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Management of Noncatastrophic Internal Carotid Artery Injury in Endoscopic Skull Base Surgery.
Arterial injuries are the most feared complication of endoscopic skull base surgery. During resection of the middle fossa component of a large ventral skull base chondrosarcoma, arterial bleeding was encountered near the right internal carotid artery (ICA). Durable hemostasis could not be achieved with packing and the patient was taken for an emergent angiogram that revealed a pseudoaneurysm of the proximal intradural ICA. Given the presence of good collateral flow through the anterior and posterior communicating arteries, the right ICA was sacrificed by coil embolization. The patient was taken back to the operating room for closure then transferred to the intensive care unit and maintained on vasopressors for five days to ensure adequate perfusion. The right ICA was coil embolized and the patient was taken back to the operating room for closure. The patient recovered without complication. Arterial injuries, although serious, are not always catastrophic. Critical steps are immediate recognition of bleeding, vascular imaging, and vessel sacrifice if necessary
The Effect of Third Party Investigation on Pay-Per-Click Advertising
Click fraud is a critical problem in pay-per-click advertising. While both service providers (SPs) and advertisers employ technologies to identify fraudulent clicks, prior work shows that they cannot be induced to make further improvements to their respective technologies. We consider the use of third-party investigation to address this problem and examine whether the responsibility of investigation payments helps induce both parties to work towards improving their technologies unilaterally. Using a principal-agent setting, we show that the advertiser always has incentives to improve his verification technology and the SP will improve his detection technology only when the detection cost is not too large. Given that the cost of detection technology is likely to be small due to the use of inexpensive online filters, our result suggests that third-party investigation helps induce further enhancements to the technologies and is a good mechanism to address the incentive problems in the click fraud setting
Prognostic validation of a new classification system for extent of resection in glioblastoma: a report of the RANO resect group
BACKGROUND
Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system was previously proposed based upon residual contrast-enhancing (CE) tumor. We aimed to (I) explore the prognostic utility of the classification system and (II) define how much removed non-CE tumor translates into a survival benefit.
METHODS
The international RANO resect group retrospectively searched previously compiled databases from seven neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma per WHO 2021 classification. Clinical and volumetric information from pre- and post-operative MRI were collected.
RESULTS
We collected 1008 patients with newly diagnosed IDHwt glioblastoma. 744 IDHwt glioblastomas were treated with radiochemotherapy per EORTC 26981/22981 (TMZ/RT→TMZ) following surgery. Among these homogenously treated patients, lower absolute residual tumor volumes (in cm 3) were favorably associated with outcome: patients with 'maximal CE resection' (class 2) had superior outcome compared to patients with 'submaximal CE resection' (class 3) or 'biopsy' (class 4). Extensive resection of non-CE tumor (≤5 cm 3 residual non-CE tumor) was associated with better survival among patients with complete CE resection, thus defining class 1 ('supramaximal CE resection'). The prognostic value of the resection classes was retained on multivariate analysis when adjusting for molecular and clinical markers.
CONCLUSIONS
The proposed "RANO categories for extent of resection in glioblastoma" are highly prognostic and may serve for stratification within clinical trials. Removal of non-CE tumor beyond the CE tumor borders may translate into additional survival benefit, providing a rationale to explicitly denominate such 'supramaximal CE resection'
Clustering Phase Transitions and Hysteresis: Pitfalls in Constructing Network Ensembles
Ensembles of networks are used as null models in many applications. However,
simple null models often show much less clustering than their real-world
counterparts. In this paper, we study a model where clustering is enhanced by
means of a fugacity term as in the Strauss (or "triangle") model, but where the
degree sequence is strictly preserved -- thus maintaining the quenched
heterogeneity of nodes found in the original degree sequence. Similar models
had been proposed previously in [R. Milo et al., Science 298, 824 (2002)]. We
find that our model exhibits phase transitions as the fugacity is changed. For
regular graphs (identical degrees for all nodes) with degree k > 2 we find a
single first order transition. For all non-regular networks that we studied
(including Erdos - Renyi and scale-free networks) we find multiple jumps
resembling first order transitions, together with strong hysteresis. The latter
transitions are driven by the sudden emergence of "cluster cores": groups of
highly interconnected nodes with higher than average degrees. To study these
cluster cores visually, we introduce q-clique adjacency plots. We find that
these cluster cores constitute distinct communities which emerge spontaneously
from the triangle generating process. Finally, we point out that cluster cores
produce pitfalls when using the present (and similar) models as null models for
strongly clustered networks, due to the very strong hysteresis which
effectively leads to broken ergodicity on realistic time scales.Comment: 13 pages, 11 figure
Towards Understanding Photodegradation Pathways in Lignins:The Role of Intramolecular Hydrogen Bonding in Excited States
The photoinduced dynamics of the lignin building blocks syringol, guaiacol, and phenol were studied using time-resolved ion yield spectroscopy and velocity map ion imaging. Following irradiation of syringol and guaiacol with a broad-band femtosecond ultraviolet laser pulse, a coherent superposition of out-of-plane OH torsion and/or OMe torsion/flapping motions is created in the first excited 1ππ* (S1) state, resulting in a vibrational wavepacket, which is probed by virtue of a dramatic nonplanar → planar geometry change upon photoionization from S1 to the ground state of the cation (D0). Any similar quantum beat pattern is absent in phenol. In syringol, the nonplanar geometry in S1 is pronounced enough to reduce the degree of intramolecular H bonding (between OH and OMe groups), enabling H atom elimination from the OH group. For guaiacol, H bonding is preserved after excitation, despite the nonplanar geometry in S1, and prevents O–H bond fission. This behavior affects the propensities for forming undesired phenoxyl radical sites in these three lignin chromophores and provides important insight into their relative “photostabilities” within the larger biopolymer
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