Buchlak, Quinlan D.Milne, Michael R.Seah, JarrelJohnson, Andrew...
7页
查看更多>>摘要：Brain computed tomography (CTB) scans are widely used to evaluate intracranial pathology. The implementa-tion and adoption of CTB has led to clinical improvements. However, interpretation errors occur and may have substantial morbidity and mortality implications for patients. Deep learning has shown promise for facilitating improved diagnostic accuracy and triage. This research charts the potential of deep learning applied to the analysis of CTB scans. It draws on the experience of practicing clinicians and technologists involved in devel-opment and implementation of deep learning-based clinical decision support systems. We consider the past, present and future of the CTB, along with limitations of existing systems as well as untapped beneficial use cases. Implementing deep learning CTB interpretation systems and effectively navigating development and imple-mentation risks can deliver many benefits to clinicians and patients, ultimately improving efficiency and safety in healthcare.
查看更多>>摘要：The purinergic receptor P2X4 is an adenosine triphosphate (ATP)-gated cation channel, which plays an essential role in regulating various biological activities in the organism. This study was designed to investigate the potential role and mechanism of P2X4 in the traumatic brain injury (TBI) rat model. Real-time PCR, Western blot, immunofluorescence, apoptosis, brain water content and neurological score analysis were evaluated. We found that the expression level of P2X4 surrounding the injured area of the brain in the TBI rat model increased significantly after 48 h. Following the P2X4 selective antagonist 5-BDBD treatment, the neurological damage after TBI was significantly improved and brain edema was reduced. The inhibition of P2X4 effectively reduced the inflammation and apoptosis of microglia, and NLRP3 may be involved in this process. Our results indicate that inhibition of P2X4 may be a potential therapeutic approach for TBI by reducing the occurrence of inflammation and apoptosis of microglia, alleviating brain edema, and improving neurological deficits.
Spetzler, Robert F.Preul, Mark C.Figueiredo, Eberval GadelhaRibas, Eduardo Carvalhal...
6页
查看更多>>摘要：Objective: To compare the area of exposure to the cisternal thalamus associated with four surgical techniques: supracerebellar-infratentorial (SCIT), occipital interhemispheric (OI), transchoroidal (TC) and subtemporal before and after parahippocampal resection (ST and STh, respectively). Methods: All approaches were performed on both sides of three heads. Qualitative anatomical analyses were performed to understand anatomical limits, advantages, and flaws of each technique. Quantitative analyses for multiple repeated dependent variables assessed significant differences between areas of exposure. Results: Exposure area was significantly more extensive using TC and STh approaches compared to ST, OI, and SCIT. STh achieved a significantly wider exposure compared to ST. Regarding dissection angle, surrounding structures and limitations, ST approaches do not provide adequate exposure, nor alignment with the thalamic axis. The OI and STh may provide a better field of exposure, but without adequate alignment and challenging deeper dissections. TC provides better exposure of the cisternal pulvinar with access to lateral pulvinar at the atrium's anterior wall but is a transcortical route that disrupts non-pathological tissue. SCIT provides an adequate area of exposure with the possibility of alignment with the thalamus axis, thus allowing an easier dissection of deeper lesions. Conclusions: For lesions at the pulvinar surface, OI and STh are adequate. For lesions restricted to medial pulvinar and deep along the thalamus axis, SCIT approaches are recommended. Lesions extending to the lateral pulvinar and ventricular atrium are best removed through TC approaches. The ST approach was not suitable to the cisternal pulvinar due to its limited angular exposure.
查看更多>>摘要：Acromegaly is a chronic progressive endocrine disease that is often accompanied by joint and bone symptoms. The correlation between bone metabolism and acromegaly is still unclear. In this study, 31 patients with acromegaly at Peking Union Medical College Hospital were included. Bone metabolism indices, such as beta-CTX, TP1NP, T-25OHD, 1,25(OH)2D3, and SAGIT score, which represent the severity of acromegaly, were examined before operation, and the patients were followed up for at least 3 months after operation. The results showed that beta-CTX and TP1NP were significantly lower than those before surgery in the remission group (p < 0.001). In the nonremission group, CTX (p = 0.226) and TP1NP (p = 0.326) did not show significant differences from those before operation. In Pearson correlation analysis, beta-CTX was significantly correlated with SAGIT score (r = 0.356, p = 0.049). By multivariate linear regression analysis, it was found that beta-CTX was an independent risk factor of SAGIT score (p = 0.001). In conclusion, indicators of bone metabolism are closely related to changes in acromegaly, and the beta-CTX value can be used as an effective predictor for assessing acromegaly.
查看更多>>摘要：The vestibulo-ocular reflex (VOR) in neurotologic patients can be evaluated most quickly by spontaneous nystagmus examinations, and the video Head Impulse Test (vHIT) quantitatively evaluates the VOR of the semicircular canals. We aimed to clarify the concordance and discrepancies between spontaneous nystagmus and vHIT findings, to provide guidance on screening vestibular functions by initial spontaneous nystagmus examination then vHIT. We evaluated 169 outpatients by spontaneous nystagmus examination in the dark using a charge-coupled device camera, then by horizontal vHIT the same day. Vestibular loss on vHIT was defined if both reduced VOR gain (< 0.8) and corrective saccade were observed. Adjusted logistic regression modelling revealed that differences in right and left VOR gain positively impacted the presence of nystagmus, which suggests lateralised vestibular dysfunction (P < 0.05; odds ratio 1.39 [95% confidence interval, 1.1-1.8] per 0.1 increment). When vHIT is regarded as the standard clinical test, the positive predictive value of nystagmus for vestibular loss on vHIT was 44.4%, and the negative predictive value was 93.5%. The adjusted odds ratio of adults >= 65 years old compared to younger patients associated with a discrepancy of nystagmus and vHIT was significant (2.4 [1.1-5.3]). In conclusion, if spontaneous nystagmus is initially observed in patients, further assessment by vHIT could confirm vestibular dysfunction in 40-50% of cases. If no nystagmus is observed, vHIT might also result in a negative finding in > 90% of cases. Older adults appear more likely to show discrepancies between nystagmus and vHIT.
查看更多>>摘要：Objective: To investigate the efficacy of percutaneous balloon compression of the Gasserian Ganglion (PCGG) in the treatment of trigeminal neuralgia(TN)and the influencing factors of recurrence after PCGG.Methods: The clinical data of 221 patients with TN treated by PCGG were retrospectively analyzed and followed up to explore the postoperative efficacy.Results: There were 158 cases of immediate disappearance of pain and 59 cases of delayed pain disappearance in patients after one PCGG operation, for an overall efficacy rate of 98.2%. Forty-nine patients experienced recurrence of pain, for a recurrence rate of 22.6%, and average recurrence time of 18 months. The effective rate of medication in patients with recurrent trigeminal neuralgia is 85.7%.Univariate and multivariate logistic regression analyses showed that hypertension disease and delayed pain disappearance were independent factors for recurrence. The incidence of inhibitory reaction of the trigeminal nerve during the operation was 97.3%. The most common postoperative complications were facial numbness, masticatory-muscle weakness, tinnitus, diplopia and keratitis, which occurred at rates of 76.9%, 28.1%, 14.5%, 11.8% and 10.4%, respectively. All of the complications resolved within 3 years after PCGG.Conclusions: PCGG is a safe and effective surgical method for the treatment of TN. The pain in most patients disappeared after surgery, leaving sequelae such as facial numbness, masticatory-muscle weakness and tinnitus. The mean time to recurrence of postoperative pain was 18 months, with hypertension disease and delayed pain disappearance as associated factors.
查看更多>>摘要：MicroRNAs (miRNAs) participate in the diagnosis and treatment of intracerebral hemorrhage (ICH). miR-141-3p has been widely reported to regulate neurological disorders and cerebropathy. However, the specific role of miR141-3p in ICH has not yet been revealed. The aim of this study was exploration of the biological functions and mechanism of miR-141-3p in ICH by establishing a collagenase-induced ICH mouse model. After ICH induction, miR-141-3p mimics or miR-NC were administered into the right striatum of the model mice followed by the performance of neurological tests. After euthanasia of the mice, the injury volume, brain water content, and injury to the blood-brain barrier (BBB) were evaluated. Evans blue (EB) was used to stain the brain slices, and EB extravasation was detected to evaluate the injury to BBB. miR-141-3p expression in perihematomal edema and hematoma areas after ICH was assessed by RT-qPCR. The levels of tight junction proteins in brain tissues and human brain microvascular endothelial cells (BMECs) were evaluated by western blotting. The FITC-dextran 20 method was used to assess BMEC permeability. The binding between miR-141-3p and zinc finger E-box-binding homeobox 2 (ZEB2) was verified with a luciferase reporter assay. In this study, miR-141-3p overexpression alleviated ICH-induced brain injury and protected BBB integrity in vivo. ZEB2 was a target gene of miR-141-3p. ZEB2 overexpression promoted BBB disruption, and miR-141-3p overexpression attenuated the promoting effect exerted by ZEB2. Overall, miR-141-3p protects against BBB disruption and attenuates brain injuries induced by ICH by targeting ZEB2.
查看更多>>摘要：Objective: To determine if Young's modulus of the optic nerve (ON) structure as measured by shear-wave elastography can suggest changes in intracranial pressure (ICP) in neuro-critical care patients.& nbsp;Materials and methods: Thirty-one healthy volunteers and twenty-two neuro-critical care patients were enrolled. ON sheath (ONS) diameter (ONSD) values and Young's modulus measurements of volunteers were collected in a calm state and during a Valsalva maneuver (VM). Ultrasound measurements and ICP values of patients were collected on operation day and at 24 and 48 h after the operation; measurements were thereafter assigned to three groups: severely elevated (ICP greater than 22 mmHg), mildly elevated (ICP = 14-22 mmHg), and normal (ICP <= 13 mmHg).& nbsp;Results: ONSD and Young's modulus for the ON and ONS of volunteers during VM were higher than those in the calm state (all P < 0.001). In contrast to ONSD, Young's modulus for ON and ONS did not correlate with age, body mass index, or sex. The best cutoff values of Young's modulus for ON for predicting elevated and severely elevated ICP were 16.67 kPa and 22.74 kPa, respectively. Accordingly, the sensitivity values were 96.7% and 88.9%, and the specificity values were 86.1% and 73.7%, which had the same diagnostic performance as ONSD.& nbsp;Conclusion: Young's modulus of the ON accurately reflects changes in ICP. It is not confounded by age, sex, or body mass index compared to ONSD.
查看更多>>摘要：Brain arteriovenous malformation (bAVM) resection imposes several post-operative clinical challenges including intracranial haemorrhage (ICH). Daily non-invasive monitoring of haemodynamic measurements may be useful in predicting post-operative ICH.& nbsp;This prospective study used transcranial colour duplex (TCCD) and central aortic pressure (CAP) measure-ments to evaluate 15 bAVM patients pre-operatively and daily & LE; 14 days post-operatively.& nbsp;TCCD measurements of middle cerebral artery and veins included peak systolic (PSV), end diastolic (EDV), and pulsatility indices (PI). Parameters were compared with 7 craniotomy patients (non-bAVM craniotomy/surgical group). Normal reference values included 20 healthy volunteers.& nbsp;Significant middle cerebral vein MCV changes in bAVM patients occurred;& nbsp;Maximal PSV was significantly higher (median 47 cm/s) compared to non-bAVM craniotomy/surgical controls (median 17 cm/s, p = 0.0123);maximal PI was significantly higher (median 0.99, p = 0.005) compared to the non-bAVM craniotomy/surgical controls (median 0.49).& nbsp;In 8 of 15 patients, increased MCV velocity and pulsatility "stabilised " within 14 days post-operatively. Mean number of days for the 8 patients to reach stable state was 5.9 days, (range 0-9 days).& nbsp;To our knowledge, this is the first imaging study demonstrating significant venous changes post bAVM resection. Significant increased venous flow occurs in pial veins bilaterally. Increased pressure of venous flow is evidenced by a significant increase in diameter and pulsatility. Subsequently, haemorrhagic complications may be due distal constriction of the pial veins causing venous hypertension. The cause of the dilated vascular bed is unknown.
查看更多>>摘要：Rosai-Dorfman disease (RDD) is an idiopathic histiocytic proliferation disease with various clinical manifestations. A retrospective study of patients with pathological diagnosed RDD primarily involved in the central nervous system was conducted from January 2011 to December 2020 at a tertiary center. The clinical profile, imaging, and treatment data were collected. There were 16 male and 5 female patients with RDD-CNS. The patients were aged from 6 to 68 years with a median of 37 years. Of these 21 patients, 15 presented with intracranial RDD and 6 with spinal RDD. The main symptoms of RDD-CNS included headache, epilepsy, and neurological deficits. 76.19% (16/21) of the patients showed dura-based, homogeneous enhancement lesion on magnetic resonance imaging (MRI). Twenty patients received surgery as first treatment, and one patient received biopsy after steroid therapy. Total lesion resection was achieved in 42.9% (9/21) of the patients, subtotal resection in 47.6% (10/21), and biopsy in 0.9% (2/21). The symptoms were alleviated or stayed stable. Some RDDs (80%, 4/5) in the skull base had some complications. The patients were followed up for 11-108 months with a median duration of 47 months. Lesion progression or recurrence was found in two patients. The various clinical manifestations, as well as the dura-based and homogenous enhancement imaging profiles of RDD-CNS patients pose a great diagnostic challenge for clinicians. Surgery is effective for RDD-CNS requiring treatment. Medical therapy and radiotherapy would be feasible as noninvasive treatments, varying degrees of efficacy. The overall prognosis of RDD-CNS is acceptable. Periodic long-term follow-up is necessary.
NSTL
Elsevier