Neuronavigation in glioma resection: current applications, challenges, and clinical outcomes.

Background: Glioma resection aims for maximal tumor removal while preserving neurological function. Neuronavigation systems (NS), with intraoperative imaging, have revolutionized this process through precise tumor localization and detailed anatomical navigation. Objective: To assess the efficacy and breadth of neuronavigation and intraoperative imaging in glioma resections, identify operational challenges, and provide educational insights to medical students and non-neurosurgeons regarding their practical applications. Methods: This systematic review analyzed studies from 2012 to 2023 on glioma patients undergoing surgical resection with neuronavigation, sourced from MEDLINE (PubMed), Embase, and Web of Science. A database-specific search strategy was employed, with independent reviewers screening for eligibility using Rayyan and extracting data using the Joanna Briggs Institute (JBI) tool. Results: The integration of neuronavigation systems with intraoperative imaging modalities such as iMRI, iUS, and 5-ALA significantly enhances gross total resection (GTR) rates and extent of resection (EOR). While advanced technology improves surgical outcomes, it does not universally reduce operative times, and its impact on long-term survival varies. Combinations like NS + iMRI and NS + 5-ALA + iMRI achieve higher GTR rates compared to NS alone, indicating that advanced imaging adjuncts enhance tumor resection accuracy and success. The results underscore the multifaceted nature of successful surgical outcomes. Conclusions: Integrating intraoperative imaging with neuronavigation improves glioma resection. Ongoing research is vital to refine technology, enhance accuracy, reduce costs, and improve training, considering various factors impacting patient survival.

The impact of psychosocial safety climate on public sector job satisfaction: the moderating role of organizational climate.

BACKGROUND: The purpose of this study is to uncover the effect of psychological safety climate (PSC) on employees' job satisfaction and organisational climate mediating processes explaining that association. It is posited that the four PSC aspects (management commitment, management priority, organisational participation, and organisational communication) are important for employees' job satisfaction and organisational climate act as resources to facilitate the enactment of managerial quality. METHODS: This study uses a quantitative approach through a questionnaire survey method involving 340 Kota Kinabalu City Hall employees who were selected through simple random sampling. RESULTS: The results of linear regression analysis found that organisation participation has a positive significant relationship with job satisfaction. Organisational communication also showed a negative and significant relationship with job satisfaction. Meanwhile, both management commitment and management priority are statistically insignificant. When the organisational climate is included in the relationship as a mediator through Structural Equation Modelling (SEM) to reinforce the role of psychological safety climate in increasing job satisfaction, such mediating role can only strengthen the relationship between management commitment and organisational participation with job satisfaction. CONCLUSION: Despite the study being cross-sectional, it contributes to knowledge on the resources facilitating PSC, which is important for employees' psychological health. From a practical viewpoint, this study contributes to the literature showing that organizations with good PSC should have policies and practices directed towards employee well-being. The implications of the study for DBKK management are to providing knowledge on the types of psychosocial safety climate domains that plays a crucial role in improving the job satisfaction of DBKK employees.

Treatment of diabetic macular edema with intravitreal DEX Implant in Germany: Efficacy and safety in naïve and pre-treated patients in clinical practice.

PURPOSE: To investigate the efficacy and safety of dexamethasone (DEX) implant in eyes with diabetic macular edema (DME) over 12-months. METHODS: In this retrospective study charts from a single center were analysed, including naïve and pre-treated patients. Best corrected visual acuity (BCVA) and central retinal thickness (CRT) were evaluated at baseline, months 1-2, 3-4, 5-6 and 7-12. RESULTS: Data of 77 eyes were analysed (58.4% were pre-treated with anti-VEGF inhibitors). Mean baseline BCVA values for the whole sample, pre-treated and naïve patients, were 60.94 (SD 13.74), 60.85 (SD 13.80) and 61.01 (SD 13.86) letters, respectively. In the whole sample BCVA changes against baseline were significant (p < 0.05) at months 1-2, 3-4 and 7-12. In the pre-treated group changes were statistically significant at months 1-2 and 7-12. No statistically significant differences were found in the naïve group and between subgroups.In the whole group and the pre-treated group, CRT changes against baseline were significant (p < 0.05) at all time points, while in the naïve group changes were only significant at time point months 3-4. No statistically significant differences were found between subgroups.IOP increases were moderate and successfully managed with topical medication. CONCLUSION: After treatment with DEX implant, BCVA increased and CRT decreased significantly in the whole population at all time points. No significant differences were found between naïve and pre-treated patients. Changes in BCVA and CRT in the naïve group were not statistically significant. This was most likely attributable to the small sample size. The data underlines the importance of DEX implant as an efficacious and safe alternative to VEGF- inhibitors in real world practice.

Antibiotic Resistance Conferred by Class 1 Integron in Vibrio Cholerae Strains: A Meta-analysis.

Background: Class 1 integron is the most ubiquitous platform among antibiotic resistance bacterial populations, including Vibrio cholerae strains. This meta-analysis aimed to determine the antibiotic resistance conferred by class 1 integron conserved segments (CS); 3'-qacEΔ1 and sul1, and 5'-int1 in V. cholerae strains. Methods: An intensive literature search of electronic databases for relevant studies from their starting dates up to April 2019 was conducted by two independent investigators. The electronic databases included; PubMed, Ovid Medline and Google Scholar databases. Only studies that determined antibiotic resistance conferred by class 1 integron in V. cholerae strains isolated from clinical and/or environmental samples using Polymerase Chain Reaction (PCR) assay were included in this study. Results: The random-effects model was selected and performed for all the studies included in this meta-analysis. Fourteen studies consisting of both qacEΔ1 and sul1, and int1 in the class 1 integron of V. cholerae strains were included. The proportions of class 1 integron 3'-CS and 5'-CS were 70.4 % (95%CI: 37.5-94.4) and 52 % (95% CI: 6.3-95.7) respectively. Conclusions: The proportions of class 1 integron in V. cholerae strains significantly contributed to the antibiotic resistances, which are comparable to other gram-negative bacteria clinical isolates. Moreover, the 3'-CS qacEΔ1 and sul1 are highly involved in the antibiotic resistance in comparison to 5'-CS int1. Generally, the study findings provide a general view on antibiotic resistance conferred by class 1 integron in Vibrio cholerae strains.

SARS-CoV-2 epidemic after social and economic reopening in three US states reveals shifts in age structure and clinical characteristics.

In the United States, state-level re-openings in spring 2020 presented an opportunity for the resurgence of SARS-CoV-2 transmission. One important question during this time was whether human contact and mixing patterns could increase gradually without increasing viral transmission, the rationale being that new mixing patterns would likely be associated with improved distancing, masking, and hygiene practices. A second key question to follow during this time was whether clinical characteristics of the epidemic would improve after the initial surge of cases. Here, we analyze age-structured case, hospitalization, and death time series from three states - Rhode Island, Massachusetts, and Pennsylvania - that had successful re-openings in May 2020 without summer waves of infection. Using a Bayesian inference framework on eleven daily data streams and flexible daily population contact parameters, we show that population-average mixing rates dropped by >50% during the lockdown period in March/April, and that the correlation between overall population mobility and transmission-capable mobility was broken in May as these states partially re-opened. We estimate the reporting rates (fraction of symptomatic cases reporting to health system) at 96.0% (RI), 72.1% (MA), and 75.5% (PA); in Rhode Island, when accounting for cases caught through general-population screening programs, the reporting rate estimate is 94.5%. We show that elderly individuals were less able to reduce contacts during the lockdown period when compared to younger individuals. Attack rate estimates through August 31 2020 are 6.4% (95% CI: 5.8% ‒ 7.3%) of the total population infected for Rhode Island, 5.7% (95% CI: 5.0% ‒ 6.8%) in Massachusetts, and 3.7% (95% CI: 3.1% ‒ 4.5%) in Pennsylvania, with some validation available through published seroprevalence studies. Infection fatality rates (IFR) estimates for the spring epidemic are higher in our analysis (>2%) than previously reported values, likely resulting from the epidemics in these three states affecting the most vulnerable sub-populations, especially the most vulnerable of the ≥80 age group.

Optimal SARS-CoV-2 vaccine allocation using real-time seroprevalence estimates in Rhode Island and Massachusetts.

As three SARS-CoV-2 vaccines come to market in Europe and North America in the winter of 2020-2021, distribution networks will be in a race against a major epidemiological wave of SARS-CoV-2 that began in autumn 2020. Rapid and optimized vaccine allocation is critical during this time. With 95% efficacy reported for two of the vaccines, near-term public health needs require that distribution is prioritized to the elderly, health-care workers, teachers, essential workers, and individuals with co-morbidities putting them at risk of severe clinical progression. Here, we evaluate various age-based vaccine distributions using a validated mathematical model based on current epidemic trends in Rhode Island and Massachusetts. We allow for varying waning efficacy of vaccine-induced immunity, as this has not yet been measured. We account for the fact that known COVID-positive cases may not be included in the first round of vaccination. And, we account for current age-specific immune patterns in both states. We find that allocating a substantial proportion ( > 75%) of vaccine supply to individuals over the age of 70 is optimal in terms of reducing total cumulative deaths through mid-2021. As we do not explicitly model other high mortality groups, this result on vaccine allocation applies to all groups at high risk of mortality if infected. Our analysis confirms that for an easily transmissible respiratory virus, allocating a large majority of vaccinations to groups with the highest mortality risk is optimal. Our analysis assumes that health systems during winter 2020-2021 have equal staffing and capacity to previous phases of the SARS-CoV-2 epidemic; we do not consider the effects of understaffed hospitals or unvaccinated medical staff. Vaccinating only seronegative individuals avoids redundancy in vaccine use on individuals that may already be immune, and will result in 1% to 2% reductions in cumulative hospitalizations and deaths by mid-2021. Assuming high vaccination coverage ( > 28%) and no major relaxations in distancing, masking, gathering size, or hygiene guidelines between now and spring 2021, our model predicts that a combination of vaccination and population immunity will lead to low or near-zero transmission levels by the second quarter of 2021.

Non-invasive proximal adhesive restoration of natural non-cavitated proximal lesions.

PURPOSE: To investigate the infiltration potential of different self-etch adhesives into natural non-cavitated proximal lesions and the effect of dehydration protocol on the infiltration of a self-etch adhesive. METHODS: 29 extracted molars and premolars with natural proximal lesions (ICDAS 1-2) were sectioned through the lesion providing two samples from each lesion. To compare the different adhesives, three groups of eight lesions were abraded with fine metallic strips and then etched with 37% H3PO4 acid for 120 seconds. All teeth were stained with rhodamine isothiocyanate. After drying with compressed air and ethanol application, lesions were infiltrated with Scotchbond Universal, Clearfil SE Protect or OneCoat 7 Universal for 180 seconds and then coated with a thin layer of flowable composite (Tetric Flow). To compare the effect of dehydration protocol on infiltration, two groups of nine paired lesions were pretreated as described above. One group was dried using compressed air alone and the second group was dried using compressed air and ethanol, both groups were then infiltrated with Scotchbond Universal then coated with a thin film of flowable composite. After light curing, un-encapsulated dye was bleached by immersion in hydrogen peroxide. Remaining lesion pores were stained with sodium fluorescein solution. Thin cuts of the teeth were observed with confocal microscopy and computer image analysis was performed (ImageJ). RESULTS: ANOVA and Duncan post-hoc tests showed no significant differences of the infiltrated area between the three adhesives (P= 0.835), no significant difference was found between the group dried with air compared to the one dried with air and ethanol. It can be concluded that the tested adhesives may be used for infiltration of natural lesions following the described pretreatment. CLINICAL SIGNIFICANCE: Enamel pretreatment with metallic strip and 37% H3PO4 acid promotes the infiltration of different adhesives into natural non-cavitated caries lesions.

Non-invasive proximal adhesive restoration (NIPAR) compared to resin infiltration for treating initial proximal carious lesions.

PURPOSE: To compare a new technique of non-invasive proximal adhesive restoration (NIPAR) to the infiltration concept technique (ICON). METHODS: Extracted human posterior teeth with non-cavitated proximal carious lesions (ICDAS code 1-2) were cut vertically to obtain two symmetrical lesions. Group 1 (NIPAR):Half of the paired lesions surfaces (n=13) were abraded with metallic strips and etched with 37% H3PO4 for 120 seconds. Group 2 (ICON):The other half of the paired lesions' surfaces (n=13) were etched with 15% HCl gel for 120 seconds. All samples were then stained with rhodamine isothiocyanate (RITC). After ethanol drying and isolation of the cut surface, Group 1 samples were infiltrated with Scotchbond Universal for 180 seconds and coated with a thin film of Tetric flow. Group 2 samples were infiltrated with ICON infiltrant following manufacturer's instructions. After light curing, unbound rhodamine was bleached by immersion in 30% hydrogen peroxide for 12 hours. Remaining lesion pores were stained with sodium fluorescein solution. Samples were observed with confocal microscopy (CLSM) and the percentage of infiltration (area of resin infiltration/area of total demineralization ×100) was calculated using ImageJ. RESULTS: 11 samples out of 13 showed larger infiltrated area of the lesions in Group 1 (NIPAR) compared to Group 2 (ICON). Statistical analysis revealed a significant difference between the two groups (P< 0.05). Within the limitations of this study, NIPAR allowed for better infiltration of non-cavitated proximal carious lesions when compared to ICON. CLINICAL SIGNIFICANCE: The combination of infiltration and sealing using non-invasive proximal adhesive restoration (NIPAR) offers a suitable non-invasive treatment option for non-cavitated proximal lesions combining the advantages of sealing and infiltration.

Testing procedures for extracting fluctuation spectra from lipid bilayer simulations.

To address concerns about how to obtain the height-height spectrum from simulations of biomembranes, we emulated the fluctuations in real space using exact input spectra. Two different methods that have given different results in the literature were then used to extract spectra from the emulated fluctuations that were then compared to the exact input spectra. A real space method shows systematic, but small deviations attributed to splines introducing an artifactual filter. A direct Fourier method obtains accurate results when the in-plane placement of the emulated particles is uncorrelated with the out-of-plane undulations, but systematic underestimates occur when the particle placement is more realistically correlated with the undulations. Although quantitative corrections cannot be estimated from our one-dimensional model, the results are qualitatively consistent with the direct Fourier method underestimating the 1/q(2) spectral dependence that is characteristic of a tilt degree of freedom in simulations.

Ceruminous adenoma

@#A 58-year-old Filipino man with a two-year history of a left external auditory canal mass associated with ipsilateral hearing loss underwent polypectomy for a clinical impression of aural polyp. We received several cream tan, irregular tissue fragments with an aggregate diameter of 1.4 cm. Histopathologic examination shows clusters of tumor cells forming variably sized ducts and glands, some of which are cystically dilated; many of these structures have irregular lumina. (Figure 1) Higher magnification shows a dual cell population: an outer layer of round to ovoid cells with clear cytoplasm, corresponding to basal myoepithelial cells; and an inner layer of cuboidal to columnar cells, that have eosinophilic and granular cytoplasm with decapitating apical ends, corresponding to luminal epithelial cells with apocrine morphology. (Figure 2) Nuclear pleomorphism is mild to moderate, nucleoli are not prominent, and mitoses, perineural invasion and necrosis are not seen. In some glands a yellow to golden brown, coarse pigment is seen at the cytoplasm of the luminal cells. (Figure 3) The tumor does not involve the epidermis, and there is a variable amount of chronic inflammation. (Figure 4) Based on these features we diagnosed it as ceruminous adenoma.

Molecular Characterization of the 16S rRNA Gene of Helicobacter fennelliae Isolated from Stools and Blood Cultures from Paediatric Patients in South Africa.

Forty strains of H. fennelliae collected from paediatric blood and stool samples over an 18 year period at a children's hospital in Cape Town, South Africa, were amplified by PCR of the 16S rRNA. Two distinct genotypes of H. fennelliae were identified based on the phylogenetic analysis. This was confirmed by sequencing a portion of the beta subunit of the RNA polymerase (rpoB) gene. All isolates from South Africa clustered with a proposed novel Helicobacter strain (accession number AF237612) isolated in Australia, while three H. fennelliae type strains from the northern hemisphere, NCTC 11612, LMG 7546 and CCUG 18820, formed a separate branch. A large (355bp) highly conserved intervening sequence (IVS) in the 16S rRNA was found in all isolates. Predicted secondary structures of the IVS from the 16S rRNA and 23S rRNA were characterised by a primary stem structure formed by base pairing of the 3' and 5' ends and internal loops and stems. This phylogenetic analysis is the largest undertaken of H. fennelliae. The South African H. fennelliae isolates are closely related to an Australian isolate previously reported to be a possible novel species of Helicobacter. This study suggests that the latter is strain of H. fennelliae.

Is an intrauterine device a contraindication for uterine artery embolization? A study of 20 patients.

The presence of an intrauterine device (IUD) has been traditionally considered a risk factor for postprocedural infection in patients undergoing uterine artery embolization (UAE). The authors retrospectively evaluated the occurrence of infectious complications following embolization in 20 women with IUDs. After a mean follow-up of 20.5 months, none of the patients developed an infectious complication. One patient required hysterectomy following embolization for persistent pain. Pathologic evaluation of the hysterectomy specimen demonstrated ischemia without evidence of inflammation. This experience suggests that the presence of an IUD might not be considered a contraindication for UAE.

Ultrastructural study of a tetratrichomonad isolated from pig fecal samples.

Trichomonads found in pigs include the commensal Tritrichomonas suis (more well known because of its synonymy to Tritrichomonas foetus, a trichomonad parasite of cattle and other animals) and Tetratrichomonas buttreyi, which appear similar to Tritrichomonas suis under the light microscope. A trichomonad isolated from pig fecal samples was subjected to scanning and transmission electron microscopy for ultrastructural study. The organism's ultrastructure revealed features commonly found in trichomonads; however, features such as the number and length of flagella, type of undulating membrane, general body form, and shape and location of organelles such as the nucleus, Golgi complex, and hydrogenosomes indicated that the isolated trichomonad is not Tritrichomonas suis nor Tritrichomonas foetus. Polymerase chain reaction (PCR) corroborated these results. Moreover, the ultrastructure was similar to the ultrastructure of previously described tetratrichomonads. It is especially suggested that the isolate is T. buttreyi. These findings could be of significance in the differentiation among different porcine trichomonads in diagnostic procedures. In addition, this is the first known detailed ultrastructural study of T. buttreyi isolated from pigs; thus, this can serve as an aid for future comparison between porcine and bovine T. buttreyi.

The influence of porcelain layer thickness on the final shade of ceramic restorations.

STATEMENT OF PROBLEM: Ceramic restorations should be made of porcelain layers of different opacity, shade, and thickness in order to provide a natural appearance. By means of CAD/CAM layering technology such as CICERO, it is feasible to produce all-ceramic crowns with porcelain layers of predetermined thickness. However, it is not yet known whether changes in thickness of these porcelain layers within the clinically available space can perceivably influence the overall shade of the restoration. PURPOSE: The purpose of this study was to determine, quantitatively, the effect of different thickness ratios of opaque porcelain (OP) and translucent porcelain (TP) layers on the overall shade of all-ceramic specimens. MATERIAL AND METHODS: The CIELAB values of 5 assembled specimens, each consisting of 2 or 3 discs (CORE 0.70 mm/OP--0, 0.25, 0.50, 0.75, or 1.00 mm/TP 1.00, 0.75, 0.50, 0.25, or 0 mm) were determined with a spectrophotometer for the Vita shades A1, A2, and A3. Distilled water was used to attain optical contact between the layers. Black or white backgrounds were used to assess the influence of the background on the final shade. Color differences (DeltaE) between layered specimens were determined. Correlation between the thickness ratio and the L*, a*, and b* values was calculated by 2-tailed Spearman correlation analysis. RESULTS: The results indicated that small changes in OP/TP thickness ratio can perceivably influence the final shade of the layered specimens (DeltaE>1). Redness a* and yellowness b* increased with the thickness of OP for all shades. Redness a* (P<.01 for all shades) correlated more strongly with thickness than yellowness b* (P<.01 for A1 and A3; P<.05 for A2). The lightness (L*) was shade dependent. The correlation (r) between OP/TP thickness and L* was 0.975 (P<.01) for shade A1, 0.700 (not statistically significant) for shade A2, and 0.900 (P<.05) for shade A3. CONCLUSION: Small changes in thickness and shade of opaque and translucent porcelain layers can influence the final shade of the layered porcelain specimen.