Intercostal neurolysis for the treatment of postsurgical thoracic pain: A case series

Introduction: We investigated the possible role of intercostal surgical neurolysis in relieving chronic neuropathic pain refractory to other nonsurgical treatments in patients with postsurgical thoracic pain. Methods: We retrospectively collected clinical data on patients referred to the Neurosurgery Unit of Policlinic Hospital of Milan. Ten patients (age range, 20-68 years) suffering from neuropathic pain for at least 2 months after thoracic surgery underwent intercostal neurolysis. Results: Compared with preneurolysis, pain intensity decreased 1 month postneurolysis and remained stable 2 months postneurolysis (median score [interquartile range]: 8 [6-9] preneurolysis, 4 [3-5] 1 month after, and 3 [2-5] 2 months after, P < 0.001). Antiepileptic drugs for pain control decreased after neurolysis. Discussion: Surgical intercostal neurolysis may be a promising therapeutic option in patients with chronic neuropathic pain associated with neurological deficits

Temporal Cross-Media Retrieval with Soft-Smoothing

Multimedia information have strong temporal correlations that shape the way modalities co-occur over time. In this paper we study the dynamic nature of multimedia and social-media information, where the temporal dimension emerges as a strong source of evidence for learning the temporal correlations across visual and textual modalities. So far, cross-media retrieval models, explored the correlations between different modalities (e.g. text and image) to learn a common subspace, in which semantically similar instances lie in the same neighbourhood. Building on such knowledge, we propose a novel temporal cross-media neural architecture, that departs from standard cross-media methods, by explicitly accounting for the temporal dimension through temporal subspace learning. The model is softly-constrained with temporal and inter-modality constraints that guide the new subspace learning task by favouring temporal correlations between semantically similar and temporally close instances. Experiments on three distinct datasets show that accounting for time turns out to be important for cross-media retrieval. Namely, the proposed method outperforms a set of baselines on the task of temporal cross-media retrieval, demonstrating its effectiveness for performing temporal subspace learning.Comment: To appear in ACM MM 201

Prospective randomized comparison of laparoscopic versus open adrenalectomy for sporadic pheochromocytoma.

BACKGROUND: Laparoscopic adrenalectomy for pheochromocytoma remains subject of debate, owing to the systemic consequences of pneumoperitoneum in patients with catecholamine-secreting tumors. METHODS: A prospective randomized study was conducted (2000-2006), evaluating cardiovascular instability during open (n = 9, group A) or laparoscopic (n = 13, group B) adrenalectomy for pheochromocytoma. Haemodynamic parameters were recorded by invasive monitoring. RESULTS: Haemodynamic instability was observed in 3/9 (group A) and 6/13 patients (group B), with a mean of 1.8 and 2.2 hypertensive peaks per patient (p = n.s.). Blood loss (164 +/- 94 cc versus 48 +/- 36 cc, p < 0.05) and operative time (180 +/- 40 versus 158 +/- 45 min, p = n.s.) favored laparoscopic procedures. Postoperative morbidity and mortality were nil. Hospital stay was shorter in group B (p < 0.05). Long-term follow-up was always normal. CONCLUSIONS: Laparoscopic approach for pheochromocytoma can be as safe as open surgery; intraoperative haemodynamic instability, although usually controlled with success, remains a source of concern

Metachronous hepatic metastases from gastric carcinoma: a multicentric survey

BACKGROUND: The treatment of hepatic metastases from gastric cancer is controversial, due to biologic aggressiveness of the disease. OBJECTIVE: To survey the clinical approach to the subset of atients presenting with metachronous hepatic metastases as sole site of recurrence after curative resection of gastric cancer, focusing on the results achieved by different therapies and to investigate the prognostic factors of major clinical relevance. METHODS: Retrospective multi-center chart review evaluating 73 patients, previously submitted to D >or= 2 gastrectomy for gastric cancer, who developed exclusive hepatic recurrence. Prognostic factors related to the patient, to the gastric malignancy and its treatment, and to the metastatic disease and its therapy were evaluated. RESULTS: Forty-five patients received supportive care, 17 were submitted to chemotherapy, and 11 to hepatic resection. Survival was independently influenced by the variables T (p=0.019), N (p=0.05) and G (p=0.018) of the gastric primary and by the therapeutic approach to the metastases (p<0.005). In particular, T4 gastric cancer, presence of lymph-node metastases and G3 tumor displayed a negative prognostic value. Therapeutic approach to the metastases was the principal prognostic variable: 1, 2, and 3 years survival rates were 22.2%, 4.4% and 2.2%, respectively, for patients without specific treatment; 44.9%, 12.8% and 6.4% after chemotherapy (p=0.08) and 80.8%, 30.3% and 20.2% after surgical resection (p<0.001). CONCLUSIONS: Our data suggest some clinical criteria that may facilitate selection of therapy for patients with hepatic recurrence after primary gastric cancer resection. The best survival rates are associated with surgical treatment, which should be chosen whenever possible

Prepping for Another Recession: Re-Assessing the Validity of Teacher Evaluation Systems for Human Capital Decision-Making

Problem. The school budget cuts concomitant with the COVID-19 pandemic mean educator jobs may again be threatened by layoffs. During prior recessions, school district administration primarily deter- mined teacher layoffs by virtue of seniority. However, as new evidence emerges that seniority policies may not be the most equitable way to determine teacher layoffs, some have turned towards performance-based measures from evaluation systems. Purpose. The purpose of this paper is to examine the validity and reli- ability of the Nevada Educator Performance Framework (NEPF) for making human capital decisions like layoffs. Recommendations. We recommend that Nevada and other states improve the differentiation in scores across the varying evaluation domains by engaging in more rigorous training of evaluators. Addi- tionally, we recommend that Nevada and other states improve the distribution of final teacher evaluation scores so that the performance measure really distinguishes among teacher performance. Strategies could include lessening the administrative burden of filling out the final evaluation, increasing the number of performance levels, or rotating the specific standards focused on each year

Anatomical basis of erector spinae plane block: a dissection and histotopographic pilot study

Purpose: Erector spinae plane (ESP) block is an interfascial blockade used in different clinical scenarios. This study investigated the ventral extent of dye diffusion in ESP block. Methods: The ultrasound-guided ESP block was bilaterally performed with an injection at the T5 vertebral level (21-Gauge, 50\ua0mm needle), using diluted black tissue marking dye (20\ua0mL; 1:4 ratio with standard saline solution) instead of local anesthetic on two fresh-frozen corpses within the body donation program of the University of Padova. Subsequently, the gross anatomical dissection was performed by a combined posterior plus anterior approach, and the histotopographic examination completed. Results: Macroscopically by gross anatomical dissection, the dye spreading ranged on the dorsal side of the chest from T2/3 to T10/11 with an extension up to 10\ua0cm laterally, and on the ventral side of the chest from T2/3\u2013T9/10. Microscopically by histotopographic examination, the dye diffused ventrally to the intercostal spaces (2\u20133 and 5\u20136 spaces on the right and left, respectively) by following the blood vessels coupled to the dorsal nerve passing through the costotransverse foramen. Conclusions: The anterior pathway of dye diffusion from the site of injection within the erector spinae muscle group during an ESP block seems to follow the blood vessels and dorsal rami of spinal nerves, suggesting the passing through the costotransverse foramen to reach the anterior paravertebral space and the intercostal nerves. These findings display an anterior histotopographic diffusion of dye resembling a paravertebral block

CW Performance of an InGaAs-GaAs-AlGaAs Laterally-Coupled Distributed Feedback (LC-DFB) Ridge Laser Diode

Single-mode distributed feedback (DFB) laser diodes typically require a two-step epitaxial growth or use of a corrugated substrate. We demonstrate InGaAs-GaAs-AlGaAs DFB lasers fabricated from a single epitaxial growth using lateral evanescent coupling of the optical field to a surface grating etehed along the sides of the ridge. A CW threshold current of 25 mA and external quantum efficiency of 0.48 mW/mA per facet were measured for a 1 mm cavity length device with anti-reflection coated facets. Single-mode output powers as high as 11 mW per facet at 935 nm wavelength were attained. A coupling coefficient of at least 5.8/cm was calculated from the subthreshold spectrum taking into account the 2% residual facet reflectivity