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Traumatic brain injury (TBI), mainly caused by road-traffic accidents and falls, is a leading cause of mortality. Survivors often display debilitating motor, sensory and cognitive symptoms, leading to reduced quality of life and a profound economic burden to society. Additionally, TBI is a risk factor for future neurodegenerative disorders including Alzheimer's disease (AD). Commonly, TBI is categorized into focal and diffuse injuries, and based on symptom severity into mild, moderate and severe TBI. Diffuse axonal injury (DAI), biomechanically caused by rotational acceleration-deceleration forces at impact, is characterized by widespread axonal injury in superficial and deep white substance. DAI comprises a clinical challenge due to its variable course and unreliable prognostic methods. Furthermore, axonal injury may convey the link to neurodegeneration since molecules associated with neurodegenerative events aggregate in injured axons.
The aim of this thesis was to study clinical consequences of axonal injury, its detection and pathological features, and potential link to neurodegeneration in severe TBI patients treated at the neurointensive care unit at Uppsala University Hospital. In paper I and IV DAI patients were studied for the relation of elevated intracranial pressure (ICP) and poor outcome to axonal injury on magnetic resonance imaging. In paper II, soluble amyloid-beta aggregates (oligomers and protofibrils), characteristic of AD pathology, were investigated in surgically resected brain tissue from severe TBI patients, using highly-selective Enzyme-Linked ImmunoSorbent Assays. In paper III, brain tissue biopsy samples from TBI patients with either focal injury or DAI were examined for differential proteome profiles using mass spectrometry-based proteomics.
The results provide evidence that axonal injury, located in the central brain stem, in substantia nigra and the mesencephalic tegmentum, is particularly related to poor outcome and increased ICP during neurointensive care of DAI patients. A novel classification system for prognostication after DAI is proposed. Furthermore, the thesis shows that severe TBI induces rapid accumulation of neurotoxic soluble amyloid-beta oligomers and protofibrils. In addition, DAI initiates unique proteome profiles different from that of focal TBI in structurally normal-appearing brain. These findings have implication for the clinical management of DAI patients, and provide new insight in the neuropathological consequences of axonal injury.
Clinical outcome after traumatic diffuse axonal injury (DAI) is difficult to predict. In this study, three magnetic resonance imaging (MRI) sequences were used to quantify the anatomical distribution of lesions, to grade DAI according to the Adams grading system, and to evaluate the value of lesion localization in combination with clinical prognostic factors to improve outcome prediction. Thirty patients (mean 31.2 years ±14.3 standard deviation) with severe DAI (Glasgow Motor Score [GMS] <6) examined with MRI within 1 week post-injury were included. Diffusion-weighted (DW), T2*-weighted gradient echo and susceptibility-weighted (SWI) sequences were used. Extended Glasgow outcome score was assessed after 6 months. Number of DW lesions in the thalamus, basal ganglia, and internal capsule and number of SWI lesions in the mesencephalon correlated significantly with outcome in univariate analysis. Age, GMS at admission, GMS at discharge, and low proportion of good monitoring time with cerebral perfusion pressure <60 mm Hg correlated significantly with outcome in univariate analysis. Multivariate analysis revealed an independent relation with poor outcome for age (p = 0.005) and lesions in the mesencephalic region corresponding to substantia nigra and tegmentum on SWI (p = 0.008). We conclude that higher age and lesions in substantia nigra and mesencephalic tegmentum indicate poor long-term outcome in DAI. We propose an extended MRI classification system based on four stages (stage I—hemispheric lesions, stage II—corpus callosum lesions, stage III—brainstem lesions, and stage IV—substantia nigra or mesencephalic tegmentum lesions); all are subdivided by age (≥/<30 years).
Deposition of amyloid-β (Aβ) is central to Alzheimer's disease (AD) pathogenesis and associated with progressive neurodegeneration in traumatic brain injury (TBI). We analyzed predisposing factors for Aβ deposition including monomeric Aβ40, Aβ42 and Aβ oligomers/protofibrils, Aβ species with pronounced neurotoxic properties, following human TBI. Highly selective ELISAs were used to analyze N-terminally intact and truncated Aβ40 and Aβ42, as well as Aβ oligomers/protofibrils, in human brain tissue, surgically resected from severe TBI patients (n = 12; mean age 49.5 ± 19 years) due to life-threatening brain swelling/hemorrhage within one week post-injury. The TBI tissues were compared to post-mortem AD brains (n = 5), to post-mortem tissue of neurologically intact (NI) subjects (n = 4) and to cortical biopsies obtained at surgery for idiopathic normal pressure hydrocephalus patients (iNPH; n = 4). The levels of Aβ40 and Aβ42 were not elevated by TBI. The levels of Aβ oligomers/protofibrils in TBI were similar to those in the significantly older AD patients and increased compared to NI and iNPH controls (P < 0.05). Moreover, TBI patients carrying the AD risk genotype Apolipoprotein E epsilon3/4 (APOE ε3/4; n = 4) had increased levels of Aβ oligomers/protofibrils (P < 0.05) and of both N-terminally intact and truncated Aβ42 (P < 0.05) compared to APOE ε3/4-negative TBI patients (n = 8). Neuropathological analysis showed insoluble Aβ aggregates (commonly referred to as Aβ plaques) in three TBI patients, all of whom were APOE ε3/4 carriers. We conclude that soluble intermediary Aβ aggregates form rapidly after TBI, especially among APOE ε3/4 carriers. Further research is needed to determine whether these aggregates aggravate the clinical short- and long-term outcome in TBI.
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The early molecular response to severe traumatic brain injury (TBI) was evaluated using biopsies of structurally normal-appearing cortex, obtained at location for intracranial pressure (ICP) monitoring, from 16 severe TBI patients. Mass spectrometry (MS; label free and stable isotope dimethyl labeling) quantitation proteomics showed a strikingly different molecular pattern in TBI in comparison to cortical biopsies from 11 idiopathic normal pressure hydrocephalus patients. Diffuse TBI showed increased expression of peptides related to neurodegeneration (Tau and Fascin, p < 0.05), reduced expression related to antioxidant defense (Glutathione S-transferase Mu 3, Peroxiredoxin-6, Thioredoxin-dependent peroxide reductase; p < 0.05) and increased expression of potential biomarkers (e.g. Neurogranin, Fatty acid-binding protein, heart p < 0.05) compared to focal TBI. Proteomics of human brain biopsies displayed considerable molecular heterogeneity among the different TBI subtypes with consequences for the pathophysiology and development of targeted treatments for TBI.
Objective: Increased intracranial pressure (ICP) in severe traumatic brain injury (TBI) patients with diffuse axonal injury (DAI) is not well defined. This study investigated the occurrence of increased ICP and whether clinical factors and lesion localization on MRI were associated with increased ICP in DAI patients.
Methods: Fifty-two severe TBI patients (median 24, range 9-61 years), with ICP-monitoring and DAI on MRI, using T2*-weighted gradient echo, susceptibility-weighted and diffusion-weighted (DW) sequences, were enrolled. Proportion of good monitoring time (GMT) with ICP>20 mmHg during the first 120 hours post-injury was calculated and associations with clinical and MRI-related factors were evaluated using linear regression.
Results: All patients had episodes of ICP>20 mmHg. The mean proportion of GMT with ICP>20 mmHg was 5% and 27% of the patients (14/52) had more than 5% of GMT with ICP>20 mmHg. Glasgow Coma Scale motor score at admission (P=0.04) and lesions on DW images in the substantia nigra and mesencephalic tegmentum (SN-T, P=0.001) were associated with the proportion of GMT with ICP>20 mmHg. In multivariate linear regression, lesions on DW images in SN-T (8% of GMT with ICP>20 mmHg, 95% CI 3–13%, P=0.004) and young age (-0.2% of GMT with ICP>20 mmHg, 95% CI -0.07–-0.3%, P=0.0008) were associated with increased ICP.
Conclusions: Increased ICP occurs in ~1/3 of severe TBI patients with DAI. Age and lesions on DW images in the central mesencephalon (SN-T) associate with elevated ICP. These findings suggest that MR lesion localization may aid prediction of increased ICP in DAI patients.
Objectives. Surgical site infections (SSIs) may be devastating for the patient and they carry high economic costs. Studies of SSI after neurosurgery report an incidence of 1 - 11%. However, patient material, follow-up time and definition of SSI have varied. In the present study we prospectively recorded the prevalence of SSI 3 months after standard intracranial neurosurgical procedures. The incidence, impact and risk factors of SSI were analysed. Methods. We included patients admitted during 2010 to our unit for postoperative care after standard neurosurgical procedures. SSI was defined as evident with positive cultures from surgical samples or CSF, and/or purulent discharge during reoperation. Follow-up was done after 3 and 12 months and statistics was obtained after 3 months. The predictive values on the outcome of demographic and clinical factors describing the surgical procedure were evaluated using linear regression. Results. A total of 448 patients were included in the study and underwent a total of 466 procedures. Within 3 and 12 months, 33 and 88 patients, respectively, had died. Of the surviving patients, 20 (4.3% of procedures) developed infections within 3 months and another 3 (4.9% of procedures) within 12 months. Risk factors for SSI were meningioma, longer operation time, craniotomy, dural substitute, and staples in wound closure. Patients with SSI had significantly longer hospital stay. Multivariate analysis showed that factors found significant in univariate analysis frequently occur together. Discussion. We studied the prevalence of SSI after 3 and 12 months in a prospective 1-year material with standard neurosurgical procedures and found it to be 4.3% and 4.9%, respectively. The analysis of the results showed that a combination of parameters indicating a longer and more complicated procedure predicted the development of SSI. Our conclusion is that the prevention of SSI has to be done at many levels, especially with patients undergoing long surgical procedures.
Purpose: Clinical outcome after traumatic diffuse axonal injury (DAI) is difficult to predict. Three MRI techniques were compared in demonstrating acute brain lesions. Relationship of the anatomical distribution of the lesions in combination with clinical prognostic factors to outcome after 6 months was evaluated.
Methods and Materials: Thirty patients, aged 16-60 years (mean 31.2 years) with severe DAI (Glasgow Motor Score = GMS < 6) were examined with MRI at 1.5T within one week after the injury. A diffusion-weighted (DW) sequence (SE-EPI, b value 1000 s/mm2), a T2*-weighted gradient echo (T2*GRE) sequence and a susceptibility-weighted (SWI) sequence were evaluated by two independent reviewers with short and long neuroradiological experiences. Clinical outcome was assessed with Extended Glasgow Outcome Score (GOSE) after ≥ 6 months.
Results: Interreviewer agreement for DAI classification was very good (ҡ 0.82 – 0.91) with all three sequences. SWI visualized more lesions than the T2*GRE or DW sequence. In univariate analysis, number of DW lesions in the deep gray matter area including the internal capsules, number of SWI lesions in the mesencephalon, age, and GMS at admission and discharge correlated significantly with poor outcome. Multivariate analysis only revealed an independent relation with poor outcome for age (p = 0.011) and lesions in the mesencephalic region including crura cerebri, substantia nigra and tegmentum on SWI (p = 0.032).
Conclusion: SWI is the most sensitive technique to visualize lesions in DAI. Age over 30 years and hemorrhagic mesencephalic lesions anterior to the tectum are indicators of poor long-term outcome in DAI.
OBJECTIVE The authors conducted a study to test if the cortical brain tissue levels of soluble amyloid beta (Aβ) reflect the propensity of cortical Aβ aggregate formation and may be an additional factor predicting surgical outcome following idiopathic normal pressure hydrocephalus (iNPH) treatment. METHODS Highly selective ELISAs (enzyme-linked immunosorbent assays) were used to quantify soluble Aβ40, Aβ42, and neurotoxic Aβ oligomers/protofibrils, associated with Aβ aggregation, in cortical biopsy samples obtained in patients with iNPH (n = 20), sampled during ventriculoperitoneal (VP) shunt surgery. Patients underwent pre- and postoperative (3-month) clinical assessment with a modified iNPH scale. The preoperative CSF biomarkers and the levels of soluble and insoluble Aβ species in cortical biopsy samples were analyzed for their association with a favorable outcome following the VP shunt procedure, defined as a ≥ 5-point increase in the iNPH scale. RESULTS The brain tissue levels of Aβ42 were negatively correlated with CSF Aβ42 (Spearman's r = -0.53, p < 0.05). The Aβ40, Aβ42, and Aβ oligomer/protofibril levels in cortical biopsy samples were higher in patients with insoluble cortical Aβ aggregates (p < 0.05). The preoperative CSF Aβ42 levels were similar in patients responding (n = 11) and not responding (n = 9) to VP shunt treatment at 3 months postsurgery. In contrast, the presence of cortical Aβ aggregates and high brain tissue Aβ42 levels were associated with a poor outcome following VP shunt treatment (p < 0.05). CONCLUSIONS Brain tissue measurements of soluble Aβ species are feasible. Since high Aβ42 levels in cortical biopsy samples obtained in patients with iNPH indicated a poor surgical outcome, tissue levels of Aβ species may be associated with the clinical response to shunt treatment.
Selective dorsal rhizotomy (SDR) is a neurosurgical procedure for the relief of spasticity interfering with motor function in children with spastic cerebral palsy (CP). The goal of the treatment is to improve function as well as reduce pain and discomfort related to severely increased spasticity. SDR is an ablative procedure that results in lifelong effects on function in the central nervous system. One must also be aware that performing SDR does not guarantee that other treatments for spasticity or orthopedic corrective procedures can be avoided. For SDR to be an effective treatment, it must be combined with specific physiotherapy over a long period of time. Today there exists a good body of evidence that SDR is an effective means of treating patients with the CP subtype spastic diplegia, as long as selection criteria are rigorously adhered to. The procedure is also safe with little risk of short or long-term complications. Further studies on long-term effects late in adulthood will show if the treatment effects are stable over time.
A recently developed experimental model consisting of athymic rats carrying human colonic tumours from the cell line LS 174 T in both hind legs was used. 125I-labelled anti-carcinoembryonic (anti-CEA) monoclonal antibodies were injected either intra-arterially after a bolus injection of mannitol, or intra-peritoneally with or without mannitol. On the fourth day the rats were killed and pieces from the tumours and various organs were measured in a well scintillation counter. Tumour pieces were then submitted to autoradiography and immunohistochemistry for examination of the antibody distribution at the cellular level. In all examined tumours injected with anti-CEA antibodies, most of the antibodies were located in the periphery close to fibrovascular septa. It appears, in addition to the specificity of the antibody for the CEA, that the tumour vascular permeability and anatomy are of utmost importance for tumour targeting in this experimental model with the particular antibody used.
The history of spinal cord injuries starts with the ancient Egyptian medical papyrus known as the Edwin Smith Surgical Papyrus. The papyrus, written about 2500 B. C. by the physician and architect of the Sakkara pyramids Imhotep, describes "crushed vertebra in his neck" as well as symptoms of neurological deterioration. An ailment not to be treated was the massage to the patients at that time. This fatalistic attitude remained until the end of World War II when the first rehabilitation centre focused on the rehabilitation of spinal cord injured patients was opened. Our knowledge of the pathophysiological processes, both the primary as well as the secondary, has increased tremendously. However, all this knowledge has only led to improved medical care but not to any therapeutic method to restore, even partially, the neurological function. Neuroprotection is defined as measures to counteract secondary injury mechanisms and/or limit the extent of damage caused by self-destructive cellular and tissue processes. The co-existence of several distinctly different injury mechanisms after trauma has provided opportunities to explore a large number of potentially neuroprotective agents in animal experiments such as methylprednisolone sodium succinate. The results of this research have been very discouraging and pharmacological neuroprotection for patients with spinal cord injury has fallen short of the expectations created by the extensive research and promising observations in animal experiments. The focus of research has now, instead, been transformed to the field of neural regeneration. This field includes the discovery of regenerating obstacles in the nerve cell and/or environmental factors but also various regeneration strategies such as bridging the gap at the site of injury as well as transplantation of foetal tissue and stem cells. The purpose of this review is to highlight selected experimental and clinical studies that form the basis for undertaking future challenges in the research field of spinal cord injury. We will focus our discussion on methods either preventing the consequences of secondary injury in the acute period ( neuroprotection) and/or various techniques of neural regeneration in the sub-acute and chronic phase and finally expose some thoughts about future avenues within this scientific field.
This study aimed to describe the consequences of acoustic neuroma surgery in terms of symptoms and quality of life.
This study was a retrospective case review.
The surgery was conducted in Uppsala, Sweden.
A consecutive sample of acoustic neuroma patients operated on between 1988 and 1994.
All patients had been operated on with the translabyrinthine technique.
A questionnaire was constructed including questions about the surgery and symptoms. The House and Brackmann scale was used for grading facial function and the Brackmann and Bars scale was used for self-assessment of facial function.
Follow-up data were collected by a postal questionnaire sent out and returned by 141 patients, which yielded a 90% response rate. Normal to moderately impaired facial function (House I-III) was evident in 85.2% of patients, although residual facial problems were reported. Most considered hearing to be worse after surgery (80%), and tinnitus was found in 60% of the sample. Balance problems (45%), dizziness (19%), and headache/pain (22%) were also reported. Work ability was affected in 23%, and 37% reported a continued need for medical consultations, mainly because of facial problems and pain. Most (89%) were pleased with the preoperative information.
This study showed that few patients with acoustic neuroma had experienced negative social consequences after surgery. Although not linked to the operation, residual symptoms were reported that may necessitate further rehabilitation.
Introduction Infusion tests are used to diagnose and select patients with idiopathic normal pressure hydrocephalus (INPH) for shunt surgery. The test characterizes cerebrospinal fluid dynamics and estimates parameters of the cerebrospinal fluid system, the pressure-volume index (PVI) and the outflow conductance (Cout). The Oscillating Pressure Infusion (OPI) method was developed to improve the test and reduce the investigation time. The aim of this study was to evaluate the new OPI method by comparing it with an established reference method. Methods Forty-seven patients (age 71.2 +/- 8.9years) with communicating hydrocephalus underwent a preoperative lumbar infusion investigation with two consecutive infusion protocols, reference (42min) and new (20min), that is, 94 infusion tests in total. The OPI method estimated Cout and PVI simultaneously. A real-time analysis of reliability was applied to investigate the possibility of infusion time reduction. Results The difference in Cout between the methods was 1.2 +/- 1.8l/s/kPa (Rout=-0.8 +/- 3.5mmHg/ml/min), P<0.05, n=47. With the reliability analysis, the preset 20min of active infusion could have been even further reduced for 19 patients to between 10 and 19min. PVI was estimated to 16.1 +/- 6.9ml, n=47. Conclusions The novel Oscillating Pressure Infusion method produced real-time estimates of Cout including estimates of reliability that was in good agreement with the reference method and allows for a reduced and individualized investigation time.
OBJECT: Shunt infections represent a major problem with risk for sequelae and even death. The aim in this retrospective study was to analyze the incidence, origin, and clinical presentation of shunt infections, with special reference to the results of cultures for anaerobic organisms performed in addition to the usual tests, to prolonged incubation times, and to infections caused by Propionibacterium acnes. METHODS: The medical records of 237 hydrocephalic children (age range 0-15 years) in whom operations were performed by a pediatric surgeon at Uppsala University Hospital during a 13-year period were reviewed. RESULTS: Thirty-four verified or suspected intraventricular shunt infections and 5 distal catheter infections occurred after 474 operations. Skin bacteria, such as coagulase-negative staphylococci ([CoNS], 19 patients), Staphylococcus aureus (7 patients), and P. acnes (6 patients) predominated. The addition of anaerobic cultures and prolonged incubation times increased the verification of shunt infection by more than one third. Children with P. acnes infection were significantly older, had a lower body temperature, fewer cerebrospinal fluid (CSF) leukocytes, a higher CSF/blood glucose ratio, more distal catheter infections, and other sources of infection. Four had an abdominal pseudocyst. Children < 1 year of age and infected with CoNS were more affected than older children with systemic and local symptoms. In children with distal catheter infection and growth of propionibacteria at the time of the distal catheter and valve replacement, no follow-up antibiotic treatment was necessary. CONCLUSIONS: Addition of anaerobic cultures and prolonged incubation times led to an increase in the detection of shunt infections. Infections caused by propionibacteria often result in mild symptoms that may be overlooked if adequate anaerobic cultures are not obtained.
OBJECT: There are no randomized studies comparing the efficacy of different antibiotic regimens for the treatment of cerebrospinal fluid (CSF) shunt infections, and in the studies that have been reported, efficacy data are limited. The aim of this study was therefore to report the authors' experience using a specific protocol for the management of shunt infections in children. Standard treatment included a two-stage procedure involving externalization of the ventricular catheter in combination with intraventricular and systemic administration of antibiotic medication followed by shunt replacement. Intraventricular treatment consisted of daily instillations of vancomycin or gentamicin with trough concentrations held at high levels of 7 to 17 mg/L for both antibiotic agents. METHODS: During a 13-year study period, the authors treated 34 consecutive intraventricular shunt infections in 30 children. Infections with coagulase-negative staphylococci predominated, and Gram-negative bacterial infection occurred in five children. Ten of the children were initially treated with intravenous antibiotic therapy for at least 3 days, but this treatment did not sterilize the CSF. After externalization of the ventricular catheter, high-dose intraventricular treatment was given for a median of 8 days (range 3-17 days) before shunt replacement. RESULTS: The CSF was found to be sterile (cultures were negative for bacteria) in one of three, seven of eight, 20 of 20, and six of six cases after 1, 2, 3, and more than 3 days' treatment, respectively. In no case was any subsequent culture positive after a negative result had been obtained. Clinical symptoms resolved in parallel with the sterilization of the CSF. There were no relapses or deaths during the 6-month follow-up period, and there have been none as of April 2007. CONCLUSIONS: Despite the ventricular catheter being left in place and the short duration of therapy, the treatment regimen described by the authors resulted in quick sterilization of the CSF, a low relapse rate, and survival of all patients in this series.
Direct electrical stimulation of functional cortical areas is a standard procedure in epilepsy and glioma surgery. Many previous studies support that stimulation of the motor cortex with short-train pulses is a less epileptogenic alternative to the 50–60 Hz 'Penfield' technique. However, whether the short-train stimulation is useful also in mapping of speech areas is unclear. In this case report we present a patient with oligodendroglioma near the Broca area. Extraoperative electrical stimulation via a subdural grid electrode was primarily performed to locate the speech area. The cortex was stimulated with short-train pulses (5 pulses, 0.5 pulse duration and 3 ms interpulse interval) in addition to 1–3 s 50 Hz stimulation.The patient had speech arrest from both types of stimulation techniques during a naming task. It was however critical that the short (14.5 ms) train stimulation was synchronized with the presentation of the naming objects. If not, there was no speech arrest. Despite this possible pitfall, this case has encouraged us to further try short-train stimulation in attempts to reduce stimulus-triggered seizures during mapping of eloquent areas.
Purpose: Recovery is limited following traumatic brain injury (TBI) since injured axons regenerate poorly and replacement of lost cells is minimal. Behavioral improvements could instead be due to plasticity of uninjured brain regions. We hypothesized that plasticity of the uninjured hemisphere occurs contralateral to a focal TBI in the adult rat. Thus, we performed cortical mapping of the cortex contralateral to the TBI using intracortical microstimulation (ICMS). Methods: A focal TBI was induced using the weight-drop technique (n = 5) and sham-injured animals were used as controls (n = 4). At five weeks post-injury, ICMS was used to map the motor area contralateral to the injury. Motor responses were detected by visual inspection and electromyography (EMG). Results: In sham- and brain-injured animals, numerous fore- and hindlimb motor responses contralateral to the stimulation (ipsilateral to the injury) were obtained. Compared to sham-injured controls, there was a markedly increased (p < 0.05) number of fore- and hindlimb responses ipsilateral to the stimulation after TBI. Conclusion: Following focal TBI in the rat, our data suggest reorganization of cortical and/or subcortical regions in the uninjured hemisphere contralateral to a focal TBI leading to an altered responsiveness to ICMS. Although we cannot exclude that these changes are maladaptive, it is plausible that this plasticity process positively influences motor recovery after TBI.
Background: Vestibular Schwannoma (VS) is a benign neoplasm arising from the 8th cranial nerve, with surgery one of the treatment modalities. In a nation-wide registry study, we describe the baseline, treatment characteristics, and short-term outcome in patients surgically treated for VS.
Methods: We performed a nationwide study with data from the Swedish Brain Tumor Registry (SBTR) for all adults diagnosed with VS 2009-2015. Patient symptoms, tumor characteristics, and postoperative complications were analyzed.
Results: In total 348 patients underwent surgery for VS. Mean age was 50.6 +/- 14.5 years and 165 patients (47.4%) were female. The most common symptom was focal neurological deficit (92.0%), with only 25 (7.2%) being asymptomatic prior to surgery, and 217 (63.6%) had no restriction in activity. Following surgery, 100 (28.7%) patients developed new deficit(s). In terms of postoperative complications; 11 (3.2%) had a hematoma, 35 (10.1%) an infection, 10 (2.9%) a venous thromboembolism, and 23 (6.6%) had a reoperation due to complication. There were no deaths within 30-days after surgery. When grouped according to tumor size (<4 vs. >= 4 cm), those with >= 4 cm tumors were more often males (p = 0.02), had more often ICP related symptoms (p = 0.03) and shorter time from imaging to surgery (p < 0.01). Analysis of the younger (<65 years) vs. elderly (>= 65 years) revealed no difference in outcome except increased 1-year mortality (p = 0.002) in elderly.
Conclusion: In this nation-wide registry-study, we benchmark the 30-day complication rate after VS surgery as collected by the SBTR. Further, we present the current neurosurgical outcome data from both VS smaller than 40 mm compared to larger tumors, as well as younger vs. elderly VS patients. Since surgical decision making is a careful consideration of short term risk vs. long term benefit, this information can be useful in clinical decision making.
Traumatic acute subdural hematomas (ASDHs) are associated with high rate of morbidity and mortality, especially in elderly individuals. However, recent reports indicate that the morbidity and mortality rates might have improved.
To evaluate postoperative (30-d) mortality in younger vs elderly (70 yr) patients with ASDH. Comparing younger and elderly patients, the secondary objectives are morbidity patterns of care and 6 mo outcome according to Glasgow outcome scale (GOS). Finally, in patients with traumatic ASDH, we aim to provide prognostic variables.
This is a large-scale population-based Scandinavian study including all neurosurgical departments in Denmark and Sweden. All adult (18 yr) patients surgically treated between 2010 and 2014 for a traumatic ASDH in Denmark and Sweden will be included. Identification at clinicaltrials.gov is NCT03284190.
We expect to provide data on potential differences between younger vs elderly patients in terms of mortality and morbidity. We hypothesize that elderly patients selected for surgery have a similar pattern of care as compared with younger patients. We will provide functional outcome in terms of GOS at 6 mo in younger vs elderly patients undergoing ASDH evacuation. Finally, clinical useful prognostic factors for favorable (GOS 4-5) vs unfavorable (GOS 1-3) will be identified.
An improved understanding of the clinical outcome, treatment and resource allocation, clinical course, and the prognostic factors of traumatic ASDH will allow neurosurgeons to make better treatment decisions.
Background: Chronic subdural hematoma (cSDH) is one of the most common conditions encountered in neurosurgical practice. Recurrence, observed in 5-30% of patients, is a major clinical problem. The temperature of the irrigation fluid used during evacuation of the hematoma might theoretically influence recurrence rates since irrigation fluid at body temperature (37 degrees C) may beneficially influence coagulation and cSDH solubility when compared to irrigation fluid at room temperature. Should no difference in recurrence rates be observed when comparing irrigation-fluid temperatures, there is no need for warmed fluids during surgery. Our main aim is to investigate the effect of irrigation-fluid temperature on recurrence rates and clinical outcomes after cSDH evacuation using a multicenter randomized controlled trial design.
Methods: The study will be conducted in three neurosurgical departments with population-based catchment areas using a similar surgical strategy. In total, 600 patients fulfilling the inclusion criteria will randomly be assigned to either intraoperative irrigation with fluid at body temperature or room temperature. The power calculation is based on a retrospective study performed at our department showing a recurrence rate of 5% versus 12% when comparing irrigation fluid at body temperature versus fluid at room temperature (unpublished data). The primary endpoint is recurrence rate of cSDH analyzed at 6 months post treatment. Secondary endpoints are mortality rate, complications and health-related quality of life.
Discussion: Irrigation-fluid temperature might influence recurrence rates in the evacuation of chronic subdural hematomas. We present a study protocol for a multicenter randomized controlled trial investigating our hypothesis that irrigation fluid at body temperature is superior to room temperature in reducing recurrence rates following evacuation of cSDH.
BACKGROUND: Neurosurgical procedures expose the brain surface to a constant risk of collateral injury. We describe a technique where the brain surface is covered with a protective layer of fibrin glue and discuss its advantages. METHODS: A thin layer of fibrin glue was applied on the brain surface after its exposure in 34 patients who underwent different craniotomies for tumoral and vascular lesions. Data of 35 more patients who underwent standard microsurgical technique were collected as a control group. Cortical and pial injuries were evaluated using an intra-operative visual scale. Eventual abnormal signals at the early postoperative T2-weighted fluid-attenuated inversion recovery (T2FLAIR) magnetic resonance imaging (MRI) sequences were evaluated in oncological patients. RESULTS: Total pial injury was noted in 63% of cases where fibrin glue was not used. In cases where fibrin glue was applied, a significantly lower percentage of 26% (P < 0.01) had pial injuries. Only 9% had injuries in areas covered with fibrin glue (P < 0.0001). Early postoperative T2FLAIR MRI confirmed the differences of altered signal around the surgical field in the two populations. CONCLUSION: We propose beside an appropriate and careful microsurgical technique the possible use of fibrin glue as alternative, safe, and helpful protection during complex microsurgical dissections. Its intrinsic features allow the neurosurgeon to minimize the cortical manipulation preventing minor collateral brain injury.
BACKGROUND: The transcavernous approach adds a significant exposure advantage in basilar aneurysm surgery. However, one of its frequently reported side effects is postoperative oculomotor nerve palsy. OBJECTIVE: To present the technique of mobilizing the oculomotor nerve throughout its intracranial course and to analyze its consequences on the nerve tension and clinical outcome. METHODS: The oculomotor nerve is mobilized from its mesencephalic origin to the superior orbital fissure. Its degree of mobility, related to the imposed pulling force, was measured in 11 cadaveric nerves. Tension was mathematically deduced and compared before and after mobilizing of the cavernous segment. One hundred four patients treated for basilar aneurysms with the orbitozygomatic pretemporal transcavernous approach were followed up for a 1-year period and evaluated for postoperative oculomotor nerve palsy. RESULTS: Releasing the transcavernous segment compared to cisternal mobilization alone resulted in a significant increase in freedom of mobility from 4 to 7.9 mm (P < .001) and in a significant decrease in tension from 0.8 to 0.5 N (P = .006). Ninety-nine percent of aneurysms treated with this technique were amenable to neck clipping, and a total of 84% of patients had a good postoperative outcome (modified Rankin Scale score, 0-2). All patients showed direct postoperative palsy; however, 97% had a complete recovery by 9 months. Only 3 patients had a persistent diplopia on medial gaze, which was corrected with prism glasses. CONCLUSION: Mobilization of the transcavernous oculomotor nerve results in better maneuverability and less tension on the nerve, which lead to successful surgical treatment and favorable oculomotor outcome.
Objective: To explore changes in pain, spasticity, range of motion, activities of daily living, bowel and lower urinary tract function and quality of life of individuals with spinal cord injury following robotic exoskeleton gait training.
Design: Prospective, observational, open-label multicentre study. Methods: Three training sessions per week for 8 weeks using an Ekso GT robotic exoskeleton (Ekso Bionics). Included were individuals with recent (<1 year) or chronic (>1 year) injury, paraplegia and tetraplegia, complete and incomplete injury, men and women.
Results: Fifty-two participants completed the training protocol. Pain was reported by 52% of participants during the week prior to training and 17% during training, but no change occurred longitudinally. Spasticity decreased after a training session compared with before the training session (p< 0.001), but not longitudinally. Chronically injured participants increased Spinal Cord Independence Measure (SCIM III) from 73 to 74 (p= 0.008) and improved life satisfaction (p= 0.036) over 8 weeks of training. Recently injured participants increased SCIM III from 62 to 70 (p<0.001), but no significant change occurred in life satisfaction. Range of motion, bowel and lower urinary function did not change over time.
Conclusion: Training seemed not to provoke new pain. Spasticity decreased after a single training session. SCIM III and quality of life increased longitudinally for subsets of participants.
Study design: Prospective quasi-experimental study, pre-and post-design.
Objectives: Assess safety, feasibility, training characteristics and changes in gait function for persons with spinal cord injury (SCI) using the robotic exoskeletons from Ekso Bionics.
Setting: Nine European rehabilitation centres.
Methods: Robotic exoskeleton gait training, three times weekly over 8 weeks. Time upright, time walking and steps in the device (training characteristics) were recorded longitudinally. Gait and neurological function were measured by 10 Metre Walk Test (10 MWT), Timed Up and Go (TUG), Berg Balance Scale (BBS), Walking Index for Spinal Cord Injury (WISCI) II and Lower Extremity Motor Score (LEMS).
Results: Fifty-two participants completed the training protocol. Median age: 35.8 years (IQR 27.5-52.5), men/women: N = 36/16, neurological level of injury: C1-L2 and severity: AIS A-D (American Spinal Injury Association Impairment Scale). Time since injury (TSI) < 1 year, N = 25; > 1 year, N = 27. No serious adverse events occurred. Three participants dropped out following ankle swelling (overuse injury). Four participants sustained a Category II pressure ulcer at contact points with the device but completed the study and skin normalized. Training characteristics increased significantly for all subgroups. The number of participants with TSI < 1 year and gait function increased from 20 to 56% (P=0.004) and 10MWT, TUG, BBS and LEMS results improved (P < 0.05). The number of participants with TSI > 1 year and gait function, increased from 41 to 44% and TUG and BBS results improved (P < 0.05).
Conclusions: Exoskeleton training was generally safe and feasible in a heterogeneous sample of persons with SCI. Results indicate potential benefits on gait function and balance.
Following traumatic brain injuries (TBI), insulin-like growth factor (IGF) is cortically widely upregulated. This upregulation has a potential role in the recovery of neuronal tissue, plasticity, and neurotrophic activity, though the molecular mechanisms involved in IGF regulation and the exact role of IGF after TBI remain unclear. Vitronectin (VN), an extracellular matrix (ECM) molecule, has recently been shown to be of importance for IGF-mediated cellular growth and migration. Since VN is downregulated after TBI, we hypothesized that insufficient VN levels after TBI impairs the potential beneficial activity of IGF. To test if vitronectin and IGF-1/IGFBP-2 could contribute to neurite growth, we cultured hippocampal neurons on +/- vitronectin-coated coverslips and them treated with +/- IGF-1/IGF binding protein 2 (IGFBP-2). Under same conditions, cell cultures were also subjected to in vitro trauma to investigate differences in the posttraumatic regenerative capacity with +/- vitronectin-coated coverslips and with +/- IGF-1/IGFBP-2 treatment. In both the control and trauma situations, hippocampal neurons showed a stronger growth pattern on vitronectin than on the control substrate. Surprisingly, the addition of IGF-1/IGFBP-2 showed a decrease in neurite growth. Since neurite growth was measured as the number of neurites per area, we hypothesized that IGF-1/IGFBP-2 contributes to the polarization of neurons and thus induced a less dense neurite network after IGF-1/IGFBP-2 treatment. This hypothesis could not be confirmed and we therefore conclude that vitronectin has a positive effect on neurite growth in vitro both under normal conditions and after trauma, but that addition of IGF-1/IGFBP-2 does not have a positive additive effect.
Perfusion and diffusion magnetic resonance imaging (pMRI, dMRI) are valuable diagnostic tools for assessing brain tumors in the clinical setting. The aim of this study was to determine the correlation of pMRI and dMRI with (11)C-methionine positron emission tomography (MET PET) in suspected low-grade gliomas (LGG) prior to surgery. Twenty-four adults with suspected LGG were enrolled in an observational study and examined by MET PET, pMRI and dMRI. Histological tumor diagnosis was confirmed in 23/24 patients (18 gliomas grade II, 5 gliomas grade III). The maximum relative cerebral blood volume (rCBVmax) and the minimum mean diffusivity (MDmin) were measured in tumor areas with highest MET uptake (hotspot) on PET by using automated co-registration of MRI and PET scans. A clearly defined hotspot on PET was present in all 23 tumors. Regions with rCBVmax corresponded with hotspot regions in all tumors, regions with MDmin corresponded with hotspot regions in 20/23 tumors. The correlation between rCBVmax (r = 0.19, P = 0.38) and MDmin (r = -0.41, P = 0.053) with MET uptake in the hotspot was not statistically significant. Taken into account the difficulties of measuring perfusion abnormalities in non-enhancing gliomas, this study demonstrates that co-registered MET PET and pMRI facilitates the identification of regions with rCBVmax. Furthermore, the lack of a clear positive correlation between tumor metabolism in terms of MET uptake and tumor vascularity measured as rCBVmax suggests that combined pMRI/PET provides complementary baseline imaging data in these tumors.
We present the case of a 50-year-old female patient with Friedreich ataxia (FA) who was treated successfully with an intrathecal baclofen (ITB)-delivering pump for painful spasms. To our knowledge, this is the second reported case of FA where ITB relieved painful and disabling spasms. We suggest that ITB should be considered in the treatment of disabling spasms in patients with FA.
Background: Nitrones such as 2-sulfo-phenyl-N-tert-butyl nitrone (S-PBN) are known to trap and stabilize free radicals and to reduce inflammation. Recently, S-PBN was shown to reduce infiltration of T lymphocytes and the expression of adhesion molecules on the endothelium in experimental traumatic brain injury. We hypothesized that S-PBN could reduce infiltration of T lymphocytes during cell-mediated xenograft rejection and thereby increase graft survival. The concordant mouse-to-rat heart transplantation model was used to test the hypothesis. In this model, grafts undergo acute humoral xenograft rejection (AHXR) almost invariably on day 3 and succumb to cell-mediated rejection on approximately day 8 if AHXR is inhibited by treatment with 15-deoxyspergualin (DSG). Material and methods: Hearts from Naval Medical Research Institute (NMRI) mice were transplanted to the neck vessels of Lewis rats. Recipients were treated with S-PBN (n = 9), DSG (n = 9), S-PBN and DSG in combination (n = 10) or left untreated (n = 9) for survival studies. S-PBN was given daily intraperitoneally at a dose of 150 mg/kg body weight (BW) on day -1 to 30, and DSG was given daily intraperitoneally at a dose of 10 mg/kg BW on day -1 to 4 and 5 mg/kg BW on day 5 to 21. Nine additional recipients were given S-PBN only on days -1 and 0 in combination with continuous DSG treatment. Grafts were monitored until they stopped beating. Additional recipients were treated with S-PBN (n = 5), DSG (n = 5), S-PBN and DSG in combination (n = 6) or left untreated (n = 5) for morphological, immunohistochemical and flow cytometry analyses on days 2 and 6 after transplantation. Results: S-PBN treatment in combination with DSG resulted in increased median graft survival compared to DSG treatment alone (14 vs. 7 days; P = 0.019). Lower number of T lymphocytes on day 6 (P = 0.019) was observed by ex vivo propagation and flow cytometry when combining S-PBN with DSG, whereas immunohistochemical analyses demonstrated a significant reduction in the number of infiltrated CD4+, but not TCR+, cells. S-PBN treatment alone had no impact on graft survival compared to untreated rats (3 vs. 3 days). No differences were seen in ICAM-1 and VCAM-1 expression or in morphology between the groups. Conclusion: The combination of S-PBN and DSG treatment increases xenograft survival. The main effect of S-PBN appears to be in direct connection with the transplantation. Because of its low toxicity, S-PBN could become useful in combination with other immunosuppressants to reduce cell-mediated xenograft rejection.
BACKGROUND: Proton beam radiotherapy of arteriovenous malformations (AVM) in the brain has been performed in Uppsala since 1991. An earlier study based on the first 26 patients concluded that proton beam can be used for treating large and medium sized AVMs that were considered difficult to treat with photons due to the risk of side effects. In the present study we analyzed the result from treating the subsequent 65 patients.
MATERIAL AND METHODS: A retrospective review of the patients' medical records, treatment protocols and radiological results was done. Information about gender, age, presenting symptoms, clinical course, the size of AVM nidus and rate of occlusion was collected. Outcome parameters were the occlusion of the AVM, clinical outcome and side effects.
RESULTS: The rate of total occlusion was overall 68%. For target volume 0-2cm(3) it was 77%, for 3-10 cm(3) 80%, for 11-15 cm(3) 50% and for 16-51 cm(3) 20%. Those with total regress of the AVM had significantly smaller target volumes (p < 0.009) higher fraction dose (p < 0.001) as well as total dose (p < 0.004) compared to the rest. The target volume was an independent predictor of total occlusion (p = 0.03). There was no difference between those with and without total occlusion regarding mean age, gender distribution or symptoms at diagnosis. Forty-one patients developed a mild radiation-induced brain edema and this was more common in those that had total occlusion of the AVM. Two patients had brain hemorrhages after treatment. One of these had no effect and the other only partial occlusion from proton beams. Two thirds of those presenting with seizures reported an improved seizure situation after treatment.
CONCLUSION: Our observations agree with earlier results and show that proton beam irradiation is a treatment alternative for brain AVMs since it has a high occlusion rate even in larger AVMs.
BACKGROUND: Increased interest in radiation dose reduction in neurointerventional procedures has led to the development of a method called "spot fluoroscopy" (SF), which enables the operator to collimate a rectangular or square region of interest anywhere within the general field of view. This has potential advantages over conventional collimation, which is limited to symmetric collimation centered over the field of view.
PURPOSE: To evaluate the effect of SF on the radiation dose.
MATERIAL AND METHODS: Thirty-five patients with intracranial aneurysms were treated with endovascular coiling. SF was used in 16 patients and conventional fluoroscopy in 19. The following parameters were analyzed: the total fluoroscopic time, the total air kerma, the total fluoroscopic dose-area product, and the fluoroscopic dose-area product rate. Statistical differences were determined using the Welch's t-test.
RESULTS: The use of SF led to a reduction of 50% of the total fluoroscopic dose-area product (CF = 106.21 Gycm(2), SD = 99.06 Gycm(2) versus SF = 51.80 Gycm(2), SD = 21.03 Gycm(2), p = 0.003884) and significant reduction of the total fluoroscopic dose-area product rate (CF = 1.42 Gycm(2)/min, SD = 0.57 Gycm(2)/s versus SF = 0.83 Gycm(2)/min, SD = 0.37 Gycm(2)/min, p = 0.00106). The use of SF did not lead to an increase in fluoroscopy time or an increase in total fluoroscopic cumulative air kerma, regardless of collimation.
CONCLUSION: The SF function is a new and promising tool for reduction of the radiation dose during neurointerventional procedures.
Juvenile nasal angiofibroma (JNA) is a hypervascularised, benign, but locally aggressive tumour that grows in the posterior, upper part of the nasal cavity and invades surrounding anatomical structures. The treatment of choice is surgical removal, but complete resection of the tumour can be hampered because of profuse perioperative bleeding. Preoperative embolisation of the tumour has been proposed as an effective method for prevention of perioperative bleeding, thereby shortening of the time of the operation. In this report of five cases, we describe successful preoperative devascularisation of the tumour by applying a modified method of direct intratumoural injection of the liquid embolic agent Onyx combined with protection of the internal carotid artery. The control of bleeding during the embolisation and occlusion of the maxillary or sphenopalatine artery was achieved by using a bi-luminal balloon catheter. Such use of the dual-lumen catheter in treatment of JNA has not been reported so far in the medical literature.
The aim of this study was to describe our experience in the treatment of various pathological conditions of the cranial and spinal blood vessels and hypervascularized lesions using dual lumen balloon catheters. Twenty-five patients were treated with endovascular techniques: two with vasospasm of cerebral blood vessels caused by subarachnoid hemorrhage, one with a hypervascularized metastasis in the vertebral body, two with spinal dural fistula, four with cerebral dural fistula, three with cerebral arteriovenous malformations, and 13 with aneurysms. The dual lumen balloon catheters were used for remodeling of the coil mesh, injection of various liquid embolic agents, particles and nimodipine, for the prevention of reflux and deployment of coils and stents. The diameter of catheterized blood vessels varied from 0.7 mm to 4 mm. Two complications occurred: perforation of an aneurysm in one case and gluing of the tip of balloon catheter by embolic material in another case. All other interventions were uneventful, and therapeutic goals were achieved in all cases except in the case with gluing of the tip of balloon catheter. The balloons effectively prevented reflux regardless of the type of the embolic material and diameter of blood vessel. The results of our study show that dual lumen balloon catheters allow complex interventions in the narrow cerebral and spinal blood vessels where the safe use of two single lumen catheters is either limited or impossible.
Studying individuals with extreme phenotypes could facilitate the understanding of disease modification by genetic or environmental factors. Our aim was to identify Huntington's disease (HD) patients with extreme symbol digit modality test (SDMT) scores. We first examined in HD the contribution of cognitive measures of the Unified Huntington's Disease Rating Scale (UHDRS) in predicting clinical endpoints. The language-independent SDMT was used to identify patients performing very well or very poorly relative to their CAG and age cohort. We used data from REGISTRY and COHORT observational study participants (5,603 HD participants with CAG repeats above 39 with 13,868 visits) and of 1,006 healthy volunteers (with 2,241 visits), included to identify natural aging and education effects on cognitive measures. Separate Cox proportional hazards models with CAG, age at study entry, education, sex, UHDRS total motor score and cognitive (SDMT, verbal fluency, Stroop tests) scores as covariates were used to predict clinical endpoints. Quantile regression for longitudinal language-independent SDMT data was used for boundary (2.5% and 97.5% quantiles) estimation and extreme score analyses stratified by age, education, and CAG repeat length. Ten percent of HD participants had an extreme SDMT phenotype for at least one visit. In contrast, only about 3% of participants were consistent SDMT extremes at two or more visits. The thresholds for the one-visit and two-visit extremes can be used to classify existing and new individuals. The identification of these phenotype extremes can be useful in the search for disease modifiers.
Cochlear implants (CI) have been used for several decades to treat patients with profound hearing loss. Nevertheless, results vary between individuals, and fine hearing is generally poor due to the lack of discrete neural stimulation from the individual receptor hair cells. A major problem is the deliverance of independent stimulation signals to individual auditory neurons. Fine hearing requires significantly more stimulation contacts with intimate neuron/electrode interphases from ordered axonal re-growth, something current CI technology cannot provide.
Here, we demonstrate the potential application of micro-textured nanocrystalline diamond (NCD) surfaces on CI electrode arrays. Such textured NCD surfaces consist of micrometer-sized nail-head-shaped pillars (size 5 5 lm2) made with sequences of micro/nano-fabrication processes, including sputtering, photolithography and plasma etching.
The results show that human and murine inner-ear ganglion neurites and, potentially, neural progenitor cells can attach to patterned NCD surfaces without an extracellular matrix coating. Microscopic methods revealed adhesion and neural growth, specifically along the nail-head-shaped NCD pillars in an ordered manner, rather than in non-textured areas. This pattern was established when the inter-NCD pillar distance varied between 4 and 9 lm.
The findings demonstrate that regenerating auditory neurons show a strong affinity to the NCD pillars, and the technique could be used for neural guidance and the creation of new neural networks. Together with the NCD's unique anti-bacterial and electrical properties, patterned NCD surfaces could provide designed neural/electrode interfaces to create independent electrical stimulation signals in CI electrode arrays for the neural population.
The mechanisms involved in traumatic brain injury have yet to be fully characterized. One mechanism that, especially in high-energy trauma, could be of importance is cavitation. Cavitation can be described as a process of vaporization, bubble generation, and bubble implosion as a result of a decrease and subsequent increase in pressure. Cavitation as an injury mechanism is difficult to visualize and model due to its short duration and limited spatial distribution. One strategy to analyze the cellular response of cavitation is to employ suitable in vitro models. The flyer-plate model is an in vitro high-energy trauma model that includes cavitation as a trauma mechanism. A copper fragment is accelerated by means of a laser, hits the bottom of a cell culture well causing cavitation, and shock waves inside the well and cell medium. We have found the flyer-plate model to be efficient, reproducible, and easy to control. In this study, we have used the model to analyze the cellular response to microcavitation in SH-SY5Y neuroblastoma, Caco-2, and C6 glioma cell lines. Mitotic activity in neuroblastoma and glioma was investigated with BrdU staining, and cell numbers were calculated using automated time-lapse imaging. We found variations between cell types and between different zones surrounding the lesion with these methods. It was also shown that the injured cell cultures released S-100B in a dose-dependent manner. Using gene expression microarray, a number of gene families of potential interest were found to be strongly, but differently regulated in neuroblastoma and glioma at 24 h post trauma. The data from the gene expression arrays may be used to identify new candidates for biomarkers in cavitation trauma. We conclude that our model is useful for studies of trauma in vitro and that it could be applied in future treatment studies.
OBJECTIVE: The aim of this study was to evaluate the robustness and zero-drift of an intracranial pressure sensor, Neurovent-P (Raumedic AG, Munchberg, Germany), when used in the clinical environment. METHODS: A prospective multicenter trial, conforming to the International Organization for Standardization 14155 Standard, was conducted in 6 European BrainIT centers between July 2005 and December 2006. Ninety-nine catheters were used. The study was observational, followed by a centralized sensor bench test after catheter removal. RESULTS: The mean recorded value before probe insertion was 0.17 +/- 1.1 mm Hg. Readings outside the range 1 mm Hg were recorded in only 3 centers on a total of 15 catheters. Complications were minimal and mainly related to the insertion bolt. The mean recorded pressure value at removal was 0.8 +/- 2.2 mm Hg. No relationship was identified between postremoval reading and length of monitoring. The postremoval bench test indicated the probability of a system failure, defined as a drift of more than 3 mm Hg, at a range between 12 and 17%. CONCLUSION: The Neurovent-P catheter performed well in clinical use in terms of robustness. The majority of technical complications were associated with the bolt fixation technology. Adverse events were rare and clinically nonsignificant. Despite the earlier reported excellent bench test zero-drift rates, under the more demanding clinical conditions, zero-drift rate remains a concern with catheter tip strain gauge technology. This performance is similar, and not superior, to other intracranial pressure devices.
Animal models of traumatic brain injury (TBI) have been the core of the research on the molecular, cellular, and functional effects of the disease. To be able to simulate the heterogeneous aspects of TBI several models have been designed. This chapter aims to describe the three most commonly used experimental models of TBI in rodents.
Traumatic brain injury (TBI) is a leading cause of death and disability TBI survivors often suffer from severe disturbances of cognition, memory and emotions. Improving the treatment is of great importance, but as of yet no specific neuroprotective treatment has been found. After TBI there are changes in ion homeostasis and protein regulation, causing generation of reactive oxygen species (ROS). Overproduction of ROS can lead to damage cellmembranes, proteins and DNA and secondary cell death. In the present thesis experimental TBI in rats were used to study the effects of the ROS scavengers α-phenyl-N-tert-butyl-nitrone (PBN) and 2-sulfophenyl-N-tert-butyl-nitrone (S-PBN) on morphology, function, intracellular signalling and apoptosis.
Posttreatment with PBN and S-PBN resulted in attenuation of tissue loss after TBI and S-PBN improved cognitive function evaluated in the Morris water maze (MWM). Pretreatment with PBN protected hippocampal morphology, which correlated to better MWM-performance after TBI.
To detect ROS-generation in vivo, a method using 4-hydroxybenzoic acid (4-HBA) microdialysis in the injured cortex was refined. 4-HBA reacts with ROS to form 3,4-DHBA, which can be quantified using HPLC, revealing that ROS-formation was increased for 90 minutes after TBI. It was possible to attenuate the formation significantly with PBN and S-PBN treatment.
The activation of extracellular signal-regulated kinase (ERK) is generally considered beneficial for cell survival. However, persistent ERK activation was found in the injured cortex after TBI, coinciding with apoptosis-like cell death 24 h after injury. Pretreatment with the MEK-inhibitor U0126 and S-PBN significantly decreased ERK activation and reduced apoptosis-like cell death. Posttreatment with U0126 or S-PBN showed robust protection of cortical tissue.
To conclude: ROS-mediated mechanisms play an important role in secondary cell death following TBI. The observed effects of ROS in intracellular signalling may be important for defining new targets for neuroprotective intervention.
A synthetic peptide with antisecretory activity, antisecretory factor (AF)-16, improves injury-related deficits in water and ion transport and decreases intracranial pressure after experimental cold lesion injury and encephalitis although its role in traumatic brain injury (TBI) is unknown. AF-16 or an inactive reference peptide was administrated intranasally 30 min following midline fluid percussion injury (mFPI; n = 52), a model of diffuse mild-moderate TBI in rats. Sham-injured (n = 14) or naive (n = 24) animals were used as controls. The rats survived for either 48 h or 15 days post-injury. At 48 h, the animals were tested in the Morris water maze (MWM) for memory function and their brains analyzed for cerebral edema. Here, mFPI-induced brain edema compared to sham or naive controls that was significantly reduced by AF-16 treatment (p < 0.05) although MWM performance was not altered. In the 15-day survival groups, the MWM learning and memory abilities as well as histological changes were analyzed. AF-16-treated brain-injured animals shortened both MWM latency and swim path in the learning trials (p < 0.05) and improved probe trial performance compared to brain-injured controls treated with the inactive reference peptide. A modest decrease by AF-16 on TBI-induced changes in hippocampal glial acidic fibrillary protein (GFAP) staining (p = 0.11) was observed. AF-16 treatment did not alter any other immunohistochemical analyses (degenerating neurons, beta-amyloid precursor protein (beta-APP), and Olig2). In conclusion, intranasal AF-16-attenuated brain edema and enhanced visuospatial learning and memory following diffuse TBI in the rat. Intranasal administration early post-injury of a promising neuroprotective substance offers a novel treatment approach for TBI.


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Catherine RIVIERE - Paris
Contacter l'auteurDr. Catherine Rivière has a private practice in Paris since 1985. She achieved her graduation in dental surgery at the University Paris V, and completed her training with a post-doctoral certificate in Implantology and Periodontics. She has been involved in teaching at Paris V University of dentistry as Assistant Professor. She is an active Nobel Biocare Mentor leading various activities as clinical lectures, step-by-step courses, special C&B&I courses for women colleagues and starter degree for students.
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Employment Opportunities
At Panache Salon & Day Spa, we take pride in our absolute commitment to quality. To insure we can meet this commitment we seek outstanding employees. The Panache family is dedicated to helping each employee reach his or her full potential and we strive to maintain a work environment that challenges our staff but rewards effort and experience.
Don't be afraid to apply – Panache wants the best, and we know you
can do it!
Want more information or have a specific question about opportunities at Panache? Please contact us at firstname.lastname@example.com with "Query" in the subject line so that we can answer your question quickly and have a reference for our e-mail records.
Current Openings
Licensed cosmetologist.
Apply in person with Ann Marie or use our online application.


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Newly discovered director dissolves into sparkling sea
Jean Epstein.LAUNCHING his career in Paris in the 1920s, Jean Epstein approached the new art of cinema from a position of rare intellectual freedom. Few filmmakers have worked so fruitfully in the zone where fictional narrative meets the avant-garde, and few have shown such wholehearted enthusiasm for using the camera to transform our vision of the world.
It has taken a while for English-language film culture to discover Epstein. A retrospective at this year's Melbourne International Film Festival gives an indication of what we have been missing.
Epstein is a ''flashy'' filmmaker, in a literal sense. He is attracted to elemental forms of movement - whatever sparkles, flows, or drifts like smoke. He loves reflections, veils, superimpositions, close-ups, blurred focus, and anything involving rivers or the sea.
His favourite device is the slow dissolve, especially when dissolving between the rippling surface of water and the face of a character in thought.
Often developing his visual ideas through conventional melodramatic stories, Epstein rarely delves into psychology as commonly understood.
Instead, he invites us to relish the faces, bodies and gestures of his performers: one sequence of The Beauty from Nivernais (1923) is devoted to a small boy doing a giddy dance, with little relevance to the plot.
There's a playfully eerie side to Epstein's work, linked to a use of slow motion that puts human activity and the inanimate on equal footing.
In his 1928 adaptation of Edgar Allan Poe's The Fall of The House of Usher, candle flames and curtains acquire wills of their own, while hands and faces move as clouds.
Covering a fraction of Epstein's output, the retrospective concentrates on his 1920s silent films. Still, the new documentary Jean Epstein, Young Oceans Of Cinema covers his later, quasi-ethnographic shorts and features.
In the 1947 short Le tempestaire the obvious camera tricks have mostly gone: what remains is a spare yet intricate game with a handful of elements of image and sound. The rhythmic flashing of a lighthouse lamp is set against the whistle of the wind, the roar of the waves, and a plaintive melody sung by a fisherman's bride-to-be as she awaits her lover's return to land.
Asked why he so often depicted the sea, Epstein said it was out of a fear that ''obliges us to do what we are afraid to do''. That might be a clue to the true nature of this mysterious filmmaker, whose works seem lucid almost to the point of abstraction, yet deeply personal in their mingled ecstasy and fright.
This story Administrator ready to work first appeared on Nanjing Night Net.


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Carbon-Neutral Delivery for Ice Cream Emergencies
photo: Ben & Jerry's
Admit it, you've been there: curled up on the couch in your pajamas, watching a good movie, and thinking to yourself, "The only thing that would make this better right now is a pint of New York Super Fudge Chunk and a spoon--but then I would have to get dressed and go outside..." Istanbul residents living near the popular shopping street Bağdat Caddesi on the Asian side of the city now have a solution to such dilemmas that is as ecofriendly as it is effortless: Bicycle delivery from Ben & Jerry's.Still a luxury item in Turkey at around $10 a pint, favorite flavors from the Vermont-based ice-cream maker are now available at Istanbul scoop shops in the city's massive Kanyon mall and trendy Nişantaşı district, in addition to the Bağdat Caddesi outlet. As bicycle delivery will be a novel sight in a traffic-clogged metropolis where most take-out is brought on overloaded (and often exhaust-spewing) mopeds, the company explained its plans in an email to customers:
If you see a Ben&Jerry;'s take away man with a cow printed bicycle at your door, don't be surprised! The brand which is famous for its fun and different identity, now comes to help for ice-cream emergencies. Ben&Jerry;'s, world's first climate neutral ice-cream, starts its take away service with carbon neutral bicycles. By this way, Ben&Jerry;'s both avoids carbon off-print and also makes its fans happy by bringing the ice-cream where ever they want.
Deliveries are made between noon and 11:30 pm from the Bağdat Caddesi shop and will soon be spreading happiness from the Nişantaşı location as well. Via: tipster Kelly
More green initiatives from Ben & Jerry's
Greenpeace and Ben & Jerry's Make Climate-Friendly Ice Cream Cooler
Climate Change College Graduates: From Green DIY to Watering-Down the Food Chain(s)
Other eco-friendly ice-cream options:
Izzy's Solar-Powered Ice Cream
No Energy Ice Cream


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by Cailey Morgan
At CBWC's 2017 Gathering in Calgary, we were able to share several short videos we thought were particularly helpful for our context. Over the summer, we will be sharing those videos here on the blog in hopes of continuing the conversation, and hearing from you about these important topics.
In today's video, our very on Shannon Youell shares Living as Ekklesia, a call to consider the history of our language around the church and the ways in which we have exchanged Kingdom values for earthly values without even noticing.
Living as Ekklesia – Being the Church from Online Discipleship on Vimeo.
What do you have to add to the discussion on Ekklesia? In what ways do we as the church today need to change our perceptions and language?


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Blueberries are little nuggets of goodness: Sweet, tart, and full of good-for-you antioxidants. So you probably think you're getting an extra boost of flavor and nutrition when you pick up a bag of blueberry bagels, or blueberry muffin mix, or blueberry-spiked cereal.
Bad news: The chances are good that those "blueberries" are actually a concoction of artificial colors, sugar, gums, starches, corn syrup, and partially hydrogenated oils (full of the dreaded "trans fats") with no actual blueberry content at all.
Investigative reporter Mike Adams, who calls himself the "Health Ranger," looked at a wide range of products from national brands, like General Mills, Kellogg's, and Betty Crocker, and found that while they were festooned with images of plump, ripe, succulent berries, they usually contained no real blueberries at all, and if they did, they were much farther down the ingredient list than the lab-created stuff.
The tipoff is the presence of artificial colors Blue #2 and Red Dye #40. They are used to mimic real blueberries' deep purple-blue hue. They're usually pretty far down the ingredient list, so make sure you read the whole label. "Health food store"-type brands are more likely to have the real deal, but it's still important to check; even seemingly healthy brands like Fiber One muffin mix have the fake blueberries in them.
Why do food companies do this? In a word, price. Real blueberries are expensive; faking them is cheap. Of course, I have to wonder if anyone was actually fooled; most "blueberry" products taste more like chemicals than like actual blueberries.
The best way to avoid this is to buy blueberries fresh in season and frozen during the rest of the year and add your own blueberries to muffins and cereal. That way you know you're getting every bit of the good stuff that you're paying for.
Image via Andrea Pokrzywinski/Flickr


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Dubai's exclusive dining destination, The Promenade welcomes guests to dine this new season and enjoy the variety of exquisite culinary concepts on offer – five concepts, one destination.
Located on the shores of the Dubai Creek, the distinctive dining venues include Mediterranean inspired favourite, Brasserie du Park, serving irresistible dishes such as the Feta and watermelon, Hummus Kawarma, Multigrain Tabbouleh, Kimali Pide, and Beef Cheek. The airy interiors and alfresco seating of the venue, combined with a relaxed atmosphere create the desired chic waterfront ambience, allowing guests to unwind and relish each dish they tuck into.
Brasserie du Park
What: Fisherman's catch
When: Every Tuesday
Time: 7:30pm to 11:45pm
Location: Brasserie du Park, The Promenade, Park Hyatt Dubai
- AED225 per person inclusive of soft drinks
- AED325 per person inclusive of soft beverage, grape, hops and house spirits
Mediterranean inspired restaurant overlooking the Dubai Creek, Brasserie du Park stuns guests with its latest offering. The Fisherman's catch includes the freshest seafood leaving guests with a bountiful selection and stations to choose from. The raw seafood bar features oysters, mussels, scallops, Omani lobster, sashimi, razor clams, salmon and tuna tartare, salmon ceviche. The chefs at the live station are cooking up delights such as pan seared scallops and prawns, grilled lobster with lemon butter, salt crust salmon, grilled crab legs, oyster, fried calamari, and seafood pasta and paella. With additional options from the grill, salad bar and dessert selection, patrons are presented a dining experience like no other.
About The Promenade
The Promenade is a dining and lifestyle destination in the heart of Dubai, featuring five distinctive culinary concepts in exquisitely designed outlets for an exclusive dining experience.
With quaint themes for gastronomic enthusiasts, The Promenade offers a variety of the finest dishes from world over, with Mediterranean inspired cuisine available at Brasserie du Park, Cape Cod's seaside fares at NOÉPE and an international range of cocktails from bar refined seventyseventy.
Located at Park Hyatt Dubai, The Promenade offers a tranquil and cosmopolitan escape from busy city life. The all-encompassing dining destination boasts panoramic vistas of the glittering marina and city skyline.


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The DocuSign Signature City Tour recently wrapped up its journey of the UK with great aplomb. Having set off on the (8.5 hour) first-leg drive from our London office to The Balmoral Hotel in Edinburgh, I don't think I've ever witnessed a more tightly packed car than that of our Volvo XC60. Fortunately for us, the drive was made worthwhile by the response we received during the first of these 8 half-day events that have been running throughout EMEA and the US since the New York kick-off in September.
Stewart Anderson joined us in one of capital's most regal venues to share Edinburgh University's interesting DocuSign use case within the Research and Innovation department. With Stewart describing how the department's legacy process has been reduced from 4 days to <1 hour, it was great to see the impact DocuSign is having on one of the top-performing enterprise universities in the UK (and the ambitious plans for future expansion within the University).
The following day we moved south of the border to a busy room at The Lowry in Manchester where we changed up the presentation format slightly, but continued with the momentum. DocuSign's Phil Lelliott was up to host a panel with Paul Hodnett of Utilities Direct and Kay Fallowfield from Qhotels, who shared best practice on the topic of eSignature within their respective industries. As always, DocuSign's technical specialists were on hand to demonstrate the product in action.
The third and final leg on the UK tour landed us in the culture capital of the West. The wonderfully alternative MShed museum held our largest tour so far, where we had three presenters from Nine Group, Brightpearl and Business West illustrate why Bristol's tech scene is thriving with the continued investment in disruptive technology.
Next month brings the tour to an end as we squeeze the remaining five trips within Europe, the Middle East and Africa in to a busy November. For our largest DocuSign tour yet, we are very excited to get back out on the road and even more so to meet our customers and the business leaders of tomorrow. We look forward to welcoming you soon!


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Jeremy Johnson
Facilities & Grounds / Men's Ministry
"Don't just tell someone how to be saved, show yourself as an example of someone who is saved"
Background: With a desire to help and encourage people along their walk with Christ, Jeremy has been on staff at the Hillspring Church since 2012. Raised in the Tri Cities, and a graduate of Washington State University, Jeremy appreciates what our community has to offer. His favorite times always revolve around family. The Johnsons enjoy traveling to Hawaii, spending time at the family cabin in the Blue Mountains, Spring Break at the Oregon Coast and cheering on the Seahawks. Jeremy and his wife Jessica have three daughters, Samantha , Emily and Claire (and Jewell the cat.)
Favorite Movie: Caddyshack
AHA! Moment: While walking up over an embankment and seeing Kailua Beach for the first time. The beauty of God's creation.


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natural herbs
Blue Spruce
Picea pungens
Herb: Blue Spruce
Latin name: Picea pungens
Family: Pinaceae (Pine Family)
Edible parts of Blue Spruce:Young male catkins - raw or cooked. Used as a flavouring. Immature female cones - cooked. The central portion, when roasted, is sweet and syrupy. The cones are about 7cm long. Inner bark - dried, ground into a powder and then used as a thickener in soups etc or added to cereals when making bread. An emergency food, it is only used when all else fails. Seed - raw. The seed is about 2 - 4mm long. It is rich in fats and has a pleasant slightly resinous flavour but is too small and fiddly to be worthwhile unless you are desperate. A refreshing tea, rich in vitamin C, can be made from the young shoot tips.
Description of the plant:
Height:20 m
(66 feet)
Habitat of the herb:Banks of streams or on first benches above them, singly or in small groves, 2000 - 3300 metres.
Other uses of Blue Spruce:A fairly wind resistant tree, it can be grown as part of a shelterbelt planting. Wood - light, soft, close grained, weak, brittle and often full of knots. The wood has little commercial value, but is used for construction and is also valued for its use in the pulp industry to make paper.
Propagation of the herb:Seed - stratification will probably improve germination so sow fresh seed in the autumn in a cold frame if possible. Sow stored seed as early in the year as possible in a cold frame. A position in light shade is probably best. Seed should not be allowed to dry out and should be stored in a cool place. Prick out the seedlings into individual pots when they are large enough to handle and grow them on in the greenhouse or cold frame for their first winter. They can be planted out into their permanent positions in early summer of the following year, or be placed in an outdoor nursery bed for a year or so to increase in size. They might need protection from spring frosts. Cuttings of semi-ripe terminal shoots, 5 - 8cm long, August in a frame. Protect from frost. Forms roots in the spring. Cuttings of mature terminal shoots, 5 - 10cm long, September/October in a cold frame. Takes 12 months. Cuttings of soft to semi-ripe wood, early summer in a frame. Slow but sure.
Cultivation of Blue Spruce:Banks of streams or on first benches above them, singly or in small groves, 2000 - 3300 metres.
Medicinal use of the herb:None known
Known hazards of Picea pungens:None known
Plant information taken from the Plants For A Future.


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Created by a professor of environmental and labor policy and overseen by an knowledgeable in chemical threat assessment, this app gives health, environmental and social impression scores on greater than 200,000 food objects and household products, from shampoos to clothing lines.


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+Share your photos!
On IHA you may choose your rental Guairá and book at the best price. In family or among friends, the destination Guairá for your seasonal holiday letting offers a wide selection of apartment flats, houses, villas and bungalows direct with the owners. Book safely, the ads for holiday letting Guairá are verified and include many photos and descriptions. A swimming pool? A hammam or even a jacuzzi? Choose the holiday letting that suits you best on IHA and enjoy ''the time of a holiday''.
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Display the map
Bungalow 650 Sq.ft. in a private property. panoramic, unobscured, mountain, country side viewGîte - Self Catering Rental in Melgarejo, Bungalow #69786 >
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View the advert


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Submitted by Anonymous on Thu, 2010-11-18 11:03
Congratulations go out to our fourth year student, Zoey Elissa Frank, for her prize-winning ARC drawing. This sensitive rendering of Poet is spun from charcoal on paper at 18 x 14 inches. To view the other fine prize winners, please visit: http://www.artrenewal.org/articles/2010/Scholarhip/results1.php
Article Tags:


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Looks like I found a new editor for my blog posts: Windows Live Writer. It's part of the messenger download package here: http://get.live.com/
Will checkout the email tool on my private notebook soon. Everything seems to work together with Google services. I think Microsoft finally starts to understand how that Internet thing works ;)


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Looking for signs of progress? Look no further than the Hurst-Euless-Bedford Independent School District. The suddenly forward-thinking District introduced Hindi, the official language of India, into its curriculum.
In a press release, Rajan Zed, the Chairperson of the Indo-American Leadership Confederation, commended the District and said that besides learning the rich languages and culture of India, it would also make good business sense to expose American children to the language, since India is becoming a global power.
"Today, China and India are powerful players in the global economy," he said. "Students in HEB ISD can get the competitive advantage by enrolling in Hindi or Mandarin Chinese classes."
Hindustani is the fourth most spoken language in the world after Chinese, Spanish, and English. Seventh, eighth, and ninth graders will be able to take the language as part of the District's International Business Initiative.
The class will also give students a peek into our bleak future in which India and China will take over the world, and systematically end out way of life. Learn to communicate with our future overlords now. And get your Big Macs while you can.


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Romania will probably sell 15 percent of Transelectrica SA, the state-controlled power grid manager, by May 2011, to help cover a budget deficit and finance investment, Chief Executive Officer Adrian Baicusi said today.
The government, which owns 73.7 percent of the utility, plans a secondary offering on the Bucharest exchange to increase Transelectrica's traded equity to 27.8 percent, Baicusi told Bloomberg News in an interview.
"We're expecting the sale via the secondary offering to happen by May if the process stays on track," Baicusi said.
Romania plans to sell minority slices of its utilities and of OMV Petrom SA, the country's biggest oil company, to meet international bailout conditions and to finance infrastructure investment. The country is relying on a 20 billion-euro ($27 billion) bailout led by the International Monetary Fund after recession and austerity measures reduced budget revenue.
Transelectrica's shares were unchanged at 18.8 lei as of 2:07 p.m. local time in Bucharest, valuing the company at 1.38 billion lei ($435 million).
To contact the reporter on this story: Irina Savu in Bucharest at email@example.com.
To contact the editor responsible for this story: James M. Gomez in Prague firstname.lastname@example.com


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American Legion Post 431 presented Plaques of Appreciation for outstanding service the past three years. Commander Denny Ross, far left, presented the plaques to, l to r, Tim Miller, Russell Hart, Gerald Groft, Denny Belle, Bill Welch and Bill Peddicord.
Legion recognizes members, nominates officers
American Legion Post 431 met in regular session April 20 with 12 members present.
Minutes and reports were read and approved.
Legacy Portraits took 24 individual portraits of families and others April 10. Members agreed this was a worthwhile project and will have Legacy back in the near future.
At present, 10 parents, grandparents or spouses have received the Blue Star Service Flag for their loved one's service in the military. Two, two-Star Service Flags have been presented. This is an ongoing project of the Legion's and the Flags are available free of charge. The only requirement is that the Service Member be serving on Active Duty. Contact the Legion if a Service Flag is desired.
Tom Eakin, a member of the Ohio Veterans Hall of Fame, will be present at the next Legion meeting to speak with members.
A $50 donation was made to the Ohio Fallen Heroes Memorial, which is located in Sunbury, and is the only state-recognized memorial for all Ohio military personnel killed or missing in action during the War on Terrorism. To date, 192 brave men and women have been lost from Ohio.
A $50 donation was made to the Newcomerstown Middle School to assist Pete Raymond, a life member of the Association of Lincoln Presenters, to portray the country's 16th President for the history class.
Commander Denny Ross announced the Vietnam Veterans Moving Wall will be in Dennison this summer. The Wall patches are available for $5. Contact the Legion at 498-6920 if a patch is desired.
Allen Duke Gadd was accepted as a regular member of the Legion.
Sick call was announced and members were encouraged to contact these comrades.
Commander Ross presented Plaques of Appreciation for outstanding service the past three years to Bill Peddicord, Bill Welch, Gerald Groft, Deny Belle, Russ Hart and Tim Miller. He said that without their service, the Legion could not have maintained operations.
Nominations for officers were received from the floor and are as follows:
Commander -- Jim Everhart and Bill Peddicord;
1st Vice Commander -- Gerald Groft;
2nd Vice Commander -- Dave Casteel;
Finance Officer -- Harry A. Kenney;
Adjutant -- Denny Belle;
Sergeant At Arms -- Russ Hart;
Three Year Trustee -- John Joyner and Jason Miller;
Chaplain -- Denny Belle;
Alternate Trustees -- Jim Everhart and Bill Welch;
Nominations also will be received from the floor at the May 18 meeting at 7 p.m. Election will follow as will the oath of offices.
Commander Ross announced the following Honor Guard activities:
May 6 -- Post and retrieve the Flag at the Chamber of Commerce Banquet.
May 16 -- Program at Waggoner Cemetery (firing and Taps).
May 24 -- Program at Bethel Cemetery (firing and Taps); program at River Hill Cemetery with Congressman Zack Space will honor deceased veterans (firing and Taps); program at Stone Creek Cemetery (firing and Taps): Port Washington Cemetery (firing and Taps); Newcomerstown East Lawn Cemetery (firing and Taps); and Newcomerstown Bridge Street Cemetery (firing and Taps).
May 25 -- Memorial Day program at Newcomerstown West Lawn Cemetery. Memorial Day program at Port Washington. (There is a dinner, free of charge, at the Legion for veterans and their families following Memorial Day programs).
May 30 -- Program at the Olde Main Street Museum and Social Center in Newcomerstown honoring Civil War veterans.
Anyone interested in joining the Honor Guard should contact the Legion.
Commander Ross and the officers encourage those interested in the Legion to become involved.
"The American Legion needs your assistance to continue our community support. A few of the Legion's support include donations to Newcomerstown Boy, Cub and Girl Scouts; Newcomerstown Museum; Newcomerstown and Port Washington Baseball Little League; Gnadenhutten Girls' Softball League; Port Washington PTO; Newcomerstown wall locker restoration; and many more. Some activities include Honor Guard participation at funerals and programs, etc. Legion members annually place the flags on graves in numerous cemeteries. Some of the cemeteries are West Lawn, East Lawn, Kings, Hartwood, Peoples, Couts, Bridge Street, Peoli and Everals. During the past several years, sons, daughters and grandchildren of Legion members have received scholarships as have some members themselves. All this has been made possible by membership participation," Commander Ross said.
The next Legion meeting is May 18 at 7 p.m.


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AWS Lambda Node
The AWS Lambda Node allows a workflow to run an AWS Lambda function and optionally store the returned value from the function in the payload.
There are two main configuration sections for the AWS Lambda node - first configuring the AWS authentication and region, and second configuring the Lambda function in particular to run.
There are three parts to configuring credentials - the
AWS Access Key ID, the
AWS Secret Access Key and the particular AWS region. Losant recommends that you create an AWS Key/Secret pair specifically for use for our workflow nodes - one that only has access to your AWS Lambda functions. All three fields can take string templates, and so can pull values from the current payload. Most users store these values in their workflow globals.
In the example above, the node is configured to pull the AWS Access Key from
globals.awsKey, the AWS Secret from
globals.awsSecret, and sets the region to
Next to configure are what particular Lambda function to call, and what to hand it as the data. The function to call can take a string template, so the value can be pulled off the payload - but in the example above, the function is hard-coded to
userNumberLookup. For configuring the data to send to the function, there are three possible options:
- Workflow Payload: with this option, the entire current workflow payload is sent as the data to the lambda call.
- Payload Path: with this option, you must provide a payload path, and the value at that path on the current payload is sent as the data to the lambda call.
- JSON Template: with this option, you must provide a JSON template, and the result of that template is sent as the data to the lambda call.
In the example above,
Workflow Payload is selected, so the entire current payload will be handed to the
userNumberLookup call.
Finally, if the Lambda function that is being called returns a result, it can optionally be stored for later use in the workflow. In the example above, the result will be stored at the payload path
data.phoneNumber on the current payload. What a Lambda function returns, though, is not just the result; it is a result object with potentially other useful information. For example, here is an example payload after the above AWS Lambda Node has been run - the actual Lambda result is placed in the
Payload field:
"time": Fri Feb 19 2016 17:26:00 GMT-0500 (EST),
"data": {
"current": 10,
"on": true,
"phoneNumber": {
"LogResult": "AWS_LOGGING_INFO_WOULD_BE_HERE",
"Payload": { "phoneNumber": "212 867-5309" },
"StatusCode": 200,
"globals": {
"awsKey": "AWS_KEY_WOULD_BE_HERE",
"awsSecret": "AWS_SECRET_WOULD_BE_HERE"
"applicationId": "568beedeb436ab01007be53d",
"applicationName": "Embree",
"triggerId": "56c8967bb8df0f0100d629120",
"triggerType": "deviceId",
"deviceTags": {
"floor": ["2"],
"location": ["warehouse1"]
"deviceName": "My Factory Device",
"flowId": "56c74add04d0b50100043381",
"flowName": "Power Usage Alert"


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FIREWIND: First Video Update From The Studio
Greek melodic metallers FIREWIND have entered the studio in the band's hometown of Thessaloniki to begin recording their new album for an early 2012 release via an as-yet-undetermined record label. Sitting behind the drum kit during the sessions is Johan Nunez of NIGHTRAGE, the former group of FIREWIND guitarist Gus G.
The first in a series of video updates featuring behind-the-scenes footage from the studio can be seen below.
FIREWIND is currently seeking a new label home following the expiration of the band's contract with Century Media Records.
In a recent interview with Oregon Music News, Gus, who is also a member of Ozzy Osbourne's band, stated about the relative lack of promotion for FIREWIND's latest studio album, "Days Of Defiance", "If were up to me, I would have released the album after I would be available to tour behind it. This was the label's idea who wanted to the album out. Our current label, Century Media, wanted it released. They said, 'We paid you to record the album and we want the masters.' I said, 'Okay, here you go.' I didn't feel good about it. This is the politics of the music business, I tried to make the label see that sure we'd get some press due to my involvement in Ozzy's band, but we would not be able to tour. Waiting 10 months to tour behind an album isn't a good business."
When asked if there were any plans for FIREWIND to re-release "Days Of Defiance" as an "expanded" edition to coincide with the band's recent North American headlining tour, Gus said, "We have thought about it but it goes back to the politics with our label. This was our last album for Century Media and unless you're signed for a long-term contract, they aren't going to do much for you. So for FIREWIND, this time around, there wasn't any creative marketing behind the album. It's sad, because I do feel that it's our best album to date and the fans absolutely love it. Unfortunately, there could have better promotion and Century Media should have waited a few months to release it, but that's record label politics for you."
"Days Of Defiance" landed at position No. 53 on the Top New Artist Albums (Heatseekers) chart, which lists the best-selling albums by new and developing artists, defined as those who have never appeared in the Top 100 of The Billboard 200. The CD was released in North America on October 26, 2010 (one day earlier internationally) via Century Media Records.