查看更多>>摘要：? 2022 Elsevier LtdBackground and objectives: Migraine is a common neurologic disorder and has a great influence on medical students’ life. This study aims to determine the prevalence of migraine as well as its association with different factors, and its impact on daily activities among medical students in the Lebanese university. Methods: This is a cross sectional, monocentric study. A self-administered questionnaire was distributed electronically in March 2021. It included the headache society criteria to diagnose migraine as well as questions about demographic data and some associated factors. The impact of migraine on daily activities was measured using the MIDAS scale. Results: Among 471 participants, prevalence of migraine was found to be 12.1%. Age (p = 0.02), family history (p < 0.001), academic year (p = 0.009), online education (p < 0.001), anxiety (p = 0.017), depression (p = 0.001) as well as insomnia (p < 0.001) were found to be associated with migraine. Lastly, based on the MIDAS scale, half of the students suffering from migraine (55%) suffered from severe disability (grade 4 MIDAS). Conclusion: High prevalence of migraine was apparent among medical students in our current study. Anxiety, depression, insomnia as well as the presence of online education were considered as factors associated with this disease.
查看更多>>摘要：? 2022 Elsevier LtdDue to lack of well-designed trials, there is no good evidence on the efficacy of stem cells in spinal cord injury. We aim to study the efficacy and outcome of bone marrow derived stem cells (BMSCs) in acute complete spinal cord injury (SCI). In this prospective study over a 3-year period, 27 patients with acute, complete SCI were randomized to receive BMSCs or placebo (intramedullary route) intraoperatively. Institutional ethics approval was taken and informed consent was taken from all patients. Functional outcome was assessed using ASIA scale, SCIM score and SSEP responses preoperatively, three and six months after surgery. Thirteen patients were available for final analysis of which six were in the stem cell group and seven received placebo. 6 patients had improvement by at least one grade in ASIA score in the stem cell group as compared to only one patient in the placebo group. However, no functional motor improvement in any of the patients. ASIA sensory score improved from a preoperative mean of 124 to 224 at 6 months compared to the static mean of 115 in the control group. Absent SSEP waveform converted to abnormal waveform at 6 months in 3 patients in the stem cell group and one patient in the control group. There was no significant difference in the SCIM scores between the groups at last follow-up. All patients in the stem cell group reported improved bladder sensation, decreased spasticity and improved posture control as compared to nine in the placebo group. BMSCs through intramedullary route are a potential therapy for acute complete SCI and more research is required in this area.
查看更多>>摘要：? 2022 Elsevier LtdBackground: Spine aneurysmal bone cysts (ABCs) rarely occur in adults. Primary and secondary lesions may show some differences and require appropriate treatments. Objective: To systematically review the literature on adult spine ABCs. Methods: PubMed, EMBASE, Scopus, and Web-of-Science were searched. Clinical-radiological features, treatments, and outcomes were analyzed and compared between primary vs secondary adult spine ABCs. Results: We included 80 studies comprising 220 patients. Primary spine ABCs were more frequent (76.4%). Main symptoms were lower-back-pain (42.8%) and motor deficits (31.2%). Tumors were mostly thoracic (31.4%) or cervical (26.8%), showing lytic (70.4%) and/or cystic (52.3%) appearances. Surgical resection (79.1%) was preferred over biopsy (20.9%). Most primary ABCs underwent curettage with bone grafting (62.1%) and laminectomy (39.1%) (P < 0.001), while most secondary ABCs underwent corpectomy (51%) and spine fixation (93.9%) (P < 0.001). Radiotherapy was delivered in 58 patients (26.4%), and embolization in 37 (16.8%). Symptomatic improvement was reported in 91.8% cases, with no differences based on etiology nor extent-of-resection. Median follow-up was 28.5 months, significantly superior in secondary ABCs. Secondary ABCs had significantly higher rates of tumor recurrence (19.2%; P = 0.011) and death (5.8%; P = 0.002). Conclusion: Surgical resection, radiotherapy, and embolization are effective in managing adult spine ABCs. Secondary tumors have worse prognoses requiring more aggressive treatments.
查看更多>>摘要：? 2022Traumatic brain injury can have devastating consequences for patients and extended hospital stays and recovery course. Recent data indicate that the initial insult causes profound changes to the immune system and leads to a pro-inflammatory state. This alteration in homeostasis predisposes patients to an increased risk of infection and underlying autoimmune conditions. Increased emphasis has been placed on understanding this process both in the clinical and preclinical literature. This review highlights the intrinsic inflammatory conditions that can occur within the initial hospital stay, discusses long-term immune consequences, highlights emerging treatment options, and delves into important pathways currently being investigated with preclinical models.
查看更多>>摘要：? 2022 Elsevier LtdBackground: Cutibacterium acnes, formerly known as Propionibacterium acnes, is increasingly recognized as a cause of surgical site infection and implant failure despite the use of prophylactic antibiotics and antiseptic surgical preparations. The aim of this study was to investigate whether C. acnes persists in the dermal layer of the skin after standard perioperative antibiotics and skin prepping with alcoholic betadine solution in consecutive patients undergoing a craniotomy. Methods: A single centre prospective observational study was performed at Flinders Medical Centre. Adult patients undergoing a cranial neurosurgical intervention between October 2019 to March 2021 were eligible for inclusion. After administration of standard preoperative antibiotics (Cefazolin), three swabs were taken for each patient: one before prepping the skin with alcoholic betadine, one after prepping the skin and a dermal swab once the skin was incised. Results: 73 patients were included. Cutibacterium acnes cultures were positive in 61 patients of the “pre-prep” group (83.6%), 12 (16.4%) in the “post-prep” group, and 53 (72.6%) were from dermal swabs There was a significant reduction of positive cultures of the skin after surgical preparation was applied (p < 0.00001). There was a non-significant reduction of positive cultures in the dermal swabs after skin preparation (p = 0.068) Conclusions: Cutibacterium acnes persists within the dermis of the scalp despite standard prophylactic measures using alcoholic betadine solution and cefazolin.
查看更多>>摘要：? 2022 Elsevier LtdPurpose: Giant thoracic disc herniations (GTDH) are considered a subgroup of TDHs with worse functional outcomes, a high calcification rate, and a considerable risk of complications. We aimed to determine whether there is a relationship between the extent of calcification of GTDH and outcomes concerning the risk of complications, the surgical technique, and changes in neuromonitoring signals. Methods: We present a retrospective analysis of 76 patients undergoing surgery for calcific GTDH. We introduced and defined a radiological definition of the calcified disc into “fully calcified” and “partially calcified.” We performed a statistical analysis between clinical and radiological variables, type of surgical procedure, the extent of excision, neuro-monitoring signals, and outcome, comparing a group of 58 “fully-calcified TDH” patients and 18 “partially-calcified TDH” patients. Results: Fully calcified TDHs, compared with partially calcified TDHs, do not have significant differences in outcome (worse outcome 4/58–6.9% versus 0/18, p = 0.25) and complications (10/58–17.24% versus 4/18–22.2%, p = 0.63); Fully calcified TDH is associated with a higher risk of alterations in neurophysiological potentials (14/58–24.1% versus 0/18, p = 0.02) and subtotal excision (18/58–31% versus 2/18–11%, p = 0.15), without significant differences between the approaches used. Conclusion: Fully calcified TDH group has a similar outcome and complication rate as the partially calcified TDH group, but they are associated with higher intraoperative neuromonitoring signal changes. We introduced a new classification system that guides the approach and helps to counsel the patients.
查看更多>>摘要：? 2022 Elsevier LtdThere is a paucity of information regarding the optimal timing of initiation or re-initiation of therapeutic anticoagulation after intracranial surgery. Anticoagulation that is started too soon after surgery may increase the risk of catastrophic intracranial bleeding. However, there are scenarios that necessitate the use of anticoagulation in the immediate post-operative period despite the increased risk of hemorrhage. Therefore, we sought to report our experience with ultra-early therapeutic anticoagulation after craniotomy. Retrospective chart review of patients from a single institution between 1/1/2010 and 10/1/2021 who were treated with therapeutic anticoagulation for venous thromboembolism on or before 7-days after a craniotomy or craniectomy. The primary endpoint was intracranial hemorrhage resulting in death or return to the operating room for hematoma evacuation. Secondary endpoints included extra-cranial hemorrhage, length of hospital stay, and 90-day readmission rate. Eighteen patients were included for analysis. The median time that therapeutic anticoagulation was started was post-operative day 5 (range 1–7 days). One patient (5.6%) met the primary endpoint as they experienced an intracranial hemorrhage 5 days after starting anticoagulation, which required surgical evacuation. No patients experienced an extra-cranial hemorrhage. The median length of hospitalization was 13 days (range 4–89 days). No patients were readmitted within 90 days. The 90-day survival rate was 100%. Ultra-early anticoagulation after craniotomy resulted in a 5.6% risk of intracranial hemorrhage. Thus, ultra-early anticoagulation can be performed safely but it does carry a substantial risk of intracranial bleeding that may require emergent hematoma evacuation or result in permeant neurologic deficits or death.
查看更多>>摘要：? 2022 Elsevier LtdThe purpose of this study is to determine the volumes of primary brain regions associated with smell and taste in Alzheimer's and Parkinson's patients and healthy controls using MR imaging and examine volumetric changes in comparison to smell/taste questionnaire and test results and endocannabinoid (EC) levels. The study included 15 AD patients with mild cognitive dysfunction scored as 18 ≤ MMSE ≤ 23, 15 PD patients with scores of 18 < MoCA < 26 and 18 ≤ MMSE ≤ 23, and 15 healthy controls. A taste and smell questionnaire was given to the participants, and their taste and smell statuses were examined using the Sniffin’ Sticks smell identification test and Burghart Taste Strips. EC levels were analyzed in the blood serum samples of the participants using the ELISA method. The volumes of the left olfactory bulb (p = 0.001), left amygdala (p = 0.004), left hippocampus (p = 0.008), and bilateral insula (left p = 0.000, right p = 0.000) were significantly smaller in the Alzheimer's patients than the healthy controls. The volumes of the left olfactory bulb (p = 0.001) and left hippocampus (p = 0.009) were significantly smaller in the Parkinson's patients than the healthy controls. A significant correlation was determined between volume reduction in the left Rolandic operculum cortical region and taste dysfunction. EC levels were significantly higher in both AD (p = 0.000) and PD (p = 0.006) in comparison to the controls. Our results showed that volumetric changes occur in the brain regions associated with smell and taste in Alzheimer's and Parkinson's patients. It was observed that ECs played a role in these volumetric changes and the olfactory and taste dysfunctions of the patients.
查看更多>>摘要：? 2022Transcranial direct current stimulation (tDCS) and transcranial random noise stimulation (tRNS) are two methods of noninvasively modulating cortical excitability below the placed electrode. Anodal tDCS over the cerebellum has been shown to modulate cerebellar brain inhibition (CBI), which is an indication of cerebellar excitability, but does not alter contralateral M1 excitability. However, the effect of tRNS over the cerebellum has not been investigated. The purpose of this study was thus to compare the effects of tDCS and tRNS over the cerebellum on CBI and the contralateral motor evoked potentials (MEPs), as well as on the relationship between CBI and contralateral MEPs. A total of 15 healthy subjects completed four-condition transcranial electrical stimulation (tES) interventions (anodal tDCS_1 mA, anodal tDCS_2 mA, tRNS, and Sham) on separate days. CBI and MEPs were measured using transcranial magnetic stimulation (TMS) before and after the 20 min tES intervention. For all conditions, there were no significant differences before and after tES in CBI or contralateral MEPs. In contrast, following tRNS, changes in CBI and MEPs were significantly correlated. No significant correlations were found in the other three conditions, indicating that cerebellar tDCS and tRNS have distinct effects on the relationship between CBI and contralateral MEPs. Taken together, these findings suggest that cerebellar tRNS may modulate the cerebellar to contralateral M1 pathway.
查看更多>>摘要：? 2022 Elsevier LtdSchmorl's nodes (SNs) have increasingly been recognized on vertebral end-plates using advanced imaging techniques. Even though vertebral end-plates are the closest structures to discs, their pathologies are underestimated in the etiology of low back pain (LBP). We aimed to detect the prevalence of SNs and other end-plate defects in subjects with/without LBP and to understand whether SNs were associated with LBP and spinal degeneration. Subjects were evaluated in terms of end-plate defects, intervertebral disc degeneration (IVDD), and vertebral end-plate changes (Modic changes) at all lumbar levels on lumbar spine magnetic resonance imagings (MRI). Control subjects were compared to patients with LBP. Higher Pfirrmann scores (OR: 2.696) and higher SN scores (OR: 8.076) were significantly associated with Modic changes at L4-L5 disc level. Patients with higher SN scores at L1-L2 or L2-L3 levels had approximately 7-fold increased risk of severe IVDD at the corresponding levels. The most significant factor associated with presence of SNs was body weight of the patients (OR: 1.417). The most significant factor associated with intensity of LBP was severe IVDD at L5-S1 level (OR: 3.670). Having higher total SN score had an OR of 1.230 (95% CI: 1.003–1.509; p = 0.047) for predicting LBP. Schmorl's nodes were seen in 33.1% of patients and 11.5% of asymptomatic subjects. Body weight was the most significant factor associated with SNs. The most significant factor associated with LBP was severe IVDD at L5-S1 level.
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