Articles: cations.
-
American College of Surgeons (ACS) verification is believed to provide benefits for trauma patients, but is associated with direct costs. ⋯ Measurable benefits in complications were observed in all age groups with MAJ trauma and in PEDS and ELD for ALL injury severity in ACS vs non-ACS trauma centers.
-
The surgical approach to the petrous apex (PA) and petroclival junction (PCJ) remains a challenge. The carotid-clival window (CCW) represents the widest window available to approach the PCJ from a mediolateral endoscopic route. Here we define the CCW radiologically in nonpathological conditions, to establish the anatomic variability of the PCJ, relate this variability to pneumatization patterns, and evaluate some technical concerns conditioned by the CCW. ⋯ The CCW varies widely among individuals. The presence of pneumatization behind the paraclival carotid represents an advantageous characteristic when planning an endoscopic approach to the PCJ.
-
Temporary arterial occlusion (TAO) is valuable for minimizing intraoperative rupture risk during intracranial aneurysm microsurgery; however, it may be associated with ischemic injury. This study aims to identify surgical and intraoperative neurophysiologic monitoring factors that predict perioperative stroke risk after TAO. ⋯ SSEP changes and increased single-episode TAO duration are independently associated with increased perioperative stroke risk. SSEP changes are most predictive for perioperative stroke in unruptured cases.
-
Repeated binge-like alcohol intoxication (RBAI) induces whole-body insulin resistance, which is predicted to increase the risk for metabolic syndrome and type 2 diabetes. Previously, we showed that acute alcohol intoxication increases mesenteric lymphatic permeability, perilymphatic adipose tissue (PLAT) inflammation, and circulating lipopolysaccharide levels in rats. We hypothesize that mesenteric lymphatic hyperpermeability, adipose tissue inflammation and associated dysregulated adipokine expression, and insulin signaling are central mechanisms underlying whole-body metabolic dysregulation resulting from RBAI. ⋯ RBAI resulted in increased lymphatic permeability, MFAT-specific expression of inflammatory cytokines and markers of inflammatory cells (macrophages, dendritic, and T cells), decreased circulating adiponectin and visfatin levels, and MFAT-specific attenuation of insulin-stimulated protein kinase B phosphorylation (Ser) compared with dextrose-treated control animals. These results suggest that RBAI-induced mesenteric lymphatic hyperpermeability promotes inflammatory milieu, decreased insulin-sensitizing adipokines, and impaired insulin signaling in MFAT, which we propose may be an early event preceding systemic metabolic dysregulation. We speculate that RBAI-induced increase in gut-derived toxins, promoting lymphatic leak, and MFAT inflammatory milieu are mechanisms deserving further investigation to elucidate lymphatic-MFAT crosstalk events that precede and predispose for alcohol-induced insulin resistance.