Gamma Knife stereotactic radiosurgery for idiopathic trigeminal neuralgia. Clinical article

Object
Trigeminal neuralgia pain causes severe disability. Stereotactic radiosurgery is the least invasive surgical option for patients with trigeminal neuralgia. Since different medical and surgical options have different rates of pain relief and morbidity, it is important to evaluate longer-term outcomes.

Methods
The authors retrospectively reviewed outcomes in 503 medically refractory patients with trigeminal neuralgia who underwent Gamma Knife surgery (GKS). The median patient age was 72 years (range 26–95 years). Prior surgery had failed in 205 patients (43%). The GKS typically was performed using MR imaging guidance, a single 4-mm isocenter, and a maximum dose of 80 Gy.

Results
Patients were evaluated for up to 16 years after GKS; 107 patients had > 5 years of follow-up. Eighty-nine percent of patients achieved initial pain relief that was adequate or better, with or without medications (Barrow Neurological Institute [BNI] Scores I–IIIb). Significant pain relief (BNI Scores I–IIIa) was achieved in 73% at 1 year, 65% at 2 years, and 41% at 5 years. Including Score IIIb (pain adequately controlled with medication), a BNI score of I–IIIb was found in 80% at 1 year, 71% at 3 years, 46% at 5 years, and 30% at 10 years. A faster initial pain response including adequate and some pain relief was seen in patients with trigeminal neuralgia without additional symptoms, patients without prior surgery, and patients with a pain duration of = 3 years. One hundred ninety-three (43%) of 450 patients who achieved initial pain relief reported some recurrent pain 3–144 months after initial relief (median 50 months). Factors associated with earlier pain recurrence that failed to maintain adequate or some pain relief were trigeminal neuralgia with additional symptoms and = 3 prior failed surgical procedures. Fifty-three patients (10.5%) developed new or increased subjective facial paresthesias or numbness and 1 developed deafferentation pain; these symptoms resolved in 17 patients. Those who developed sensory loss had better long-term pain control (78% at 5 years).

Conclusions
Gamma Knife surgery proved to be safe and effective in the treatment of medically refractory trigeminal neuralgia and is of value for initial or recurrent pain management. Despite the goal of minimizing sensory loss with this procedure, some sensory loss may improve long-term outcomes. Pain relapse is amenable to additional GKS or another procedure.

Work stress, smoking status, and smoking intensity: an observational study of 46 190 employees

Study objective: To examine the relation between work stress, as indicated by the job strain model, and the effort-reward imbalance model, and smoking.

Carrefours de la sociocritique. E´ dite´ par ANTHONY GLINOER. (¼ Texte: revue de critique et de the´orie litte´raire, 45/46). Toronto: E´ ditions Trintexte, 2009. 227 pp. Pb CAD $35.00

French Studies (2012) 66 (1): 125-126 doi:10.1093/fs/knr208

Severe aplastic anaemia in association with a unique constitutional translocation 46,XY,t(6;10)(q13;q22)c

Severe aplastic anaemia (SAA) is an uncommon disorder which may be associated with several congenital syndromes. However, it has rarely been described in association with a constitutional karyotypic abnormality. The breakpoint of the balanced t(6:10)(q13:q22) translocation described here does not disrupt any currently recognized gene of haemopoietic or stromal importance. This report also highlights the problems inherent in the use of bone marrow transplantation (BMT) for treating multiply transfused aplastic anaemia patients.

Mass spectrometry parameters optimization for the 46 multiclass pesticides determination in strawberries with gas chromatography ion-trap tandem mass spectrometry

Multiclass analysis method was optimized in order to analyze pesticides traces by gas chromatography with ion-trap and tandem mass spectrometry (GC-MS/MS). The influence of some analytical parameters on pesticide signal response was explored. Five ion trap mass spectrometry (IT-MS) operating parameters, including isolation time (IT), excitation voltage (EV), excitation time (ET),maximum excitation energy or “q” value (q), and isolationmass window (IMW) were numerically tested in order to maximize the instrument analytical signal response. For this, multiple linear regression was used in data analysis to evaluate the influence of the five parameters on the analytical response in the ion trap mass spectrometer and to predict its response. The assessment of the five parameters based on the regression equations substantially increased the sensitivity of IT-MS/MS in the MS/MS mode. The results obtained show that for most of the pesticides, these parameters have a strong influence on both signal response and detection limit.Using the optimized method, a multiclass pesticide analysis was performed for 46 pesticides in a strawberry matrix. Levels higher than the limit established for strawberries by the European Union were found in some samples.

Unesp Ciência, 2013, ano 5, número 46

Revista elaborada pela Assessoria de Comunicação e Imprensa da Reitoria da UNESP

Archives parlementaires de 1787 à 1860 ; 34-51. Assemblée nationale législative. Série 1 / Tome 46 / impr. par ordre du Sénat et de la Chambre des députés ; sous la dir. de M. J. Mavidal,... et de M. E. Laurent,... ; avec la collab. de MM. E. Tonnier et C. Pionnier

Collection : Les archives de la Révolution française ; 3.1

Recueil de poésies, par « HENRY BAULDE » (fol. 30, 32, 35, 36, 37, 39, 40, 43, 44, 46, 47, 56, 59, 60, 61, 65, 68, 69, 70, 73, 74), « ALAIN CHARRETIER » (fol. 15), « JEHAN DAUTON » (fol. 9), « JEHAN MAROT » (fol. 29, 30), « JEHAN MOLINET » (fol. 77, 85, 90, 93, 94, 95) et « JEHAN ROBERTET » (fol. 1, 75).

Commençant par : « Estant couché soubz ung myrthe plaisant, Et maintz chasteaulx en Espaigne faisant... » et finissant par : « Sans parage ou riens n'est nect, Moulu d'un groz Moulinet. Fin de la complaincte de Grece, composée par le dict Molinet » .