Pineal Region Gliomas: A Systematic Review of Clinical Features and Treatment Outcomes.

BACKGROUND/AIM: To review the current literature on pineal region gliomas, summarizing the clinical characteristics and treatment outcomes. MATERIALS AND METHODS: PubMed, Scopus, and Cochrane databases were used to identify relevant articles. Comprehensive clinical characteristic review and survival analysis were conducted. RESULTS: Twelve studies describing 81 patients were included. The median age was 39 years (male=54.3%). Fifty patients (61.7%) had obstructive hydrocephalus requiring cerebrospinal fluid diversion with either ventriculoperitoneal shunt (VPS) (40.0%) or endoscopic third ventriculostomy (ETV) (24.0%). Patients who underwent VPS had significant survival benefits compared to ETV (p<0.05). All patients in our review underwent surgery, and gross-total resection (≥98%) was achieved in 34.6%. The supracerebellar infratentorial approach was the most employed surgical approach (62.3%). Chemotherapy was administered in 32.1% of cases, and radiotherapy in 40.7%. The median overall survival (OS) was 12 months, and the overall one-year survival rate was 60%. CONCLUSION: This study could not establish a correlation between the extent of tumor resection and positive treatment outcomes. However, among cases with hydrocephalus, patients who underwent VPS placement had better survival as compared to ETV.

Postoperative opioid prescribing practices in US adult trauma patients: A systematic review.

BACKGROUND: Opioids have been proven effective in pain management, but overprescription can lead to addiction and abuse. Although current guidelines regarding opioid prescription for chronic and acute pain are available, they fail to address the use of opioids for pain management in traumatic injury patients who undergo operations. The primary objective of this study was to examine opioid prescribing practices for US adult trauma patients who require surgical management, based on prior history of opioid use, type of surgical practice, and age. METHODS: PubMed and Cochrane Journals were used to identify relevant articles between October 2010 and December 29, 2020. Our primary outcome was discrepancies of morphine milligram equivalents (MMEs) prescribed to trauma patients. Significance was defined as p < 0.05. RESULTS: Eleven studies on US trauma patients prescribed opioids were evaluated, creating a total of 30,249 patients stratified by prior opioid use, age, and race. Patterns seen among patients with prior opioid use include higher MMEs prescribed, lower likelihoods of opioid discontinuation, higher mortality rates, and higher complication rates. Orthopedic surgeons prescribed higher values of MMEs than nonorthopedic surgeons. CONCLUSION: Higher incidences of opioid prescriptions are seen with orthopedic trauma surgery and prior opioid use by the patient. We recommend further development of national protocol implementation for acute pain management for the US trauma population. LEVEL OF EVIDENCE: Systematic review, level III.

An Analysis of Patients Dead on Arrival in the American College of Surgeons Trauma Quality Program Participant Use File Data Set.

BACKGROUND: Trauma patient care begins on-scene as field triage and mode of transportation are determinants of patient outcomes. This study evaluates the US national patterns of dead on arrival (DOA) among the trauma population. METHODS: A cross-sectional review of the American College of Surgeons (ACS) Trauma Quality Program Participant Use File (TQP-PUF) data set (2013-2017) was performed. Trauma patients reported as DOA were stratified by ISS into low (<15), intermediate (15-24), or high (≥25) severity. Each group was then subdivided by patient demographics, mechanism, type of injury, and mode of transportation. RESULTS: Of the 4 336 816 injury cases in the TQP-PUF data set, 33 199 were DOA (.77%). 77.1% (25 604/33 199) of DOAs were male. In the low-ISS group, .36% (13 272/3 639 811) were DOA; in the intermediate-ISS group, 1.2% (4868/421 994) were DOA; and in the high-ISS group, 5.5% (15 059/275 011) were DOA. Motor vehicle collisions (MVCs) (11 262) and firearms (8894) were the most common injury types, equating to 60.7% of DOAs. Falls accounted for 9.1% of all DOAs. The most common DOA age-group was 18-64 years, followed by ≥65 years. CONCLUSION: DOA trauma patients are predominately adult men suffering fatal blunt force injuries most frequently via MVC. DOAs are caused by all ranges of injury severity. We recommend further development of prevention programs thereby reducing the prevalence of common traumatic injuries, notably MVC, falls, and firearms to improve survival. Future studies should also investigate the access to and distribution of trauma centers and the role of helicopter, ground, and police transport modalities and transport time on and reducing DOAs and improving trauma patient outcomes.

Comparison of Blister Aneurysm Treatment Techniques: A Systematic Review and Meta-Analysis.

OBJECTIVE: Blood blister aneurysms are small, thin-walled, rapidly growing side-wall aneurysms that have proved particularly difficult to treat, and evidence-based guidance for treatment strategies is lacking. A systematic review and meta-analysis was performed to aggregate the available data and compare the 3 primary treatment modalities. METHODS: We performed a comprehensive literature search according to PRISMA guidelines followed by an indirect meta-analysis that compares the safety and efficacy of surgical, flow-diverting stents (FDS), and other endovascular approaches for the treatment of ruptured blood blister aneurysms. RESULTS: A total of 102 studies were included for quantitative synthesis, with sample sizes of 687 treated surgically, 704 treated endovascularly without FDS, and 125 treated via flow diversion. Comparatively, FDS achieved significantly reduced rates of perioperative retreatment compared with both surgical (P = 0.025) and non-FDS endovascular (P < 0.001). The FDS subgroup also achieved a significantly lower incidence of perioperative rebleed (P < 0.001), perioperative hydrocephalus (P = 0.012), postoperative infarction (P = 0.002), postoperative hydrocephalus (P < 0.001), and postoperative vasospasm (P = 0.002) compared with those patients in the open surgical subgroup. Although no significant differences were found among groups on the basis of functional outcomes, angiographic outcomes detailed by rates of radiographic complete occlusion were highest for surgical (90.7%, 262/289) and FDS (89.1%, 98/110) subgroups versus the non-FDS endovascular subgroup (82.7%, 268/324). CONCLUSIONS: Flow diversion seems to be an effective treatment strategy for ruptured blood blister aneurysms, with lower rates of perioperative complications compared with surgical and other endovascular techniques, but studies investigating long-term outcomes after flow diversion warrant further study.

The Association of Body Mass Index and Outcomes in Adult Patients with Chest Wall Injuries.

BACKGROUND: Thoracic injury secondary to rib fractures following motor vehicle collisions (MVCs) significantly contribute to morbidity and mortality. While obesity has reached epidemic proportions, little is known regarding how BMI impacts outcomes in MVCs. The aim of this study was to examine how BMI impacts outcomes in MVC patients with rib fractures. METHODS: The ACS-TQIP Database was utilized to evaluate adult MVC patients with ≥3 rib fractures. Patients with a non-thoracic AIS ≥3 were excluded, to focus on chest injuries. Patients were sorted according to the presence or absence of flail chest injuries and BMI into groups with a low (<15), intermediate (15-24), or severe (≥25) ISS. RESULTS: Overweight and obese patients in the non-flail cohort had decreased odds of pneumothorax in all ISS groups (P < 0.05). Overweight (P = 0.049) and obese (P = 0.011) patients in the low ISS non-flail cohort had decreased odds of splenic laceration. In the non-flail cohort, obese patients with a low and intermediate ISS had decreased odds of pulmonary contusion (P < 0.01). Obese patients in the low and intermediate ISS non-flail cohorts had increased odds of PE (P < 0.05). In both the flail and non-flail cohorts, obese patients with an intermediate ISS had decreased odds of liver laceration (P < 0.05), as well as a longer HLOS, ICU-LOS, and mechanical ventilation time (P < 0.01). CONCLUSION: Obesity affects associated injuries, complications, and hospital outcomes in a complex way after MVC related chest wall trauma. Thus, the effect of BMI should be taken into consideration when assessing and treating obese MVC trauma patients.

Microwave Ablation as a Treatment for Spinal Metastatic Tumors: A Systematic Review.

BACKGROUND: Microwave ablation (MWA) is a novel technique that offers several potential advantages over existing ablation systems, which include production of larger ablation zones, shorter procedural times, and more effective heating through high impedance tissues such as bone. METHODS: A systematic review was performed using inclusion criteria defined as follows: 1) metastatic spinal tumors treated with open or percutaneous MWA alone or in combination with other treatments, 2) available data on pain palliation and/or local tumor control, and 3) retrospective or prospective studies with at least 1 patient. RESULTS: A total of 156 patients harboring 196 spinal lesions underwent MWA in the 8 included studies. Most studies employed the use of additional interventions, which included minimally invasive open surgery with pedicle screw fixation, traditional open surgical intervention, and cement augmentation. Despite the variability in time intervals for pain assessment, postoperative pain scores decreased considerably in both percutaneous and open MWA studies. No evidence of tumor progression was additionally seen in >80% of patients at the last follow-up across 5 studies. Complications were reported in 6.5% of all patients who underwent percutaneous MWA and in 12.2% of patients who underwent open MWA. CONCLUSIONS: This review showed that MWA can be effective in achieving analgesia for up to 6 months in select cases, although most procedures were performed in combination with augmentation and/or open surgery. Local tumor control was additionally successful in most patients, suggestive of a potential curative role for MWA.

Effectiveness and Safety of Tranexamic Acid Use in Acute Traumatic Injury in the Prehospital and In-hospital Settings: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background and Objectives: This systematic review and meta-analysis of randomized controlled trials (RCTs) aims to assess efficacy and safety of tranexamic acid (TXA) use in acute traumatic injuries. Methods: PubMed and Cochrane libraries were searched for relevant RCTs published between January 2011 and January 3, 2021. Cohen's Q Test for heterogeneous effects was used to determine the appropriateness of fixed versus random effects models. Results: Twenty-two studies met inclusion criteria. Meta-analysis of relative risk of mortality between treatment and placebo groups in the in-hospital, and perioperative settings was not significant. However, the risk of mortality is significantly lower in the treatment versus placebo group when TXA was given as loading dose only. Ten of the 11 studies evaluating perioperative use of TXA included in systematic review found significantly lower blood loss in the treatment compared with placebo groups, but results of meta-analysis showed no significant difference. Results of meta-analysis indicate that the risk of venous thromboembolism (VTE) in the in-hospital treatment group is greater than that of the placebo. In subset analysis of studies using only a single loading dose, there were no significant differences in VTE. Conclusions: Systematic review supports TXA benefits are most evident when given shortly after injury and meta-analysis supports TXA reduces mortality as a single loading dose. Systematic review supports perioperative use of TXA when large volume blood loss is anticipated. Meta-results showed no significant difference in risk of thromboembolism in single-dose TXA treatment compared with placebo. These findings suggest that TXA is safe and effective for control of traumatic bleeding.

Lumbar Facet Joint Cyst Treated With Decompression and Interlaminar Stabilization.

Spinal facet joint cysts (FJCs) are an increasingly reported cause of lower back pain, radiculopathy, and neurological deficits owing to their proximity to adjacent nerve roots. The etiology of these cysts has not yet been fully elucidated, although they appear to be related to degenerative changes in the facet joints themselves. Conservative management strategies including physical therapy and oral analgesics rarely result in spontaneous regression of an FJC, often providing only short-term relief. The current treatment modalities reported for FJCs generally range from percutaneous cyst aspiration to decompression surgery with or without instrumented spinal fusion. However, instrumented fusion often results in a higher rate of complications such as pseudoarthrosis and adjacent segment disease. The Coflex® (Paradigm Spine, LLC, New York, NY) interlaminar stabilization (ILS) implant is a novel titanium, U-shaped device which acts as a motion-preserving stabilizer and has proven to be a viable alternative to instrumental fusion. Here, we discuss a case of an FJC treated with both decompression and placement of a Coflex ILS device.

Testing a phantom eye under various signal-to-noise ratio conditions using eleven different OCT devices.

We compared eleven OCT devices in their ability to quantify retinal layer thicknesses under different signal-strength conditions, using a commercially available phantom eye. We analyzed a medium-intensity 50 µm layer in an identical manner for all devices, using the provided log-scale images and a reconstructed linear-scale tissue reflectivity metric. Thickness measurements were highly comparable when the data were analyzed in an identical manner. With optimal signal strength, the thickness of the 50 µm layer was overestimated by a mean of 4.3 µm in the log-scale images and of 2.7 µm in the linear-scale images.

A Common Pathway of Root Growth Control and Response to CLE Peptides Through Two Receptor Kinases in Arabidopsis.

Cell-cell communication is essential for plants to integrate developmental programs with external cues that affect their growth. Recent advances in plant signaling have uncovered similar molecular mechanisms in shoot, root, and vascular meristem signaling that involve receptor-like kinases and small, secreted peptides. Here, we report that the receptor-like kinases TOAD2/RPK2 and RPK1 regulate root growth by controlling cell proliferation and affecting meristem size. Two types of developmental alterations were observed upon exogenous CLE peptide application. The first type was detected in all plants treated, and comprise increased proliferative activity of cells in the stem cell niche and a delay of progression in differentiation of daughter cells. The second type was changes specific to the genotypes that are sensitive to CLE-driven root meristem inhibition and include a large decrease in the occurrence of cell divisions in longitudinal files, correlating with shorter meristems and cessation of root growth. The root meristems of toad2/rpk2 mutant plants are insensitive to the inhibitory effect of CLE17 peptide treatment, consistent with TOAD2/RPK2 function as a receptor for CLE peptides. In addition, a strong reduction in the expression of RPK1 protein upon CLE treatment, dependent on TOAD2/RPK2, suggests that these two RLKs mediate CLE signaling in a common pathway to control root growth.

Worst-case losses from a cylindrical calorimeter for solar simulator calibration.

High-flux solar simulators consist of lamps that mimic concentrated sunlight from a field of heliostats or parabolic dish. These installations are used to test promising solar-thermal technologies for commercial potential. Solar simulators can be calibrated with cylindrical calorimeters, devices that approximate black body absorbers. Calorimeter accuracy is crucial to solar simulator characterization and maintenance. To discover the worst-case performance of a cylindrical calorimeter during flux measurement Monte Carlo ray tracing was coupled to finite volume simulations. Results indicated that the calorimeter can exhibit an observer effect that distorts the solar simulator flux profile. Furthermore, the proposed design was sensitive to changes in calorimeter optical properties, changes that can result from oxidation and/or photobleaching over time. Design fidelity and robustness were substantially improved through the use of a beveled (conical) calorimeter aperture.

Coordination of the maize transcriptome by a conserved circadian clock.

BACKGROUND: The plant circadian clock orchestrates 24-hour rhythms in internal physiological processes to coordinate these activities with daily and seasonal changes in the environment. The circadian clock has a profound impact on many aspects of plant growth and development, including biomass accumulation and flowering time. Despite recent advances in understanding the circadian system of the model plant Arabidopsis thaliana, the contribution of the circadian oscillator to important agronomic traits in Zea mays and other cereals remains poorly defined. To address this deficit, this study investigated the transcriptional landscape of the maize circadian system. RESULTS: Since transcriptional regulation is a fundamental aspect of circadian systems, genes exhibiting circadian expression were identified in the sequenced maize inbred B73. Of the over 13,000 transcripts examined, approximately 10 percent displayed circadian expression patterns. The majority of cycling genes had peak expression at subjective dawn and dusk, similar to other plant circadian systems. The maize circadian clock organized co-regulation of genes participating in fundamental physiological processes, including photosynthesis, carbohydrate metabolism, cell wall biogenesis, and phytohormone biosynthesis pathways. CONCLUSIONS: Circadian regulation of the maize genome was widespread and key genes in several major metabolic pathways had circadian expression waveforms. The maize circadian clock coordinated transcription to be coincident with oncoming day or night, which was consistent with the circadian oscillator acting to prepare the plant for these major recurring environmental changes. These findings highlighted the multiple processes in maize plants under circadian regulation and, as a result, provided insight into the important contribution this regulatory system makes to agronomic traits in maize and potentially other C4 plant species.

Intragenic suppression of a trafficking-defective brassinosteroid receptor mutant in Arabidopsis.

The cell surface receptor kinase BRASSINOSTEROID-INSENSITIVE-1 (BRI1) is the major receptor for steroid hormones in Arabidopsis. Plants homozygous for loss-of-function mutations in BRI1 display a reduction in the size of vegetative organs, resulting in dwarfism. The recessive bri1-5 mutation produces receptors that do not accumulate to wild-type levels and are retained mainly in the endoplasmic reticulum. We have isolated a dominant suppressor of the dwarf phenotype of bri1-5 plants. We show that this suppression is caused by a second-site mutation in BRI1, bri1-5R1. The bri1-5R1 mutation partially rescues the phenotypes of bri1-5 in many tissues and enhances bri1-5 phenotypes above wild-type levels in several other tissues. We demonstrate that the phenotypes of bri1-5R1 plants are due to both increased cell expansion and increased cell division. To test the mechanism of bri1-5 suppression, we assessed whether the phenotypic suppression in bri1-5R1 was dependent on ligand availability and the integrity of the signaling pathway. Our results indicate that the suppression of the dwarf phenotypes associated with bri1-5R1 requires both BR biosynthesis and the receptor kinase BRI1-ASSOCIATED KINASE-1 (BAK1). Finally, we show that bri1-5R1 partially restores the accumulation and plasma membrane localization of BRI1. Collectively, our results point toward a model in which bri1-R1 compensates for the protein-folding abnormalities caused by bri1-5, restoring accumulation of the receptor and its delivery to the cell surface.