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1.
Acta Neurochir (Wien) ; 166(1): 152, 2024 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-38532155

RESUMO

PURPOSE: Surgical resection with bony margins would be the treatment of choice for tumours with osseous involvement such as meningiomas and metastasis. By developing and designing pre-operative customised 3D modelled implants, the patient can undergo resection of meningioma and repair of bone defect in the same operation. We present a generalisable method for designing pre-operative cranioplasty in patients to repair the bone defect after the resection of tumours. MATERIALS AND METHODS: We included six patients who presented with a tumour that was associated with overlying bone involvement. They underwent placement of customised cranioplasty in the same setting. A customised implant using a pre-operative imaging was designed with a 2-cm margin to allow for any intra-operative requirements for extending the craniectomy. RESULTS: Six patients were evaluated in this case series. Four patients had meningiomas, 1 patient had metastatic breast cancer on final histology, and 1 patient was found to have an intra-osseous arteriovenous malformation. Craniectomy based on margins provided by a cutting guide was fashioned. After tumour removal and haemostasis, the cranioplasty was then placed. All patients recovered well post-operatively with satisfactory cosmetic results. No wound infection was reported in our series. CONCLUSION: Our series demonstrate the feasibility of utilising pre-designed cranioplasty for meningiomas and other tumours with osseous involvement. Following strict infection protocols, minimal intra-operative handling/modification of the implant, and close follow-up has resulted in good cosmetic outcomes with no implant-related infections.


Assuntos
Craniectomia Descompressiva , Neoplasias Meníngeas , Meningioma , Procedimentos de Cirurgia Plástica , Humanos , Meningioma/cirurgia , Craniectomia Descompressiva/métodos , Crânio/cirurgia , Complicações Pós-Operatórias/cirurgia , Neoplasias Meníngeas/cirurgia , Estudos Retrospectivos
2.
Brain Spine ; 4: 102761, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38510640

RESUMO

Introduction: Planning cranioplasty (CPL) in patients with suspected or proven post-traumatic hydrocephalus (PTH) poses a significant management challenge due to a lack of clear guidance. Research question: This project aims to create a European document to improve adherence and adapt to local protocols based on available resources and national health systems. Methods: After a thorough non-systematic review, a steering committee (SC) formed a European expert panel (EP) for a two-round questionnaire using the Delphi method. The questionnaire employed a 9-point Likert scale to assess the appropriateness of statements inherent to two sections: "Diagnostic criteria for PTH" and "Surgical strategies for PTH and cranial reconstruction." Results: The panel reached a consensus on 29 statements. In the "Diagnostic criteria for PTH" section, five statements were deemed "appropriate" (consensus 74.2-90.3 %), two were labeled "inappropriate," and seven were marked as "uncertain."In the "Surgical strategies for PTH and cranial reconstruction" section, four statements were considered "appropriate" (consensus 74.2-90.4 %), six were "inappropriate," and five were "uncertain." Discussion and conclusion: Planning a cranioplasty alongside hydrocephalus remains a significant challenge in neurosurgery. Our consensus conference suggests that, in patients with cranial decompression and suspected hydrocephalus, the most suitable diagnostic approach involves a combination of evolving clinical conditions and neuroradiological imaging. The recommended management sequence prioritizes cranial reconstruction, with the option of a ventriculoperitoneal shunt when needed, preferably with a programmable valve. We strongly recommend to adopt local protocols based on expert consensus, such as this, to guide patient care.

3.
Brain Spine ; 3: 102702, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-38021005

RESUMO

Introduction: The epidemiology and prognosis of the isolated traumatic brain injury (TBI) and spinal cord injury (SCI) are well studied. However, the knowledge of the impact of concurrent neurotrauma is very limited. Research questions: To characterize the longitudinal incidence of concurrent TBI and SCI and to investigate their combined impact on clinical care and outcomes, compared to a comparative but isolated SCI or TBI. Materials and methods: Data from 167,793 patients in the Trauma Audit and Research Network (TARN) registry collected in England and Wales between 2008 and 2018 were analysed. Tandem neurotrauma was defined as patients with concurrent TBI and SCI. The patient with isolated TBI or SCI was matched to the patient with tandem neurotrauma using propensity scores. Results: The incidence of tandem neurotrauma increased tenfold between 2008 and 2018, from 0.21 to 2.21 per 100,000 person-years. Patients in the tandem neurotrauma group were more likely to require multiple surgeries, ICU admission, longer ICU and hospital LOS, higher 30-day mortality, and were more likely to be transferred to acute hospitals and rehabilitation or suffer death at discharge, compared to patients with isolated TBI. Likewise, individuals with tandem neurotrauma compared to those with isolated SCI had a higher tendency to receive more than one surgery, ICU admission, longer LOS for ICU and higher mortality either at 30-day follow-up or at discharge. Discussion and conclusions: The incidence of tandem neurotrauma has increased steadily during the past decade. Its occurrence leads to greater mortality and care requirements, particularly when compared to TBI alone. Further investigations are warranted to improve outcomes in tandem neurotrauma.

4.
Br J Neurosurg ; : 1-11, 2023 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-37698133

RESUMO

BACKGROUND: The increased popularity of cycling is leading to an anticipated increase in cycling-related traffic accidents and a need to better understand the demographics and epidemiology of craniospinal injuries in this vulnerable road user group. This study aims to systematically investigate and characterise cycling-related head and spine injuries seen in the Major Trauma Centre for the Eastern region, which has the highest cycling rates in the UK. METHODS: We performed a retrospective cohort study comparing the incidence, patterns, and severity of head and spine injuries in pedal cyclists presenting to the Major Trauma Centre in Cambridge between January 2012 and December 2020. Comparisons of injury patterns, characteristics, and associations were made according to mechanism of injury, helmet use, patient age and gender. RESULTS: A total of 851 patients were admitted after being involved in cycling-related collisions over the study period, with 454 (53%) sustaining head or spine injuries. The majority of victims (80%) were male and in mid-adulthood (median age 46 years). Head injuries were more common than spine injuries, with the most common head injuries being intracranial bleeds (29%), followed by skull fractures (12%), and cerebral contusions (10%). The most common spine injuries were cervical segment fractures, particularly C6 (9%), C7 (9%), and C2 (8%). Motorised collisions had a higher prevalence of spine fractures at each segment (p < 0.001) and were associated with a higher proportion of multi-vertebral fractures (p < 0.001). These collisions were also associated with impaired consciousness at the scene and more severe systemic injuries, including a lower Glasgow coma scale (R = -0.23, p < 0.001), higher injury severity score (R = 0.24, p < 0.001), and longer length of stay (R = 0.21, p < 0.001). Helmet use data showed that lack of head protection was associated with more severe injuries and poorer outcomes. CONCLUSION: As cycling rates continue to increase, healthcare providers may expect to see an increase in bicycle-related injuries in their practice. The insights gained from this study can inform the treatment of these injuries while highlighting the need for future initiatives aimed at increasing road safety and accident prevention.


Study of 851 cycling-related trauma patients in Cambridge, UK, shows high rates of head & spine injuries.Motorised collisions were associated with more severe injuries and impaired consciousness at the scene.The lack of helmet use was linked to more severe head injuries and impaired consciousness, but not to a longer hospital stay.Rising cycling rates may lead to increased incidence of these injuries in clinical practice.Our findings may be relevant for clinicians treating cycling-related traumatic injuries to head and spine.

5.
World Neurosurg ; 176: e68-e76, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37141939

RESUMO

BACKGROUND: Mixed reality (MR) technology has opened new avenues for planning, visualization, and education in surgery. Neurosurgical pathologies require a very clear understanding of the relationships between pathology and critical neurovascular structures. The decline in cadaveric dissections and resource constraints has pushed the educators to find newer ways of rendering the same knowledge. The aim of this study was to determine the feasibility of employing a MR device in a high-volume center for neurosurgical teaching. The study also evaluated the results of the trainee experience in using the MR platform. METHODS: Three neurosurgical consultants who are part of the teaching faculty were asked to facilitate the session. No prior training on utilizing the MR device was given to the trainees. HoloLens 2 was used as the MR device. Two questionnaires were used to understand the experience of the trainees. RESULTS: Eight active neurosurgical trainees who are currently training at our institution were recruited for the purposes of this study. Despite having no prior training on a MR platform, the learning curve was short for most of the trainees. Whether MR replace current traditional methods of teaching neuroanatomy, the response was divided across the trainees. The results of the User Experience Questionnaire were positive with the trainees finding the device as attractive, dependable, novel, and user-friendly. CONCLUSION: This study demonstrates the feasibility of using MR platform in neurosurgery training without significant preparation requirements. These data are required to justify the future investment in this technology for training institutions.


Assuntos
Realidade Aumentada , Neurocirurgia , Humanos , Neurocirurgia/educação , Procedimentos Neurocirúrgicos/métodos , Curva de Aprendizado , Escolaridade
6.
N Engl J Med ; 388(24): 2219-2229, 2023 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-37092792

RESUMO

BACKGROUND: Traumatic acute subdural hematomas frequently warrant surgical evacuation by means of a craniotomy (bone flap replaced) or decompressive craniectomy (bone flap not replaced). Craniectomy may prevent intracranial hypertension, but whether it is associated with better outcomes is unclear. METHODS: We conducted a trial in which patients undergoing surgery for traumatic acute subdural hematoma were randomly assigned to undergo craniotomy or decompressive craniectomy. An inclusion criterion was a bone flap with an anteroposterior diameter of 11 cm or more. The primary outcome was the rating on the Extended Glasgow Outcome Scale (GOSE) (an 8-point scale, ranging from death to "upper good recovery" [no injury-related problems]) at 12 months. Secondary outcomes included the GOSE rating at 6 months and quality of life as assessed by the EuroQol Group 5-Dimension 5-Level questionnaire (EQ-5D-5L). RESULTS: A total of 228 patients were assigned to the craniotomy group and 222 to the decompressive craniectomy group. The median diameter of the bone flap was 13 cm (interquartile range, 12 to 14) in both groups. The common odds ratio for the differences across GOSE ratings at 12 months was 0.85 (95% confidence interval, 0.60 to 1.18; P = 0.32). Results were similar at 6 months. At 12 months, death had occurred in 30.2% of the patients in the craniotomy group and in 32.2% of those in the craniectomy group; a vegetative state occurred in 2.3% and 2.8%, respectively, and a lower or upper good recovery occurred in 25.6% and 19.9%. EQ-5D-5L scores were similar in the two groups at 12 months. Additional cranial surgery within 2 weeks after randomization was performed in 14.6% of the craniotomy group and in 6.9% of the craniectomy group. Wound complications occurred in 3.9% of the craniotomy group and in 12.2% of the craniectomy group. CONCLUSIONS: Among patients with traumatic acute subdural hematoma who underwent craniotomy or decompressive craniectomy, disability and quality-of-life outcomes were similar with the two approaches. Additional surgery was performed in a higher proportion of the craniotomy group, but more wound complications occurred in the craniectomy group. (Funded by the National Institute for Health and Care Research; RESCUE-ASDH ISRCTN Registry number, ISRCTN87370545.).


Assuntos
Craniotomia , Craniectomia Descompressiva , Hematoma Subdural Agudo , Humanos , Craniotomia/efeitos adversos , Craniotomia/métodos , Craniectomia Descompressiva/efeitos adversos , Craniectomia Descompressiva/métodos , Escala de Resultado de Glasgow , Hematoma Subdural Agudo/cirurgia , Qualidade de Vida , Estudos Retrospectivos , Crânio/cirurgia , Resultado do Tratamento , Retalhos Cirúrgicos/cirurgia
7.
Nanomaterials (Basel) ; 13(4)2023 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-36839064

RESUMO

Recently, two-dimensional materials have attracted attention owing to their special optical characteristics and miniaturization, with low thickness as well as extremely high responsivity. Additionally, Tamm plasmon polariton (TPP) resonance can be observed by combining a metal film and a one-dimensional (1D) photonic crystal (PC), where an electric field confinement is located at the metal-1D PC interface. In this study, a graphene layer combined with a TPP is proposed as a wavelength- and angle-selective photodetector. The graphene layer is located where the strong field confinement occurs, and the photocurrent response is significantly enhanced with increasing absorption by over four times (from 62.5 µA⋅W-1 to 271 µA⋅W-1 and undetected state to 330 µA⋅W-1 in two different samples). Moreover, the graphene-TPP photodetector has wavelength and angle selectivity, which can be applied in LiDAR detecting, sun sensors, laser beacon tracking, and navigational instruments in the future.

8.
J Neurotrauma ; 40(3-4): 195-209, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36112699

RESUMO

After traumatic brain injury (TBI), cerebral metabolism can become deranged, contributing to secondary injury. Cerebral microdialysis (CMD) allows cerebral metabolism assessment and is often used with other neuro-monitoring modalities. CMD-derived parameters such as the lactate/pyruvate ratio (LPR) show a failure of oxidative energy generation. CMD-based abnormal metabolic states can be described following TBI, informing the etiology of physiological derangements. This systematic review summarizes the published literature on microdialysis-based abnormal metabolic classifications following TBI. Original research studies in which the populations were patients with TBI were included. Studies that described CMD-based classifications of metabolic abnormalities were included in the synthesis of the narrative results. A total of 825 studies underwent two-step screening after duplicates were removed. Fifty-three articles that used CMD in TBI patients were included. Of these, 14 described abnormal metabolic states based on CMD parameters. Classifications were heterogeneous between studies. LPR was the most frequently used parameter in the classifications; high LPR values were described as metabolic crisis. Ischemia was consistently defined as high LPR with low CMD substrate levels (glucose or pyruvate). Mitochondrial dysfunction, describing inability to use energy substrate despite availability, was identified based on raised LPR with near-normal levels of pyruvate. This is the first systematic review summarizing the published literature on microdialysis-based abnormal metabolic states following TBI. Although variability exists among individual classifications, there is broad agreement about broad definitions of metabolic crisis, ischemia, and mitochondrial dysfunction. Identifying the etiology of deranged cerebral metabolism after TBI is important for targeting therapeutic interventions.


Assuntos
Lesões Encefálicas Traumáticas , Humanos , Microdiálise/métodos , Lesões Encefálicas Traumáticas/metabolismo , Glucose/metabolismo , Metabolismo Energético/fisiologia , Ácido Pirúvico/metabolismo , Ácido Pirúvico/uso terapêutico , Encéfalo
9.
Environ Geochem Health ; 45(5): 1669-1694, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-35583719

RESUMO

Benzo[a]pyrene (BaP) is one of the priority pollutants in the urban environment. For the first time, the accumulation of BaP in road dust on different types of Moscow roads has been determined. The average BaP content in road dust is 0.26 mg/kg, which is 53 times higher than the BaP content in the background topsoils (Umbric Albeluvisols) of the Moscow Meshchera lowland, 50 km east of the city. The most polluted territories are large roads (0.29 mg/kg, excess of the maximum permissible concentration (MPC) in soils by 14 times) and parking lots in the courtyards (0.37 mg/kg, MPC excess by 19 times). In the city center, the BaP content in the dust of courtyards reaches 1.02 mg/kg (MPC excess by 51 times). The accumulation of BaP depends on the parameters of street canyons formed by buildings along the roads: in short canyons (< 500 m), the content of BaP reaches maximum. Relatively wide canyons accumulate BaP 1.6 times more actively than narrow canyons. The BaP accumulation in road dust significantly increases on the Third Ring Road (TRR), highways, medium and small roads with an average height of the canyon > 20 m. Public health risks from exposure to BaP-contaminated road dust particles were assessed using the US EPA methodology. The main BaP exposure pathway is oral via ingestion (> 90% of the total BaP intake). The carcinogenic risk for adults is the highest in courtyard areas in the south, southwest, northwest, and center of Moscow. The minimum carcinogenic risk is characteristic of the highways and TRR with predominance of nonstop traffic.


Assuntos
Poluentes Atmosféricos , Hidrocarbonetos Policíclicos Aromáticos , Poeira/análise , Benzo(a)pireno , Hidrocarbonetos Policíclicos Aromáticos/análise , Poluentes Atmosféricos/análise , Moscou , Monitoramento Ambiental/métodos , Carcinógenos/análise , Medição de Risco
10.
JMIR Res Protoc ; 12: e37442, 2023 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-35759752

RESUMO

BACKGROUND: Core outcome sets (COSs) are important and necessary as they help standardize reporting in research studies. Cranioplasty following traumatic brain injury (TBI) or stroke is becoming increasingly common, leading to an ever-growing clinical and research interest, especially regarding the optimal material, cost-effectiveness, and timing of cranioplasty concerning neurological recovery and complications. Consequently, heterogeneous reporting of outcomes from such diverse studies has led to limited meta-analysis ability and an ongoing risk of outcome reporting bias. This study aims to define a standardized COS for reporting in all future TBI and stroke cranioplasty studies. OBJECTIVE: This study has four aims: (1) undertake a systematic review to collate the most current outcome measures used within the cranioplasty literature; (2) undertake a qualitative study to understand better the views of clinicians, patients' relatives, and allied health professionals regarding clinical outcomes following cranioplasty; (3) undertake a Delphi survey as part of the process of gaining consensus for the COS; and (4) finalize consensus through a consensus meeting resulting in the COS. METHODS: An international steering committee has been formed to guide the development of the COS. In addition, recommendations from other clinical initiatives such as COMET (Core Outcomes and Effectiveness Trials) and OMERACT (Outcome Measures in Rheumatology) have been adhered to. Phase 1 is data collection through a systematic review and qualitative study. Phase 2 is the COS development through a Delphi survey and consensus meetings with consensus definitions decided and agreed upon before the Delphi survey begins to avoid bias. RESULTS: Phase 1 started at the end of 2019, following ethical approval in December 2019, and the project completion date is planned for the end of 2022 or beginning of 2023. CONCLUSIONS: This study should result in a consensus on a COS for cranioplasty, following TBI or stroke, to help standardize outcome reporting for future studies, which can be applied to future research and clinical services, help align future studies, build an increased understanding of cranioplasty and its impact on a patient's function and recovery, and help standardize the evidence base. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37442.

11.
Br J Neurosurg ; : 1-7, 2022 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-36495241

RESUMO

PURPOSE: The degree of disability that is acceptable to patients following traumatic brain injury (TBI) continues to be debated. While the dichotomization of outcome on the Glasgow Outcome Score (GOSE) into 'favourable' and 'unfavourable' continues to guide clinical decisions, this may not reflect an individual's subjective experience. The aim of this study is to assess how patients' self-reported quality of life (QoL) relates to objective outcome assessments and how it compares to other debilitating neurosurgical pathologies, including subarachnoid haemorrhage (SAH) and cervical myelopathy. METHOD: A retrospective analysis of over 1300 patients seen in Addenbrooke's Hospital, Cambridge, UK with TBI, SAH and patients pre- and post- cervical surgery was performed. QoL was assessed using the SF-36 questionnaire. Kruskal-Wallis test was used to analyse the difference in SF-36 domain scores between the four unpaired patient groups. To determine how the point of dichotomization of GOSE into 'favourable' and 'unfavourable' outcome affected QOL, SF-36 scores were compared between GOSE and mRS. RESULTS: There was a statistically significant difference in the median Physical Component Score (PCS) and Mental Component Score (MCS) of SF-36 between the three neurosurgical pathologies. Patients with TBI and SAH scored higher on most SF-36 domains when compared with cervical myelopathy patients in the severe category. While patients with Upper Severe Disability on GOSE showed significantly higher PC and MC scores compared to GOSE 3, there was a significant degree of variability in individual responses across the groups. CONCLUSION: A significant number of patients following TBI and SAH have better self-reported QOL than cervical spine patients and patients' subjective perception and expectations following injury do not always correspond to objective disability. These results can guide discussion of treatment and outcomes with patients and families.

12.
Materials (Basel) ; 15(22)2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36431584

RESUMO

Soft matters include polymers, liquid crystals, colloids, biological tissues, and many smart materials [...].

13.
Appl Opt ; 61(17): 5049-5054, 2022 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-36256182

RESUMO

The influence of the volume fraction of plasmonic nanoparticles on the efficiency of the Tamm-plasmon-polariton-based organic solar cell is investigated in the framework of temporal coupled mode theory and confirmed by the transfer matrix method. It is shown that, unlike a conventional plasmonic solar cell, in which the efficiency is directly proportional to the volume fraction of nanoparticles in the photosensitive layer, the efficiency of the proposed solar cell reaches the highest value at low volume fractions. This effect is explained by the fact that at these volume fractions, the critical coupling condition of the incident field with the Tamm plasmon polariton is fulfilled. Thus, for the incoming radiation range of 350 to 500 nm, a maximal cell efficiency of 28% is achieved with a volume fraction of nanoparticles equal to 10%. Additionally, the optical properties of the photosensitive layer are compared for the cases of determining its complex refractive index by effective medium theory and the S-parameter retrieval method. A good agreement between the results is demonstrated, which encourages the use of the effective medium theory for preliminary calculations.

14.
Materials (Basel) ; 15(17)2022 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-36079396

RESUMO

We consider Tamm plasmon polariton in a subwavelength grating patterned on top of a Bragg reflector. We demonstrate dynamic control of the phase and amplitude of a plane wave reflected from such metagrating due to resonant coupling with the Tamm plasmon polariton. The tunability of the phase and amplitude of the reflected wave arises from modulation of the refractive index of a transparent conductive oxide layer by applying the bias voltage. The electrical switching of diffracted beams of the ±1st order is shown. The possibility of doubling the angular resolution of beam steering by using asymmetric reflected phase distribution with integer and half-integer periods of the metagrating is demonstrated.

15.
JAMA Neurol ; 79(7): 664-671, 2022 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-35666526

RESUMO

Importance: Trials often assess primary outcomes of traumatic brain injury at 6 months. Longer-term data are needed to assess outcomes for patients receiving surgical vs medical treatment for traumatic intracranial hypertension. Objective: To evaluate 24-month outcomes for patients with traumatic intracranial hypertension treated with decompressive craniectomy or standard medical care. Design, Setting, and Participants: Prespecified secondary analysis of the Randomized Evaluation of Surgery With Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp) randomized clinical trial data was performed for patients with traumatic intracranial hypertension (>25 mm Hg) from 52 centers in 20 countries. Enrollment occurred between January 2004 and March 2014. Data were analyzed between 2018 and 2021. Eligibility criteria were age 10 to 65 years, traumatic brain injury (confirmed via computed tomography), intracranial pressure monitoring, and sustained and refractory elevated intracranial pressure for 1 to 12 hours despite pressure-controlling measures. Exclusion criteria were bilateral fixed and dilated pupils, bleeding diathesis, or unsurvivable injury. Interventions: Patients were randomly assigned 1:1 to receive a decompressive craniectomy with standard care (surgical group) or to ongoing medical treatment with the option to add barbiturate infusion (medical group). Main Outcomes and Measures: The primary outcome was measured with the 8-point Extended Glasgow Outcome Scale (1 indicates death and 8 denotes upper good recovery), and the 6- to 24-month outcome trajectory was examined. Results: This study enrolled 408 patients: 206 in the surgical group and 202 in the medical group. The mean (SD) age was 32.3 (13.2) and 34.8 (13.7) years, respectively, and the study population was predominantly male (165 [81.7%] and 156 [80.0%], respectively). At 24 months, patients in the surgical group had reduced mortality (61 [33.5%] vs 94 [54.0%]; absolute difference, -20.5 [95% CI, -30.8 to -10.2]) and higher rates of vegetative state (absolute difference, 4.3 [95% CI, 0.0 to 8.6]), lower or upper moderate disability (4.7 [-0.9 to 10.3] vs 2.8 [-4.2 to 9.8]), and lower or upper severe disability (2.2 [-5.4 to 9.8] vs 6.5 [1.8 to 11.2]; χ27 = 24.20, P = .001). For every 100 individuals treated surgically, 21 additional patients survived at 24 months; 4 were in a vegetative state, 2 had lower and 7 had upper severe disability, and 5 had lower and 3 had upper moderate disability, respectively. Rates of lower and upper good recovery were similar for the surgical and medical groups (20 [11.0%] vs 19 [10.9%]), and significant differences in net improvement (≥1 grade) were observed between 6 and 24 months (55 [30.0%] vs 25 [14.0%]; χ22 = 13.27, P = .001). Conclusions and Relevance: At 24 months, patients with surgically treated posttraumatic refractory intracranial hypertension had a sustained reduction in mortality and higher rates of vegetative state, severe disability, and moderate disability. Patients in the surgical group were more likely to improve over time vs patients in the medical group. Trial Registration: ISRCTN Identifier: 66202560.


Assuntos
Lesões Encefálicas Traumáticas , Lesões Encefálicas , Craniectomia Descompressiva , Hipertensão Intracraniana , Adolescente , Adulto , Idoso , Lesões Encefálicas/complicações , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Lesões Encefálicas Traumáticas/cirurgia , Criança , Craniectomia Descompressiva/métodos , Feminino , Humanos , Hipertensão Intracraniana/complicações , Hipertensão Intracraniana/cirurgia , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente , Resultado do Tratamento , Adulto Jovem
16.
BMJ Open ; 12(4): e048072, 2022 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-35459659

RESUMO

INTRODUCTION: Cranioplasty is a widely practised neurosurgical procedure aimed at reconstructing a skull defect, but its impact on a patient's rehabilitation following a traumatic brain injury (TBI) or stroke could be better understood. In addition, there are many issues that a TBI patient or the patient who had a stroke and their families may have to adapt to. Insight into some of the potential social barriers, including issues related to social engagement and cosmetic considerations, would be beneficial. Currently, little is known about how this procedure impacts a patient's recovery, the patient's perceptions of rehabilitation precranioplasty and postcranioplasty and the broader issues of cosmesis and social reintegration. This study hopes to understand some of these issues and therefore help inform clinicians of some of the difficulties and perceptions that patients and their relatives may have. METHODS AND ANALYSIS: A mixed-methods study. Data will be collected through focus groups with healthcare professionals (HCPs) and semi-structured interviews with patients and their relatives, field notes, a researcher diary and a patient questionnaire. Different perspectives will be brought together through method triangulation. Patient and relative data will be analysed using interpretive phenomenological analysis, and HCPs data will be analysed thematically using deductive and inductive coding. ETHICS AND DISSEMINATION: Ethical approval has been obtained from the Wales REC 7 ethics committee (Rec ref: 19/WA/0315). There is limited literature regarding a patient's perception of the cranioplasty process, the potential impact on rehabilitation and how this may impact their reintegration into the community. The results of this study will be presented at national brain injury conferences and published in peer-reviewed, national and international journals.


Assuntos
Lesões Encefálicas Traumáticas , Acidente Vascular Cerebral , Lesões Encefálicas Traumáticas/cirurgia , Pessoal de Saúde , Humanos , Projetos de Pesquisa , Crânio
17.
Nanomaterials (Basel) ; 12(6)2022 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-35335740

RESUMO

An electrode of a light-induced cell for water splitting based on a broadband Tamm plasmon polariton localized at the interface between a thin TiN layer and a chirped photonic crystal has been developed. To facilitate the injection of hot electrons from the metal layer by decreasing the Schottky barrier, a thin n-Si film is embedded between the metal layer and multilayer mirror. The chipping of a multilayer mirror provides a large band gap and, as a result, leads to an increase in the integral absorption from 52 to 60 percent in the wavelength range from 700 to 1400 nm. It was shown that the photoresponsivity of the device is 32.1 mA/W, and solar to hydrogen efficiency is 3.95%.

18.
Phys Chem Chem Phys ; 24(7): 4475-4484, 2022 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-35113093

RESUMO

Triplet states of photoexcited organic molecules are promising spin labels with advanced spectroscopic properties for pulsed dipolar electron paramagnetic resonance (PD EPR) spectroscopy. Recently proposed triplet fullerene labels have shown great potential for double electron-electron resonance (DEER) distance measurements as "observer spins" due to a high quantum yield of the triplet state, hyperpolarization and relatively narrow EPR spectra. Here, we demonstrate the applicability of fullerene labels to other PD EPR techniques, such as relaxation induced dipolar modulation enhancement (RIDME) and laser induced magnetic dipolar spectroscopy (LaserIMD). In particular, a specific contaminating signal in LaserIMD experiments was observed, explained and mitigated. Comparative analyses of the signal-to-noise (SNR) ratios were performed for all employed methods. DEER on the fullerene-triarylmethyl pair shows the best performance, which allows state-of-the-art DEER acquisition at 100 nM with a SNR of ∼35 within reasonable 42 hours.


Assuntos
Fulerenos , Espectroscopia de Ressonância de Spin Eletrônica/métodos , Marcadores de Spin
19.
ACS Nano ; 16(4): 5994-6001, 2022 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-35191683

RESUMO

In O-and C-band optical communications, Ge is a promising material for detecting optical signals that are encoded into electrical signals. Herein, we study 2D periodic Ge metasurfaces that support optically induced electric dipole and magnetic dipole lattice resonances. By overlapping Mie resonances and electric dipole lattice resonances, we realize the resonant lattice Kerker effect and achieve narrowband absorption. This effect was applied to the photodetector demonstrated in this study. The absorptance of the Ge nanoantenna arrays increased 6-fold compared to that of the unpatterned Ge films. In addition, the photocurrent in such Ge metasurface photodetectors increases by approximately 5 times compared with that in plane Ge film photodetectors by the interaction of these strong near-fields with semiconductors and the further transformation of the optical energy into electricity.

20.
Nanomaterials (Basel) ; 12(2)2022 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-35055252

RESUMO

This numerical study demonstrates the possibility of exciting a chiral optical Tamm state localized at the interface between a cholesteric liquid crystal and a polarization-preserving anisotropic mirror conjugated to a metasurface. The difference of the proposed structure from a fully dielectric one is that the metasurface makes it possible to decrease the number of layers of a polarization-preserving anisotropic mirror by a factor of more than two at the retained Q-factor of the localized state. It is shown that the proposed structure can be used in a vertically emitting laser.

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