The efficacy of surgical site suction drain insertion in pterional craniotomy for intracranial cerebral aneurysm.

Objective: We evaluated the role of subgaleal closed suction drains in postoperative epidural hematoma (EDH) and wound complications following pterional craniotomy for cerebral aneurysm. Methods: We reviewed 5,280 pterional craniotomies performed on 5,139 patients between January 2006 and December 2020. A drain was placed subgalealy and tip of drain was positioned between the bone flap and the deep temporalis. 1,637 cases (31%) had a subgaleal suction drain. We analyzed demographic and clinical variables related to EDH requiring evacuation and wound complications in patients with and without drains. Univariate and multivariate logistic regression analyses were performed to determine the associated risk factors. Results: Fourteen cases (0.27%) of EDH requiring evacuation and 30 cases (0.57%) of wound complications were identified. Univariate analysis found that drain insertion, subarachnoid hemorrhage (SAH), and operation time were associated with EDH, while drain insertion, SAH, male gender, older age, and longer operation time were associated with wound complications. Multivariate analysis found no significant association between drain use and EDH (OR=1.62, p=0.402) or wound complications (OR=1.45, p=0.342). Conclusions: Routine use of subgaleal closed suction drains may not be necessary after pterional craniotomy, as drain insertion was not associated with a reduced risk of EDH requiring evacuation or wound complications.

A Ruptured lenticulostriate artery aneurysm in moyamoya disease treated with Onyx embolization.

Lenticulostriate artery (LSA) aneurysms are uncommon. Here, we report one case of ruptured LSA aneurysm which is related to Moyamoya disease (MMD). Surgical treatment of this aneurysm is challenging because of its deep location and complex neural structures around the LSA. We report one case treated with endovascular Onyx embolization, successfully and review LSA aneurysm associated with MMD.

Postoperative Non-Pathological Fever Following Posterior Cervical Fusion Surgery : Is Laminoplasty a Better Preventive Method than Laminectomy?

OBJECTIVE: To analyze the incidence and characteristics of delayed postoperative fever in posterior cervical fusion using cervical pedicle screws (CPS). METHODS: This study analyzed 119 patients who underwent posterior cervical fusion surgery using CPS. Delayed fever was defined as no fever for the first 3 postoperative days, followed by an ear temperature ≥38°C on postoperative day 4 and subsequent days. Patient age, sex, diagnosis, laminectomy, surgical level, revision status, body mass index, underlying medical disease, surgical duration, and transfusion status were retrospectively reviewed. RESULTS: Of 119 patients, seven were excluded due to surgical site infection, spondylitis, pneumonia, or surgical level that included the thoracic spine. Of the 112 included patients, 28 (25%) were febrile and 84 (75%) were afebrile. Multivariate logistic regression analysis showed that laminectomy was a statistically significant risk factor for postoperative non-pathological fever (odds ratio, 10.251; p=0.000). In contrast, trauma or tumor surgery and underlying medical disease were not significant risk factors for fever. CONCLUSION: Patients who develop delayed fever 4 days after posterior cervical fusion surgery using CPS are more likely to have non-pathologic fever than surgical site infection. Laminectomy is a significant risk factor for non-pathologic fever.

An Assessment of the Medial Angle of Inserted Subaxial Cervical Pedicle Screw during Surgery: Practical Use of Preoperative CT Scanning and Intraoperative X-rays.

The most important factor for cervical pedicle screw placement (CPS) is creating a sufficient medial angle. We aimed to know the medial angle of the inserted subaxial CPS during surgery using intraoperative AP X-rays. From March 2012 to September 2014, we performed posterior cervical fusions using CPS on 75 patients, including a total of 389 CPS insertions. Using preoperative CT scanning, we determined the θlat (i.e., an angle between a vertical line and a line to connect the planned entry point and the axial middle point of the pedicle) and θmed (i.e., an angle between a vertical line and a line to connect a new medial entry point and the axial middle point of the pedicle; this angle was regarded as minimally acceptable and a safe medial angle). The actual inserted medial angle (θins) was checked and we determined whether it was between the θmed and θlat in the accurately placed CPS, and not in the laterally violated CPS. We measured the horizontal distance of the CPS body (l; using an intraoperative AP X-ray). If the actual screw length (L) was known, we could calculate the medial angle (θAP) as sin-1 l / L. We checked the θAP and θins for all of the same levels. Intra- and inter-observer agreement was analyzed. Among 368 accurately inserted CPSs, we found that 360 of the θins values were greater than or equal to the θmed on the same level (P <0.001). The intra-observer agreements were 0.781 and 0.847. The inter-observer agreements were 0.917 and 0.949. It was important that θins was greater than or equal to the θmed. Our suggested formula, θAP = sin-1 l / L, seems to be useful for predicting the medial angle of the inserted CPS and for comparing it with θmed during surgery based on an AP X-ray and preoperative CT scan.

NIK and IKKbeta interdependence in NF-kappaB signalling--flux analysis of regulation through metabolites.

Activation of the transcription factor NF-kappaB is central to control of immune and inflammatory responses. Cytokine induced activation through the classical or canonical pathway relies on degradation of the inhibitor, IkappaBalpha and regulation by the IKKbeta kinase. In addition, the NF-kappaB is activated through the NF-kappaB-inducing kinase, NIK. Analysis of the IKK/NIK inter-relationship and its impact on NF-kappaB control, were analysed by mathematical modelling, using matrix formalism and stoichiometrically balanced reactions. The analysis considered a range of bio-reactions and core metabolites and their role in relation to kinase activation and in control of specific steps of the NF-kappaB pathway. The model predicts a growth-rate and time-dependent transfer of the primary kinase activity from IKKbeta to NIK. In addition, it suggests that NIK/IKKbeta interdependence is controlled by intermediates of phosphoribosylpyrophosphate (PRPP) within the glycolysis pathway, and thus, identifies a link between specific metabolic events and kinase activation in inflammatory signal transduction. Subsequent in vitro experiments, carried out to validate the impact of IKK/NIK interdependence, confirmed signal amplification at the level of the NF-kappaB/IkappaBalpha complex control in the presence of both kinases. Further, they demonstrate that the induced potentiation is due to synergistic enhancement of relA-dependent activation.

Effect of multi-polar magnetic field on the properties of nanocrystalline silicon thin film deposited by internal-type inductively coupled plasma.

An internal linear-type inductively coupled plasma (ICP) source with multi-polar permanent magnets was used to deposit nanocrystalline silicon thin films on a large-area substrate (470 mm x 370 mm), and the effects of a magnetic field on the characteristics of the plasma and deposited film were investigated. By applying the magnetic field, it was possible to obtain a high-density plasma of 2.8 x 10(11) cm(-3) at 15 mTorr Ar and 4000 W of RF power, which is about 50% higher than was obtained for the source without the magnetic field. The application of the multi-polar magnet field to the ICP source during the deposition of silicon film using SiH4/H2 also increased the deposition rates of the silicon thin films and the ratio Halpha*/SiH*, which transformed the structure of the silicon films deposited on the glass substrates from amorphous to nanocrystalline. Furthermore, the use of the magnetic field increased crystalline volume fraction and dark conductivity while decreasing the absorption coefficient. The improved characteristics were related to the increase in the ionization rate and the dissociation rate of SiH4/H2, which confined the plasma to the chamber volume and avoided losses to the chamber wall. The decrease in the absorption coefficient of the nanocrystalline silicon film deposited with a higher H2 percentage and with the magnetic field present is also related to the increase in the crystallization volume fraction. At 70% H2 with the magnetic field present, the nanocrystalline silicon thin films had a high crystalline volume fraction (68%), a dark conductivity of 3.4E-7 omega(-1) cm(-1), a deposition rate of 10 angstroms/s, and grain sizes of approximately 15 nm.

Metabolic flux analysis for calcium dependent antibiotic (CDA) production in Streptomyces coelicolor.

The calcium dependent antibiotic (CDA) is a nonribosomal lipopeptide produced by Streptomyces coelicolor. We constructed a metabolic network of more than 400 reactions for the primary and secondary metabolism of S. coelicolor and used computational metabolic flux balancing to investigate some of the factors affecting growth and production of CDA. Computational results indicated that the CDA production was concomitant with growth. Computational specific growth rates were twice as high as the experimental specific growth rates. Metabolic flux distributions and sensitivity analyses computed for various phases of the batch culture indicated that the specific CDA production rate was affected by nitrogen assimilation, pentose phosphate pathway, shikimate biosynthesis, and oxoglutarate fluxes. Consequently, these metabolic targets were tested using genetic deletions in the model which increased the in silico specific CDA production rate.