. Our study aimed to investigate the association between NLR on admission and rebleeding following aSAH. METHODS Clinical and laboratorial data from patients with aSAH were retrospectively collected, including leukocyte, neutrophil, lymphocyte, and NLR. Univariate and multivariate analyses were performed to assess for the association of NLR with rebleeding. We performed propensity-score matching analyses to correct imbalances in patient characteristics between the rebleeding group and nonrebleeding group. RESULTS Rebleeding occurred in 30 of 716 (4.19%) patients with aSAH in this cohort. Patients with rebleeding had significantly higher NLR comparing with patients without rebleeding (11.27 vs. 5.5; P less then 0.05) in the univariate analysis. In the multivariate analysis, NLR was considered as a risk factor of rebleeding (odds ratio, 0.283; 95% confidence interval, 0.130-0.620; P = 0.002), as well as Fisher grade (odds ratio, 0.353, 95% confidence interval, 0.151-0.824; P = 0.016). ML198 The area under the curve of the NLR and combined NLR-Fisher grade model was 0.702 and 0.744 (sensitivity was 39.94%, and specificity was 100%) for predicting rebleeding, respectively. After propensity-score matching, the optimal cutoff value for NLR as a predictor for rebleeding following aSAH was determined as 5.4 (sensitivity was 83.33%, and the specificity was 63.33%). CONCLUSIONS Higher NLR predicts the occurrence of rebleeding and poor outcome, and NLR combined with Fisher grade significantly improves the prediction of rebleeding following aSAH. BACKGROUND Chronic midline low back pain is the number one reason for disability in the United States despite the prolific use of medical and surgical interventions. Notwithstanding the widespread use of epidural spinal cord stimulators (SCSs), there remains a large portion of the population with inadequate pain control thought to be because of the limited volume of stimulated neural tissue. Intradural SCSs represent an underexplored alternative strategy with the potential to improve selectivity, power efficiency, and efficacy. We studied and carried out development of an intradural form of an SCS. Herein we present the findings of in vivo testing of a prototype intradural SCS in a porcine model. METHODS Six female juvenile pigs underwent surgical investigation. One control animal underwent a laminectomy only, whereas the 5 other animals had implantation of an intradural SCS prototype. One of the prototypes was fully wired to enable acute stimulation and concurrent electromyographic recordings. All animals underwent terminal surgery 3 months postimplantation, with harvesting of the spinal column. Imaging (microcomputed tomography scan) and histopathologic examinations were subsequently performed. RESULTS All animals survived implantation without evidence of neurologic deficits or infection. Postmortem imaging and histopathologic examination of the spinal column revealed no evidence of spinal cord damage, cerebrospinal fluid fistula formation, abnormal bony overgrowth, or dural defect. Viable dura was present between the intra- and extradural plates of the device. Electromyographic recordings revealed evoked motor units from the stimulator. CONCLUSIONS Chronically implanted intradural device in the porcine model demonstrated safety and feasibility for translation into humans. BACKGROUND Surgical treatment for symptomatic extracranial carotid artery aneurysms should be encouraged because of their high recurrence rates. CASE DESCRIPTION A 55-year-old man presented with progressive right-sided hemiparesis and dysarthria. Computed tomography angiography revealed the cause of his repeated cerebral infarction was due to the distal emboli from an intra-aneurysmal thrombus of a giant thrombosed aneurysm at the origin of left common carotid artery. Right common carotid artery-saphenous vein graft-left common carotid artery bypass followed by left common carotid artery ligation was successfully performed. CONCLUSIONS Carotid-carotid bypass followed by common carotid artery ligation is an optional procedure for symptomatic proximal common carotid artery aneurysm. Conventional ophthalmic eye drops are limited by their rapid elimination rate and short time of action. Ion exchange resin has been used to achieve sustained ocular drug delivery but the high selectivity of drug molecules restricts its broad application. In situ gel system seems to be a good strategy to address these problems but the influence of in situ gel type on the sustained release behavior and tissue distribution after ocular application is unclear. Therefore, in this study, using betaxolol hydrochloride as a model drug, poloxamer 407 and methylcellulose as the carriers, two thermosensitive in situ gel systems were prepared and characterized. Influence of formulation composition type and concentration on in vitro drug release was studied. Tissue distribution after ocular delivery of two different thermosensitive in situ gels was studied and compared with commercial BH eye drop (Betoptic S®). In vitro studies demonstrated that addition of 4% HPMC 606W in 15% P407 solution and 5% PEG4000 in 2% MC solution obtained gels with appropriate gelation temperature and similar sustained drug release rate. In vivo tissue distribution study indicated that they presented similar drug concentration in cornea, iris-ciliary and aqueous humor irrespective of gel type, with higher drug concentration achieved after 4 h compared to the commercial resin suspension eye drops. The AUC and MRT of the two in situ gel eye drops were 2 times higher than that of the commercial resin suspension eye drops in cornea. In conclusion, the two thermosensitive in situ gels have prolonged drug release after ocular drug delivery compared with ion exchange resin eye drops, implying their potential applications in clinic with broad drug adoptability. Finite dose experiments represent clinical use wherein depletion of dose, evaporation of excipients, and gradual change in vehicle composition may occur. In the present study, we attempted a mathematical approach for predicting skin permeation and concentration of a cosmetic active, rhododendrol (RD), from complex vehicle-based formulations applied in finite dose. In vitro skin permeation and concentration studies of RD were conducted from formulations containing water and polyols with concentrations ranging from 10 to 100% under infinite and finite dose conditions using vertical Franz diffusion cells. Observed data for skin permeation and the viable epidermis and dermis (VED) concentration of RD were estimated by the differential equations under Fick's second law of diffusion together with water evaporation kinetics and changes in the partition coefficient from vehicles to the stratum corneum. As a result, a goodness-of-fit was observed allowing accurate estimation of skin permeation and VED concentration of RD.
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