Impact of Cochlear Dose on Hearing Preservation Following Stereotactic Radiosurgery in Treatment of Vestibular Schwannomas: A Multi-Center Study

OBJECTIVE

Stereotactic radiosurgery (SRS) is a well-established treatment for vestibular schwannomas (VS). Hearing loss remains a main morbidity of VS and its treatments, including SRS. The effects of radiation parameters of SRS on hearing remain unknown. The goal of this study is to determine the effect of tumor volume, patient demographics, pretreatment hearing status, cochlear radiation dose, total tumor radiation dose, fractionation, and other radiotherapy parameters on hearing deterioration.

METHODS

Multicenter retrospective analysis of 611 patients who underwent SRS for VS from 1990-2020 and had pre- and post-treatment audiograms.

RESULTS

Pure tone averages (PTAs) increased and word recognition scores (WRSs) decreased in treated ears at 12-60 months while remaining stable in untreated ears. Higher baseline PTA, higher tumor radiation dose, higher maximum cochlear dose, and usage of single fraction resulted in higher post radiation PTA; WRS was only predicted by baseline WRS and age. Higher baseline PTA, single fraction treatment, higher tumor radiation dose, and higher maximum cochlear dose resulted in a faster deterioration in PTA. Below a maximum cochlear dose of 3 Gy, there were no statistically significant changes in PTA or WRS.

CONCLUSIONS

Decline of hearing at one year in VS patients after SRS is directly related to maximum cochlear dose, single versus 3-fraction treatment, total tumor radiation dose, and baseline hearing level. The maximum safe cochlear dose for hearingtbrowd preservation at one year is 3 Gy, and the use of 3 fractions instead of one fraction was better at preserving hearing.

Association of Hyperchloremia and Acute Kidney Injury in Patients With Traumatic Brain Injury

Introduction:

Hypertonic saline is often used to treat patients with traumatic brain injury. It carries the undesired side effect of hyperchloremia, which has been linked to acute kidney injury (AKI). We sought to evaluate the relationship of hyperchloremia and AKI in this population and whether the absolute exposure to hyperchloremia, including maximal hyperchloremia and duration of hyperchloremia were associated with AKI.

Methods:

A retrospective study of severe traumatic brain injury patients who received hypertonic saline at a single academic institution. Demographics, head abbreviated injury scale, development of hyperchloremia (Cl ≥ 115), duration of hyperchloremia, highest chloride level, duration of hypertonic saline use, admission GFR, and administration of nephrotoxic medications were abstracted. The outcome of interest was the association between renal function and hyperchloremia.

Results:

A total of 123 patients were included in the study. Multivariable logistic regression analysis demonstrated that only duration of hyperchloremia ( p = 0.014) and GFR on admission ( p = 0.004) were independently associated with development of AKI. The number of days of hypertonic saline infusion ( p = 0.79) without the persistence of hyperchloremia and highest serum chloride levels ( p = 0.23) were not predictive of AKI development.

Discussion:

In patients with traumatic brain injury, admission GFR and prolonged hyperchloremia rather than the highest chloride level or the duration of hypertonic saline infusion were associated with the development of AKI.

Beta-blocker Therapy is Associated with Decreased 1-year Mortality After Emergency Laparotomy in Geriatric Patients

Background and Aims:

Emergency laparotomy is associated with a great risk of mortality in the elderly. The hyperadrenergic state induced by surgical trauma may play an important role in the pathophysiology of this increased risk. Studies have shown that beta-blocker exposure may be associated with decreased morbidity and mortality in the perioperative period. We aimed to study the effect of beta-blocker on mortality in geriatric patients undergoing emergency laparotomy.

Material and Methods:

This is a retrospective study of patients who underwent emergency laparotomy between 1 January 2015 and 31 December 2016 at a single institution. The outcomes of interest were the association between post-operative complications and in-hospital and 1-year mortality in patients on beta-blocker therapy (BB(+)) and those who were not (BB(−)). The Poisson regression analysis was used to evaluate the association.

Results:

A total of 192 patients were included of whom 62 (32.2%) had pre-operative beta-blocker therapy with continued exposure during their hospital stay. The in-hospital mortality was 17.7% in the BB(+) and 23.8% in the BB(−) cohorts ( p = 0.441). One-year mortality was significantly lower in the BB(+) group compared to the BB(−) group (30.6% versus 47.7%; p = 0.038). After adjusting for confounders, the incidence of deaths during 1 year post-operatively decreased by 35% in the BB(+) group (incidence rate ratio = 0.65, p = 0.004). No significant differences in the incidence of post-operative complications between the two groups could be measured.

Conclusion:

Beta-blocker therapy may be associated with reduced 1-year mortality following emergency laparotomy in geriatric patients.

Early Operation in Patients With Mitral Valve Infective Endocarditis and Acute Stroke Is Safe

BACKGROUND

To determine if preoperative embolic stroke is associated with an increased risk of postoperative stroke among patients undergoing early operation for mitral valve (MV) infective endocarditis (IE), we compared outcomes among patients presenting with and without acute stroke.

METHODS

From 2003 to 2015, 243 consecutive patients underwent surgery for active MV IE. Patients were categorized into 2 groups: 72% (174 of 243 patients) with no preoperative acute stroke (clinical, radiographic or both) and 28% (69 of 243 patients) with stroke. Both preoperative and postoperative strokes were confirmed in all patients with brain computed tomography or magnetic resonance imaging and comprehensive examination by a neurologist.

RESULTS

Among patients presenting with stroke, 33% (23 of 69 patients) were asymptomatic and had only positive imaging findings. The median time from admission to operation was 5 days. The overall rate of new postoperative stroke was 4% (10 of 243 patients). The rate of postoperative stroke was not different between the 2 groups: 4% (7 of 174 patients) among patients with no preoperative stroke and 4% (3 of 69 patients) with stroke (p = 0.9). One patient developed a hemorrhagic conversion of an acute infarct. Operative mortality was 7% (13 of 174 patients) among patients with no preoperative stroke and 7% (5 of 69 patients) among patients with stroke (p = 0.9).

CONCLUSIONS

MV surgery for IE and acute stroke can be performed early with a low risk of postoperative neurologic complications. When indicated, surgical intervention for MV IE complicated by acute stroke should not be delayed.

FUNCTIONALIZED SBRs IN SILICA-REINFORCED TIRE TREAD COMPOUNDS: EVIDENCE FOR INTERACTIONS BETWEEN SILICA FILLER AND ZINC OXIDE

Unlike carbon black, silica is polar and naturally not compatible with nonpolar hydrocarbon elastomers. This lack of interaction or compatibility between the filler and the elastomer typically causes lower properties compared with carbon black–filled compounds. A common approach to deal with this problem is to use silane coupling agents in the system to link the silica and the polymer chains via covalent bonds. An alternative is the introduction of polar functional groups or chemically reactive groups into the elastomer chains, which can improve the compatibility of elastomers with fillers such as silica. In this article, the effect of three functionalized SBRs, one backbone modified with carboxylate moieties, one modified with dithiol groups, and one partially Si-coupled, on the dynamic and mechanical properties of a silica-reinforced tire tread compound will be discussed and compared with a reference compound that contains unmodified s-SBR as the main polymer. The results show the significant potential of two of these modified SBRs to reduce the rolling resistance of tire treads made thereof, while no major change in wet grip occurs. Zinc oxide is known as the best activator for sulfur vulcanization. Zn ions combine with accelerators to form an active complex that catalyzes the vulcanization process. However, in silica-filled compounds, ZnO may interfere with the silanization process because of its alkaline nature, and it may compete with the silanes in reacting with the acidic –OH groups on the surface of silica particles. When functionalized SBRs with higher polarity are used in silica compounds, ZnO may interact with these moieties as well. To investigate the effect of ZnO on the properties of the silica-reinforced tread compound, a series of compounds have been prepared, in which the addition of ZnO in a later stage was compared with conventional mixing. The dynamic and mechanical properties of the final compounds are discussed.

ROLE OF MATERIAL COMPOSITION IN THE CONSTRUCTION OF VISCOELASTIC MASTER CURVES: SILICA-FILLER NETWORK EFFECTS

One of the important aspects in the development of new tire compounds is the correlation between the dynamic mechanical properties of the rubber, measured on a laboratory scale, and the actual tire performance. The measuring protocol for dynamic mechanical properties with high precision and good correlation with tire properties is therefore of main concern. To predict wet traction, the viscoelastic behavior of the rubber materials at high frequencies (in the MHz range) need to be known. Viscoelastic master curves derived from time-temperature superposition can be used to describe the properties of the materials over a wide frequency range. The construction of master curves for tread compounds filled with different amounts of silica is discussed. From the vertical shifts as a function of temperature, activation energies are derived that apparently are in the linear response region by fulfilling the Kramers-Kronig relations, and their values correspond to physical phenomena as the underlying principle. Strain sweep viscoelastic measurements, per definition outside the linear region, lead to much higher activation energies. Because the deformation strains employed for these strain sweep measurements are more realistic for wet traction or skidding phenomena, it is concluded that the value of the above measurements in the linear region to predict traction is only limited or a first but still important indication.

NKX3.1 is regulated by protein kinase CK2 in prostate tumor cells

Diminished expression of NKX3.1 is associated with prostate cancer progression in humans, and in mice, loss of nkx3.1 leads to epithelial cell proliferation and altered gene expression patterns. The NKX3.1 amino acid sequence includes multiple potential phosphoacceptor sites for protein kinase CK2. To investigate posttranslational regulation of NKX3.1, phosphorylation of NKX3.1 by CK2 was studied. In vitro kinase assays followed by mass spectrometric analyses demonstrated that CK2 phosphorylated recombinant NKX3.1 on Thr89 and Thr93. Blocking CK2 activity in LNCaP cells with apigenin or 5,6-dichlorobenzimidazole riboside led to a rapid decrease in NKX3.1 accumulation that was rescued by proteasome inhibition. Replacing Thr89 and Thr93 with alanines decreased NKX3.1 stability in vivo. Small interfering RNA knockdown of CK2alpha' but not CK2alpha also led to a decrease in NKX3.1 steady-state level. In-gel kinase assays and Western blot analyses using fractionated extracts of LNCaP cells demonstrated that free CK2alpha' could phosphorylate recombinant human and mouse NKX3.1, whereas CK2alpha' liberated from the holoenzyme could not. These data establish CK2 as a regulator of NKX3.1 in prostate tumor cells and provide evidence for functionally distinct pools of CK2alpha' in LNCaP cells.