Implementation of Different Conversion/Alloy Active Materials as Anodes for Lithium-Based Solid-State Batteries.

To complement or outperform lithium-ion batteries with liquid electrolyte as energy storage devices, a high-energy as well as high-power anode material must be used in solid-state batteries. An overlooked class of anode materials is the one of conversion/alloy active materials (e.g., SnO2, which is already extensively studied in liquid electrolyte-based batteries). Conversion/alloy active materials offer high specific capacities and often also fast lithium-ion diffusion and reaction kinetics, which are required for high C-rates and application in high-energy and high-power devices such as battery electric vehicles. To date, there are only very few reports on conversion/alloy active materials─namely, SnO2─as anode material in sulfide-based solid-state batteries, with a relatively complex electrode design. Otherwise, conversion-alloy active materials are used as a seed layer or interlayer for a homogeneous Li deposition or to mitigate the formation and growth of the SEI, respectively. Within this work, four different conversion/alloy active materials─SnO2, Sn0.9Fe0.1O2, ZnO, and Zn0.9Fe0.1O─are synthesized and incorporated as negative active materials ("anodes") in composite electrodes into SSBs with Li6PS5Cl as solid electrolyte. The structure and the microstructure of the as-synthesized active materials and composite electrodes are investigated by XRD, SEM, and FIB-SEM. All active materials are evaluated based on their C-rate performance and long-term cyclability by galvanostatic cycling under a constant pressure of 40 MPa. Furthermore, light is shed on the degradation processes that take place at the interface between the active material and solid electrolyte. It is evidenced that the decomposition of Li6PS5Cl to LiCl, Li2S, and Li3P at the anode is amplified by Fe substitution. Lastly, a 2D sheet electrode is designed and cycled to tackle the interfacial degradation processes. This approach leads to an improved C-rate performance (factor of 3) as well as long-term cyclability (factor of 2.3).

N-cadherin directs the collective Schwann cell migration required for nerve regeneration through Slit2/3-mediated contact inhibition of locomotion.

Collective cell migration is fundamental for the development of organisms and in the adult for tissue regeneration and in pathological conditions such as cancer. Migration as a coherent group requires the maintenance of cell-cell interactions, while contact inhibition of locomotion (CIL), a local repulsive force, can propel the group forward. Here we show that the cell-cell interaction molecule, N-cadherin, regulates both adhesion and repulsion processes during Schwann cell (SC) collective migration, which is required for peripheral nerve regeneration. However, distinct from its role in cell-cell adhesion, the repulsion process is independent of N-cadherin trans-homodimerisation and the associated adherens junction complex. Rather, the extracellular domain of N-cadherin is required to present the repulsive Slit2/Slit3 signal at the cell surface. Inhibiting Slit2/Slit3 signalling inhibits CIL and subsequently collective SC migration, resulting in adherent, nonmigratory cell clusters. Moreover, analysis of ex vivo explants from mice following sciatic nerve injury showed that inhibition of Slit2 decreased SC collective migration and increased clustering of SCs within the nerve bridge. These findings provide insight into how opposing signals can mediate collective cell migration and how CIL pathways are promising targets for inhibiting pathological cell migration.

Synergistic lignin degradation between Phanerochaete chrysosporium and Fenton chemistry is mediated through iron cycling and ligninolytic enzyme induction.

Removal of recalcitrant lignin from wastewater remains a critical bottleneck in multiple aspects relating to microbial carbon cycling ranging from incomplete treatment of biosolids during wastewater treatment to limited conversion of biomass feedstock to biofuels. Based on previous studies showing that the white rot fungus Phanerochaete chrysosporium and Fenton chemistry synergistically degrade lignin, we sought to determine optimum levels of Fenton addition and the mechanisms underlying this synergy. We tested the extent of degradation of lignin under different ratios of Fenton reagents and found that relatively low levels of H2O2 and Fe(II) enhanced fungal lignin degradation, achieving 80.4 ± 1.61 % lignin degradation at 1.5 mM H2O2 and 0.3 mM Fe(II). Using a combination of whole-transcriptome sequencing and iron speciation assays, we determined that at these concentrations, Fenton chemistry induced the upregulation of 80 differentially expressed genes in P. ch including several oxidative enzymes. This study underlines the importance of non-canonical, auxiliary lignin-degrading pathways in the synergy between white rot fungi and Fenton chemistry in lignin degradation. We also found that, relative to the abiotic control, P. ch. increases the availability of Fe(II) for the production of hydroxyl radicals in the Fenton reaction by recycling Fe(III) (p < 0.001), decreasing the Fe(II) inputs necessary for lignin degradation via the Fenton reaction.

Electrochemical Lithiation/Delithiation of ZnO in 3D-Structured Electrodes: Elucidating the Mechanism and the Solid Electrolyte Interphase Formation.

Conversion/alloy active materials, such as ZnO, are one of the most promising candidates to replace graphite anodes in lithium-ion batteries. Besides a high specific capacity (qZnO = 987 mAh g-1), ZnO offers a high lithium-ion diffusion and fast reaction kinetics, leading to a high-rate capability, which is required for the intended fast charging of battery electric vehicles. However, lithium-ion storage in ZnO is accompanied by the formation of lithium-rich solid electrolyte interphase (SEI) layers, immense volume expansion, and a large voltage hysteresis. Nonetheless, ZnO is appealing as an anode material for lithium-ion batteries and is investigated intensively. Surprisingly, the conclusions reported on the reaction mechanism are contradictory and the formation and composition of the SEI are addressed in only a few works. In this work, we investigate lithiation, delithiation, and SEI formation with ZnO in ether-based electrolytes for the first time reported in the literature. The combination of operando and ex situ experiments (cyclic voltammetry, X-ray photoelectron spectroscopy, X-ray diffraction, coupled gas chromatography and mass spectrometry, differential electrochemical mass spectrometry, and scanning electron microscopy) clarifies the misunderstanding of the reaction mechanism. We evidence that the conversion and alloy reaction take place simultaneously inside the bulk of the electrode. Furthermore, we show that a two-layered SEI is formed on the surface. The SEI is decomposed reversibly upon cycling. In the end, we address the issue of the volume expansion and associated capacity fading by incorporating ZnO into a mesoporous carbon network. This approach reduces the capacity fading and yields cells with a specific capacity of above 500 mAh g-1 after 150 cycles.

Incorporating Diamondoids as Electrolyte Additive in the Sodium Metal Anode to Mitigate Dendrite Growth.

Owing to the high abundance and gravimetric capacity (1165.78 mAh g-1 ) of pure sodium, it is considered as a promising candidate for the anode of next-generation batteries. However, one major challenge needs to be solved before commercializing the sodium metal anode: The growth of dendrites during metal plating. One possibility to address this challenge is to use additives in the electrolyte to form a protective solid electrolyte interphase on the anode surface. In this work, we introduce a diamondoid-based additive, which is incorporated into the anode to target this problem. Combining operando and ex situ experiments (electrochemical impedance spectroscopy, optical characterization, and cycling experiments), we show that molecular diamondoids are incorporated into the anode during cycling and successfully mitigate the growth of dendrites. Furthermore, we demonstrate the positive effect of the additive on the operation of sodium-oxygen batteries by means of increased energy density.

Questioning the use of an age-adjusted D-dimer threshold to exclude venous thromboembolism: analysis of individual patient data from two diagnostic studies.

Essentials It is unclear if raising the D-dimer level to exclude venous thrombosis in older patients is valid. We compared this 'age-adjusted' strategy with other ways of interpreting D-dimer results. A non-age adjusted increase, and using higher thresholds in younger patients, was just as accurate. Age-adjustment of D-dimer thresholds does not appear to be appropriate. Click to hear Prof. le Gal's presentation on controversies in venous thromboembolism diagnosis SUMMARY: Background Using a progressively higher D-dimer level to exclude venous thromboembolism (VTE) with increasing age has been proposed but is not well validated. Objective To determine whether it is appropriate to use a progressively higher D-dimer level to exclude VTE with increasing age. Patients/methods We analyzed clinical data and blood samples from 1649 patients with a first suspected deep vein thrombosis or pulmonary embolism. We compared the negative predictive values (NPVs) for VTE, and the proportions of patients with a negative D-dimer result, by using three D-dimer interpretation strategies: a progressively higher D-dimer threshold with increasing age (age-adjusted strategy); the same higher D-dimer threshold in all patients (mean D-dimer strategy); and a progressively higher D-dimer threshold with decreasing age (inverse age-adjusted strategy). Results The NPV with the age-adjusted strategy (99.6%; 95% confidence interval [CI] 99.0-99.9%) was not different from that with the mean D-dimer strategy (99.7%; 95% CI 99.0-99.9%) or that with the inverse age-adjusted strategy (99.8%; 95% CI 99.1-99.9%). The proportion of patients with a negative result with the age-adjusted strategy (50.9%; 95% CI 48.5-53.4%) was not different from the proportion of patients with a negative result with the mean D-dimer strategy (51.7%; 95% CI 49.3-54.1%) or with the inverse age-adjusted strategy (49.5%; 95% CI 47.1-51.9%). Conclusions Our analysis does not support the use of a progressively higher D-dimer level to exclude VTE with increasing age.

D-dimer levels and recurrence in patients with unprovoked VTE and a negative qualitative D-dimer test after treatment.

BACKGROUND: The rate of recurrent venous thromboembolism (VTE) in patients with a first unprovoked VTE who had a negative qualitative D-dimer test one month after stopping anticoagulant therapy was higher than expected in the D-dimer Optimal Duration Study (DODS). OBJECTIVES: To determine whether quantitative D-dimer levels using a low threshold, age- and sex-specific thresholds, or repeated measurements, would improve identification of patients at low risk of recurrent VTE. MATERIALS AND METHODS: D-dimer levels were quantified in banked samples from 307 patients in DODS who had a negative qualitative D-dimer test while on, and 1month after stopping, anticoagulant therapy and the rates of recurrent VTE were determined in patients with D-dimer levels below various predefined thresholds. RESULTS: The rate (per patient year) of recurrent VTE was: 5.9% with D-dimer levels<250µg/l at one month; 5.2% with D-dimer levels between 250 and 499µg/l at one month; 5.0% with D-dimer levels less than predefined age- and sex-specific thresholds at one month; and 6.3% when D-dimer levels were <500µg/l at both one and 7months after stopping anticoagulant therapy. These rates are similar to the overall event rate of 6.3% in patients who stopped treatment. CONCLUSIONS: Among unprovoked VTE patients who had a negative qualitative D-dimer test during and after anticoagulant therapy, low D-dimer thresholds, age and sex-adjusted thresholds or repeated measurements, did not identify subgroups with a very low rate of recurrence.

Macrophage-Induced Blood Vessels Guide Schwann Cell-Mediated Regeneration of Peripheral Nerves.

The peripheral nervous system has remarkable regenerative capacities in that it can repair a fully cut nerve. This requires Schwann cells to migrate collectively to guide regrowing axons across a 'bridge' of new tissue, which forms to reconnect a severed nerve. Here we show that blood vessels direct the migrating cords of Schwann cells. This multicellular process is initiated by hypoxia, selectively sensed by macrophages within the bridge, which via VEGF-A secretion induce a polarized vasculature that relieves the hypoxia. Schwann cells then use the blood vessels as "tracks" to cross the bridge taking regrowing axons with them. Importantly, disrupting the organization of the newly formed blood vessels in vivo, either by inhibiting the angiogenic signal or by re-orienting them, compromises Schwann cell directionality resulting in defective nerve repair. This study provides important insights into how the choreography of multiple cell-types is required for the regeneration of an adult tissue.

(18)F-fluorodeoxyglucose positron-emission tomography-computed tomography to diagnose recurrent cancer.

BACKGROUND: Sometimes the diagnosis of recurrent cancer in patients with a previous malignancy can be challenging. This prospective cohort study assessed the clinical utility of (18)F-fluorodeoxyglucose positron-emission tomography-computed tomography ((18)F-FDG PET-CT) in the diagnosis of clinically suspected recurrence of cancer. METHODS: Patients were eligible if cancer recurrence (non-small-cell lung (NSCL), breast, head and neck, ovarian, oesophageal, Hodgkin's or non-Hodgkin's lymphoma) was suspected clinically, and if conventional imaging was non-diagnostic. Clinicians were asked to indicate their management plan before and after (18)F-FDG PET-CT scanning. The primary outcome was change in planned management after (18)F-FDG PET-CT. RESULTS: Between April 2009 and June 2011, 101 patients (age, median 65 years; 55% female) were enroled from four cancer centres in Ontario, Canada. Distribution by primary tumour type was: NSCL (55%), breast (19%), ovarian (10%), oesophageal (6%), lymphoma (6%), and head and neck (4%). Of the 99 subjects who underwent (18)F-FDG PET-CT, planned management changed after (18)F-FDG PET-CT in 52 subjects (53%, 95% confidence interval (CI), 42-63%); a major change in plan from no treatment to treatment was observed in 38 subjects (38%, 95% CI, 29-49%), and was typically associated with (18)F-FDG PET-CT findings that were positive for recurrent cancer (37 subjects). After 3 months, the stated post-(18)F-FDG PET-CT management plan was actually completed in 88 subjects (89%, 95% CI, 81-94%). CONCLUSION: In patients with suspected cancer recurrence and conventional imaging that is non-diagnostic, (18)F-FDG PET-CT often provides new information that leads to important changes in patient management.

Application of stages of change model to adolescents' physical activity in relation to psychological variables.

AIM: This study investigated the stages of change in physical activity in relation to psychological variables: self-efficacy, physical self-concept and barriers to physical activity, as well as gender. Furthermore, cluster profiles were created based on psychological variables to be compared with stages of change groups. METHODS: Data were obtained from a representative sample of adolescents (N.=1618, 14.46±1.28 years) from Aragon region (Spain). The different strata were selected according to the geographical region, environment, type of school, age and gender RESULTS: Males (75.5%) and very active adolescents (96.9% participant boys and 93.5% participants girls) were more prevalent in the action and maintenance groups. We found significant differences in psychosocial variables by stages of change and gender, showing higher scores in active groups for physical self-concept (effects of gender and stages of change: F(1, 1618)=313.82 P<0.001, η²=0.230) and self-efficacy (F(1, 1618)=324.34 P<0.001, η²=0.236), and lower scores in passive groups for intrapersonal (F(1, 1618)=179.73 P<0.001, η²=0.146) and extrapersonal barriers (F(1, 1618)=189.42 P<0.001, η²=0.153). Psychological cluster profiles created with these variables showed significant relationships with stages of change groups (χ²(1)=162,76, P<0.001; Pearson R=0.359 P<0.001). CONCLUSION: The findings of the research suggest the importance of the study, showing strong determinants of PA, physical self-concept, self-efficacy and perceived barriers, in relation to the intention to change behaviour, not only stage of change model variables. Furthermore, the study can be relevant to designing more effective health promotion programmes in the adolescent population.

[Juvenile nasopharyngeal angiofibroma with orbital extension]. / Angiofibroma nasofaríngeo juvenil con extensión orbitaria.

CLINICAL CASE: The case is presented of a 21 year-old male with a history of left proptosis and diplopia of two weeks of onset. The MRI showed an ethmoid-orbital vascular lesion with anterior skull base invasion and orbital extension. Biopsy of the ethmoid confirmed fibrovascular tissue, which supported the diagnosis of angiofibroma. DISCUSSION: It is a benign neoplasm with local characteristics of malignancy due to its ability to invade adjacent areas. In this case, the debut presented with manifestations of orbital extension. A broad and multidisciplinary approach is needed in order to improve prognosis.

Do epoch lengths affect adolescents' compliance with physical activity guidelines?

AIM: This study examined the effect of different epoch lengths (from 3 to 60 s) on (a) moderate to vigorous physical activity (MVPA), (b) 10 minutes bouts of MVPA and (c) compliance with World Health Organization (WHO) guidelines, as measured with an ActiGraph accelerometer. METHODS: A sample of 401 adolescents (14.48±0.69 years) wore a GT3X accelerometer to measure physical activity (PA) for 7 consecutive days. Data, originally collected in 1-s epoch(s), were then reintegrated into epochs of 3-, 5-, 10-, 15-, 30-, 45- and 60-s. RESULTS: The results showed a significant epoch effect (P=0.000) for time spent in MVPA, 10-min bouts of MVPA and the extent of compliance with guidelines percentage of compliance of guidelines. Bland-Altman analysis showed good agreement between 5- and 10-, 5- and 15-, and 10- and 15-s data, both for MVPA and 10-min bouts of MVPA. CONCLUSION: Epidemiological studies should take into account the sampling interval to offer accurate conclusions with regard to levels of MVPA and the extent to which adolescents comply with guidelines. Shorter epochs, such as 5-, 10- or 15-s are proposed for comparative studies carried out with adolescents in this area.

Competing events in patients with malignant disease who are at risk for recurrent venous thromboembolism.

Patients with malignant disease enrolled in trials of thrombotic disorders may experience competing events such as death. The occurrence of a competing event may prevent the thrombotic event from being observed. Standard survival analysis techniques ignore competing risks, resulting in possible bias and distorted inferences. To assess the impact of competing events on the results of a previously reported trial comparing low molecular weight heparin (LMWH) with oral anticoagulant (OAC) therapy for the prevention of recurrent venous thromboembolism (VTE) in patients with advanced cancer, we compare the results from standard survival analysis with those from competing risk techniques which are based on the cumulative incidence function (CIF) and Gray's test. The Kaplan-Meier method overestimates the risk of recurrent VTE (17.2% in the OAC group and 8.7% in the LMWH group). Risk of recurrence using the CIF is 12.0% and 6.0% in the OAC and LMWH groups, respectively. Both the log-rank test (p=0.002) and Gray's test (p=0.006) suggest evidence in favor of LMWH. The overestimation of risk is 30% in each treatment group, resulting in a similar relative treatment effect; using the Cox model the hazard ratio (HR) is 0.48 (95% confidence interval [CI], 0.30 to 0.78) and HR=0.47 (95% CI, 0.29 to 0.74) using the CIF model. Failing to account for competing risks may lead to incorrect interpretations of the probability of recurrent VTE. However, when the distribution of competing risks is similar within each treatment group, standard and competing risk methods yield comparable relative treatment effects.

Barriers to adolescent girls' participation in physical activity defined by physical activity levels.

AIM: Perceived barriers were the single most powerful predictors of a change in health behaviours and the most consistent negative correlate of children's actual physical activity (PA). The purpose of this study was to compare the perceived barriers of physical activity in 714 adolescent girls defined by physical activity levels. METHODS: The final sample consisted of 714 adolescent, student girls. The age of these students ranged from 12 to 15 years, with a mean age of 13.5 ± 0.7 years. Perceived physical activity and perceived barriers to physical activity were measured using the Physical Self-Description Questionnaire and a Scale of Barriers that includes 17 units of barriers divided into two categories: intrapersonal barriers and environmental/contextual barriers. RESULTS: In our study, girls with a low activity level perceived a greater number of barriers than those with a high activity level, more specifically three intrapersonal barriers and two environmental/contextual barriers. Girls with a low activity level reported greater barriers to physical activity than high-active girls for these barriers: don't like physical activity (F=23.405, p=0.001), not good at physical activity and sports (F=24.160, p=0.001), I'm too lazy to do physical activity (F=8.415, P=0.001), it is not safe to do physical activity outdoors (F=11.39, P<0.001) and there is no-one to do physical activity with (F=15.22 P<0.001). CONCLUSION: This study shows the need to learn and effectively use time management strategies that emphasize prioritising and better scheduling of physical activities.

Physical activity patterns in normal-weight adolescents on week-days and week-ends.

AIM: This study aimed to assess the day-to-day variability of children's physical activity by accelerometer on week-days and week-end days, and to determine the proportion of children that comply with the established physical activity (PA) guidelines. METHODS: Physical activity was recorded every minute by uniaxial accelerometer in 104 normal-weight adolescent students (64 boys and 40 girls) for up to two different weeks (in winter and spring) and over seven consecutive days each week. We examined the difference in minutes for each gender and for the intensity of physical activity over the days of the week. The study took place in the north-east of Spain in 2009. RESULTS: Gender was found to produce the most significant results. Boys engaged in more moderate, vigorous and moderate to vigorous physical activity (MVPA) than girls. Children accumulated more physical activity on week-days than on week-end days. Adolescents' PA is mainly derived from their engagement in light activities. The majority of the adolescents did not reach the recommended ≥60 minutes of MVPA. CONCLUSION: This study suggests that Spanish adolescents engage in limited amounts of MVPA on week-days and week-ends, with activity levels differing according to sex and day of the week. Given that less activity is accumulated at the week-end, especially amongst girls, the out-of-school environment should be the focus for more activity.

[Spinal pleomorphic xantoastrocytoma. Case report]. / Xantoastrocitoma pleomórfico espinal. Caso clínico.

INTRODUCTION: we report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma, an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature. CASE REPORT: a 60 years old woman consulted with doctor because she felt progressive clumsiness accompanied by occasional paresthesias on her left hand. Neurological examination showed up weakness and slight propioceptive disturbances. The differential imagine diagnosis was established between intramedullary astrocytoma and ependimoma. Patient underwent surgical gross total remove. Histopathological examination confirmed the diagnosis of pleomorfic xanthoastrocytoma. We performed MRI controls at 6, 12, 24 and 36 months that did not reveal recurrence. Nowadays, the patient has regained her previous quality of life. DISCUSSION AND CONCLUSION: comparing to published cases about intracranial pleomorphic xanthoastrocytomas, spinal pleomorphic xanthoastrocytomas (SPXA) present different epidemiological characteristics. The known SPXAs affected to cervical and/or high thoracic levels. The hypothesis about a more aggressive behaviour of PXA in spinal cord may be corroborated after literature review. Extension examination is mandatory since dissemination along the neuroaxis has been described. Removal extension is crucial in the prevention of tumour recurrence. Adyuvant radiotherapy should only be considered when there is postoperative residual tumour and/or anaplastic features. Randomized clinical trials or databases are necessary to know all the aspects of this pathological entity.

Xantoastrocitoma pleomórfico espinal. Caso clínico / Spinal pleomorphic xantoastrocytoma. Case report

Introducción. Presentamos los aspectos clinicopatológicos y radiológicos de uno de los escasos casos dexantoastrocitoma pleomórfico espinal publicado, una entidad neoplásica infrecuente en una realmente rara localización. Revisamos la breve literatura inglesa disponible y establecemos un apropiado manejo en función de ésta.Caso clínico. Mujer de 60 años de edad que consultó por acorchamiento progresivo de su mano izquierda, acompañado de ocasionales parestesias de dos meses de evolución. La exploración neurológica mostró debilidad y un leve trastorno de la sensibilidad propioceptiva de la extremidad superior derecha. El diagnóstico diferencial tras las pruebas de imagen se estableció entre astrocitoma y ependimoma. La paciente recibió tratamiento quirúrgico obteniéndose una resección completa y el diagnóstico de xantoastrocitoma pleomórfico. En los controles de imagen realizados a los 6, 12, 24 y 36 meses no seo bjetivó recidiva tumoral. Actualmente la paciente ha recuperado su calidad de vida previa.Discusión y conclusión. Comparando con los xantoastrocitomas pleomórficos intracraneales, aquellos con localización espinal (XAPE) presentan diferentes características epidemiológicas, con afectación predominante de niveles cervical y dorsal alto. La hipótesis de comportamiento más agresivo de los XAPE podría ser corroborada tras la revisión de la literatura. El estudio de extensión es fundamental para descartar la descrita diseminación a través del neuroeje. El grado de extensión de la resección quirúrgica es crucial en la prevención de la recurrencia tumoral. La radioterapia adyuvante debería únicamente considerarse cuando aparece tumor residual y/o anaplasia. Ensayos clínicos randomizados y bases de datos multicéntricas son necesariaspara conocer todos los aspectos de esta entidad neoplásica (AU)

Summary Introduction. We report the clinical, radiological and pathological features of a spinal pleomorphic xanthoastrocytoma,an unusual neoplastic entity in a really rare location, establish an appropriated management of these lesions and review the short available english literature.Case report. A 60 years old woman consulted with doctor because she felt progressive clumsiness accompanied by occasional paresthesias on her left hand.Neurological examination showed up weakness and slight propioceptive disturbances. The differential imagine diagnosis was established between intramedullary astrocytoma and ependimoma. Patient under went surgicalgross total remove. Histopathological examination confirmed the diagnosis of pleomorfic xanthoastrocytoma.We performed MRI controls at 6, 12, 24 and 36 months that did not reveal recurrence. Nowadays, the patient has regained her previous quality of life.Discussion and conclusion. Comparing to published cases about intracranial pleomorphic xanthoastrocytomas, spinal pleomorphic xanthoastrocytomas (SPXA)present different epidemiological characteristics. The known SPXAs affected to cervical and/or high thoraciclevels. The hypothesis about a more aggressive behaviour of PXA in spinal cord may be corroborated after literature review. Extension examination is mandatory since dissemination along the neuroaxis has been described.Removal extension is crucial in the prevention of tumour recurrence. Adyuvant radiotherapy should only be considered when there is postoperative residualtumour and/or anaplastic features. Randomized clinical trials or databases are necessary to know all the aspects of this pathological entity (AU)

Intracranial and fatal bleeding according to indication for long-term oral anticoagulant therapy.

BACKGROUND: Rate of major bleeding is generally accepted as a good measure of the risks associated with anticoagulant therapy, but this may not be true if the proportion of major bleeds with the most serious consequences differs according to the indication for anticoagulant therapy. OBJECTIVE: To determine whether the indication for long-term oral anticoagulant therapy influences the proportion of major bleeds that are intracranial and fatal. PATIENTS/METHODS: Two authors abstracted intracranial and fatal bleeds from randomized trials of patients who received anticoagulant therapy for a minimum of 6months for atrial fibrillation, ischemic heart disease, venous thromboembolism, prosthetic heart valves and ischemic stroke. RESULTS: There were 877 major bleeds among 23,518 patients in 39 studies. The proportion of bleeds that were intracranial was significantly higher in patients with ischemic stroke (36%; 95% CI, 22-52%; P=0.02) compared with patients with venous thromboembolism (10%; 95% CI, 5-20%). The difference in the proportion of bleeds that were intracranial among atrial fibrillation, ischemic heart disease, venous thromboembolism and prosthetic heart valves was not statistically significant; however, the estimates varied from 10% to 27%. The proportion of bleeds that were fatal did not differ significantly according to indication, but varied from 8% to 20%. For all indications for anticoagulation, intracranial bleeds were much more likely to be fatal than extracranial major bleeds (44% vs. 4% overall). CONCLUSIONS: In current practise, the indication for oral anticoagulant therapy has limited influence on the proportion of major bleeds that are intracranial or fatal.