Consensus statement from the international consensus meeting on post-traumatic cranioplasty

Background

Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach.

Methods

The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP.

Results

The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations.

Conclusions

This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.

Synthesis, spectroscopic, thermal and antimicrobial studies of neodymium(III) and samarium(III) complexes derived from tetradentate ligands containing N and S donor atoms

Trivalent lanthanide complexes of the type [Ln(L)Cl(H2O)2] (where Ln=Nd(III) or Sm(III) and LH2=Schiff bases derived by the condensation of 3-(phenyl/substitutedphenyl)-4-amino-5-mercapto-1,2,4-triazole with diacetyl/benzil) have been synthesized by the reactions of anhydrous lanthanide(III) chloride with Schiff bases in methanol. The structures of the complexes have been proposed on the basis of elemental analysis, electrical conductance, magnetic moment, spectroscopic measurements (IR, 1H, 13C NMR and UV-vis spectra) and X-ray diffraction studies. The spectral data reveal that the Schiff base ligands behave as dibasic tetradentate chelating agents having coordination sites at two thiol sulfur atoms and two azomethine nitrogen atoms. The presence of coordinated water in metal complexes was confirmed by thermal and IR data of the complexes. All the Schiff bases and their metal complexes have also been screened for their antibacterial activity against Bacillus subtilis, Staphylococcus aureus and antifungal activities against Aspergillus niger, Curvularia pallescens and Colletotrichum capsici.

Synthesis, spectral characterization and antimicrobial studies of nano-sized oxovanadium(IV) complexes with Schiff bases derived from 5-(phenyl/substituted phenyl)-2-hydrazino-1,3,4-thiadiazole and indoline-2,3-dione

A new class of oxovanadium(IV) complexes with Schiff bases derived by the condensation of 5-(phenyl/substituted phenyl)-2-hydrazino-1,3,4-thiadiazoles and indoline-2,3-dione have been prepared in ethanol in the presence of sodium acetate. Micro-analytical data, magnetic susceptibility, UV-Vis, IR, EPR and XRD spectral techniques were used to confirm the structures. Electronic absorption spectra of the complexes suggest a square-pyramidal geometry. The oxovanadium(IV) complexes have monoclinic crystal system and particle sizes were found to be in the range 18.0 nm to 24.0 nm (nano-size). In vitro antifungal activity of synthesized compounds was determined against fungi Aspergillus niger, Colletotrichum falcatum and Colletotrichum pallescence and in vitro antibacterial activity was determined by screening the compounds against Gram-negative (Escherichia coli and Salmonella typhi) and Gram-positive (Staphylococcus aureus and Bacillus subtilis) bacterial strains. The oxovanadium(IV) complexes have higher antimicrobial effect than free ligands.

Computational studies on nitramino derivatives of 1-amino-1,2-azaboriridine as high energetic material

DFT calculations performed on 1-amino-2,3,3-trinitramino-1,2-azaboriridine show it to be a potential high energetic material with detonation performance comparable to HMX.

Synthesis, spectral and antimicrobial activity of Zn(II) complexes with Schiff bases derived from 2-hydrazino-5-[substituted phenyl]-1,3,4-thiadiazole and benzaldehyde/2-hydroxyacetophenone/indoline-2,3-dione

Zn(II) complexes have been synthesized by reacting zinc acetate with Schiff bases derived from 2-hydrazino-5-[substituted phenyl]-1,3,4-thiadiazole and 2-hydroxyacetophenone/benzaldehyde/indoline-2,3-dione. All these complexes are soluble in DMF and DMSO; low molar conductance values indicate that they are non electrolytes. Elemental analyses suggest that the complexes have 1:2 metal to ligands stoichiometry of the types [ZnL2(H2O)2](L=monoanionic Schiff bases derived from 2-hydrazino-5-[substituted phenyl]-1,3,4-thiadiazole and 2-hydroxyacetophenone/indoline-2,3-dione) [ZnL2(')(OOCCH3)2(H2O)2](L'=neutral Schiff bases derived from 2-hydrazino-5-[substituted phenyl]-1,3,4-thiadiazole and benzaldehyde), and they were characterized by IR, (1)H NMR, and (13)C NMR. Particle sizes of synthesized compounds were measured with dynamic light scattering (DLS) analyser which indicates that particle diameter are of the range ca. 100-200nm. All these Schiff bases and their complexes have also been screened for their antibacterial (Bacillus subtilis (B. subtilis), Escherichia coli (E. coli) and antifungal activities (Colletotrichum falcatum (C. falcatum), Aspergillus niger (A. niger), Fusarium oxysporium (F. oxysporium) Curvularia pallescence (C. pallescence). The antimicrobial activities have shown that upon complexation the activity increases.

Template synthesis, spectroscopic characterization and preliminary insulin-mimetic activity of oxovanadium(IV) complexes with N₂O₂ diazadioxa macrocycles

A new series of diazadioxa oxovanadium(IV) macrocyclic complexes of type [VO(mac)]SO(4) have been synthesized via the condensation reaction of a 3-(phenyl/substituted phenyl)-4-amino-5-hydrazino-1,2,4-triazole (H(2)L) with salicylaldehyde/2-hydroxyacetophenone and 1,4-dibromobutane in the presence of oxovanadium(IV) sulfate in ethanol. All the newly synthesized compounds were characterized on the basis of elemental analyses, conductance measurements, magnetic properties, spectral (UV-Vis, IR, EPR) and XRD studies. The particle size of the complexes has been calculated from XRD spectra using Debye-Scherrer formula and these are found to be in 31-32 nm range. The efficacy of two macrocyclic complexes was also studied in streptozotocin-induced diabetic rats over a period of 30 days. The administration of these complexes in diabetic rats reversed the diabetic effect due to their insulin-mimetic effects.

Synthesis, spectral characterization and biological activity of zinc(II) complexes with 3-substituted phenyl-4-amino-5-hydrazino-1, 2, 4-triazole Schiff bases

New Zn(II) complexes have been synthesized by the reactions of zinc(II) acetate with Schiff bases derived from 3-substituted phenyl-4-amino-5-hydrazino-1, 2, 4-triazole and benzaldehyde, 2-hydroxyacetophenone or indoline-2,3-dione. All these complexes are soluble in DMF and DMSO; low molar conductance values indicate that they are non-electrolytes. Elemental analyses suggest that the complexes have 1:1 stoichiometry of the type [ZnL(H(2)O)(2)], [ZnL'(OAc)(2)(H(2)O)(2)] (L=dianionic Schiff bases derived from 3-(substituted phenyl)-4-amino-5-hydrazino-1, 2, 4-triazole and 2-hydroxyacetophenone or indoline-2,3-dione; L'=neutral Schiff bases derived from 3-(substituted phenyl)-4-amino-5-hydrazino-1, 2, 4-triazole and benzaldehyde) and they were characterized by FT-IR, (1)H NMR, (13)C NMR and FAB mass. All these Schiff bases and their complexes have also been screened for their antibacterial activities against Bacillus subtilis, Escherichia coli and antifungal activities against Colletotrichum falcatum, Aspergillus niger, Fusarium oxysporium and Carvularia pallescence by petriplates methods.

Organophosphorus derivatives containing isatin-3-hydrazones as chemotherapeutants against fungal pathogens of sugarcane

A total of 20 novel organophosphorus derivatives have been synthesized by the reactions of O,O-diethylchlorophosphate/thiophosphate with isatin-3-(substituted benzoic acid/phenoxy acetic acid hydrazones). The derivatives have been characterized on the basis of analysis and spectral (IR and (1)H and (13)C NMR) data. Fungicidal activities of the derivatives against Colletotrichum falcatum , Fusarium oxysporum , and Curvularia pallescence have been evaluated. The screening results have been correlated with the structural features of the tested compounds. The greater potency has been observed with thiophosphates compared to phosphates, with substituted phenoxy acetic acid hydrazones compared to substituted benzoic acid hydrazones, and with substitutent Cl(-) attached to the aromatic ring compared to other substitutents. O,O-Diethylchlorophosphate compounds containing isatin-3-(4-chlorophenoxy acetic acid hydrazone) (IIe) and the compound containing two molecules of O,O-diethylchlorophosphate attached to isatin-3-(4-hydroxy phenoxy acetic acid) hydrazone (IIh) were proven to be more active than some prevalent commercial synthetic fungicides.

Synthesis, spectroscopic, thermal and antifungal studies on lanthanum(III) and praseodymium(III) derivatives of 1,1-diacetylferrocenyl hydrazones

A series of new coordination complexes of La(III) and Pr(III) with hydrazones, derived from 1,1-diacetylferrocene and different aromatic acid hydrazides have been synthesized and characterized by elemental analyses, electrical conductance, magnetic moment, IR, (1)H NMR, UV-vis spectra and molar conductance. The thermal behaviour of the complexes under non-isothermal condition was investigated by TG and DTG techniques. The antifungal activity of hydrazones and their corresponding complexes were also investigated.

Real-time holographic deconvolution techniques for one-way image transmission through an aberrating medium: characterization, modeling, and measurements

We propose and demonstrate a new photorefractive real-time holographic deconvolution technique for adaptive one-way image transmission through aberrating media by means of four-wave mixing. In contrast with earlier methods, which typically required various codings of the exact phase or two-way image transmission for correcting phase distortion, our technique relies on one-way image transmission through the use of exact phase information. Our technique can simultaneously correct both amplitude and phase distortions. We include several forms of image degradation, various test cases, and experimental results. We characterize the performance as a function of the input beam ratios for four metrics: signal-to-noise ratio, normalized root-mean-square error, edge restoration, and peak-to-total energy ratio. In our characterization we use false-color graphic images to display the best beam-intensity ratio two-dimensional region(s) for each of these metrics. Test cases are simulated at the optimal values of the beam-intensity ratios. We demonstrate our results through both experiment and computer simulation.

Photoconductive optically driven deformable membrane under high-frequency bias: fabrication, characterization, and modeling

The fabrication and characterization of an optically addressable deformable mirror for a spatial light modulator are described. Device operation utilizes an electrostatically driven pixelated aluminized polymeric membrane mirror supported above an optically controlled photoconductive GaAs substrate. A 5 mum thick grid of patterned photoresist supports the 2 mum thick aluminized Mylar membrane. A conductive ZnO layer is placed on the backside of the GaAs wafer. Similar devices were also fabricated with InP. A standard Michelson interferometer is used to measure mirror deformation data as a function of illumination, applied voltage, and frequency. The device operates as an impedance distribution between two cascaded impedances of deformable membrane substrate, substrate, and electrode. An analysis of device's operation under several bias conditions, which relates membrane deformation to operating parameters, is presented.

Optically driven microelectromechanical-system deformable mirror under high-frequency AC bias

A new, optically addressed deformable mirror device is demonstrated. The device consists of a pixellated metalized polymeric membrane mirror supported above an optically addressed photoconductive substrate. A conductive transparent ZnO layer is deposited on the back side of the substrate. A very high-frequency AC bias is applied between the membrane and the back electrode of the device. The membrane is deformed when the back of the device is illuminated because of impedance and bias redistribution between two cascaded impedances. We fabricated, demonstrated, and modeled the operation of this device.

Organophosphorus derivatives containing piperazine dithiosemicarbazones as chemotherapeutants against fungal pathogens of sugarcane

Five novel organophosphorus derivatives have been synthesized by the reactions of O,O-diethylchlorophosphate with piperazine dithiosemicarbazones. The derivatives have been characterized on the basis of analyses and spectral (IR, 1H NMR) data. Fungicidal activities of these derivatives against Colletotrichum falcatum, Fusarium oxysporum, and Curvularia pallescence have been evaluated. The screening results have been correlated with the structural features of the tested compounds. Organophosphorus derivatives containing 1,4-bis(4-chlorobenzaldehyde)piperazine dithiosemicarbazone and 1,4-bis(4-methoxybenzaldehyde)piperazine dithiosemicarbazone proved to be more active than some prevalent commercial synthetic fungicides.

Mono-and Bis(cyclopentadienyl)hafnium(IV) Derivatives with Higher Fatty Acids

The reactions of Cp2HfCl2 with some higher monocarboxylic acids having straight chains, caprylic (C8H16O2), lauric (C12H24O2), myristic (C14H28O2), palmitic (C16H32O2), stearic (C18H36O2), and behenic (C22H44O2) acid, have been studied in anhydrous tetrahydrofuran in 1:1 and 1:2 molar ratios, respectively. The reaction products isolated, of types Cp2Hf(L)Cl, CpHf(L)2Cl (LH represents different carboxylic acids), have been characterised by conductivity and magnetic susceptibility measurements and spectral (infrared, electronic, 1HNMR and 13C NMR) data. The bonding of the carboxylato ligand in these complexes has been discussed and plausible structures have been established.

Promoting, building and sustaining a regional laboratory network in a changing environment

The Queen's University Department of Pathology and its affiliated hospital laboratories (Kingston, Canada) have operated a successful laboratory outreach program for more than a decade in Southeastern Ontario. The outreach program provides high quality reference testing and technical and professional expertise in laboratory medicine to largely rural and small urban community hospitals. As a consequence of dramatic cuts to the publicly funded health-care system in the Province of Ontario, the environment in which laboratory medicine is practiced has altered irrevocably. This article discusses some of the difficult internal and external challenges faced by the outreach program within the region and how they were effectively managed, not only to maintain but to enhance the program's services. The result has been a continued improvement in the quality of laboratory services in the region with significantly increased cost-effectiveness, largely through reengineering and consolidation.

Adult head and neck lymphomas in Papua New Guinea: a retrospective study of 70 cases

BACKGROUND

During a 10-year period (1986-95), 70 adult Papua New Guineans with head and neck lymphomas were seen in the 18 years-and-above age group.

METHODS

The clinical information was obtained from the medical records section of the Port Moresby General Hospital. Relevant treatment modalities and the follow-up data were acquired from the National Cancer Centre, Angau Memorial Hospital, Lae.

RESULTS

Of a total of 227 adult lymphomas recorded in a 10-year period, 70 cases were seen in the head and neck region. Non-Hodgkin's lymphoma constituted 56 cases, which included seven cases of adult Burkitt's-like lymphoma. Fourteen cases of Hodgkin's lymphoma were recorded.

CONCLUSIONS

In Papua New Guinea, malignant lymphomas primarily affecting the head and neck region were seen in 30.8% of all lymphomas. This constitues 2.8% of all malignancies in this region. These lymphomas appear to be more aggressive at this site. Proper tissue diagnosis and combination chemoradiotherapy are the key factors in its management.

Paediatric head and neck lymphomas in Papua New Guinea: a review and analysis of 67 cases

A retrospective study of head and neck lymphomas in Papua Newguinean children between the age of 0 and 12 years for a 10-year period has been attempted. A total of 67 cases are recorded. This constitutes approximately 23% of all lymphomas seen during this period. There was a male predominance in all groups. Non-Hodgkin's lymphomas (NHL) comprised of 92% of which Burkitt's lymphomas (BL) predominate (64%). Almost 50% of these cases seen were in the age group of 5-8 years. In BL, cheek swelling and upper jaw involvement are the common modes of presentation, however, in 23% of cases advanced disease with multiple sites of involvement are noted. In other NHL cases, approximately 55% presented with cervical lymphadenopathy only, maxillary sinus was affected in four cases and orbit in two cases. Histological evaluation of NHL cases excluding BL revealed two high grade, nine intermediate grade and seven low grade tumours. Hodgkin's lymphoma (HL) comprised of 8%. All cases of HL presented with cervical lymphadenopathy. Standard therapeutic modalities for lymphomas with multidrug chemotherapy, surgery and radiotherapy were followed. Proper prognostic evaluation following the treatment had not been possible in view of poor patient compliance and lack of follow up.

Integrating academic and community laboratory needs: developing a successful outreach program

Remarkably few large regional laboratory programs involving academic health centers exist in Canada. We present a model of a successful laboratory outreach program established by the Queen's University Department of Pathology (Kingston, Ontario) and its affiliated hospital laboratories. Community hospitals in small urban and semi-rural areas benefit from a diffusion of specialty expertise in laboratory medicine and technology, which enables them to increase their local testing capabilities and improve turn-around time. Testing and services of a more complex nature are referred to the academic hospitals. The result has been a steady improvement in the quality of laboratory services in the region with increased cost-effectiveness through shared services and focused economies of scale.

Cystic lesions of the nasal cavity and the paranasal sinuses: report of two unusual cases

The clinicopathological features of two unusual cystic lesions, one arising in the nose, a calcified mucocele or a calcified retention cyst and the other in the maxillary sinus, a dentigerous cyst originating in a supernumerary tooth, are described. The literature on these two rare lesions is briefly reviewed.

Intestinal infarction in systemic lupus erythematosus--report of a case with an unusual obliterative vascular lesion

Intestinal infarction is a rare complication of systemic lupus erythematosus (SLE). A 26-year-old Papua New Guinean female who developed such a complication and underwent emergency laparotomy is described. The pathological changes in the mesenteric vessels and possible pathogenetic mechanisms are discussed. The relevant literature is briefly reviewed.

Nasopharyngeal osteosarcoma as second malignant neoplasm in a post-treated unilateral retinoblastoma: report of a case and review of literature

A rare case of osteosarcoma primarily originating in the nasopharynx of an 11-year-old Papua New Guinean female who received irradiation and multi-agent chemotherapy for unilateral non-hereditary retinoblasma is described. The relevant literature is briefly reviewed. The complex role of radiation, cytotoxic drugs and genes in the development of a second malignant neoplasm in association with retinoblasma is also discussed.

Heterogeneity within the Epstein-Barr virus nuclear antigen 2 gene in different strains of Epstein-Barr virus

DNA isolated from biopsies of endemic Burkitt's lymphoma (BL) from New Guinea was analysed for the presence of Epstein-Barr virus (EBV) sequences using the polymerase chain reaction. Primers were designed to amplify sequences within the Epstein-Barr virus nuclear antigen (EBNA) 1 and 2 genes. These analyses detected the EBNA1 sequence in all the biopsies studied. Additional sets of primers directed against the EBNA2 gene were used in order to categorize the EBV strains as A-type or B-type (39% A-type; 50% B-type; 5% A- and B-type; 5% untypeable). These results indicated that DNA sequence heterogeneity within the EBNA2 gene region may exist in different strains of EBV. The extent of DNA sequence heterogeneity among different strains of EBV was determined by sequencing of a region within the EBNA2 gene in a number of different A-type and B-type strains of EBV originating from Africa or New Guinea. The results demonstrated DNA sequence heterogeneity within the EBNA2 gene in different strains of EBV. This heterogeneity was more extensive among A-type strains than B-type strains of EBV.

Surgical thyroid disease in Papua New Guinea

A clinical and histopathological analysis was carried out on 376 thyroid specimens removed under various diagnoses from the surgical clinics of Papua New Guinea over a period of 11 years (1980-90). Solitary nodular goitre (solid and cystic) was the most common clinical diagnosis. Nineteen per cent of the solid and 35% of the cystic solitary nodular goitres were found to be malignant. Malignant goitres were confirmed histologically in 73.3% of the clinically diagnosed cases of malignancy. The presence of amyloid goitre (1.9%) posed a significant diagnostic and therapeutic problem due to its clinical features resembling that of malignant goitre. Hemithyroidectomy (lobectomy) was the most common surgical procedure employed for all unilateral thyroid lesions and partial or subtotal thyroidectomy was performed for benign and most malignant lesions.

The spectrum of cancer in Papua New Guinea. An analysis based on the Cancer Registry 1979-1988

Malignant tumors registered with the Tumour Registry of Papua New Guinea (PNG) from 1958-1988 were analyzed with emphasis on the variation of incidence with time and different regions. Cancer incidence was generally low in PNG. During this period, carcinoma of oral cavity, cervix, breast, and skin, hepatoma, and lymphoma were the most common types of malignant lesions detected. The incidence of carcinoma of the oral cavity has increased. Currently, it is more common in the Highlands region and is associated with the spread of betel nut chewing. A threefold increase in cervical carcinoma registration was observed nationally, with a sixfold increase in the Highlands region; this was attributed both to social changes and improved registration. The incidence of breast cancer has doubled, in keeping with better registration, but there is little interregional variation. The decline in registrations of hepatocellular carcinoma is artifactual. PNG is a high-incidence area for Burkitt lymphoma, but Hodgkin disease is rare. Both Burkitt and other non-Hodgkin lymphomas are uncommon in the Highlands. A decline in the incidence of squamous carcinoma of skin was observed that was associated with improved control of tropical ulcers. The incidence of stomach cancer is falling. The registered cancer incidence in PNG is low, even when compared with that in native people from other Pacific nations, such as Fijians and New Caledonian Melanesians. Preventive measures have been hitherto ineffective, with the exception of squamous carcinoma of skin.

Gastric stenosis following the ingestion of car battery acid

The acute consequences of the ingestion of corrosive substances include acute necrosis of the upper gastrointestinal tract, haemorrhage and perforation. Late complications include the development of stenotic lesions. A case of fibrous gastric stenosis following the ingestion of car battery acid is presented. Endoscopically, the appearances were consistent with gastric carcinoma.