Cisternostomy for Traumatic Brain Injury: A New Era Begins

Traumatic brain injury (TBI) is a major cause of death and disability especially in the young generations. In the United States TBI affects about 1.7 million people annually [1] and this number is higher in the developing countries. It is well known that TBI is associated to a primary and secondary brain injury. The first is without solution and depends on the impact. In surviving patients, what plays a critical role is the subsequent secondary injury since, without effective treatments, complex cascades will promote additional brain damage

Anatomy and physiology of cisternostomy

Cisternostomy is defined as opening the basal cisterns to atmospheric pressure. This technique helps to reduce the intracranial pressure in severe head trauma as well as other conditions when the so-called sudden "brain swelling" troubles the surgeon. We elaborated the surgical anatomy of this procedure as well as the proposed physiology of how cisternostomy works. This novel technique may change the current trends in neurosurgery

Adatom controlled emergence of high hardness in biocompatible beta-Ti3Au intermetallic thin film surfaces

There is growing international interest in hard biocompatible thin film surface coatings to extend the lifetime of medical implants. Parameters of the physical vapour deposition technique can be utilized to fine tune the microstructure and resulting properties of the growing thin film surface by modifying the adatom mobility of the incoming species. This work investigates the evolution of high hardness and biocompatibility of sputter deposited beta-Ti3Au intermetallic thin film surfaces as a function of growth temperature and pressure. Titanium and gold are sputtered in an optimised 3:1 ratio over glass and Ti6Al4V substrates at varying pressures of 0.3 to 1.2 Pa and temperatures of 25 to 450°C. The microstructure and crystallinity of the deposited films improved with reduction in pressure from 1.2 to 0.3 Pa but development of the β-Ti3Au intermetallic compound occurred at temperatures above 350˚C. The density of the films also increased with reducing pressure, whereas improvement in their columnar structure was observed with increasing substrate temperature. These microstructural changes caused by adatom mobility variation, led to the emergence of superior mechanical surface hardness, reaching a peak value of 12.5 GPa for films grown at 0.3 Pa and 450°C. All thin film surfaces were highly biocompatible with ion leaching levels below 1 ppm, and films deposited at lower pressure exhibited much safer cytotoxic profiles against L929 mouse fibroblasts. This work demonstrates the emergence of high hardness and biocompatibility in Ti3Au thin film surfaces with potential as next generation medical implant coating materials

Magnetically tunable electrokinetic instability and structuring of non-equilibrium nanoparticle gradients

Inspired by emergent behaviors of living matter, there is increasing interest in developing approaches to create dynamic patterns and structures in synthetic materials with controllable complexity to enable functionalities that are not possible in thermodynamic equilibrium. Here we show that electrophoretically driven and maintained non-equilibrium gradients of magnetic nanoparticles in non-polar solvent can undergo electrokinetic instabilities (EKI), leading to various electrically controllable spatiotemporally patterned states. These electrokinetic instabilities and patterns can be tuned with a magnetic field via magnetostatic energy reduction mechanism to both increase and decrease the pattern complexity. We reflect the experimental observations on the theoretical electrokinetic and magnetostatic arguments. We further show that small amounts of polar water in the otherwise non-polar system are critical enablers for the electrophoretic mobility of the nanoparticles. Since functionalities of magnetic nanoparticles are widely tunable, we foresee that the combination of dissipative electrokinetic driving and magnetic energy reduction can lead to novel functional dissipative materials

Investigation of the Forest-Fire Model on a Small-World Network

It is shown that the forest-fire model of Bak et al. run on a square lattice network with additional long-range interactions in the spirit of a small-world network results in a scale-free system reminiscent of self-organized criticality without recourse to fine tuning. As the number of these long-range interactions is increased, the cluster size distribution exponent is found to decrease in magnitude as the small-world regime is entered, indicating a change in its universality class. It is suggested that such a model could have applicability in the study of disease spreading in human populations

The influence of an eddy in the success rates and distributions of passively advected or actively swimming biological organisms crossing the continental slope

Author Posting. © American Meteorological Society, 2020. This article is posted here by permission of American Meteorological Society for personal use, not for redistribution. The definitive version was published in Journal of Physical Oceanography 50(7), (2020): 1839-1852, https://doi.org/10.1175/JPO-D-19-0209.1.The Lagrangian characteristics of the surface flow field arising when an idealized, anticyclonic, mesoscale, isolated deep-ocean eddy collides with continental slope and shelf topography are explored. In addition to fluid parcel trajectories, we consider the trajectories of biological organisms that are able to navigate and swim, and for which shallow water is a destination. Of particular interest is the movement of organisms initially located in the offshore eddy, the manner in which the eddy influences the ability of the organisms to reach the shelf break, and the spatial and temporal distributions of organisms that do so. For nonswimmers or very slow swimmers, the organisms arrive at the shelf break in distinct pulses, with different pulses occurring at different locations along the shelf break. This phenomenon is closely related to the episodic formation of trailing vortices that are formed after the eddy collides with the continental slope, turns, and travels parallel to the coast. Analysis based on finite-time Lyapunov exponents reveals initial locations of all successful trajectories reaching the shoreline, and provides maps of the transport pathways showing that much of the cross-shelf-break transport occurs in the lee of the eddy as it moves parallel to the shore. The same analysis shows that the onshore transport is interrupted after a trailing vortex detaches. As the swimming speeds are increased, the organisms are influenced less by the eddy and tend to show up en mass and in a single pulse.IR and LP were supported by National Science Foundation (NSF) Grant OCE-1558806. DC was supported by NSF U.S. National Science Foundation’s Physical Oceanography program through Grants OCE-1059632 and OCE-1433953 as well as the Academic Programs Office, Woods Hole Oceanographic Institution. We acknowledge high-performance computing support from Yellowstone (http://n2t.net/ark:/85065/d7wd3xhc) provided by NCAR’s Computational and Information Systems Laboratory, sponsored by the National Science Foundation

First-order structural transition in the magnetically ordered phase of Fe1.13Te

Specific heat, resistivity, magnetic susceptibility, linear thermal expansion (LTE), and high-resolution synchrotron X-ray powder diffraction investigations of single crystals Fe1+yTe (0.06 < y < 0.15) reveal a splitting of a single, first-order transition for y 0.12. Most strikingly, all measurements on identical samples Fe1.13Te consistently indicate that, upon cooling, the magnetic transition at T_N precedes the first-order structural transition at a lower temperature T_s. The structural transition in turn coincides with a change in the character of the magnetic structure. The LTE measurements along the crystallographic c-axis displays a small distortion close to T_N due to a lattice striction as a consequence of magnetic ordering, and a much larger change at T_s. The lattice symmetry changes, however, only below T_s as indicated by powder X-ray diffraction. This behavior is in stark contrast to the sequence in which the phase transitions occur in Fe pnictides.Comment: 6 page

Isolated bilateral simplex ureteric ectopia: Bladder capacity as an indicator of continence outcome

INTRODUCTION: Isolated bilateral simplex ectopic ureters (BSEUs) are rare but pose a therapeutic challenge: ureteric reimplantation alone does not accomplish continence in all. Identifying the patients needing additional procedures for continence early could prevent multiple operations. OBJECTIVE: Potential preoperative indicators for postoperative continence are explored in eight BSEU girls without cloacal, anorectal, or spinal anomalies. STUDY DESIGN: With institutional approval, all patients with BSEU between 1985 and 2012 were retrospectively reviewed. Cystoscopy determined the site of ureteric ectopia (6 of 16 at the bladder neck [BN], 5 of 16 below the BN, and 5 of 16 in the distal urethra). Bladders were assessed by a combination of ultrasound, urodynamics, micturating cystourethrogram, cystoscopic, and intraoperative observations. Expected bladder capacity for age (EBCA) was calculated by 30 ml + (30 ml × age in years) or 38 ml + (2.5 ml × age in months) for children greater or less than 2 years, respectively. Continence outcomes were appraised at a minimum of 4 years. The small number of patients precludes credible statistical analysis and therefore raw data are presented. RESULTS: Patients underwent cross-trigonal ureteric reimplantation at 1–5.5 years, in five without BN surgery and in three with a Young–Dees–Leadbetter BN tightening. Of those without BN surgery at reimplantation, four achieved satisfactory continence for their age, but one has had multiple procedures culminating in BN closure, ileocystoplasty, and Mitrofanoff. Among the BN-tightening group, one was in nappies at 4 years, one had residual stress incontinence after two further BN injections, and one proceeded to artificial urinary sphincter after two BN injections. Five patients had significant renal impairment. DISCUSSION: Patients with satisfactory continence after reimplantation alone and those needing further procedures tended to differ in their preoperative observations of bladder capacity and apparent BN competence. This study suggests preoperative observations of an empty bladder on serial ultrasound and/or a wide-open BN with small or even moderate bladder capacity at cystoscopy to indicate the need for BN surgery. In contrast, children with bladder filling to at least 30% of expected bladder capacity for age on preoperative ultrasound or apposition of the BN at cystoscopy may achieve satisfactory continence after ureteric reimplantation alone. Bladder capacity as an indicator of BN competence can also be correlated to continence outcomes in previously published series. Polyuria associated with renal impairment can exacerbate the challenge for continence. CONCLUSION: Preoperative bladder capacity appears to be an indicator of inherent BN function and a thorough assessment of the urinary tract by cystoscopy, ultrasound, micturating cystourethrogram, and functional imaging may guide the surgeon on the need for BN surgery at the time of ureteric reimplantation. Where continence remains elusive, patients should be counselled that a further BN injection is occasionally of value although more significant BN procedures are required for most