关键词： full-term infants   Hammersmith Neonatal Neurological Examination   late-preterm infant   optimality score   raw score   term-corrected age  

摘要： Aim We hypothesise that clinically well late-preterm infants (LPI) (34(+0)-36(+6) weeks) are neurologically more immature than their term counterparts, and this immaturity persists even when these infants reach term-corrected age (TCA). The primary aim of our study was to characterise and contrast the neurodevelopmental profile of well LPI with full-term infants (FTI) (39(+0)-41(+6) weeks) using the Hammersmith Neonatal Neurological Examination (HNNE). Our secondary aim was to obtain local reference ranges for the 34 items in the HNNE in an Asian-dominant population. Methods LPI were assessed at two time points: 12-72 h of life and at TCA of 39(+0)-41(+6) weeks, while FTI were assessed at 12-72 h of life using the HNNE. Each of the 34 items on the HNNE was assigned an optimality score (OS) of 0, 0.5 or 1, totalling up to 34. A quantitative comparison of the neurobehavioral patterns was made using two-sample t-tests. Results A total of 212 infants (79 LPI and 133 FTI) were recruited. Mean OSs for LPI and FTI at birth were (25.11 +/- 3.36)/34 and (31.19 +/- 1.50)/34, respectively, with a mean difference of 6.08 (P value <0.0001). The mean OS for LPI on reaching TCA was (28.91 +/- 2.30)/34, with a mean difference of 2.28 (P value <0.0001). Reference OSs for the 34 items on the HNNE were also obtained. Conclusion LPI are more immature than their term counterparts even on reaching TCA, with discrepancies most apparent in 'tone' and 'movement'. We provide reference OSs of 34 items in the HNNE for infants in an Asian-dominant population.

关键词： Stroke   Mechanical thrombectomy   Prognosis  

摘要： BackgroundWe investigated the prevalence and mechanisms of neurological deterioration after endovascular *** January 2011 and October 2017, acute ischemic stroke patients treated by endovascular thrombectomy in a tertiary university hospital were included. Early neurological deterioration (END) was defined as an increase of 2 or more National Institute of Health Stroke Scale (NIHSS) compared to the best neurological status after stroke within 7 days. The END mechanism was categorized into ischemia progression, symptomatic hemorrhage, and brain *** total of 125 acute ischemic stroke patients received endovascular thrombectomy. Neurological deterioration was detected in 44 patients, and 38 cases (86.4% of END) occurred within 72h. The END mechanism included 20 ischemia progression, 16 brain edema and 8 hemorrhagic transformation cases. Multivariable logistic regression analysis revealed that the patients who experienced END were more likely to have poor functional outcome defined as modified Rankin scale 3-6at 90 days than neurologically stable patients (odds ratio (OR)=4.06, confidence interval (CI)=1.39-11.9). The risk factor of END due to ischemia progression was stroke subtype of large artery atherosclerosis (OR=6.28, CI=1.79-22.0). Successful recanalization (OR=0.11, CI=0.03-0.39) and NIHSS after endovascular thrombectomy (OR=1.15 per one-point increase, CI=1.06-1.24) were significantly associated with END due to hemorrhage or brain *** deterioration frequently occurs after endovascular thrombectomy, and the risk factors of END differ according to the mechanism of END.

关键词： Academic achievement   Neuropsychological assessment   Cancer   Pediatrics   Neurological complications   Treatment  

摘要： Survivors of childhood brain tumors exhibit impairments in academic performance and have lower rates of educational attainment compared to healthy same-aged peers. Prior research has demonstrated the concurrent validity of the Neurological Predictor Scale (NPS), a measure that incorporates tumor-related treatments and complications into one cumulative score, in predicting IQ, adaptive functioning, and core neurocognitive skills. The purpose of this study is to determine whether the NPS predicts academic achievement outcomes over and above the effects of individual treatment factors alone. Sixty-two adult survivors completed four untimed measures of academic achievement from the Woodcock-Johnson III. NPS scores significantly predicted performance on all four academic measures: Letter Word ID (R-2 = - 0.454, p < .01), Calculation (R-2 = - 0.494, p < .01), Spelling (R-2 = - 0.428, p < .01) and Passage Comprehension (R-2 = - 0.447, p < .01). 16% of survivors were impaired on the Letter Word ID, 23% on Calculation, 19% on Spelling, and 11% on Passage Comprehension subtests with impairment defined as z ae- 1.5. The NPS predicted academic outcomes over and above chemotherapy, surgery, seizure medication, endocrine dysfunction, hydrocephalus, and radiation on all measures. This study extends prior research by demonstrating that the NPS is significantly associated with academic achievement in survivors on average 15.9 years after diagnosis. The NPS may be especially helpful in clinical research when studies lack the statistical power to investigate how treatments and neurological conditions individually contribute to outcomes.

关键词： neurology  

关键词： Atherosclerosis   Neurodegeneration   Ischemia   Gene expression   Endothelial dysfunction  

摘要： Neurodegeneration is traditionally viewed as a consequence of peptide accumulation in the brain, stroke and/or cerebral ischemia. Nonetheless, a number of scattered observations suggest that neurological disease and atherosclerosis may be linked by more complex mechanisms. Understanding the intricate link between atherosclerosis and neurological conditions may have a significant impact on the quality of life of the growing ageing population and of high cardiovascular risk groups in general. Epidemiological data support the notion that neurological dysfunction and atherosclerosis coexist long before any evident clinical complications of cardiovascular disease appear and may be causally linked. Baffling, often overlooked, molecular data suggest that nervous tissue-specific gene expression is relaxed specifically in the atheromatous vascular wall, and/or that a systemic dysregulation of genes involved in nervous system biology dictates a concomitant progression of neurological disease and atherosclerosis. Further epidemiological and experimental work is needed to clarify the details and clinical relevance of those complex links.

关键词： S-DFO   Iron chelation   Zebrafish   Toxicity   ZnO  

摘要： Objectives: Clinically approved iron chelators are effective in decreasing significant transfusional iron accumulation. Starch-Deferoxamine (S-DFO), a novel high molecular weight iron chelator, was produced to increase binding capacity to iron and reduce toxicity. Although its efficacy was established in one small cohort clinical trial, its potential adverse effect was not adequately addressed. Methods: We utilized zebrafish model to assess S-DFO toxicity using following assays: mortality, teratogenicity, hatching rate, tail flicking, Acridine Orange staining for apoptosis detection, o-dianisidine staining for hemoglobin synthesis, and the level of Hsp70 as a general stress indicator. Embryos were exposed to different concentrations of S-DFO, Zinc Oxide nanoparticle (ZnO) (positive control), along with untreated control (UC). Results: S-DFO showed no significant mortality nor deformities at all tested concentrations (0.0-1000 pM). Thus, the LC50 is expected to > 1000 pM. 100 pM S-DFO treatment did not affect embryo development (as judged by hatching rate);neuromuscular activity (as judged by tail flicking);and hemoglobin synthesis. Neither apoptosis, nor increase in Hsp70 level was noticed upon S-DFO treatment. Conclusion: Our assays demonstrate that S-DFO does not induce cellular or biochemical stress and has no adverse effect on organ development of zebrafish embryos, suggesting its safe use as an iron chelator.

关键词： Intradural   Extramedullary   Meningioma   Multinomial logistic regression   Spinal cord  

摘要： Among many factors leading to a worse functional prognosis in spinal meningioma (SM) surgery, in a previous study, we recognized anterior/anterolateral axial topography, sphincter involvement at first evaluation, surgery performed on a recurrence, and worse preoperative functional status. The purpose of this paper is to evaluate the cumulative weight of these factors on prognosis through a multinomial logistic regression model performed on an original evaluation scale designed by the authors on the ground of the experience of the neurosurgical departments of our University. The original SM database composed of 173 cases was classified in regard to sex, age, symptoms, axial and sagittal location, Simpson grade resection, and functional pre/postoperative status. Fine presurgical and follow-up reevaluations were available. The authors propose a scale (Spinal Meningiomas Prognostic Evaluation Score (SPES)) of preoperative evaluation to assess the surgery-related risk of neurological worsening experienced by the patients included in the present cohort. The authors describe a strong statistical association between the SPES and the follow-up Frankel and McCormick scores (r=-460 and .441, p .001, both). Through a univariate ANOVA analysis, we disclosed that patients presenting scores 2 and 3 had a significantly higher association to lesser Frankel and McCormick postoperative scores, in respect to patients presenting SPES scores 0-1 (univariate ANOVA, p .008 and .011). Anterior or anterolateral axial location, operating on a recurrence of SM, sphincter involvement, and worse functional grade at onset present, along with the SPES scores are fairly predictive and reliable in respect to the long-term results of patients suffering from SM.

关键词： CT   image fusion   MR   multimodal   SPECT  

摘要： Multimodal medical image fusion (MMIF) has a significant role for a better visualization of the diagnostic statistics, those help the medical professionals in the precise diagnosis of several critical diseases. This paper presents an improved fusion framework that uses the entire features extracted by the nonsubsampled shearlet transform (NSST) and adaptive biologically inspired neural model. The proposed scheme retains the required information without losing the resolution of the disease morphology. In the proposed method, the adaptive neural model based on local visibility and log Gabor energy based rules are applied to low and high-frequency components, respectively. The better fusion results obtained by the proposed approach are confirmed by a large extent of simulations on the different MR-SPECT and CT-MR neurological images. Based on all these simulated results, it states that the proposed approach is superior than the other approaches as it produces better visually fused images with improved computational measures.

关键词： spinal anaesthesia   local anaesthetics   bupivacaine   extended-release preparations   liposomes  

摘要： Background: An injectable liposomal bupivacaine suspension (EXPAREL (TM)) is approved by the US Food and Drug Administration for analgesia by tissue infiltration and interscalene brachial plexus, but not for use in the neuraxial space. This pilot study describes neurological and histological outcomes of escalating doses of this extended-release formulation of bupivacaine after subarachnoid administration. Methods: Twenty-five pigs (Sus scrofa domesticus) weighing 36.2 (4.4) kg were randomly assigned to one of five groups to receive a subarachnoid injection of sodium chloride 0.9%, 3 ml (negative control), preservative-free bupivacaine hydrochloride 0.5%, 3 ml (positive control), or one of three doses of liposomal bupivacaine suspension 1.33%: 1.5, 3, or 5 ml. After recovering from general anaesthesia, neurological outcomes were assessed by blinded observers. Three weeks later, the animals were sacrificed for histological evaluations of neurotoxicity. Results: Animals that received sodium chloride 0.9%, bupivacaine hydrochloride, or liposomal bupivacaine 1.5 ml recovered within 2, 5, or 4 h, respectively. Animals that received liposomal bupivacaine 3 or 5 ml exhibited signs of neuraxial block (decreased nociception and proprioception) up to 32 h after injection. No histological evidence of neurotoxicity was found in any of the groups. Conclusions: Subarachnoid administration of liposomal bupivacaine in pigs exhibited a dose-response effect, and resulted in longer duration of neuraxial block than bupivacaine hydrochloride without histological evidence of neurotoxicity. Our study contributes preliminary data to inform further toxicological assessments and regulatory approval before subarachnoid administration in humans.

关键词： Lumbar interbody fusion   Intraoperative monitoring   Somatosensory evoked potentials   Neurological deficit  

摘要： Background: Lumbar interbody spinal fusion (LIF) surgeries are performed to treat or prevent back pain in patients with degenerated intervertebral discs and a variety of spinal diseases. However, post-operative neurological complications may ensue. Intraoperative monitoring techniques have been used to predict and potentially reduce the risk of complications. Methods: This study examined the diagnostic accuracy of significant changes of somatosensory evoked potentials (SSEPs) to evaluate and predict post-operative neurological deficits after LIF. All patients underwent LIF at UPMC from 2010 to 2012. One thousand fifty-seven patients had pre-operative baseline and continuous intraoperative SSEP monitoring. Statistical analysis was completed using SPSS version 22. No relevant disclosure. Results: Patient outcomes were not significantly affected by age over 65, gender, obesity, and abnormal baselines. Lower extremity (LE) significant changes in SSEPs and LE loss of responses resulted in a sensitivity/specificity of 0.03/0.99 and 0.03/0.99;they had an AUC of 0.54/0.73 with a 95% confidence interval (CI) of [0.34, 0.74]/[0.29, 1.00]. Conclusions: Significant SSEP changes during LIF are a very specific but poorly sensitive indicator of peri-operative neurological deficits. The odds ratio for LE loss of responses was 29.14 with a 95% CI of 1.79-475.5, so LE SSEP loss of responses can serve as a biomarker of perioperative neurological deficits after LIF. Published by Elsevier Ltd.