Cerebral Venous Thrombosis in Patients With Traumatic Brain Injury: Epidemiology and Outcome.

The natural history and epidemiological aspects of traumatic cerebral venous thrombosis (CVT) are not fully understood. Due to the concomitant occurrence with intracranial hemorrhages, guidelines for medical treatment have been highly controversial. In this study, our objective was to carry out an analysis description of the population and to conduct a literature review. A prospectively gathered radiology registry data of patients hospitalized at the tertiary hospital of Centro Hospitalar Universitário do São João, Porto, Portugal, between 2016 and 2021 was carried out. All patients with traumatic brain injury (TBI) and concomitant CVT were identified. CVT was confirmed by CT venogram. Demographic, clinical, and radiological data and their medical management were reported. In-hospital complications and treatment outcomes were compared between patients measured by the Glasgow Outcome Score Extended (GOSE) at discharge and GOSE at three months. There were 41 patients with traumatic CVT admitted to this study. The majority (45.2%) had a hyperdense signal near the lateral sinus at admission, and only 26.2% presented with skull fractures. Of this cohort, 95% had experienced lateral sinus thrombosis. Twenty-five patients (60%) had occlusive venous thrombosis. Venous infarct was the main complication following CVT. Thirty-two patients (78%) were anticoagulated after CVT and four developed complications. At the three-month follow-up after discharge, 28.2% had good recovery (GOSE > 6). This study revealed a higher incidence of CVT in severe TBI and a mild association with skull fractures. There is a higher incidence of CVT in the lateral sinus. Management was inconsistent, with no difference in outcome without or with anticoagulation. Larger, prospective cohort studies are required to better comprehend this condition and determine evidence-based guidelines.

The impact of selection bias in the treatment for ruptured anterior communicating artery aneurysms: different results or different patients?

Background: Anterior communicating artery is one of the most frequent locations for the development of intracranial aneurysm. The availability and advances of different treatments modalities allows for case-specific selection, but potentially impacts our ability to assess equipoise among them. Objective: Investigate and compare clinical and morphological variables among surgical and endovascular treatment groups with ruptured anterior communicating artery aneurysms. Methods: Data from patients from a single university hospital treated for ruptured anterior communicating aneurysms after multidisciplinary discussion in a period from January 2009 to January 2020 were retrospectively reviewed. Demographics, clinical status, aneurysm morphologic features and in-hospital complications were registered for each treatment (endovascular coiling vs. microsurgical clipping). Clinical assessment was made from outpatient evaluation at 1-year follow-up. Results: A total of 119 patients was obtained adding surgical (n = 80) and endovascular (n = 39) treatment groups. No significant changes between groups were detected regarding gender, age of treatment or other risk factors. Global complication rate (p = 0.335, p = 0.225, p = 0.428) and clinical outcome (p = 0.802) was similar among both groups. Univariate and multivariate analysis revealed statistically significant differences between endovascular and surgical treatment groups regarding dome orientation (p = 0.011), aneurysm height (p < 0.001) and maximum diameter (p < 0.001), aspect-ratio (p < 0.001), dome-to-neck ratio (p < 0.001) and dome diameter (p = 0.014). Conclusions: Despite similar clinical outcomes and rate of complications, morphological differences highlight the presence of a selection bias and high heterogeneity, which hampers inferential analysis when comparing both techniques.

Building an alliance to map global supply networks.

New firm-level data can inform policy-making.

Giant Vertebrobasilar Aneurysm: The Rule of Decompressive Craniectomy Previous to Endovascular Treatment.

Giant vertebral-basilar aneurysms are rare and represent 1% of intracranial aneurysms. Natural history and treatment are associated with severe clinical manifestations, such as ischemia, mass effect, hydrocephalus, and subarachnoid hemorrhage, leading to high mortality and morbidity. In this case, a 51-year-old male with no relevant medical history presented to the emergency department with severe pulsatile right temporo-occipital headache, radiating to the territory of the maxillary branch of the trigeminal nerve. Investigation revealed a giant unruptured vertebrobasilar aneurysm partially thrombosed. As treatment strategy, a suboccipital craniectomy was initially performed, and a week later, as a second stage, the patient underwent a stent placement from the V3 segment of the vertebral artery to the distal segment of the basilar trunk. Very few cases of this entity have been reported, and the endovascular treatment of this type of aneurysm is complex, with a high risk of mortality or morbidity, caused by thrombosis or by the inflammatory response secondary to the treatment, with compression of the brainstem. Decompressive craniectomy prior to endovascular treatment may play an important role in preventing life-threatening complications.

Relationship between fatty infiltration of paraspinal muscles and clinical outcome after lumbar discectomy.

Introduction: Cross sectional area (CSA) and fat infiltration (FI) are important parameters to assess paravertebral muscle atrophy. However, the relationship of muscular fat infiltration in patients with symptomatic lumbar disc herniation undergoing surgery remains unclear. Research question: Does lumbar paravertebral muscle atrophy have prognostic value regarding the clinical outcome for patients with symptomatic lumbar disc herniation undergoing surgery? Methods: Patients over 18 years of age with lumbar disc herniation and radicular pain who underwent single-level discectomy were included. Multifidus, erector spinae and psoas cross-sectional area (CSA) and fatty infiltration (FI) were measured by ImageJ software at the levels of L3-L4, L4-L5 and L5-S1 from T2-weighted Magnetic Resonance axial images. Clinical status was assessed preoperatively and one-year after surgery with patient reported outcome measurements (PROMS), that included Numeric Rating Score for back and leg pain, Core Outcome Measurement Index (COMI), Oswestry Disability Index and EuroQoL-5D. Univariate and multiple linear regressions were performed. Results: Erector spinae FI was the only muscle-related factor that correlated to postoperative PROMS. Postoperative COMI was higher in patients with FI>30% (median: 4.4, IQR: 3.2) and lower when FI<15% (median: 1.2, IQR: 1.6) (Kruskal-Wallis, p â€‹< â€‹0.001). Male gender was associated with better outcome as well as erector spinae FI<15%, while FI >30% was related to worse postoperative status. Conclusions: In the current study, increased fat infiltration of erector spinae muscles correlated to less favorable clinical outcomes following lumbar discectomies.

Selection bias in patients proposed for neurosurgical versus endovascular treatment of aneurysms of the posterior communicating artery.

BACKGROUND: Microsurgical clipping and endovascular coiling are viable treatment options for posterior communicating artery (PComA) aneurysms, but there are still major limitations to evidence-based decisions regarding standard-of-care treatment. In this study, we aimed at assessing potential selection biases that may influence our ability to extract conclusions about the comparative effectiveness or efficacy of the aneurysm treatment. OBJECTIVE: To study the patient/aneurysm characteristics as possible biases in the option for endovascular or neurosurgical treatment of PComA aneurysms. METHODS: A single-center, retrospective cohort study was performed, including all patients with treated PComA aneurysms with neurosurgical clipping or endovascular coiling between January 2010 and January 2021. Clinical and morphological data were collected from electronic records, and statistical analysis was performed. RESULTS: A total of 64 patients was eligible for inclusion; 24 (37.5%) patients were proposed for neurosurgical treatment, while 40 (62.5%) for endovascular treatment; 10 patients (25%) crossed over to the clipping group whereas none crossed over to the coiling side. Actual treatment analysis showed significantly higher diameters of mother vessel (t-test, p = 0.034) and aneurysm neck (Mann-Whitney, p = 0.029) in the clipping group and higher aspect and dome-to-neck ratios in the endovascular group (Mann-Whitney, p = 0.008). A significantly higher vasospasm frequency was found in the clipping group but only in the intention-to-treat analysis (Chi-square, p = 0.032). CONCLUSION: Significant morphological differences between effective endovascular and surgical groups and differences in intention-to-treat analysis may limit the validity of a direct comparison between treatment options and suggest the presence of a possible selection bias.

How production networks amplify economic growth.

Technological improvement is the most important cause of long-term economic growth. In standard growth models, technology is treated in the aggregate, but an economy can also be viewed as a network in which producers buy goods, convert them to new goods, and sell the production to households or other producers. We develop predictions for how this network amplifies the effects of technological improvements as they propagate along chains of production, showing that longer production chains for an industry bias it toward faster price reduction and that longer production chains for a country bias it toward faster growth. These predictions are in good agreement with data from the World Input Output Database and improve with the passage of time. The results show that production chains play a major role in shaping the long-term evolution of prices, output growth, and structural change.

Tracking the COVID-19 crisis with high-resolution transaction data.

Payments systems generate vast amounts of naturally occurring transaction data rarely used for constructing official statistics. We consider billions of transactions from card data from a large bank, Banco Bilbao Vizcaya Argentaria, as an alternative source of information for measuring consumption. We show, via validation against official consumption measures, that transaction data complements national accounts and consumption surveys. We then analyse the impact of COVID-19 in Spain, and document: (i) strong consumption responses to business closures, but smaller effects for capacity restrictions; (ii) a steeper decline in spending in rich neighbourhoods; (iii) higher mobility for residents of lower-income neighbourhoods, correlating with increased disease incidence.

From In-Person to the Online World: Insights Into Organizing Events in Bioinformatics.

Bioinformatics is a fast-evolving research field, requiring effective educational initiatives to bring computational knowledge to Life Sciences. Since 2017, an organizing committee composed of graduate students and postdoctoral researchers from the Universidade Federal de Minas Gerais (Brazil) promotes a week-long event named Summer Course in Bioinformatics (CVBioinfo). This event aims to diffuse bioinformatic principles, news, and methods mainly focused on audiences of undergraduate students. Furthermore, as the advent of the COVID-19 global pandemic has precluded in-person events, we offered the event in online mode, using free video transmission platforms. Herein, we present and discuss the insights obtained from promoting the Online Workshop in Bioinformatics (WOB) organized in November 2020, comparing it to our experience in previous in-person editions of the same event.

Major Cardiac Events After Non-cardiac Surgery.

INTRODUCTION: Postoperative cardiovascular complications might be difficult to assess and are known to be associated with longer hospital stay and increased costs as well as higher morbidity and mortality rates. The aim of this study was to evaluate the predictors for major cardiac events (MCE) after non-cardiac surgery. METHODS: The study included 4398 patients who were admitted to the Surgical Intensive Care Unit between January 1, 2006 and July 19, 2013. Acute physiology and chronic health evaluation II score and simplified acute physiology score (SAPS II) were calculated, and all variables entered as parameters were evaluated independently. Multivariate logistic regression analysis was performed to assess the independent factors for MCE. RESULTS: A total of 107 people experienced MCE. The independent predictors for postoperative MCE were higher fraction of inspired oxygen (FiO2) (odds ratio [OR] 38.97; 95 % confidence interval [CI] 10.81-140.36), history of ischemic heart disease (OR 3.38; 95 % CI 2.12-5.39), history of congestive heart disease (OR 2.39; 95 % CI 1.49-3.85), history of insulin therapy for diabetes (OR 2.93; 95 % CI 1.66-5.19), and increased SAPS II (OR 1.03; 95 % CI 1.01-1.05). Having a MCE was associated with a longer length of stay in the surgical intensive care unit (OR 1.01, 95 % CI 1.00-1.01). CONCLUSIONS: FiO2, ischemic heart disease, congestive heart disease, insulin therapy for diabetes, SAPS II, and length of stay in the surgical intensive care unit were independent predictors for MCE.

The cultural divide: exponential growth in classical 2D and metabolic equilibrium in 3D environments.

INTRODUCTION: Cellular metabolism can be considered to have two extremes: one is characterized by exponential growth (in 2D cultures) and the other by a dynamic equilibrium (in 3D cultures). We have analyzed the proteome and cellular architecture at these two extremes and found that they are dramatically different. RESULTS: Structurally, actin organization is changed, microtubules are increased and keratins 8 and 18 decreased. Metabolically, glycolysis, fatty acid metabolism and the pentose phosphate shunt are increased while TCA cycle and oxidative phosphorylation is unchanged. Enzymes involved in cholesterol and urea synthesis are increased consistent with the attainment of cholesterol and urea production rates seen in vivo. DNA repair enzymes are increased even though cells are predominantly in Go. Transport around the cell--along the microtubules, through the nuclear pore and in various types of vesicles has been prioritized. There are numerous coherent changes in transcription, splicing, translation, protein folding and degradation. The amount of individual proteins within complexes is shown to be highly coordinated. Typically subunits which initiate a particular function are present in increased amounts compared to other subunits of the same complex. SUMMARY: We have previously demonstrated that cells at dynamic equilibrium can match the physiological performance of cells in tissues in vivo. Here we describe the multitude of protein changes necessary to achieve this performance.

Statistical analysis of teeth autotransplantation in Portugal's region of Chaves.

AIM: The aim of this study was to evaluate the success rate of 33 transplanted teeth in a northern population of Portugal. METHODS: The mean follow-up period was 7 years, ranging from 6 months to 20 years. RESULTS: Six teeth (18%) were rated as unsuccessful, 52% of the donor teeth were transplanted to receptor alveolus after immediate exodontia and 24% were transplanted to receptor alveolus surgically prepared. From the total number of cases, 64% had open root apex at the time of the transplantation and, in the latest control, of all teeth root development was over in 55%. Teeth ankylosis was present in 38% of all cases and 58% of all 33 transplants presented pulpar vitality. Data shows that, in males, teeth transplanted into natural alveolus were non-ankylosed, with normal color and vital teeth with incomplete root development at the time of the surgery. All cumulative curves obtained showed no statistical significance, mainly due to the low number of unsuccessful teeth autotransplantations. Orthodontic treatment performed after tooth autotransplantation showed success in 15% of all cases. CONCLUSION: Data reconfirms that autotransplantation of teeth is, in selected patients, the best option to replace a missing tooth in young patients.

The influence of customized abutments and custom metal abutments on the presence of the interproximal papilla at implants inserted in single-unit gaps: a 1-year prospective clinical study.

OBJECTIVES: To assess and compare the papilla presence mesially and distally to dental implants restored with customized abutments and custom metal abutments in the anterior maxilla. MATERIAL AND METHODS: Thirty-eight patients receiving 38 single-tooth implants, restored with 26 customized abutments and 12 custom metal abutments in the anterior maxillary region were enrolled in this study. The cases where did not existed contact point were excluded. Presence/absence of the interproximal papilla, inter-tooth-implant distance (ITD) and distance from the base of the contact point to dental crest bone of adjacent tooth (CPB) were accessed. Global P-values were determined for changes in CPB and papilla score over time (P < 0.05). RESULTS: Thirty-six patients with 36 implants were available for the 12-month follow-up. The abutments and reconstruction survival rate was 100% with no fracture or crown loss. A mean mesial CPB of 5.71 ± 1.54 mm and distal CPB of 4.01 ± 1.73 mm were assessed in the customized abutment group for an overall mean papilla presence of 1.69 ± 0.46. A mean mesial CPB of 5.41 ± 1.31 mm and distal CPB of 4.77 ± 1.21 mm were assessed in the control group for an overall mean papilla presence of 1.08 ± 0.65. CONCLUSIONS: The restoration of single-implants using computer-assisted design/computer-assisted manufacturing abutments appears to help maintaining a regular papillary filling although the variations of the implant positioning or the restoration/teeth relation.

[Conservative aortic valve surgery]. / Cirurgia conservadora da válvula aórtica.

Conservative aortic valve surgery is an attractive approach for the correction of the aortic insufficiency and the dilation of the aortic root. Despite being a surgery made in a minority of the patients it's receiving increased attention in the last decade because it can minimize the complications and risks that are inherent to the use of a mechanic or biologic valve. In the following article we propose ourselves to review the actual state of knowledge regarding conservative aortic valve surgery and the path that this type of surgical procedure must have in order to become the gold standard approach for the surgical correction of the aortic insufficiency or dilation of aortic root.

Clinical Outcome of Inter-Proximal Papilla between a Tooth and a Single Implant Treated with CAD/CAM Abutments: a Cross-Sectional Study.

OBJECTIVES: The aim of this study was to assess the clinical outcomes achieved with Computer-Assisted Design/Computer-Assisted Manufacturing implant abutments in the anterior maxilla. MATERIAL AND METHODS: Nineteen patients with a mean age of 41 (range form 26 to 63) years, treated with 21 single tooth implants and 21 Computer-Assisted Design/Computer-Assisted Manufacturing (CAD/CAM) abutments in the anterior maxillary region were included in this study. The patients followed 4 criteria of inclusion: (1) had a single-tooth implant in the anterior maxilla, (2) had a CAD/CAM abutment, (3) had a contralateral natural tooth, (4) the implant was restored and in function for at least 6 months up to 2 years. Cases without contact point were excluded. Presence/absence of the interproximal papilla, inter tooth-implant distance (ITD) and distance from the base of the contact point to dental crest bone of adjacent tooth (CPB) were accessed. RESULTS: Forty interproximal spaces were evaluated, with an average mesial CPB of 5.65 (SD 1.65) mm and distal CPB of 4.65 (SD 1.98) mm. An average mesial ITD of 2.49 (SD 0.69) mm and an average distal ITD of 1.89 (SD 0.63) mm were achieved. Papilla was present in all the interproximal spaces accessed. CONCLUSIONS: The restoration of dental implants using CAD/CAM abutments is a predictable treatment with improved aesthetic results. These type of abutments seem to help maintaining a regular papillary filling although the variations of the implant positioning or the restoration teeth relation.