Evaluation of modified surgical technique outcomes in single-suture and complex craniosynostosis

Uvod: Kraniosinostoze su oboljenja koja se karakterišu patološkom prevremenom fuzijom jedne ili više kranijalnih sutura usled čega dolazi do nastanka abnormalnog oblika lobanje, intrakranijalne hipertenzije i poremećaja neurokognitivnog razvoja obolele dece. Cilj: Ova doktorska teza ima za cilj evaluaciju rezultata lečenja modifikovanim hirurškim tehnikama u tretmanu unisuturnih i kompleksnih kraniosinostoza, koja podrazumeva: 1. detaljan prikaz novih modifikovanih hirurških tehnika: trikvadratna proširena osteotomija (triple square extended osteotomies, TSEO), dinamička remodelacija sa plivajućim čelom (floating forehead dynamic remodeling, FFDR) i frontoorbitalna hiperkorektivna remodelacija (fronto-orbital hypercorrective remodeling, FOHR) 2. procenu estetskih rezultata hirurškog lečenja prema standardnim klasifikacijama 3. procenu morfološkog ishoda hirurškog lečenja 4. neurokognitivnu evaluaciju operisanih pacijenata Materijal i metode: Ukupno 187 pacijenata sa prevremenim srastanjem jedne ili više kranijalnih sutura hirurški su lečeni u Klinici za neurohirurgiju KCS u Beogradu od januara 1999. do januara 2014. godine. Kod svih pacijenata sprovedena je adekvatna preoperativna neuroradiološka evaluacija, koja je podrazumevala nativni kraniogram i kompjuterizovanu tomografiju glave; magnetna rezonanca nije rutinski rađena i bila je razmatrana isključivo za sindromske slučajeve. Klinički parametri dobijeni su iz istorija bolesti i služili su za formiranje detaljnog upitnika. Kraniometrijske referentne vrednosti od interesa: preoperativni i postoperativni kranijalni indeks (CI), endokranijalni bifrontalni ugao (EBA) i modifikovani indeks za procenu simetrije kranijuma (modified cranial vault asymmetry index - mCVAI) korišćene su za morfološku procenu uspešnosti lečenja. Estetski rezultat lečenja evaluiran je Whitakerovom i Sloanovom klasifikacijom. Prisutni neurokognitivni poremećaj, zaostajanje u psihomotornom razvoju, kao i intelektualnom funkcionisanju, procenjivan je korišćenjem Razvojnog testa Čuturić, REVISK skale i testa NEPSY-II...Introduction: The term craniosynostosis refers to premature fusion of one of more cranial sutures that can lead to severe craniofacial disfigurement, intracranial hypertension and abnormal neurocognitive development in affected children. Aim: The present thesis has the intention to evaluate results of modified surgical techniques used in the treatment of unisutural and complex craniosynostosis that comprises of: 1. Detailed presentation of the new modified surgical techniques: triple square extended osteotomies (TSEO), floating forehead dynamic remodeling (FFDR) and frontoorbital hypercorrective remodeling (FOHR) techniques 2. Estimation of the aesthetic results after surgical treatment according to standard classifications 3. Estimation of morphological outcome of surgical treatment 4. Neurocognitive evaluation of treated patients Material and method: A total of 187 consecutive patients with premature fusion of one or more cranial sutures were surgically treated in Clinic of Neurosurgery KCS in Belgrade from January 1999 to January 2014. All patients underwent preoperative neuroradiological evaluation with plain cranial radiography and computerized tomography; magnetic resonance was not routinely performed and was considered strictly for syndromes. Clinical data were extracted from patient's medical history and comprehensive patient interview. Craniometrical referent points of interest: preoperative and postoperative cranial index (CI), endocranial bifrontal angle (EBA) and modified cranial vault asymmetry index (mCVAI) changes were used to estimate morphological outcome of surgery. Aesthetic outcome was assessed using Whitaker and Sloan classification. Presence of neurocognitive impairment, delay in psychomotor development and intellectual functioning were assessed with Cuturic developmental test, REVISK scale and NEPSY-II test..

The prospective randomized study of the safety and efficacy of surgical revascularization of myocardium after carotid stent implantation versus simultaneous carotid and coronary surgical revascularization

Инциденца тешке каротидне болести у пацијената који се подвргавају операцији реваскуларизације срца је у распону од 6-12%. У ових пацијената постоји три пута већи ризик од неуролошких компликација након миокардне реваскуларизације, чак и у случајевима асимптоматске каротидне болести. И поред присутних доказа о комплексности и озбиљности комбиноване каротидне и коронарне болести, оптималан третман је и даље контроверзан. Два протокола се најчешће користе: каротидно стентирање или ендартеректомија која претходи реваскуларизацији срца 2-4 недеље или, симултана интервенција. Ниједна од ових опција није показала супериорност, а, за сада, не постоје ни рандомизоване студије који би дале одговор на то питање. Код временски раздвојених интервенција где се примарно лечи каротидна болест, ризик од акутног инфаркта миокарда пре срчане операције је висок, уколико је у питању каротидна ендартеректомија, док у стентирању постоји већи ризик од неуролошких компликација. С друге стране, симултана операција је повезана са повишеним периоперативним морбидитетом и морталитетом. Код симултане хируршке реваскуларизације, и поред елиминисања међу-процедуралног ризика, резултати су слични хируршкој интервенцији у два времена, а у многим студијама су инфериорнији у односу на резултате каротидног стентирања и коронарног премошћавања када се изводи одвојено, углавном, због високог ризика од периоперативног шлога. Однедавно, доступни су подаци о четвртој опцији- симултано каротидно стентирање и миокардна реваскуларизација. Све серије су нерандомизоване, већина је ретроспективна, а све су лимитиране малим бројем пацијената и имају различите пери и постпроцедуралне протоколе. Ова студија је проспективна, рандомизована, а њен циљ је поређење раних и средњорочних резултата симултане хибридне реваскуларизације (каротидно стентирање и миокардна реваскуларизација) са хируршком комбинованом каротидном ендартеректомијом и коронарном операцијом...The prevalence of severe carotid artery disease among patients undergoing coronary artery bypass surgery (CABG) is estimated to be 6-12%. These patients have three-fold higher risk for neurological complications after CABG, even if the carotid artery disease is asymptomatic. Despite the acknowledgment of its significance, treatment options for the significant carotid artery disease in the patient undergoing CABG remain controversial. Overall, two protocols are widely used: staged procedure, with carotid artery stenting (CAS) or carotid eversion endarterectomy (CEA) followed by CABG (2-4 weeks later), and simultaneous CAS/CEA with CABG. However, either of these proved not to be superior. Moreover, there have been no randomized trials aiming to assess properly which strategy is more appropriate. In the staged surgical approach that addresses the carotid artery lesion first, the risk of acute myocardial infarction prior to CABG is rather high when performing CEA while the risk of stroke is increased in patients undergoing CAS. On the other hand, the combined surgical approach is associated with an increased risk of both cerebral and cardiac mortality and morbidity. With combined CEA/CABG, despite eliminating inter-stage risk, outcomes have been similar to staged CEA/CABG and in many studies inferior to the staged CAS/CABG, mainly due to higher operative stroke risk. Recently, more data are available for the fourth option - the simultaneous, combined approach of CAS and CABG. All published series were nonrandomized, most were retrospective, and all with limited number of patients, as well as with different periand postprocedural protocols. We performed prospective, randomized study with an aim to compare the early postprocedural results of simultaneous hybrid CAS and coronary bypass surgery vs. concomitant CEA – CABG procedure..

Dynamic adsorption characteristics of thin layered activated charcoal materials used in chemical protective overgarments

The efficiency of a thin layered activated charcoal material used in chemical protective overgarments has been evaluated. The study has been conducted with the aim to obtain protective materials with best characteristics considering resistance to benzene effect under dynamic conditions and to create a new filtration protection device. In order to evaluate dynamic adsorption characteristics of thin layered sorption materials, sophisticated dynamic gas chromatography method is used. The curves of benzene penetration are determined for sandwich materials, and sorption layers used in filtrating protective clothing shows that thin layered carbon sorption materials (type MOO) have good protective properties as compared to other similar materials. The findings will help to create conditions for developing a functional model for producing a new protective overgarment in the near future

Ukupna taložna tvar na području Primorsko-goranske županije u razdoblju 1975.-2008.

Dustfall measurements in Primorsko-goranska county started in 1975 in the Bakar Bay (Site 2 - Bakar and Site 3 - Kraljevica). The measurements were extended to the city of Rijeka (Site 1 - Rijeka) in 1982, to the nearby islands (Site 4 - Krk and Site 5 - Cres) in 1986, and inland to Gorski Kotar (Site 6 - Delnice and Site 7 - Lividraga) in 1995. This article brings the results of dustfall measurements from 1975 to 2008. Dustfall was low in the city, the nearby islands, and Gorski Kotar. Recommended and limit values were occasionally exceeded in the Bakar Bay due to emissions from the coke plant and harbour at Site 2 (1979-1997) and from the shipyard at Site 3. Lead content in the dustfall was below the national limits, save for two occasions at Site 2. Deposition of sulphur and nitrogen at the inland sites were below the respective critical load values.Ispitivanja ukupne taložne tvari u Primorsko-goranskoj županiji započela su 1975. godine na području Bakarskog zaljeva. Mjerenja su se 1982. god proširila na grad Rijeku, 1986. na otoke Krk i Cres, a 1995. i na područje Gorskog kotara. U radu su prikazani rezultati mjerenja ukupne taložne tvari u razdoblju 1975.-2008. na sedam odabranih postaja: u gradu Rijeci, dvije na području Bakarskog zaljeva (Bakar i Kraljevica), dvije na otocima (Krk i Cres) te dvije u Gorskom kotaru (Delnice i Lividraga). Analizirano je kretanje prosječnih godišnjih vrijednosti ukupno istaloženih tvari te u njima prisutnih količina sagorivog pepela, sulfata, nitrata, amonija i olova. Na području grada Rijeke, otoka Krka i Cresa te Gorskog kotara količina ukupne taložne tvari je niska. Količine ukupne taložne tvari povremeno su prelazile preporučenu graničnu vrijednost u Bakru (1979.-1994.), zbog emisija iz koksare i iz luke za rasuti teret te u Kraljevici, gdje se osamdesetih godina osjećao utjecaj koksare u Bakru, a od sredine devedesetih pojačani rad u brodogradilištu. Količine olova u taložnoj tvari su niske na svim postajama, osim povremenih skokova u Bakru, kada su prijeđene preporučene vrijednosti. Količine istaloženog sumpora i dušika na području Gorskog kotara ispod su odgovarajućih vrijednosti kritičnog opterećenja za ispitivana područja

Dynamic adsorption characteristics of thin layered activated charcoal materials used in chemical protective overgarments

The efficiency of a thin layered activated charcoal material used in chemical protective overgarments has been evaluated. The study has been conducted with the aim to obtain protective materials with best characteristics considering resistance to benzene effect under dynamic conditions and to create a new filtration protection device. In order to evaluate dynamic adsorption characteristics of thin layered sorption materials, sophisticated dynamic gas chromatography method is used. The curves of benzene penetration are determined for sandwich materials, and sorption layers used in filtrating protective clothing shows that thin layered carbon sorption materials (type MOO) have good protective properties as compared to other similar materials. The findings will help to create conditions for developing a functional model for producing a new protective overgarment in the near future

Evaluation of modified surgical technique outcomes in single-suture and complex craniosynostosis

Uvod: Kraniosinostoze su oboljenja koja se karakterišu patološkom prevremenom fuzijom jedne ili više kranijalnih sutura usled čega dolazi do nastanka abnormalnog oblika lobanje, intrakranijalne hipertenzije i poremećaja neurokognitivnog razvoja obolele dece. Cilj: Ova doktorska teza ima za cilj evaluaciju rezultata lečenja modifikovanim hirurškim tehnikama u tretmanu unisuturnih i kompleksnih kraniosinostoza, koja podrazumeva: 1. detaljan prikaz novih modifikovanih hirurških tehnika: trikvadratna proširena osteotomija (triple square extended osteotomies, TSEO), dinamička remodelacija sa plivajućim čelom (floating forehead dynamic remodeling, FFDR) i frontoorbitalna hiperkorektivna remodelacija (fronto-orbital hypercorrective remodeling, FOHR) 2. procenu estetskih rezultata hirurškog lečenja prema standardnim klasifikacijama 3. procenu morfološkog ishoda hirurškog lečenja 4. neurokognitivnu evaluaciju operisanih pacijenata Materijal i metode: Ukupno 187 pacijenata sa prevremenim srastanjem jedne ili više kranijalnih sutura hirurški su lečeni u Klinici za neurohirurgiju KCS u Beogradu od januara 1999. do januara 2014. godine. Kod svih pacijenata sprovedena je adekvatna preoperativna neuroradiološka evaluacija, koja je podrazumevala nativni kraniogram i kompjuterizovanu tomografiju glave; magnetna rezonanca nije rutinski rađena i bila je razmatrana isključivo za sindromske slučajeve. Klinički parametri dobijeni su iz istorija bolesti i služili su za formiranje detaljnog upitnika. Kraniometrijske referentne vrednosti od interesa: preoperativni i postoperativni kranijalni indeks (CI), endokranijalni bifrontalni ugao (EBA) i modifikovani indeks za procenu simetrije kranijuma (modified cranial vault asymmetry index - mCVAI) korišćene su za morfološku procenu uspešnosti lečenja. Estetski rezultat lečenja evaluiran je Whitakerovom i Sloanovom klasifikacijom. Prisutni neurokognitivni poremećaj, zaostajanje u psihomotornom razvoju, kao i intelektualnom funkcionisanju, procenjivan je korišćenjem Razvojnog testa Čuturić, REVISK skale i testa NEPSY-II...Introduction: The term craniosynostosis refers to premature fusion of one of more cranial sutures that can lead to severe craniofacial disfigurement, intracranial hypertension and abnormal neurocognitive development in affected children. Aim: The present thesis has the intention to evaluate results of modified surgical techniques used in the treatment of unisutural and complex craniosynostosis that comprises of: 1. Detailed presentation of the new modified surgical techniques: triple square extended osteotomies (TSEO), floating forehead dynamic remodeling (FFDR) and frontoorbital hypercorrective remodeling (FOHR) techniques 2. Estimation of the aesthetic results after surgical treatment according to standard classifications 3. Estimation of morphological outcome of surgical treatment 4. Neurocognitive evaluation of treated patients Material and method: A total of 187 consecutive patients with premature fusion of one or more cranial sutures were surgically treated in Clinic of Neurosurgery KCS in Belgrade from January 1999 to January 2014. All patients underwent preoperative neuroradiological evaluation with plain cranial radiography and computerized tomography; magnetic resonance was not routinely performed and was considered strictly for syndromes. Clinical data were extracted from patient's medical history and comprehensive patient interview. Craniometrical referent points of interest: preoperative and postoperative cranial index (CI), endocranial bifrontal angle (EBA) and modified cranial vault asymmetry index (mCVAI) changes were used to estimate morphological outcome of surgery. Aesthetic outcome was assessed using Whitaker and Sloan classification. Presence of neurocognitive impairment, delay in psychomotor development and intellectual functioning were assessed with Cuturic developmental test, REVISK scale and NEPSY-II test..

Evaluation of modified surgical technique outcomes in single-suture and complex craniosynostosis

Uvod: Kraniosinostoze su oboljenja koja se karakterišu patološkom prevremenom fuzijom jedne ili više kranijalnih sutura usled čega dolazi do nastanka abnormalnog oblika lobanje, intrakranijalne hipertenzije i poremećaja neurokognitivnog razvoja obolele dece. Cilj: Ova doktorska teza ima za cilj evaluaciju rezultata lečenja modifikovanim hirurškim tehnikama u tretmanu unisuturnih i kompleksnih kraniosinostoza, koja podrazumeva: 1. detaljan prikaz novih modifikovanih hirurških tehnika: trikvadratna proširena osteotomija (triple square extended osteotomies, TSEO), dinamička remodelacija sa plivajućim čelom (floating forehead dynamic remodeling, FFDR) i frontoorbitalna hiperkorektivna remodelacija (fronto-orbital hypercorrective remodeling, FOHR) 2. procenu estetskih rezultata hirurškog lečenja prema standardnim klasifikacijama 3. procenu morfološkog ishoda hirurškog lečenja 4. neurokognitivnu evaluaciju operisanih pacijenata Materijal i metode: Ukupno 187 pacijenata sa prevremenim srastanjem jedne ili više kranijalnih sutura hirurški su lečeni u Klinici za neurohirurgiju KCS u Beogradu od januara 1999. do januara 2014. godine. Kod svih pacijenata sprovedena je adekvatna preoperativna neuroradiološka evaluacija, koja je podrazumevala nativni kraniogram i kompjuterizovanu tomografiju glave; magnetna rezonanca nije rutinski rađena i bila je razmatrana isključivo za sindromske slučajeve. Klinički parametri dobijeni su iz istorija bolesti i služili su za formiranje detaljnog upitnika. Kraniometrijske referentne vrednosti od interesa: preoperativni i postoperativni kranijalni indeks (CI), endokranijalni bifrontalni ugao (EBA) i modifikovani indeks za procenu simetrije kranijuma (modified cranial vault asymmetry index - mCVAI) korišćene su za morfološku procenu uspešnosti lečenja. Estetski rezultat lečenja evaluiran je Whitakerovom i Sloanovom klasifikacijom. Prisutni neurokognitivni poremećaj, zaostajanje u psihomotornom razvoju, kao i intelektualnom funkcionisanju, procenjivan je korišćenjem Razvojnog testa Čuturić, REVISK skale i testa NEPSY-II...Introduction: The term craniosynostosis refers to premature fusion of one of more cranial sutures that can lead to severe craniofacial disfigurement, intracranial hypertension and abnormal neurocognitive development in affected children. Aim: The present thesis has the intention to evaluate results of modified surgical techniques used in the treatment of unisutural and complex craniosynostosis that comprises of: 1. Detailed presentation of the new modified surgical techniques: triple square extended osteotomies (TSEO), floating forehead dynamic remodeling (FFDR) and frontoorbital hypercorrective remodeling (FOHR) techniques 2. Estimation of the aesthetic results after surgical treatment according to standard classifications 3. Estimation of morphological outcome of surgical treatment 4. Neurocognitive evaluation of treated patients Material and method: A total of 187 consecutive patients with premature fusion of one or more cranial sutures were surgically treated in Clinic of Neurosurgery KCS in Belgrade from January 1999 to January 2014. All patients underwent preoperative neuroradiological evaluation with plain cranial radiography and computerized tomography; magnetic resonance was not routinely performed and was considered strictly for syndromes. Clinical data were extracted from patient's medical history and comprehensive patient interview. Craniometrical referent points of interest: preoperative and postoperative cranial index (CI), endocranial bifrontal angle (EBA) and modified cranial vault asymmetry index (mCVAI) changes were used to estimate morphological outcome of surgery. Aesthetic outcome was assessed using Whitaker and Sloan classification. Presence of neurocognitive impairment, delay in psychomotor development and intellectual functioning were assessed with Cuturic developmental test, REVISK scale and NEPSY-II test..

Steric interactions and the activity of fentanyl analogs at the mu-opioid receptor

Fentanyl is a highly potent and clinically widely used narcotic analgesic. The synthesis of its analogs remains a challenge in the attempt to develop highly selective p-opioid receptor agonists with specific pharmacological properties. In this paper, the use of flexible molecular docking in a Study of the formation of complexes between a series of active fentanyl analogs and the mu-opioid receptor is described. The optimal position and orientation Of fourteen fentanyl analogs in the binding pocket of the mu-receptor were determined. The major receptor amino acids and the ligand functional groups participating in the complex formation were identified. Stereochemical effects on the potency and binding are explained. The proposed model of ligand-receptor binding is in agreement with point mutation experiments explaining the role of the amino acids: Asp147, Tyr148, Asn230, His297, Trp318, His319, Cys321, and Tyr326 in the complex formation. In addition, the following amino acids were identified as being important for ligand binding or receptor activation: Ile322, Gly325, Val300, Met203, Leu200, Val143, and Ile144. (c) 2005 Elsevier Ltd. All rights reserved

Intramolecular cyclization of 3β-acetoxy-16-picolinylidene-5-androsten-17-one by catalytic hydrogenation

Intramolecular cyclization by catalytic hydrogenation of 3β-acetoxy-16-picolinylidene-5-androsten-17-one (IV) (80° and 50-60 atm of hydrogen pressure over Pd/C as catalyst) gives rise to the formation of two cyclic products, namely, 5′,6′,7′,8′-tetrahydro-2′αH-3′αH-9′αH-3β-acetoxy-androst-5-eno [16.17-b]indolizine (VII) and its 9′βH-isomer (VIII), in a total yield of over 80%, the ratio of the two isomers being 3:1. The cyclized products have structures similar to naturally occuring alkaloid solanidine. A mechanism is proposed for the cyclization