Abstract
Objective
Reconstruction after open surgery of anterior skull base lesions is challenging. The fascia lata graft is our workhorse for achieving dural sealing and preventing cerebrospinal ...fluid leak and meningitis. This study seeks to analyze the donor and recipient site complication rates after fascia lata reconstruction.
Methods
This is a retrospective review of all open anterior skull base operations in which a double-layer fascia lata graft was used for the reconstruction of the defect from 2000 to 2016 at the Tel-Aviv Sourasky Medical Center, a tertiary referral center in Israel.
Results
Of the 369 patients operated for skull base lesions, 119 underwent open anterior skull base surgery and were reconstructed with a fascia lata graft. The patients' mean age was 47.1 years, and 68 (57.1%) were males. The overall postoperative early and late donor site complication rates were 6.7% (
n
= 8) and 5.9% (
n
= 7), respectively. Multivariate analysis found minor comorbidities and persistent/recurrent disease as being predictors for early-term complications. The overall postoperative early central nervous system (CNS) complication rate was 21.8% (
n
= 26), while 12.6% (
n
= 15) of the patients had late postoperative CNS complications.
Conclusion
Reconstruction of open anterior skull base lesions with fascia lata grafting is a safe procedure with acceptable complication and donor site morbidity rates.
This work presents an ultrasonic-assisted approach for fast impregnation of thermoset and thermoplastic polymers including solvent-free epoxy resins, polydimethylsiloxane resins, and polypropylene ...into multi-walled carbon nanotube (MWCNT) nanopapers to prepare nanocomposites or prepregs with high loading (>20 wt%) of well-dispersed MWCNTs, not achievable by the conventional compounding or resin transfer molding methods. The approach involves making MWCNTs into macroscopic paper-like sheets (also called “nanopapers”) via a dispersion-filtration method and then impregnating the mesoporous nanopapers with polymeric resins using an ultrasonic infiltration method to form a prepreg or nanocomposite. The formed nanocomposites revealed an excellent combination of mechanical strength, sand erosion and scratch resistance, electrical and thermal properties, and good processing flexibility.
•A cost-effective, scalable, and environmentally friendly process for CNT nanopaper production via filtration was developed.•An ultrasonic infiltration method was developed to infiltrate resins into CNT nanopapers to make prepreg nanotapes.•The composites showed improved abrasion/scratch resistance, heat release, EMI shielding, and processing flexibility.•The prepreg has potential uses in automotive, sporting goods, mobile electronics, wind energy, and aerospace markets.
Aims
To assess the 6 months immunogenicity to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) mRNA vaccine in a population of heart transplanted (HTx) recipients and left ventricular ...assist device (LVAD)‐supported patients.
Methods and results
A prospective single‐centre cohort study of HTx recipients and LVAD‐supported patients who received a two‐dose SARSCoV‐2 mRNA vaccine (BNT162b2, Pfizer‐BioNTech). Whole blood for anti‐spike IgG (S‐IgG) antibodies were drawn at 6 months after the first vaccine dose. S‐IgG data at 6 weeks were available for a subgroup of HTx recipients. S‐IgG ≥ 50 AU/mL were interpreted positive. The cohort included 53 HTx recipients and 18 LVAD‐supported patients. The median time from HTx or LVAD implantation to the 1st vaccine dose was 90 (IQR 30, 172) months and 22 (IQR 6, 78) months, respectively. The seropositivity rates of S‐IgG antibodies and their titre levels in HTx recipients and LVAD‐supported patients were 45% and 83% respectively, (P = 0.006), and 35 (IQR 7, 306) AU/mL and 311 (IQR 86, 774) AU/mL, respectively, (P = 0.006). Reduced SARSCoV‐2 vaccine immunogenicity in HTx recipients was associated with older age odds ratio (OR) 0.917 confidence interval (CI 0.871, 0.966), P = 0.011 and with the use of anti‐metabolites‐based immunosuppressive regimens OR 0.224 (CI 0.065, 0.777), P = 0.018. mTOR inhibitors were associated with higher immunogenicity OR 3.1 (CI 1.01, 9.65), P = 0.048. Out of 13 HTx recipients who were S‐IgG seropositive at 6 weeks after the first vaccine dose, 85% remained S‐IgG seropositive at 6 month follow‐up.
Conclusions
At 6 months post‐vaccination, S‐IgG immunogenicity in HTx recipients is low, particularly in older HTx recipients and in those treated with anti‐metabolites drugs.
The redox chemistry of CeIIIDOTA in cage in carbonate solutions was studied using electrochemistry and radiolysis techniques (continuous radiolysis and pulse radiolysis). Spectroscopic measurements ...point out that the species present in the solutions at high bicarbonate concentrations are CeIIIDOTA(CO3)3– (or less plausible CeIIIDOTA(HCO3)2–) with the carbonate (bicarbonate) anion as the ninth ligand versus CeIIIDOTA(H2O)− present in the absence of bicarbonate. Electrochemical results show a relatively low increase in the thermodynamic stabilization of the redox couple CeIV/III in the presence of carbonate versus its aqueous analogue. CeIVDOTA(CO3)2– and CeIVDOTA(H2O), prepared electrochemically, decompose photolytically. However, kept in the dark, both are relatively long lived; CeIVDOTA(H2O), though, is orders of magnitude kinetically more stable (a considerably longer half-life). Thus, one concludes that the carbonate species have a different mechanism of decomposition depending also on the presence of dioxygen after its preparation (in deaerated/aerated solutions). The CeIVDOTA(CO3)2– species is produced radiolytically by oxidation of the trivalent species by CO3 •– with a rate constant, measured using pulse radiolysis, of 3.3 × 105 M–1 s–1. This rate constant is at least 1 order of magnitude smaller than most of the rate constants so far reported for the reaction of CO3 •– with transition metal/lanthanide (cerium)/actinide complexes. This result together with the bulkiness of the reactants might suggest an outer-sphere electron transfer rather than the inner-sphere one so far proposed. The lifetime of the tetravalent cerium species obtained radiolytically in the presence of carbonate is shorter than the electrochemical one, suggesting a different conformer involved.
Background
Papillary thyroid cancer (PTC) usually metastasizes via lymphatic channels in a sequential fashion, first to the central compartment, followed by the lateral neck. PTC patients diagnosed ...with lateral neck disease (N1b) without proof for central involvement traditionally undergo prophylactic central neck dissection (pCND). However, substantial evidence on outcomes to support this approach is lacking.
Materials and Methods
We conducted a dual center retrospective study to compare the rate of central neck recurrence between N1b PTC patients undergoing pCND and those spared pCND. All patients diagnosed with N1b PTC who underwent total thyroidectomy and lateral neck dissections with or without pCND between January 1998 and December 2015 were included in this study. The rates of central neck recurrences were compared between the groups.
Results
The 111 patients who met the inclusion criteria were 44 females (39.6%) and 67 males (60.4%), with a mean age of 50.2 ± 17.7 years, and a mean follow‐up of 10.2 ± 5.3 years. Sixty patients (54.1%) underwent a pCND and 51 patients (45.9%) did not (non‐pCND). During follow‐up, 18 patients (16.2%) had level VI recurrences, 13 in the pCND group and 5 in the non‐pCND group. Cox‐regression models with propensity scoring did not reveal any inclination or an advantage for performing pCND.
Conclusion
The present study demonstrated no advantage in performing pCND to prevent central neck recurrence among PTC patients with lateral neck involvement only. These findings question the need for pCND in patients without clinical evidence of central neck disease.
Background
The prognostic value of the first posttreatment whole body integrated positron emission tomography‐computed tomography (PET/CT) scanning in patients with sinonasal/skull base malignancies ...is undetermined.
Methods
We retrospectively reviewed the data of all patients that underwent surgery for sinonasal/skull base malignancies in 2000‐2015. The results of the pretreatment and posttreatment PET/CT findings and the clinical course were retrieved.
Results
Thirty‐eight patients (average age 60.6 years, 20 males) were included. Sensitivity and specificity, positive predictive value, and negative predictive value of the first PET/CT scan for predicting persistent/recurrent disease were 85.7%, 87.5%, 80%, and 91.3%, respectively. Overall 5‐year survival was significantly lower in the first posttreatment PET/CT‐positive group (35%) compared to the PET/CT‐negative group (93%) (P = .0008).
Conclusion
Posttreatment PET/CT findings are highly prognostic in patients with sinonasal/skull base malignancies. Negative findings on the first posttreatment PET/CT scan predict a significantly better overall survival.
Abstract
OBJECTIVES
In this study, we aimed to determine the comparative outcomes of patients supported with continuous-flow left ventricular assist devices (LVADs): HeartMate 2 (HM2), HeartWare (HW) ...and HeartMate 3 (HM3) in a real-world setting.
METHODS
The study was an investigator-initiated comparative retrospective analysis of patients who underwent continuous-flow LVAD implantation at our institution between 2008 and 2017. The follow-up duration was 18 months after implantation.
RESULTS
The study included 105 continuous-flow LVAD-supported patients of whom 51% (n = 54), 24% (25) and 25% (26) underwent implantation of HM2, HW and HM3, respectively. During follow-up, patients who were supported with HM3 versus either HM2 or HW LVADs demonstrated a lower risk of stroke (0% vs 26%, P < 0.001 and 0% vs 40%, P < 0.001, respectively) and lower rates of thrombosis (0% vs 31%, P < 0.001 and 0% vs 12%, P < 0.001, respectively), findings that were consistent with their calculated haemocompatibility scores (cumulative score 5, 89 and 56 for HM3, HM2 and HW, respectively, P < 0.001). Moreover, patients supported with HM3 versus HW had fewer unplanned hospitalizations median 1 (25th–75th interquartile range 0–2) vs 3 (interquartile range 2–4), P = 0.012. Importantly, survival free from stroke or device exchange was higher in patients supported with HM3 compared with either the HM2 or the HW LVADs hazard ratio (HR) 2.77, confidence interval (CI) 1.13–6.78; P = 0.026 and HR 2.70, CI 1.01–7.20; P = 0.047, respectively.
CONCLUSIONS
HM3 device currently presents better prognostic and adverse events profiles when compared with the HM2 or the HW LVADs. A larger-scale head-to-head comparison between the devices is warranted in order to confirm our findings.
During the 2010-2011 E/V Nautilus exploration of the Levantine basin's sediments at the depth of 300-1300 m, densely patched orange-yellow flocculent mats were observed at various locations along the ...continental margin of Israel. Cores from the mat and the control locations were collected by remotely operated vehicle system (ROV) operated by the E/V Nautilus team. Microscopic observation and phylogenetic analysis of microbial 16S and 23S rRNA gene sequences indicated the presence of zetaproteobacterial stalk forming Mariprofundus spp.-like prokaryotes in the mats. Bacterial tag-encoded FLX amplicon pyrosequencing determined that zetaproteobacterial populations were a dominant fraction of microbial community in the biofilm. We show for the first time that zetaproteobacterial may thrive at the continental margins, regardless of crustal iron supply, indicating significant fluxes of ferrous iron to the sediment-water interface. In light of this discovery, we discuss the potential bioavailability of sediment-water interface iron for organisms in the overlying water column.
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