Ghost in the machine

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Efficacy of Pregabalin in Acute Postoperative Pain Under Different Surgical Categories: a meta-analysis

published_or_final_versio

Linkless octree using multi-level perfect hashing

The standard C/C++ implementation of a spatial partitioning data structure, such as octree and quadtree, is often inefficient in terms of storage requirements particularly when the memory overhead for maintaining parent-to-child pointers is significant with respect to the amount of actual data in each tree node. In this work, we present a novel data structure that implements uniform spatial partitioning without storing explicit parent-to-child pointer links. Our linkless tree encodes the storage locations of subdivided nodes using perfect hashing while retaining important properties of uniform spatial partitioning trees, such as coarse-to-fine hierarchical representation, efficient storage usage, and efficient random accessibility. We demonstrate the performance of our linkless trees using image compression and path planning examples.postprin

Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies

PURPOSE: While several clinical prediction rules (CPRs) of survival exist for patients with symptomatic spinal metastasis (SSM), these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL). We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs. METHODS: Seven electronic databases were searched (1990-2015), without language restriction, to identify studies that performed multivariate analysis of preoperative predictors of survival, neurological, functional and HRQoL outcomes in surgical patients with SSM. Individual studies were assessed for class of evidence. The strength of the overall body of evidence was evaluated using GRADE for each predictor. RESULTS: Among 4,818 unique citations, 17 were included; all were in English, rated Class III and focused on survival, revealing a total of 46 predictors. The strength of the overall body of evidence was very low for 39 and low for 7 predictors. Due to considerable heterogeneity in patient samples and prognostic factors investigated as well as several methodological issues, our results had a moderately high risk of bias and were difficult to interpret. CONCLUSIONS: The quality of evidence for predictors of survival was, at best, low. We failed to identify studies that evaluated preoperative prognostic factors for neurological, functional, or HRQoL outcomes in surgical patients with SSM. We formulated methodological recommendations for prognostic studies to promote acquiring high-quality evidence to better estimate predictor effect sizes to improve patient education, surgical decision-making and development of CPRs

Effects of Intra-Operative Total Intravenous Anaesthesia with Propofol versus Inhalational Anaesthesia with Sevoflurane on Post-Operative Pain in Liver Surgery: A Retrospective Case-Control Study

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Intradural Metastasis from Cutaneous Squamous Cell Carcinoma Causing Cauda Equina Syndrome

BACKGROUND: Spinal leptomeningeal carcinomatosis from a cutaneous squamous cell carcinoma (SCC) origin is exceedingly rare. Herein, we describe the first report of cauda equina syndrome secondary to drop metastases from a skin SCC. CASE DESCRIPTION: A 69-year-old male with a history of recurrent SCC of the face with known cranial nerve involvement presented with acute onset sphincter and lower extremity symptoms. Neuroimaging revealed a compressive intradural mass at the lumbosacral junction. The patient underwent urgent surgical decompression followed by adjuvant fractionated radiotherapy. Substantial improvement in function and quality of life was reported on postoperative follow-up. CONCLUSION: Cauda equina syndrome manifestations in a patient with a history of cutaneous SCC with perineural spread should raise suspicion for drop metastases. In this case, a relatively straight forward surgical procedure resulted in significant improvement in the quality of life. Therefore, operative intervention should be considered to prevent permanent neurological deficits depending on the patient’s goals of care and overall clinical status

Preventive Treatment with Ketamine attenuates the ischaemia-reperfusion response in a chronic postichaemia pain model

published_or_final_versio

Inhibition of Nitric Oxide and Prostaglandin E2 Expression by Methanol Extract of Polyopes affinis in Lipopolysaccharide-stimulated BV2 Microglial Cells through Suppression of Akt-dependent NF-kB Activity and MAPK Pathway

Purpose: To determine whether the methanol extract of Polyopes affinis (MEPA) down-regulates the expression of pro-inflammatory mediators in lipopolysaccharide (LPS)-stimulated BV2 microglial cells.Methods: The production of nitric oxide (NO) and prostaglandin E2 (PGE2) was measured by the Griess reagents and enzyme-linked immunosorbent assay (ELISA), respectively. Expression levels of mRNA and protein in LPS-stimulated BV2 microglial cells were assessed by reverse transcription-polymerase (RT-PCR) and Western blot analysis. Activation of nuclear factor-êB (NF-êB) was detected by electrophoretic mobility shift assay (EMSA).Results: MEPA inhibited the expression of LPS-induced pro-inflammatory mediators, NO and PGE2, as well as their respective genes, iNOS and COX-2, at both protein and mRNA levels, without any accompanying cytotoxicity. Moreover, treatment with MEPA significantly suppressed the LPS-induced DNA-binding activity of NF-êB, which is known as a main transcription factor for the regulation of proinflammatory genes, as well as the nuclear translocation of its subunit p65 and p50, by degrading IêBá.MEPA increased Akt dephosphorylation which leads to suppression of the DNA-binding activity of NF-kB in LPS-stimulated BV2 microglial cells and suppressed phosphorylation of ERK and JNK, which are involved in the mitogen-activated protein kinase (MAPK) signaling pathway for regulating proinflammatory genes.Conclusion: Our results indicate that MEPA down-regulates  pro-inflammatory mediators such as NO and PGE2 by suppressing Akt-dependent NF-êB activity as well as phosphorylation of ERK and JNK inLPS-stimulated BV2 microglial cells.Keywords: Polyopes affinis, Nitric oxide, Prostaglandin E2, Nuclear factor-k