Ghost in the machine

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Efficacy of Pregabalin in Acute Postoperative Pain Under Different Surgical Categories: a meta-analysis

published_or_final_versio

Linkless octree using multi-level perfect hashing

The standard C/C++ implementation of a spatial partitioning data structure, such as octree and quadtree, is often inefficient in terms of storage requirements particularly when the memory overhead for maintaining parent-to-child pointers is significant with respect to the amount of actual data in each tree node. In this work, we present a novel data structure that implements uniform spatial partitioning without storing explicit parent-to-child pointer links. Our linkless tree encodes the storage locations of subdivided nodes using perfect hashing while retaining important properties of uniform spatial partitioning trees, such as coarse-to-fine hierarchical representation, efficient storage usage, and efficient random accessibility. We demonstrate the performance of our linkless trees using image compression and path planning examples.postprin

Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies

PURPOSE: While several clinical prediction rules (CPRs) of survival exist for patients with symptomatic spinal metastasis (SSM), these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL). We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs. METHODS: Seven electronic databases were searched (1990-2015), without language restriction, to identify studies that performed multivariate analysis of preoperative predictors of survival, neurological, functional and HRQoL outcomes in surgical patients with SSM. Individual studies were assessed for class of evidence. The strength of the overall body of evidence was evaluated using GRADE for each predictor. RESULTS: Among 4,818 unique citations, 17 were included; all were in English, rated Class III and focused on survival, revealing a total of 46 predictors. The strength of the overall body of evidence was very low for 39 and low for 7 predictors. Due to considerable heterogeneity in patient samples and prognostic factors investigated as well as several methodological issues, our results had a moderately high risk of bias and were difficult to interpret. CONCLUSIONS: The quality of evidence for predictors of survival was, at best, low. We failed to identify studies that evaluated preoperative prognostic factors for neurological, functional, or HRQoL outcomes in surgical patients with SSM. We formulated methodological recommendations for prognostic studies to promote acquiring high-quality evidence to better estimate predictor effect sizes to improve patient education, surgical decision-making and development of CPRs

Effects of Intra-Operative Total Intravenous Anaesthesia with Propofol versus Inhalational Anaesthesia with Sevoflurane on Post-Operative Pain in Liver Surgery: A Retrospective Case-Control Study

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Intradural Metastasis from Cutaneous Squamous Cell Carcinoma Causing Cauda Equina Syndrome

BACKGROUND: Spinal leptomeningeal carcinomatosis from a cutaneous squamous cell carcinoma (SCC) origin is exceedingly rare. Herein, we describe the first report of cauda equina syndrome secondary to drop metastases from a skin SCC. CASE DESCRIPTION: A 69-year-old male with a history of recurrent SCC of the face with known cranial nerve involvement presented with acute onset sphincter and lower extremity symptoms. Neuroimaging revealed a compressive intradural mass at the lumbosacral junction. The patient underwent urgent surgical decompression followed by adjuvant fractionated radiotherapy. Substantial improvement in function and quality of life was reported on postoperative follow-up. CONCLUSION: Cauda equina syndrome manifestations in a patient with a history of cutaneous SCC with perineural spread should raise suspicion for drop metastases. In this case, a relatively straight forward surgical procedure resulted in significant improvement in the quality of life. Therefore, operative intervention should be considered to prevent permanent neurological deficits depending on the patient’s goals of care and overall clinical status

Preventive Treatment with Ketamine attenuates the ischaemia-reperfusion response in a chronic postichaemia pain model

published_or_final_versio

Methanol Extract of Myelophycus caespitosus Inhibits the Inflammatory Response in Lipopolysaccharidestimulated BV2 Microglial Cells by Downregulating NF-kB via Inhibition of the Akt Signaling Pathway

Purpose: To determine whether the methanol extract of Myelophycus caespitosus (MEMC) downregulates the expression of pro-inflammatory mediators in lipopolysaccharide (LPS)-stimulated BV2 microglial cells.Methods: Reverse transcription-polymerase chain reaction (RT-PCR) together with Western blot analysis was used to evaluate the expression of pro-inflammatory mediators such as nitric oxide (NO) and prostaglandin E2(PGE2) as well as their regulatory genes such as inducible NO synthase (iNOS) and cyclooxygenase-2 (COX-2), in LPS-stimulated BV2 microglial cells. The level of NO production was analyzed using Griess reaction.The release of PGE2 was determined using sandwich enzyme-linked immunosorbent assay. The DNA-binding activity of nuclear factor-êB (NF-êB) was measured by electrophoretic mobility shift assay.Results: MEMC inhibited LPS-induced pro-inflammatory mediators, NO and PGE2, as well as their respective genes, iNOS and COX-2, at both protein and mRNA levels, without any significant cytotoxicity. Treatment withMEMC also substantially reduced the LPS-induced DNA-binding activity of NF-êB and nuclear translocation of NF-êB subunits p65 and p50 via the inhibition of IêBá phosphorylation and degradation. MEMC promoteddephosphorylation of Akt that subsequently suppressed the DNA-binding activity of NF-êB in LPS-stimulated BV2 microglial cells.Conclusion: Collectively, these data suggest that MEMC attenuates expression of pro-inflammatory mediators such as NO and PGE2 by suppression of their regulatory genes through the inhibition of Aktmediated NF-êB activity.Keywords: Myelophycus caespitosus, Nitric oxide, Prostaglandin E2, Nuclear factor-êB