Telovelar vs. Transvermian approach for the fourth ventricle tumors: A systematic review and meta-analysis

BACKGROUND

Tumors in the fourth ventricle can be critical due to the small size of the fourth ventricle, which causes symptoms to be detected even in the presence of lesser mass effects. A proper surgical approach to the fourth ventricle poses challenges due to its deep location and proximity to vital compartments within the brainstem. The two commonly used approaches to these tumors are the transvermian and telovelar approaches.

METHODS

A comprehensive systematic study was conducted based on a literature search of the databases. All case controls, cohorts, and case series including patients with fourth ventricle tumors, who were operated on with either telovelar or transvermian approaches were considered eligible. The evaluated outcomes were comparative postoperative complications of the telovelar vs. transvermian approach. After screening and data extraction, a meta-analysis was performed whenever adequate quantitative data were available.

RESULTS

Seven studies with a total number of 848 patients, discussed both telovelar and transvermian approaches, with comparative reporting of outcomes in each group. Postoperative outcomes including cranial nerve deficit, mutism, diplopia, CSF leak, need for CSF diversion, and postoperative gait disturbance were not significantly different between telovelar and transvermian approaches.

CONCLUSION

Postoperative complications were not significantly different between telovelar and transvermian approaches. Moreover, it could be proposed that such complications would be more likely to be a multifactorial matter concerning the patient's clinical condition, tumor characteristics, and surgeon's experience, rather than the surgical approach alone.

Diverse Expression Patterns of EBV Oncogenes (LMP2A, EBV-Encoded microRNA, and EBV-encoded dUTPase) in EBV Associated Gastric Carcinoma and their Association with Viral Loads

The chromogenic in situ hybridization (CISH) test is the gold standard for detecting Epstein-Barr virus (EBV)-associated gastric carcinoma (GC). Real-time (RT) PCR method is also a sensitive test that can detect the viral load in samples. As such, three EBV oncogenes were investigated in this study. RNA extraction and cDNA synthesis were performed on GC tissues of nine patients, who were previously confirmed to have EBVGC subtype. In addition, 44 patients that had positive RT-PCR but negative CISH results were also included as the control group. TaqMan RT-PCR analysis was performed to determine the expression of EBV-encoded microRNAs, and the expression of EBV-encoded dUTPase, as well as LMP2A, was analyzed by SYBR Green RT-PCR. EBV-encoded microRNAs and LMP2A were identified in 2 out of 9 (22%) EBVGC subtypes. In addition, EBV-encoded dUTPase was detected in 4 out of 9 (44.5%) EBVGC subtypes. EBV-encoded dUTPase was also expressed in a sample of the control group. The expression of LMP2A, EBV-encoded microRNAs, and EBV-encoded dUTPase viral oncogenes in patients with high EBV viral loads indicates that these expressions correlate with viral loads. Our findings indicate that the EBV-encoded dUTPase gene may have a role in EBVGC patients' non-response to treatment and might be considered a Biomarker-targeted therapy.

Magnetic Cc/Cs-corrector compensating for the chromatic aberration and the spherical aberration of electron lenses

Aberration correction in transmission electron microscopy has proven feasible and useful over a large range of acceleration voltages. The spherical aberration has been corrected for beam energies from 15 kV [1] up to 1.2 MeV [2] while the correction of the chromatic aberration has been achieved for beam energies ranging from 20 kV[3] up to 300 kV[4]. Above this threshold the conventional correction principle based on mixed electric and magnetic focusing elements becomes infeasible with present technology [5]. For conventional electron sources at high voltages the relative energy width of the beam gets so small that chromatic correction becomes less important. Nevertheless, for new applications with pulsed electron sources with energy spreads in the order of 100 eV chromatic aberration will become a limiting factor even at high energies [6]. To enable chromatic aberration correction for such systems a novel type of a feasible, purely magnetic multipole aberration corrector with curved optic axis is proposed which is capable of compensating for the chromatic and spherical aberration up to several MeV.

Investigation of persistent infection of bovine viral diarrhea virus (BVDV) in Holstein dairy cows

The aim of this study was to investigate the persistent infection (PI) of bovine viral diarrhea virus (BVDV) along with its coexistence between BVDV antibody titer and BVD virus in blood of Holstein dairy cows. Only large commercial farms (each contained < 1000-3000 unvaccinated cows) were included. There were 11 dairy cattle herds. They included nearly 20,000 dairy cows. Totally, 140 cows, > 3 months to almost 10 years old, were randomly sampled. Indirect enzyme-linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR) were used to detect BVDV antibody and virus, respectively. The percent positivity (PP) < 14 and ≥ 14 values are interpreted negative and positive, respectively. Simultaneously, whole blood samples pooled in groups of 10 animals were used for molecular detection of BVDV. The results revealed that 138 (98.56%) out of 140 cows were positive for BVDV antibody, while the BVDV antigen was detected only in 2 (1.42%) cows, which were negative for BVDV antibody and so were considered as persistent infection (PI) cows. They were also retested 3 weeks apart. Since the results showed the strong coexistence between seropositivity and BVD virus, in the infected dairy cattle herds, the combination of simple ELISA and pooled whole blood RT-PCR strategy could be an achievable approach to detect PI animals.

Rotation induced by uniform and non-uniform magnetic fields in a conducting fluid carrying an electric current

External magnetic field induces controllable rotation in a conducting fluid carrying an electric current.

Evaluating validity of clinical criteria for requesting chest X-rays in trauma patients referred to emergency room

Background:

Our goal was to identify the clinical criteria for requesting the chest X-ray in patients with blunt trauma and whether its findings such as clinical signs with a high sensitivity could be used to codify the final criteria.

Materials and Methods:

386 patients with multiple trauma or blunt chest trauma examined by a physician and the injury mechanism, vital signs, O₂ saturation, auscultation findings, abrasions and ecchymosis, crepitation, tenderness on palpation, and pain on lateral compression were noted. The physician's clinical judgment on the necessity of a chest X-ray was also noted in a questionnaire. After taking the X-ray, a digital photo was taken and showed to a radiologist to report any significant chest injury. Data were collected and the positive and negative predictive values, sensitivity and specificity were estimated.

Results:

350 males (90.9%) and 35 females (9.1%) with the mean age of 47.1 ± 15.5 years old were evaluated. Falling down (37.7%) was the major mechanism of injury and chest pain (48%) the first complaint of patients. In 87.3% of the chest X-rays, there was no abnormal finding. Among several pathological findings in the chest X-rays, hemothorax, and rib fracture (each with 3.4% prevalence) had a higher prevalence. Tenderness on palpation with clinical judgment had a higher sensitivity about 95% and higher specificity about 100% in crepitation detected.

Conclusion:

Results showed the combination of positive chest pain and tachypnea in the patients could identify a significant chest injury with 100% sensitivity. More studies on this issue are warranted.

Evaluation of morning report in an emergency medicine department

BACKGROUND

Morning report is considered as an important educational tool in different branches of medicine. The purpose of the present study was to examine the method of case selection, the leadership, the participant's satisfaction and the educational value of morning report held in our centre.

METHOD

In September 2007, a formal feedback about the morning report was provided by questionnaire surveys. The data on the method of case selection, the leadership, the participant's satisfaction and the educational value of the sessions were collected from the residents, medical students and the academic staff in emergency medicine department. Each questionnaire also contained an open-ended question, asking for the responders' suggestions for improving these sessions.

RESULTS

73.2% of the responders were satisfied with the current model of the conference hall. The data showed that 46.3% of the participants believed these sessions are held for giving the medical team the required information and 65.9% for solving the patient's problems. The data showed that the participants had evaluated the presentation strategy to be good; however, the presentation pattern was reported to be traditional and based on differential diagnosis in 53.7% of the cases and modern problem oriented in only 39%.

CONCLUSION

Most participants considered morning report sessions held in our hospital to be effective in the way it is; however, issues such as communication skill, emergency department management, critical thinking, ethics, professionalism and evidence-based medicine should also be added to the sessions.