Cranioplasty optimal timing in cases of decompressive craniectomy after severe head injury: a systematic literature review

AbstractObjectCranioplasty has been considered for several decades as a protective and cosmetic procedure. It has recently been postulated that cranioplasty may have a therapeutic role, and improve the patient’s functional outcome after decompressive craniectomy (DC). The appropriate timing for cranioplasty remains unknown. In our current study, we review the literature for evaluating the relationship of cranioplasty timing and its complication rate and outcome.MethodsThe PubMed database was searched to identify any relevant articles. The following terms were used as keywords: “cranioplasty”, “timing cranioplasty”, “early cranioplasty”, “late cranioplasty”, “delayed cranioplasty”, “early versus late cranioplasty”. Clinical studies with more than 10 participants, and closed head injury as the underlying cause for DC were included in our study. The study design, the timing performing cranioplasty, the complication rate, and the patients’ outcome were evaluated.ResultsTen clinical series met our inclusion criteria. The observed complication rate associated to cranioplasty after DC is not negligible. Several reports have demonstrated that late cranioplasty may minimize procedure-associated complications. Early cranioplasty has been associated with complications, but improves CSF dynamics, and regional cerebral perfusion and metabolism, minimizes the complications from a sunken scalp, reduces the overall length of hospitalization, and thus the overall cost of care.ConclusionsCranioplasty is a relatively simple procedure that is nevertheless burdened by considerable morbidity. However, an early cranioplasty procedure may improve the outcome in selected cases. Prospective, large-scale studies are necessary to outline the actual complication rate, the neurological outcome, and define the optimal timing for a cranioplasty

The FGA Thr312Ala polymorphism and risk of intracerebral haemorrhage in Polish and Greek populations

Background and purpose Spontaneous intracerebral haemorrhage (ICH) is the most fatal form of stroke with the highest morbidity and disability rate of all stroke types. Recent data suggest that the genetic background has a sizeable and mostly undiscovered effect on the brain haemorrhage risk. Since the coagulation system is crucial to ICH pathology, we studied the significance of the FGA Thr312Ala polymorphism in two European populations. Materials and methods We genotyped 550 and 224 controls as well as 261 and 242 stroke patients in Polish and Greek populations, respectively. The ICH diagnosis was confirmed by computed tomography. The FGA Thr312Ala polymorphism was analysed using real-time polymorphism chain reaction. Results Both crude and multivariable regression analyses showed that the studied polymorphism is a protective factor in the Polish population under the dominant and additive models of inheritance. Those results did not replicate in the Greek population. The meta-analysis of results from the Polish and the Greek populations proved that FGA Thr312Ala polymorphism affects the risk of ICH in the dominant model of inheritance. Conclusions The FGA Thr312Ala polymorphism affects a risk for ICH in the Polish but not in the Greek population. An advanced meta-analysis of well-designed studies with a significant number of cases might provide useful information of novel polymorphisms, including the FGA Thr312Ala polymorphism, and their role in ICH pathology

Weather impact on containership routing in closed seas: A chance-constraint optimization approach

Weather conditions have a strong effect on the operation of vessels and unavoidably influence total time at sea and associated transportation costs. The velocity and direction of the wind in particular may considerably affect travel speed of vessels and therefore the reliability of scheduled maritime services. This paper considers weather effects in containership routing; a stochastic model is developed for determining optimal routes for a homogeneous fleet performing pick-ups and deliveries of containers between a hub and several spoke ports, while incorporating travel time uncertainties attributed to the weather. The problem is originally formulated as a chance-constrained variant of the vehicle routing problem with simultaneous pick-ups and deliveries and time constraints and solved using a genetic algorithm. The model is implemented to a network of island ports of the Aegean Sea. Results on the application of algorithm reveal that a small fleet is sufficient enough to serve network’s islands, under the influence of minor delays. A sensitivity analysis based on alternative scenarios in the problem’s parameters, leads to encouraging conclusions with respect to the efficiency and robustness of the algorithm