How Safe and Effective Is Shifting from Pterional to Supraorbital Keyhole Approach for Clipping Ruptured Anterior Circulation Aneurysms? A Surgeon’s Transition Phase Comparative Study

Background Comparative studies between standard pterional and supraorbital keyhole approaches for aneurysms had potential biases with the heterogeneity of patient selection, differences among surgeons, or varying expertise across the surgeon’s learning curve. This is a study of a surgeon’s transition from pterional to keyhole approach for early clipping of selected consecutive ruptured anterior circulation aneurysms. Methods Patients more than 18 years, presenting within 72 hours of ictus, in good clinical grades 1 to 3, no midline shift, with saccular aneurysms less than 25 mm at either communicating segment of internal carotid artery, anterior communicating artery, or middle cerebral artery segment till bifurcation were studied between the last 25 cases of pterional and first 25 cases of the keyhole, for the intraoperative and postoperative surgical outcome parameters. Results There was no significant difference among baseline parameters, including the location of aneurysms across both groups. While only four cases of pterional had an intraoperative ventricular puncture, the lumbar drain was electively inserted in all keyhole patients. The intraoperative parameters, such as a dural tear, adequate parent vessel exposure, temporary clipping, and intraoperative rupture, did not show any significant difference. None had immediate postoperative deficits. While delayed cerebral ischemia and wound complaints were similar in both groups, temporal hollowing and chewing difficulty were significantly more in pterional patients(p = 0.01). Conclusion A surgeon experienced in pterional approach can comfortably and safely shift to the keyhole for early clipping of selected ruptured aneurysms less than 25 mm, with a comparable surgical outcome but better cosmesis and mastication

Genomic interrogation of ancestral Mycobacterium tuberculosis from south India

Mycobacterium tuberculosis is a very important global pathogen. One quarter of the world’s TB cases occur in India. The tuberculosis strains isolated from south Indian patients exhibit certain phenotypic characteristics like low virulence in guinea-pigs, resistance to isoniazid, thiophene-2- carboxylic acid hydrazide (TCH) and para-amino salicylic acid (PAS), and enhanced susceptibility to H2O2. Besides this, a large percentage of the isolates harbor only a single copy of IS 6110 which makes these strains distinct. Hence, we have studied the genotypic characteristics of these strains by using advanced techniques like Deletion Micro array, deletion PCR, allelic discrimination RT-PCR using several lineage specific markers and KatG G1388T (non-synonymous) polymorphism along with spoligotyping. The analysis of 1215 tuberculosis patient isolates from south India revealed that 85.2% belonged to the ancestral lineage of M. tuberculosis. Comparative whole-genome hybridization identified six new genomic regions within this lineage that were variably deleted

Oxidation of bis-(2-hydroxy-1-naphthyl)methane with 2,3-dichloro-5,6-dicyano-1,4-benzoquinone. X-Ray crystal structure of a novel product

A novel compound obtained by the oxidation of the title compound with 2,3-dichloro-5,6-dicyano-1,4-benzoquinone has been assigned structure (5) on the basis of spectral data and X-ray crystal structure analysis

Oxidation of bis(2-hydroxy-1-naphthyl)methane and similar bisnaphthols with 2,3-dichloro-5,6-dicyano-1,4-benzoquinone. Structure and synthesis of novel products

Oxidation of bis(2-hydroxy-1-naphthyl)methane (4a) with 2,3-dichloro-5,6-dicyano-1,4-benzoqui-none (DDQ) has been shown to give the novel compounds, cis- and trans-dispiro{naphthalene-1,2'(1'H)-naphtho[2,1-b]pyran-3',1"-naphthalene}-2(1H),2"(1"H)-dione (12a) and (13a) together with the quinone methide dimer (6a) and the spiroketone (5a). Compounds (12a) and (13a) were characterised on the basis of their spectral properties and the structures were finally confirmed by an X-ray crystal structure analysis of (12a). Hydrogenation of compounds (12a) and (13a) has been shown to give the dihydroxy compound (14) via C-C bond cleavage. An alternative synthesis of the dispironaphthalenones (12a) and (13a) was achieved by oxidation of the dihydroxy compound (14), prepared by an independent method. The generality of the oxidation of bisnaphthols of type (4a) to give novel products of the type (12a) and (13a) has been shown by studying the oxidation of the variously substituted bisnaphthols (4b-d, f) with DDQ. A mechanism has been proposed invoking the intermediacy of the quinol ethers (22) and (24)

Why blockchains need the law: Secondary rules as the missing piece of blockchain governance

Governance issues limit blockchains’ ability to evolve and face unforeseen challenges. It seems possible to argue that this impasse is because most blockchains lack meta-rules. This work considers blockchains as a socio-technical system of rules, in order to draw a comparison with legal systems. Following the comparison, one finds that most blockchains lack what, in legal theory, are considered secondary rules. That is, the meta-rule of the system. This works examines the relevant concepts and provides their definitions, then proceeds to outline concrete example of the failure of governance among popular blockchains before drawing the parallelism with legal systems and argue that secondary rules might solve some of the issues of the governance of blockchains. Secondary rules are the necessary infrastructure for building sound governance structures and a necessary condition for blockchains to succeed as a new mode of governance. The conclusion provides future research directions

Three-dimensional assessment of unilateral subcondylar fracture using computed tomography after open reduction

Objective: The aim was to assess the accuracy of three-dimensional anatomical reductions achieved by open method of treatment in cases of displaced unilateral mandibular subcondylar fractures using preoperative (pre op) and postoperative (post op) computed tomography (CT) scans. Materials and Methods: In this prospective study, 10 patients with unilateral sub condylar fractures confirmed by an orthopantomogram were included. A pre op and post op CT after 1 week of surgical procedure was taken in axial, coronal and sagittal plane along with three-dimensional reconstruction. Standard anatomical parameters, which undergo changes due to fractures of the mandibular condyle were measured in pre and post op CT scans in three planes and statistically analysed for the accuracy of the reduction comparing the following variables: (a) Pre op fractured and nonfractured side (b) post op fractured and nonfractured side (c) pre op fractured and post op fractured side. P < 0.05 was considered as significant. Results: Three-dimensional anatomical reduction was possible in 9 out of 10 cases (90%). The statistical analysis of each parameter in three variables revealed (P < 0.05) that there was a gross change in the dimensions of the parameters obtained in pre op fractured and nonfractured side. When these parameters were assessed in post op CT for the three variables there was no statistical difference between the post op fractured side and non fractured side. The same parameters were analysed for the three variables in pre op fractured and post op fractured side and found significant statistical difference suggesting a considerable change in the dimensions of the fractured side post operatively. Conclusion: The statistical and clinical results in our study emphasised that it is possible to fix the condyle in three-dimensional anatomical positions with open method of treatment and avoid post op degenerative joint changes. CT is the ideal imaging tool and should be used on a regular basis for cases of condylar fractures

Modification of the genome of Rhodobacter sphaeroides and construction of synthetic operons

The α-proteobacterium Rhodobacter sphaeroides is an exemplary model organism for the creation and study of novel protein expression systems, especially membrane protein complexes that harvest light energy to yield electrical energy. Advantages of this organism include a sequenced genome, tools for genetic engineering, a well-characterized metabolism, and a large membrane surface area when grown under hypoxic or anoxic conditions. This chapter provides a framework for the utilization of R. sphaeroides as a model organism for membrane protein expression, highlighting key advantages and shortcomings. Procedures covered in this chapter include the creation of chromosomal gene deletions, disruptions, and replacements, as well as the construction of a synthetic operon using a model promoter to induce expression of modified photosynthetic reaction center proteins for structural and functional analysis.20 page(s