关键词： CMOS circuit   embedded DSP   implantable system   low noise low power amplifier   Neural interface  

摘要： Developing new tools to better understand disorders of the nervous system, with a goal to more effectively treat them, is an active area of bioelectronic medicine research. Future tools must be flexible and configurable, given the evolving understanding of both neuromodulation mechanisms and how to configure a system for optimal clinical outcomes. We describe a system, the Summit RC+S "neural coprocessor," that attempts to bring the capability and flexibility of a microprocessor to a prosthesis embedded within the nervous system. This paper describes the updated system architecture for the Summit RC+S system, the five custom integrated circuits required for bi-directional neural interfacing, the supporting firmware/software ecosystem, and the verification and validation activities to prepare for human implantation. Emphasis is placed on design changes motivated by experience with the CE-marked Activa PC+S research tool;specifically, enhancement of sense-stim performance for improved bi-directional communication to the nervous system, implementation of rechargeable technology to extend device longevity, and application of MICS-band telemetry for algorithm development and data management. The technology was validated in a chronic treatment paradigm for canines with naturally occurring epilepsy, including free ambulation in the home environment, which represents a typical use case for future human protocols.

关键词： Stereotactic irradiation   Brain metastases   Survey in Japan  

摘要： BackgroundTo determine the current practice of stereotactic irradiation (STI) for brain metastases in Japan by a questionnaire *** questionnaire was distributed to 313 institutions performing STI with one of the following machines: Gamma Knife (GK), CyberKnife (CK), Novalis (Nov), or other linear accelerator (LINAC)-based systems (OLS). The participation was *** were 163 responding institutions. The total number of STI treatments between April 2013 and March 2014 was 10,684. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) were performed in 8624 (80.7%) and 2060 (19.3%) cases, respectively. Whole-brain radiation therapy (WBRT) was performed for a total of 3515 cases. For a case model of a 1.5-cm solitary brain metastasis in a non-eloquent area, the most common GTV-PTV margin was 2mm (22 of 114 institutions), and an institutional standard fraction was 1 (75 of 114 institutions). The doses for the model case also varied from 13.0 to 26.0Gy (Median 20Gy) when converted to SRS (/=10). A prescription point was at the PTV margin the most. The median dose constraints which were converted to SRS (/=3) to organs at risk were 12.2, 12.7, and 13.7Gy for optic nerves, cavernous sinus, and brainstem, *** for brain metastases in current practice varied significantly among institutions. These different strategies relied mostly on the type of treatment machine used. It is thus necessary to establish a common guideline to express dose prescriptions and plan qualities for different STI machines.

关键词： Carotid artery stenting   Occlusion intolerance   NIRS cerebral oximetry   Stump pressure  

摘要： Carotid artery stenting (CAS) with proximal protection can expose occlusion intolerance (OI) due to ipsilateral cerebral hemisphere hypoperfusion. Near-infrared spectroscopy (NIRS) cerebral oximetry can monitor regional cerebral oxygenation (rSO(2)) in the frontal lobes, and is used during CAS to predict cerebral blood flow insufficiency. The aim of this study was to evaluate rSO(2) as a predictor of OI during CAS. We retrospectively examined 146 patients who underwent CAS with proximal protection. An INVOS NIRS oximeter was used for rSO(2) measurement, which was compared with stump pressure (SP) measured by a guiding catheter during occlusion of the common carotid artery (CCA) and external carotid artery. For the lesion with OI, distal filter protection was combined with proximal protection if possible, and CCA was intermittently occluded during the procedure. Twenty-seven patients (18%) developed OI. The relative decrease in NIRS oximeter saturation (Delta rSO(2)) on the ipsilateral side was significantly lower in the OI group than in the tolerance group (14 5.1% vs. 3.4 +/- 3.5, p < 0.0OI). Using Delta rSO(2) of 8% as the cutoff value for predicting OI, sensitivity was 92% and specificity was 89%. SP was significantly lower in the OI group than in the tolerance group (22 +/- 13 mmHg vs. 40 +/- 22 mmHg, p < 0.0OI). Using SP <= 25 mmHg as the cutoff value for predicting Dl, sensitivity was 78% and specificity was 77%. Delta rSO(2) was more reliable than SP for predicting OI. Distal filter protection should be combined with proximal protection to prevent prolonged neurological symptoms due to OI. (C) 2018 Elsevier Ltd. All rights reserved.

关键词： Medical education   Educational measurement   Medical students   Physical examination   Neurology  

摘要： Introduction. - Since 2014-2015, practical teaching of clinical observation skills for 2nd year medical students at our faculty has been discipline-based;previously, each clinical lecturer had to cover all medical fields. We assessed the impact of this teaching reform on the neurological examination skills of medical students in a before-and-after study. Methods. - Pre-reform 3rd and post-reform 2nd and 3rd year medical students (n = 62, n = 71 and 52, respectively) had to perform 7 neurological examination items, for which performance criteria had been pre-defined. Subsequently, we assessed whether the mean grade in neurological examination skills during the test at the end of the 2nd year was different between students who had received neurological teaching from a neurologist (n = 29) or another specialist (n = 102). Results. - The median [interquartile range] number of items acquired by post-reform 3rd year students (4 [2-5]) was higher than that of pre-reform 3rd year students (2 [1-3];P<0.001), but lower than that of post-reform 2nd year students (5 [4-6];P = 0.01). The mean grade obtained during the practical test was not different in students trained by a neurologist or another specialist. Conclusion. - Acquisition of neurological examination skills improved after the teaching reform which consisted of: (1) a discipline-based practical teaching of clinical observation skills;(2) a training of clinical lecturers to teach a limited list of educational objectives;and (3) the introduction of a practical test at the end of the 2nd year of medical studies. However, there was a decline in clinical observation skills between 2nd and 3rd year medical students. (C) 2018 Societe Nationale Francaise de Medecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

关键词： Quantitative EEG   Cardiac arrest   Post anoxic Coma   Machine learning   Medical informatics  

摘要： Objective: Analysis of the electroencephalogram (EEG) background pattern helps predicting neurological outcome of comatose patients after cardiac arrest (CA). Visual analysis may not extract all discriminative information. We present predictive values of the revised Cerebral Recovery Index (rCRI), based on continuous extraction and combination of a large set of evolving quantitative EEG (qEEG) features and machine learning techniques. Methods: We included 551 subsequent patients from a prospective cohort study on continuous EEG after CA in two hospitals. Outcome at six months was classified as good (Cerebral Performance Category (CPC) 1-2) or poor (CPC 3-5). Forty-four qEEG features (from time, frequency and entropy domain) were selected by the least absolute shrinkage and selection operator (LASSO) method and used in a Random Forests classification system. We trained and evaluated the system with 10-fold cross validation. For poor outcome prediction, the sensitivity at 100% specificity (Se-100) and the area under the receiver operator curve (AUC) were used as performance of the prediction model. For good outcome, we used the sensitivity at 95% specificity (Se-95). Results: Two hundred fifty-six (47%) patients had a good outcome. The rCRI predicted poor outcome with AUC = 0.94 (95% CI: 0.83-0.91), Se-100 = 0.66 (0.65-0.78), and AUC = 0.88 (0.78-0.93), Se-100 = 0.60 (0.510.75) at 12 and 24 h after CA, respectively. The rCRI predicted good outcome with Se-95 = 0.72 (0.61-0.85) and 0.40 (0.30-0.51) at 12 and 24 h after CA, respectively. Conclusions: Results obtained in this study suggest that with machine learning algorithms and large set of qEEG features, it is possible to efficiently monitor patient outcome after CA. We also demonstrate the importance of selection of optimal performance metric to train a classifier model for outcome prediction. Significance: The rCRI is a sensitive, reliable predictor of neurological outcome of comatose patients after CA. (C) 2018 In

关键词： PARNELL'S mustached bat   AUDITORY processing disorder   AUDITORY cortex   MAGNETIC resonance imaging   BRAIN stem  

摘要： Substantial knowledge of auditory processing within mammalian nervous systems emerged from neurophysiological studies of the mustached bat (Pteronotus parnellii). This highly social and vocal species retrieves precise information about the velocity and range of its targets through echolocation. Such high acoustic processing demands were likely the evolutionary pressures driving the over-development at peripheral (cochlea), metencephalic (cochlear nucleus), mesencephalic (inferior colliculus), diencephalic (medial geniculate body of the thalamus), and telencephalic (auditory cortex) auditory processing levels in this species. Auditory researchers stand to benefit from a three dimensional brain atlas of this species, due to its considerable contribution to auditory neuroscience. Our MRI-based atlas was generated from 2 sets of image data of an ex-vivo male mustached bat's brain: a detailed 3D-T2-weighted-RARE scan [(59 x 63 x 85) mu m(3)] and track density images based on super resolution diffusion tensor images [(78) mu m(3)] reconstructed from a set of low resolution diffusion weighted images using Super-Resolution-Reconstruction (SRR). By surface-rendering these delineations and extrapolating from cortical landmarks and data from previous studies, we generated overlays that estimate the locations of classic functional subregions within mustached bat auditory cortex. This atlas is freely available from our website and can simplify future electrophysiological, microinjection, and neuroimaging studies in this and related species.

关键词： eye movement disorders   inborn errors of metabolism   movement disorders   adult-onset  

摘要： Inborn errors of metabolism in adults are still largely unexplored. Despite the fact that adult-onset phenotypes have been known for many years, little attention is given to these disorders in neurological practice. The adult-onset presentation differs from childhood-onset phenotypes, often leading to considerable diagnostic delay. The identification of these patients at the earliest stage of disease is important, given that early treatment may prevent or lessen further brain damage. Neurological and psychiatric symptoms occur more frequently in adult forms. Abnormalities of eye movements are also common and can be the presenting sign. Eye movement disorders can be classified as central or peripheral. Central forms are frequently observed in lysosomal storage disorders, whereas peripheral forms are a key feature of mitochondrial disease. Furthermore, oculogyric crisis is an important feature in disorders affecting dopamine syntheses or transport. Ocular motor disorders are often not reported by the patient, and abnormalities can be easily overlooked in a general examination. In adults with unexplained psychiatric and neurological symptoms, a special focus on examination of eye movements can serve as a relatively simple clinical tool to detect a metabolic disorder. Eye movements can be easily quantified and analyzed with video-oculography, making them a valuable biomarker for following the natural course of disease or the response to therapies. Here, we review, for the first time, eye movement disorders that can occur in inborn errors of metabolism, with a focus on late-onset forms. We provide a step-by-step overview that will help clinicians to examine and interpret eye movement disorders. (c) 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

关键词： Musculoskeletal disorders   neurological disorders   gait analysis   feature selection  

摘要： Musculoskeletal and neurological disorders are common devastating companions of ageing, leading to a reduction in quality of life and increased mortality. Gait analysis is a popular method for diagnosing these disorders. However, manually analyzing the motion data is a labor-intensive task, and the quality of the results depends on the experience of the doctors. In this paper, we propose an automatic framework for classifying musculoskeletal and neurological disorders among older people based on 3D motion data. We also propose two new features to capture the relationship between joints across frames, known as 3D Relative Joint Displacement (3DRJDP) and 6D Symmetric Relative Joint Displacement (6DSymRJDP), such that the relative movement between joints can be analyzed. To optimize the classification performance, we adapt feature selection methods to choose an optimal feature set from the raw feature input. Experimental results show that we achieve a classification accuracy of 84.29% using the proposed relative joint features, outperforming existing features that focus on the movement of individual joints. Considering the limited open motion database for gait analysis focusing on such disorders, we construct a comprehensive, openly accessible 3D full-body motion database from 45 subjects.

关键词： Patient outcome assessment   Perforator territory infarction   Small size   Statin   Surgical treatment   Unruptured intracranial aneurysm  

摘要： The risk associated with surgical treatment for small-to-moderate size unruptured intracranial aneurysms (SMUlAs, defined as <15 mm) has not been well characterized. Authors aimed to investigate risk factors for poor outcome in surgical treatment of SMUlAs. The data of prospectively collected 801 consecutive patients harboring 971 surgically treated SMUlAs was evaluated. Neurological worsening (NW) was defined as an increase in 1 or more modified Rankin Scale at 12-month. Clinical and radiological characteristics were compared. Neurological worsening was observed in 45 (4.6%). In multivariate analysis, only perforator territory infarction (PTI) on postoperative diffusion-weighted imaging (odds ratio (OR), 13;95% confidence interval (CI), 4.9-32, p < 0.0001), and aneurysm locations (paraclinoid (OR, 6.9;95% CI, 3.1-15, p < 0.0001), basilar artery (OR, 4.5;95% CI, 1.5-14, p = 0.008), vertebral artery (OR, 11;95% CI, 3.3-34, p < 0.0001)) were related to neurological worsening. Multivariate analysis showed that statin use (OR, 12;95% CI, 3.8-39, p < 0.0001) and aneurysm locations (internal carotid artery-posterior communicating artery (OR, 3.9;95% CI, 1.8-8.2, p < 0.0001) and basilar artery (OR, 6.3;95% CI, 2.3-17, p = 0.008)), and aneurysm size >10 mm (OR, 5.3;95% CI, 1.8-15, p = 0.003) were related to PTI. Although all SMUlAs should be carefully considered whether to be treated, those with statins, specific locations, and larger sizes should perhaps be more meticulously contemplated, and neurosurgeons should continue to avoid PTI. (C) 2018 Elsevier Ltd. All rights reserved.