Utilizing real-time pressure and tissue oxygenation monitoring to assess the adequacy of hinge craniotomy

AbstractHinge craniotomy has been described as a feasible option for certain patients in need of decompression as a result of a mass lesion. The technique of hinging the bone flap alleviates the need to return to the operating room for cranioplasty as is the case with a traditional decompressive craniectomy. Intracranial pressure and brain tissue oxygenation monitoring can be utilized for intraoperative guidance to assess adequacy of hinge craniotomy. We report a case where intraoperative monitoring helped guide surgical decision making for a 23year old male patient with a left traumatic subdural hematoma. The patient had a Licox monitor placed in the right frontal region, showing elevated intracranial pressure and decreased brain tissue oxygenation. The patient underwent hinge craniotomy, which initially lowered his intracranial pressure from 54 to 11cmH2O and allowed his brain tissue oxygenation to rise to a normal value of 20.5mmHg. However, upon closure of the skin, the patient's intracranial pressure increased to 24cmH2O and brain tissue oxygenation decreased to 7.8mmHg. As a result, the patient underwent decompressive craniectomy and the intracranial pressure and brain tissue oxygenation values normalized postoperatively. Intracranial pressure and brain tissue oxygenation can be helpful intraoperative guides in determining whether hinge craniotomy is adequate

Perioperative hemodynamic goal-directed therapy and mortality: a systematic review and meta-analysis with meta-regression

INTRODUCTION: Recent data found that perioperative goal directed therapy (GDT) was effective only in higher control mortality rates (> 20%) with a relatively high heterogeneity that limited the strength of evidence. The aim of the present meta-analysis was to clearly understand which high risk patients may benefit of GDT.EVIDENCE ACQUISITION: Systematic review of randomized controlled trials with meta-analyses, including a meta-regression technique. MEDLINE, EMBASE, and The Cochrane Library databases were searched (1980-January 2015). Trials enrolling adult surgical patients and comparing the effects of GDT versus standard hemodynamic therapy were considered. The primary outcome measure was mortality. Data synthesis was obtained by using Odds Ratio (OR) with 95% confidence interval (CI) by random-effects model.EVIDENCE SYNTHESIS: Fifty eight studies met the inclusion criteria (8171 participants). Pooled OR for mortality was 0.70 (95% CI 0.56-0.88, P= 0.002, no statistical heterogeneity). GDT significantly reduced mortality when it is > 10% in control group (OR 0.43, 95% CI 0.30-0.61, P< 0.00001). The meta-regression model showed that the cut off of 10% of mortality rate in control group significantly differentiates 43 studies from the other 15, with a regression coefficient b of -0.033 and a P value of 0.0001. The significant effect of GDT was driven by high risk of bias studies (OR 0.48, 95% CI 0.34-0.67, P< 0.0001).CONCLUSIONS: The present meta-analysis, adopting the meta-regression technique, suggests that GDT significantly reduces mortality even when the event control rate is > 10%

Perché le norme editoriali?

Partendo da alcuni esempi, il lavoro intende proporre una riflessione sulle norme editoriali relative a pubblicazioni scientifiche, in particolare sulla loro coerenza interna e sulla loro utilità nella trasmissione dei testi

Indici della rivista “Elenchos” 2010-2019

Con il presente contributo si forniscono gli Indici completi delle ultime dieci annate della rivista “Elenchos” e il collegamento ipertestuale alle due precedenti edizioni di Indici, rispettivamente del ventennio 1980-1999 e del decennio 2000-2009, entrambi curati da chi scrive e pubblicati dalla Casa editrice Bibliopoli

Note per la preparazione di prodotti editoriali elettronici e a stampa

This paper provides some operational guidelines for processing editorial products as scholarly texts (documents with many type of characters and footnotes) using Microsoft Word for Windows/Macintosh. The most important tasks to tackle will be printing, digitizing and uploading the text on the web. The elements of the published products are the text, the metadata of the text and the paratext. Following the analysis of those elements, publishing will follow four steps: set up the metatext, preparing the file, editing, and pagination. For every phase operational indications, tools and practical suggestions are furnished

The Influence of Two Different Breeding Systems on Quality and Clotting Properties of Milk from Dairy Buffaloes Reared in Sicily (Italy)

This study focuses on nine buffalo farms (a total of 692 buffaloes), five intensive herds (161 lactating buffalo cows) and four semiextensive herds (111 lactating buffalo cows), which are the most common in Sicily. The average milk and cheese yield, fat, protein and lactose contents were very similar between the two breeding systems. Milk casein was higher (P=0.04) in intensive herds than in semiextensive herds (4.07% vs 3.51%), whereas the urea content was higher in semi-extensive herds (40.68 mg/dL vs 37.50 mg/dL), yet within the normal range for buffalo milk. As regards milk pH and titration acidity (°SH), no difference was observed between the two breeding systems. Milk produced by the intensive herds scored the best clotting ability with shorter curd firming time (k20 3.08 min) and greater curd firmness (a30 32.69 mm). Milk produced by the semi-extensive herds, instead, was characterized by a longer curd firming time (k20 5.26 min) and lower curd firmness (a30 27.33 mm). This milk from buffaloes bred in Sicily (Italy) also showed a good chemical composition and clotting ability in particular when produced by the intensive herds

"Hemolysis, or not hemolysis, that is the question". Use of hydroxychloroquine in a patient with COVID-19 infection and G6PD deficiency

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Economic impact of industry-sponsored clinical trials in inflammatory bowel diseases: Results from the national institute of gastroenterology “Saverio de Bellis”

Introduction: The majority of the money spent on possible new medications’ clinical trials is accounted for by the innovative pharmaceutical sector, which also stimulates the economy of a nation. The objective of this study was to evaluate the impact of pharmaceutical industry-sponsored clinical trials (ISCTs) in inflammatory bowel diseases (IBDs) towards the national health service (NHS) in terms of avoided costs and leverage effect. Methodology: The research was conducted at National Institute of Gastroenterology, “Saverio De Bellis”, Castellana Grotte (Apulia, Italy) collecting data from profit ISCTs of pharmaceutical products conducted over the time period 2018-2020 with focus on inflammatory bowel diseases. After the quantification of health services and drug costs from the latter studies, avoided costs and leverage effects were then estimated. Results: The results on the avoided costs for healthcare facilities deriving from the conduct of clinical studies show that, in relation to the sample of five drug companies participating in our 2018-2020 analysis, out of a total of 235,102.46 €, identified as direct investment, 628,158.21 € of avoided costs for the NHS were measured, with an additional saving (leverage effect) for the NHS of 3.67 € for each € invested by the companies promoting clinical trials