Festival-like atmosphere for shuttle Endeavour’s Los Angeles move.


The retired space shuttle Endeavour was greeted with a festival-like atmosphere in the Los Angeles suburb of Inglewood on Saturday, where it has paused from its snail-like crawl through narrow city streets towards its new home at a local museum.

Endeavour nosed out of Los Angeles International Airport before dawn on Friday to begin a two-day, 12-mile (19-km) journey atop a massive wheeled transporter to the California Science Centre on the edge of downtown.

The shuttle, which flew from 1992 to 2011, will become a tourist attraction at the Centre. Endeavour was largely built in Southern California and was a workhorse of the U.S. space program, flying 25 missions.

Thousands of area residents, many of whom walked a mile or more to get to where the shuttle was parked outside an arena on Saturday morning, celebrated the icon’s visit to their neighbourhood with food trucks and music.

Two brothers from the area, German and Joseph Raudales, watched the shuttle with smiles on their faces.

“I’m excited, I want to be an astronaut when I grow up,” said 10-year-old Joseph Raudales.

The shuttle is 122 feet (37 meters) long and 78 feet (24 meters) wide and stands 5 stories tall at the tail – which police said makes it the largest object ever to move through Los Angeles. Its combined weight with the transporter is 80 tons.

Organizers say only a few inches separate Endeavour’s wings from structures along the route, and workers have felled 400 trees along curbs to clear a path. The science Centre will plant more than 1,000 trees to make up for their loss.

Some street lights, traffic signals, power poles and parking meters also have been temporarily removed.

OTHER SHUTTLES FIND HOMES

The project to move Endeavour will cost over $10 million (6.2 million pounds), said Shell Amega, a spokeswoman for the science Centre. Charitable foundations and corporations have donated money and services for the move.

The Centre beat out a number of other institutions when the U.S. space agency NASA chose it last year as the permanent home for Endeavour, which was taken out of service because of the end of the shuttle program.

Endeavour has hop-scotched across the country from Cape Canaveral, Florida, on the back of a modified Boeing 747. It had been parked at the airport in Los Angeles since arriving on September 21 after a ceremonial piggyback flight around California.

Endeavour was built to replace Challenger, using spare parts from two prior shuttles, according to Ken Phillips, aerospace curator at the science Centre. Challenger was lost in a 1986 accident that killed seven astronauts.

The shuttle will be displayed in a temporary hangar-style metal structure to protect it from the elements. In 2017, a 200-foot-tall (61-meter) structure will open in which Endeavour will stand vertically, Phillips said.

The other remaining shuttles also have found homes.

The Smithsonian in Washington has Discovery at its Steven F. Udvar-Hazy Centre museum in Virginia. New York City has the prototype shuttle Enterprise at its Intrepid Sea, Air and Space Museum. And the Kennedy Space Centre in Cape Canaveral has Atlantis, which the Centre will move to an on-site visitors complex next month.

Source: NASA

Overheated and melted intracranial pressure transducer as cause of thermal brain injury during magnetic resonance imaging.


Case report

Magnetic resonance imaging is used with increasing frequency to provide accurate clinical information in cases of acute brain injury, and it is important to ensure that intracranial pressure (ICP) monitoring devices are both safe and accurate inside the MRI suite. A rare case of thermal brain injury during MRI associated with an overheated ICP transducer is reported.

This 20-year-old man had sustained a severe contusion of the right temporal and parietal lobes during a motor vehicle accident. An MR-compatible ICP transducer was placed in the left frontal lobe. The patient was treated with therapeutic hypothermia, barbiturate therapy, partial right temporal lobectomy, and decompressive craniectomy. Immediately after MRI examination on hospital Day 6, the ICP monitor was found to have stopped working, and the transducer was subsequently removed. The patient developed meningitis after this event, and repeat MRI revealed additional brain injury deep in the white matter on the left side, at the location of the ICP transducer. It is suspected that this new injury was caused by heating due to the radiofrequency radiation used in MRI because it was ascertained that the tip of the transducer had been melted and scorched. Scanning conditions—including configuration of the transducer, MRI parameters such as the type of radiofrequency coil, and the specific absorption rate limit—deviated from the manufacturer’s recommendations. In cooperation with the manufacturer, the authors developed a precautionary tag describing guidelines for safe MR scanning to attach to the display unit of the product.

Strict adherence to the manufacturer’s guidelines is very important for preventing serious complications in patients with ICP monitors undergoing MRI examinations.

Source: Journal of Neurosurgery

 

 

 

 

Subdural interhemispheric grid electrodes for intracranial epilepsy monitoring: feasibility, safety, and utility.


Intracranial monitoring for epilepsy has been proven to enhance diagnostic accuracy and provide localizing information for surgical treatment of intractable seizures. The authors investigated their experience with interhemispheric grid electrodes (IHGEs) to assess the hypothesis that they are feasible, safe, and useful.

Methods

Between 1992 and 2010, 50 patients underwent IHGE implantation (curvilinear double-sided 2 × 8 or 3 × 8 grids) as part of arrays for invasive seizure monitoring, and their charts were retrospectively reviewed.

Results

Of the 50 patients who underwent intracranial investigation with IHGEs, 38 eventually underwent resection of the seizure focus. These 38 patients had a mean age of 30.7 years (range 11–58 years), and 63% were males. Complications as a result of IHGE implantation consisted of transient leg weakness in 1 patient. Of all the patients who underwent resective surgery, 21 (55.3%) had medial frontal resections, 9 of whom (43%) had normal MRI results. Localization in all of these cases was possible only because of data from IHGEs, and the extent of resection was tailored based on these data. Of the 17 patients (44.7%) who underwent other cortical resections, IHGEs were helpful in excluding medial seizure onset. Twelve patients did not undergo resection because of nonlocalizable or multifocal disease; in 2 patients localization to the motor cortex precluded resection. Seventy-one percent of patients who underwent resection had Engel Class I outcome at the 2-year follow-up.

Conclusions

The use of IHGEs in intracranial epilepsy monitoring has a favorable risk profile and in the authors’ experience proved to be a valuable component of intracranial investigation, providing the sole evidence for resection of some epileptogenic foci.

Source: Journal of Neurosurgery

 

 

Impaired pulsation absorber mechanism in idiopathic normal pressure hydrocephalus.


The pathophysiology of normal pressure hydrocephalus (NPH), and the related problem of patient selection for treatment of this condition, have been of great interest since the description of this seemingly paradoxical condition nearly 50 years ago. Recently, Eide has reported that measurements of the amplitude of the intracranial pressure (ICP) can both positively and negatively predict response to CSF shunting. Specifically, the fraction of time spent in a “high amplitude” (> 4 mm Hg) state predicted response to shunting, which may represent a marker for hydrocephalic pathophysiology. Increased ICP amplitude might suggest decreased brain compliance, meaning a static measure of a pressure-volume ratio. Recent studies of canine data have shown that the brain compliance can be described as a frequency-dependent function. The normal canine brain seems to show enhanced ability to absorb the pulsations around the heart rate, quantified as a cardiac pulsation absorbance (CPA), with properties like a notch filter in engineering. This frequency dependence of the function is diminished with development of hydrocephalus in dogs. In this pilot study, the authors sought to determine whether frequency dependence could be observed in humans, and whether the frequency dependence would be any different in epochs with high ICP amplitude compared with epochs of low ICP amplitude.

Methods

Systems analysis was applied to arterial blood pressure (ABP) and ICP waveforms recorded from 10 patients undergoing evaluations of idiopathic NPH to calculate a time-varying transfer function that reveals frequency dependence and CPA, the measure of frequency-dependent compliance previously used in animal experiments. The ICP amplitude was also calculated in the same samples, so that epochs with high (> 4 mm Hg) versus low (≤ 4 mm Hg) amplitude could be compared in CPA and transfer functions.

Results

Transfer function analysis for the more “normal” epochs with low amplitude exhibits a dip or notch in the physiological frequency range of the heart rate, confirming in humans the pulsation absorber phenomenon previously observed in canine studies. Under high amplitude, however, the dip in the transfer function is absent. An inverse relationship between CPA index and ICP amplitude is evident and statistically significant. Thus, elevated ICP amplitude indicates decreased performance of the human pulsation absorber.

Conclusions

The results suggest that the human intracranial system shows frequency dependence as seen in animal experiments. There is an inverse relationship between CPA index and ICP amplitude, indicating that higher amplitudes may occur with a reduced performance of the pulsation absorber. Our findings show that frequency dependence can be observed in humans and imply that reduced frequency-dependent compliance may be responsible for elevated ICP amplitude observed in patients who respond to CSF shunting.

Source: Journal of Neurosurgery

 

 

 

 

Inflammasome proteins in cerebrospinal fluid of brain-injured patients as biomarkers of functional outcome.


Traumatic brain injury (TBI), the third most common CNS pathology, plagues 5.3 million Americans with permanent TBI-related disabilities. To evaluate injury severity and prognosis, physicians rely on clinical variables. Here, the authors seek objective, biochemical markers reflecting molecular injury mechanisms specific to the CNS as more accurate measurements of injury severity and outcome. One such secondary injury mechanism, the innate immune response, is regulated by the inflammasome, a molecular platform that activates caspase-1 and interleukin-1β.

Methods

The authors investigated whether inflammasome components were present in the CSF of 23 patients with TBI and whether levels of inflammasome components correlate with outcome. The authors performed an immunoblot analysis of CSF samples from patients who suffered TBI and nontrauma controls and assessed the outcomes 5 months postinjury by using the Glasgow Outcome Scale. Data were analyzed using Mann-Whitney U-tests and linear regression analysis.

Results

Patients with severe or moderate cranial trauma exhibited significantly higher CSF levels of the inflammasome proteins ASC, caspase-1, and NALP-1 than nontrauma controls (p < 0.0001, p = 0.0029, and p = 0.0202, respectively). Expression of each protein correlated significantly with the Glasgow Outcome Scale score at 5 months postinjury (p < 0.05). ASC, caspase-1, and NALP-1 were significantly higher in the CSF of patients with unfavorable outcomes, including death and severe disability (p < 0.0001).

Conclusions

NALP-1 inflammasome proteins are potential biomarkers to assess TBI severity, outcome, and the secondary injury mechanisms impeding recovery, serving as adjuncts to clinical predictors.

Source: Journal of Neurosurgery

 

 

 

 

A randomized controlled study comparing omeprazole and cimetidine for the prophylaxis of stress-related upper gastrointestinal bleeding in patients with intracerebral hemorrhage.


Patients with intracerebral hemorrhage (ICH) are at high risk for severe stress-related upper gastrointestinal (UGI) bleeding, which is predictive of higher mortality. The aim of this study was to evaluate the effectiveness of omeprazole and cimetidine compared with a placebo in the prevention and management of stress-related UGI bleeding in patients with ICH.

Methods

In a single-center, randomized, placebo-controlled study, 184 surgically treated patients with CT-proven ICH within 72 hours of ictus and negative results for gastric occult blood testing were included. Of these patients, 165 who were qualified upon further evaluation were randomized into 3 groups: 58 patients received 40 mg intravenous omeprazole every 12 hours, 54 patients received 300 mg intravenous cimetidine every 6 hours, and 53 patients received a placebo. Patients whose gastric occult blood tests were positive at admission (n = 70) and during/after the prophylaxis procedure (n = 48) were treated with high-dose omeprazole at 80 mg bolus plus 8 mg/hr infusion for 3 days, followed by 40 mg intravenous omeprazole every 12 hours for 7 days.

Results

Of the 165 assessable patients, stress-related UGI bleeding occurred in 9 (15.5%) in the omeprazole group compared with 15 patients (27.8%) in the cimetidine group and 24 patients (45.3%) in the placebo group (p = 0.003). The occurrence of UGI bleeding was significantly related to death (p = 0.022). Nosocomial pneumonia occurred in 14 patients (24.1%) receiving omeprazole, 12 (22.2%) receiving cimetidine, and 8 (15.1%) receiving placebo (p > 0.05). In patients with UGI bleeding in which high-dose omeprazole was initiated, UGI bleeding arrested within the first 3 days in 103 patients (87.3%).

Conclusions

Omeprazole significantly reduced the morbidity of stress-related UGI bleeding in patients with ICH due to its effective prophylactic effect without increasing the risk of nosocomial pneumonia, but it did not reduce the 1-month mortality or ICU stay. Further evaluation of high-dose omeprazole as the drug of choice for patients presenting with UGI bleeding is warranted.

Source: Journal of Neurosurgery

 

 

 

 

ACIP Updates Pneumococcal Vaccine Recommendations for High-Risk Adults.


The Advisory Committee on Immunization Practices has published updated recommendations for pneumococcal vaccination of high-risk adults in MMWR.

ACIP now recommends routine use of the 13-valent pneumococcal conjugate vaccine (PCV13; Prevnar) in addition to the previously recommended 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax) for adults aged 19 and older with immunocompromising conditions (such as HIV, cancer, and renal disease), functional or anatomic asplenia, cerebrospinal fluid leaks, or cochlear implants.

Patients who have not previously received either vaccine should be given one dose of PCV13 followed by one dose of PPSV23 after at least 8 weeks. Patients who have previously received PPSV23 vaccine should be given one dose of PCV13 at least 1 year after the last PPSV23 dose.

Source: MMWR

 

Compounding Pharmacies Come Under Scrutiny in Light of Meningitis Outbreak.


Compounding pharmacies are getting widespread attention in the midst of the fungal meningitis outbreak that has affected at least 170 patients and claimed 14 lives. The outbreak has been linked to methylprednisolone acetate injections distributed by the New England Compounding Center (NECC) in Massachusetts.

Compounding pharmacies are not regulated by the FDA but rather “are subject to a patchwork of state oversight,” Reuters notes. A second compounding pharmacy in Massachusetts, Ameridose, temporarily closed pending an inspection by state officials. NECC and Ameridose share an owner.

In other outbreak-related news, the CDC says that 10 of the meningitis patients have tested positive for the fungus Exserohilum and 1 for Aspergillus.

In Tennessee, the hardest hit state, health officials estimate that 5% of patients who received the implicated injections from NECC have contracted meningitis.

Source: Wall Street Journal

 

FDA Warns That Opana Abusers Risk Blood Disorder .


The extended-release formulation of the opioid Opana (oxymorphone) can cause thrombotic thrombocytopenic purpura if the pills are crushed and injected intravenously, the FDA warned on Thursday.

The complication can lead to kidney failure, brain damage, or stroke. Injecting Opana has resulted in at least one death.

Abuse of this painkiller has been on the rise since 2010, when Oxycontin (oxycodone) was made more difficult to inject or snort, according to Reuters. A crush-resistant formulation of Opana was announced by the manufacturer last month.

Source: FDA

Triple Therapy for Chronic HCV Infection Is Cost-Effective in Some Patients.


Exceptions are patients without rapid viral response to boceprevir or the IL28B genotype, for whom dual therapy is still best.

The new triple therapy regimens with peginterferon alfa, ribavirin, and boceprevir or telaprevir lead to high rates of sustained virologic response (SVR) in patients with hepatitis C virus (HCV) infection (JW Gastroenterol Mar 30 2011 and JW Gastroenterol Sep 16 2011). But, given their adverse effects, drug interactions, potential viral mutations, and expense, it is unclear whether these regimens are more cost-effective than dual therapy.

Now, European investigators have created a Markov decision model — using data from untreated patients with genotype 1 HCV infection and stage 2 liver fibrosis — to evaluate the cost-effectiveness of the following five strategies over a 20-year horizon:

  • Boceprevir response-guided therapy (RGT)
  • Boceprevir IL28B genotype-guided therapy (IL28B)
  • Boceprevir rapid virologic response–guided therapy (RVRT)
  • Telaprevir RGT
  • Telaprevir IL28B

In the IL28B strategies, if the IL28B CC genotype was identified, patients underwent dual therapy. In the boceprevir RVRT strategy, if rapid viral response was achieved during boceprevir lead-in, patients received dual therapy. Outcomes included costs (in 2011 euros), years of life gained, and incremental cost-effectiveness ratio (ICER).

The telaprevir IL28B and boceprevir RVRT strategies were the most clinically effective (survival improvement, 4.42 years and 4.04 years, respectively) and the most cost-effective. For both of these strategies, the quality-adjusted life year (QALY) estimate was improved by about 7 years, thanks to a 25% improvement in SVR rate, compared with dual therapy. This gain in SVR came at a relatively low cost of ICER per QALY of <10,000.

Comment: These results show that HCV triple therapy regimens are more cost-effective than previous dual therapy, especially if RVRT and IL28B data are used. Furthermore, the ICER per QALY was lower than the accepted societal threshold for willingness to pay. As with many modeling studies, the results are highly sensitive to certain assumptions and variables, including the cost of the regimens.

Source: Journal Watch Gastroenterology