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Journal of clinical neuroscience
Churchill Livingstone
Journal of clinical neuroscience

Churchill Livingstone

0967-5868

Journal of clinical neuroscience/Journal Journal of clinical neuroscienceSSCISCIISTPAHCI
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    Influence of socioeconomic status on the incidence of aneurysmal subarachnoid haemorrhage and clinical recovery

    Mariajoseph, Frederick P.Huang, HelenLai, Leon T.
    5页
    查看更多>>摘要：Background: The relevance of socioeconomic status (SES) on the incidence of aneurysmal subarachnoid haemorrhage (aSAH) and discharge functional outcomes following treatment is not clear. Methods: A retrospective cross-sectional study was performed on data retrieved from the Nationwide Hospital Morbidity Database for all aSAH cases in Australia between 2012 and 2018. Information on patient characteristics, procedures performed, discharge disposition and SES were extracted. SES data was derived from classifications by the Australian Bureau of Statistics. Putative risk factors were evalu-ated with univariate and multivariate logistic regression analysis to identify independent predictor of unfavourable discharge outcomes (defined as death or dependency). Results: A total of 3,591 low SES patients (49.8%) were identified in our study cohort. Average crude inci-dence of aSAH was persistently higher among the SES disadvantaged (6.6 cases per 100,000 person-years, 95% CI 6.3 - 6.8), compared to the SES advantaged group (4.1 cases per 100,000 person-years, 95% CI 4.0- 4.2) (p < 0.0001). Patients in the Low SES group were more likely to be active smokers, have type 2 dia-betes mellitus, or live in non-metropolitan residence, and have overall worse discharge functional out-comes (27.7% versus 24.5%, p = 0.0015). Adjusting for well-established risk factors such as older age, and intracranial bleed (ICH and/or IVH), disadvantaged SES remained a significant predictor of poor dis -charge outcome following aSAH (p = 0.0003). Conclusion: aSAH occurs more frequently among low SES communities, and once ruptured, there is a greater risk of poor recovery.. (c) 2021 Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Roles of IL-35-producing T and B cells in anti-acetylcholine receptor antibody-positive myasthenia gravis

    Li, Li-MinZhang, Lin-JieZhu, Si-yuLiu, Xiao-jiao...
    6页
    查看更多>>摘要：Background: Interleukin 35 (IL-35) plays an anti-inflammatory in numerous autoimmune diseases. However, the potential roles of IL-35-producing T and B cells and serum IL-35 levels in the pathogenesis of myasthenia gravis (MG) and its association with disease activity in patients with MG remain unclear. Methods: The percentages of IL-35-producing CD4 + CD25 + T cells and CD19 + B cells among peripheral blood mononuclear cells were determined in 37 patients with anti-acetylcholine receptor (AChR) antibody-positive MG and 35 healthy controls (HCs) by performing a flow cytometry analysis. Serum IL-35 levels in participants were determined using an enzyme-linked immunosorbent assay. Further, the correlations between IL35 levels and disease activity were analysed. Results: The percentages of IL-35-producing CD4 + CD25 + T cells and CD19 + B cells were significantly lower in patients with anti-AChR antibody-positive MG than in HCs (p = 0.001 and p = 0.002, respectively). Furthermore, patients with thymoma and patients with generalized MG had lower percentages of IL-35-producing CD4 + CD25 + T cells and CD19 + B cells than those without thymoma and those with ocular MG (p = 0.001 and p = 0.003; p = 0.008 and p = 0.001, respectively). Interestingly, the suppression of IL-35 secretion correlated negatively with the activities of daily living scores of patients with MG (r = 0.4774, p = 0.0028) and the quantitative MG scores (r =-0.4656, p = 0.0037). The proportions of IL-35 producing T cells and B cells and serum levels of IL-35 increased after treatment. Conclusions: IL-35 may represent a potential biomarker for the clinical evaluation of MG. (c) 2021 Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Micro-RNA levels and symptom profile after mild traumatic brain injury: A longitudinal cohort study

    Mitra, BiswadevReyes, JonathanO'Brien, William T.Surendran, Nanda...
    7页
    查看更多>>摘要：Micro riboneucleic acids (miRNAs) may be transcribed after brain injury and be detectable in plasma. This study aimed to assess the discriminative ability of seven miRNAs in plasma to differentiate between patients with mild traumatic brain injury (mTBI) and healthy controls. Changes in miRNA levels over 28 days were compared to changes in self-reported symptom profile. This was a prospective cohort study with longitudinal measurements of miRNA levels and symptom self-report. The Rivermead Post-Concussion Symptom Questionnaire (RPQ) was used to determine symptom severity. Mean normalised expression ratios (NER) of miRNAs at day 0 between mTBI and healthy controls were compared. An anal-ysis of response profiles compared the response over time of miRNA species with RPQ symptom severity. miRNA levels of subjects who were defined to have "recovered" on Day 7 and 28 were compared to "non-recovered" subjects. There were 28 mTBI patients and 30 healthy controls included for analysis. Symptom severity was significantly higher on the day of injury among mTBI subjects (p < 0.001), and miRNA 32-5p levels were also higher (p = 0.009). Change of miRNA levels were similar to RPQ change at Day 7, but sig-nificantly different at Day 28. Differences were observed among miRNA levels of recovered subjects. This study demonstrated differences in miRNA levels among mTBI subjects compared to healthy controls and different miRNA levels among those who had recovered compared to those reporting symptoms. The change in profiles of miRNAs was different to symptom severity, suggesting that the two measures reflect different aspects of brain injury and recovery. (c) 2021 Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    National trends in the surgical management of metastatic lung cancer to the spine using the national inpatient sample database from 2005 to 2014

    Zehri, Aqib H.Peterson, Keyan A.Lee, Katriel E.Kittel, Carol A....
    6页
    查看更多>>摘要：Optimal management of metastatic lung cancer to the spine (MLCS) incorporates a multidisciplinary approach. With improvements in lung cancer screening and nonsurgical treatment, the role for surgery may be affected. The objective of this study is to assess trends in the surgical management of MLCS using the National Inpatient Sample (NIS) database. The NIS was queried for patients with MLCS who underwent surgery from 2005 to 2014. The frequencies of spinal decompression alone, spinal stabilization with or without (+/-) decompression, and vertebral augmentation were calculated. Statistical analysis was performed to analyze the effect of patient characteristics on outcomes. The most common procedure performed was vertebral augmentation (10719, 44.3%), followed by spinal stabilization +/decompression (8634, 35.7%) and then decompression alone (4824, 20.0%). The total number of surgeries remained stable, while the rate of spinal stabilizations increased throughout the study period (p < 0.001). Invasive procedures such as stabilization and decompression were associated with greater costs, length of stay, complications and mortality. Increasing comorbidity was associated with increased odds of complication, especially in patients undergoing more invasive procedures. In patients with low pre-operative comorbidity, the type of procedure did not influence the odds of complication. Graded increases in length of stay, cost and mortality were seen with increasing complication rate. The rate of spinal stabilizations increased, which may be due to either increased early detection of disease facilitating use of outpatient vertebral augmentation procedures and/or the recognition that surgical decompression and stabilization are necessary for optimal outcome in the setting of MLCS with neurological deficit. (c) 2021 Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    BMP use in the surgical treatment of pyogenic spondylodiscitis: Is it safe?

    Tee, Lawrence Yoon YawBaker, Joseph F.Hunter, Sarah
    5页
    查看更多>>摘要：Objective: Use of BMP in the setting of infection remains controversial. We examined the safety and effec-tiveness of BMP in the surgical treatment of pyogenic spondylodiscitis and compared patients who have been treated with or without BMP during surgery. Methods: 57 patients who have undergone surgery for pyogenic spondylodiscitis after presenting to a tertiary Spine referral institution between 2011 and 2020 were included. 18 underwent surgery alone without BMP and 39 underwent surgery with BMP. Outcomes were compared between the two groups, including re-operations, infection recurrences, BMP-related complications and radiological fusion. Results: The cohort comprised 41 males (71.9%) with a mean age 63.7 +/-13.3 years. Surgical indications include instability (n = 18), pain (n = 4), neurological deficit (n = 15) and sepsis or failure of non-operative management (n = 20). In the group who underwent surgery without BMP, there were two cases of re -operation for infection recurrence (11.1%) and three cases of cage subsidence; 80% achieved definitive and probable fusion. In the group who underwent surgery with BMP, there were three cases of re -operation for infection recurrence (7.7%), three cases of cage subsidence and one case of BMP-related radiculitis; 96.5% achieved definitive and probable fusion. Conclusions: The use of BMP in the surgical treatment of pyogenic spondylodiscitis did not confer an increased risk of infection recurrence, revision surgery or radiculitis. BMP can be a useful and safe adjunct in surgical intervention for pyogenic spondylodiscitis. (c) 2021 Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Peripheral and central smell regions in children with epilepsy: An MRI evaluation

    Alpcan, AysegulMuluk, Nuray BayarInal, MikailErkmen, SelminPerihan Komurcu...
    7页
    查看更多>>摘要：Objectives: We investigated the peripheral and central olfactory regions in children with epilepsy using cranial MRI. Methods: In this retrospective study, cranial MRI images were obtained from 23 children with epilepsy and 23 healthy controls. Olfactory bulb (OB) volume and olfactory sulcus (OS) depth in the peripheral olfactory region and insular cortex and corpus amygdala areas in the central olfactory region were measured. Results: There was no significant difference in the OB volume and OS depth in the peripheral olfactory regions in the two groups (p > 0.05). In the central olfactory region, the insular cortex and corpus amygdala areas in the epilepsy group were significantly smaller than those in the control group (p < 0.05). In both groups, the OS depth on the right side was significantly higher than that on the left side (p < 0.05). In the epilepsy group, there were positive correlations between each of the OB volumes, OS depths, insular cortex areas, and corpus amygdala areas bilaterally (p < 0.05). In both groups, there were positive correlations between the OB volume and OS depth, OS depth and insular cortex area and insular cortex area and corpus amygdala areas (p < 0.05). Conclusion: A change in the central olfactory region in epileptic patients may be related to central tissue damage due to epilepsy. This finding has important implications for epilepsy patients, with early diagnosis and treatment potentially preventing a reduction in the volumes/depths of components of the central olfactory region in the pediatric population.
      原文链接:
    • NSTL
    • Elsevier

    Experimental study The effect of 4-Week rehabilitation by aerobic exercise on hippocampus BDNF and TGF-beta 1 gene expressions in A beta 1-42-induced rat model of Alzheimer's disease

    Fakhraei, SaeidAlmasi, Mohammad RezaPeeri, MaghsoudGharakhanlou, Reza...
    6页
    查看更多>>摘要：Alzheimer's disease (AD) is a type of brain dysfunction featuring a gradual loss in memory. This study aimed to determine the effect of 4 weeks of aerobic rehabilitation exercise (RhExe) on the genes expression of BDNF and TGF-beta 1 in the hippocampus tissue of rats with the AD induced by injection of amyloid-beta (A beta(1-42)). Twenty-one male Wistar rats were randomly divided into 3 groups: A beta injection (n = 7), A beta + exercise (n = 7) and control (n = 7). AD was induced by a single dose of A beta injection into the hippocampus of rats. Three days after surgery, the A beta + exercise group experienced four weeks of the RhExe (5 days/week). Forty-eight hours after the last training session, the animals underwent the Morris water maze test. The animals were sacrificed 24 h after the test, and hippocampal tissue was split. The mRNA expression of BDNF, TGF-beta 1, and TGF-beta 1 II receptors was measured. The TGF-beta 1 and TGF-beta 1 II receptor genes expression of A beta + exercise group were significantly higher than the A beta injection group (P <= 0.001). BDNF gene expression in the hippocampus of the A beta + exercise group was significantly higher than the A beta injection group (P <= 0.001). Spatial memory was significantly higher in the A beta + exercise group than in the A beta injection group (p <= 0.01). It seems that aerobic exercise can counteract the harmful effects of A beta through the BDNF and TGF-beta 1molecular signaling pathways. (c) 2021 Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    A predictive model of perioperative myocardial infarction following elective spine surgery

    Passias, Peter G.Pierce, Katherine E.Alas, HaddyBortz, Cole...
    6页
    查看更多>>摘要：Myocardial infarction (MI), and its predictive factors, has been an understudied complication following spine operations. The objective was to assess the risk factors for perioperative MI in elective spine surgery patients as a retrospective case control study. Elective spine surgery patients with a perioperative MI were isolated in the NSQIP. The relationship between MI and non-MI spine patients was assessed using chi-squared and independent samples t-tests. Univariate/multivariate analyses assessed predictive factors of MI. Logistic regression with stepwise model selection was employed to create a model to predict MI occurrence. The study included 196,523 elective spine surgery patients (57.1 yrs, 48%F, 30.4 kg/m(2)), and 436 patients with acute MI (Spine-MI). Incidence of MI did not change from 2010 to 2016 (0.2%- 0.3%, p = 0.298). Spine-MI patients underwent more fusions than patients without MI (73.6% vs 58.4%, p < 0.001), with an average of 1.03 levels fused. Spine-MI patients also had significantly more SPO (5.0% vs 1.8%, p < 0.001) and 3CO (0.9% vs 0.2%, p < 0.001), but less decompression-only procedures (26.4% vs 41.6%, p < 0.001). Spine-MI underwent more revisions (5.3% vs 2.9%, p = 0.003), had greater invasiveness scores (3.41 vs 2.73, p < 0.001) and longer operative times (211.6 vs 147.3 min, p < 0.001). Mortality rate for Spine-MI patients was 4.6% versus 0.05% (p < 0.001). Multivariate modeling for Spine-MI predictors yielded an AUC of 83.7%, and included history of diabetes, cardiac arrest and PVD, past blood transfusion, dialysis-dependence, low preoperative platelet count, superficial SSI and days from operation to discharge. A model with good predictive capacity for MI after spine surgery now exists and can aid in risk-stratification of patients, consequently improving preoperative patient counseling and optimization in the peri-operative period. (c) 2021 Elsevier Ltd. All rights reserved.
      原文链接:
    • NSTL
    • Elsevier

    Direction-changing spontaneous nystagmus in cerebellopontine angle tumour

    Jeong, HaminLee, Dong-HanShin, Jung EunKim, Chang-Hee...
    5页
    查看更多>>摘要：The most common symptoms of tumours involving the cerebellopontine angle (CPA) are unilateral sensorineural hearing loss, dizziness, and asymmetric tinnitus. While the clinical manifestations have been well documented in previous studies, the nystagmus findings in these patients have not been thoroughly investigated yet. This study aimed to investigate the incidence of direction-changing spontaneous nystagmus in patients with CPA tumours, evaluate their radiologic characteristics, and gain insight into the mechanisms underlying nystagmus. Direction-changing spontaneous nystagmus was observed in 6 out of 83 patients (7%) with CPA tumours during the 7-year period. Temporal bone magnetic resonance imaging findings revealed the presence of an intrameatal mass in CPA tumours in all six patients with direction-changing spontaneous nystagmus. Vestibular schwannomas were confined within the internal auditory meatus in four patients, and petroclival meningiomas extended into the internal auditory meatus in two patients. The mechanism of direction-changing spontaneous nystagmus may be explained as paroxysmal secondary central hyperactivity in the vestibular nucleus due to the long-standing pressure effect in the vestibular nerve by tumours, or by ephaptic discharges in the vestibular nerve.
      原文链接:
    • NSTL
    • Elsevier

    Long-term reoperation rates and causes for reoperations following lumbar microendoscopic discectomy and decompression: 10-year follow-up

    Aihara, TakatoKojima, AtsushiUrushibara, MakotoEndo, Kenji...
    6页
    查看更多>>摘要：Objective: To investigate the 10-year rates and causes of reoperations following lumbar microendoscopic discectomy for disc herniation (MEDH) and microendoscopic decompression for spinal stenosis (MEDS), as well as to define the reoperations at index and different lumbar levels. Methods: Between June 2005 and May 2011, the same surgeon had been using MEDH and/or MEDS on 355 consecutive patients. The follow-up rate was 88.3%. The causes and rates of reoperations (RORs) were determined at 10 years after the initial operations. Results: The 10-year reoperation rate for all patients combined was 22.1% (67/303). The 10-year reoperation rate for all cases that underwent repeat operations in the same segment was 16.5% (50/303); the most frequent reason for reoperation (FRR) was recurrence of disc herniation (ROR, 25/251 = 9.96%), the second FRR was an increase of postoperative spondylolisthesis and/or instability (ROR, 8/303 = 2.64%), and the third FRR was surgical site infection (ROR, 5/303 = 1.65%). Ten-year reoperation rate for all cases that underwent repeat operation at different lumbar levels was 5.61% (17/303); the most FRR was new disc herniation at another lumbar level (ROR, 10/303 = 3.30%), the second FRR was residual segmental stenosis (ROR, 4/303 = 1.32%), and the third FRR was new segmental stenosis at other lumbar levels (ROR, 2/303 = 0.66%). Conclusions: Three-fourths of all repeat operations were conducted in the same segment and one-fourth were performed at different lumbar levels. We believe that it is important to understand and prevent related problems.
      原文链接:
    • NSTL
    • Elsevier