Antiepileptic drugs and foetal malformation: analysis of 20 years of data in a pregnancy register.

Related Articles

Antiepileptic drugs and foetal malformation: analysis of 20 years of data in a pregnancy register.

Seizure. 2018 Dec 19;65:6-11

Authors: Vajda FJE, Graham JE, Hitchcock AA, Lander CM, O'Brien TJ, Eadie MJ

Abstract
PURPOSE: This paper reports additional data supplementing earlier publications based on Australian Pregnancy Register (APR) data.
METHOD: Over 20 years, the APR has collected Information on pregnancies in Australian women with epilepsy (WWE), untreated WWE and those taking AEDs for other indications. Contact is by telephone, at set intervals. Treatment is not interfered with. Data are analysed using conventional statistical techniques, confidence interval methods, and logistic regression.
RESULTS: By 2018, the APR contained details of 2148 pregnancies. AEDs were taken throughout 1972 of the pregnancies (91.8%). The remaining 176 (8.2%) did not receive AEDs, at least early in pregnancy. There were (i) dose-related increased incidences of pregnancies carrying foetal malformations associated with maternal intake of valproate and topiramate when topiramate was a component of AED polytherapy (P < .05), (ii) a similar dose-related trend in relation to carbamazepine intake, (iii) no evidence that levetiracetam and lamotrigine were unsafe from the foetal standpoint, (iv) insufficient data to permit conclusions regarding teratogenicity in relation to other AEDs, and (v) no evidence that pre-conception folate supplementation reduced the hazard of AED-associated foetal malformation. AED polytherapy did not increase foetal hazard unless valproate or topiramate was involved in the AED combination. Genetic factors probably contributed to the malformation hazard. Seizures occurring in earlier pregnancy probably did not contribute to the malformation hazard.
CONCLUSIONS: If it were not for the importance of maintaining seizure control, the above findings suggest that it would be better to avoid using certain AEDs, particularly valproate and topiramate, during pregnancy.

PMID: 30593875 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2QXtIcd

Diffusion kurtosis imaging of endometrial carcinoma: Correlation with histopathological findings

Publication date: Available online 30 December 2018

Source: Magnetic Resonance Imaging

Author(s): Ichiro Yamada, Junichiro Sakamoto, Daisuke Kobayashi, Naoyuki Miyasaka, Kimio Wakana, Noriko Oshima, Akira Wakabayashi, Yukihisa Saida, Ukihide Tateishi, Yoshinobu Eishi

Abstract

Purpose

In this study, we aimed to determine the usefulness of diffusion kurtosis imaging (DKI) as a noninvasive method for the evaluation of tumor invasion depth, histological grade, and lymph node metastasis in patients with endometrial carcinoma (EMC).

Materials and methods

Our institutional review board approved this retrospective study and waived informed consent. In total, 24 patients suspected of having EMC were examined by a 1.5-T magnetic resonance imaging. DKI data were obtained using a single-shot echo-planar imaging sequence with four b values (0, 500, 1000, and 2000 s/mm²). Kurtosis (K), diffusivity (D), and apparent diffusion coefficient (ADC) maps were generated and compared with histopathological findings.

Results

K maps from all patients identified the junctional zone as a distinct high-K zone (1.443 ± 0.362). This zone was significantly different from the zone of endometrium and outer myometrium (0.678 ± 0.179 and 0.694 ± 0.113, respectively; P < 0.001). K and D values of all EMCs were significantly different from those of all normal uterine wall layers. K and D values were significantly correlated with histological grades of endometrioid adenocarcinomas (r = 0.799, P < 0.001 and r = −0.799, P < 0.001, respectively), while ADC values were not (r = −0.243, P = 0.382). Metastatic and nonmetastatic lymph nodes showed significantly different K (P = 0.001) and D (P = 0.001) values, but not ADC values (P = 0.827).

Conclusions

DKI may be clinically useful for the noninvasive evaluation of depth of tumor invasion, histological grade, and lymph node metastasis in patients with EMC.

from A via a.sfakia on Inoreader http://bit.ly/2VjM4ms

Photoelectrochemical determination of alkaline phosphatase activity based on a photo-excited electron transfer strategy

Publication date: 1 May 2019

Source: Talanta, Volume 196

Author(s): Jiuying Tian, Yanting Yang, Mingjuan Huang, Chunhong Zhou, Jusheng Lu

Abstract

A sensitive photoelectrochemical (PEC) biosensor for determination of alkaline phosphatase (ALP) activity was constructed based on a photo-excited electron transfer strategy. Immobilization of CdTe quantum dots (QDs) on TiO₂ nanotube arrays (TNAs), addition of iron (III) and adenosine triphosphate (ATP) in turn can effectively adjust the photocurrent response of TNAs under visible light irradiation due to a photo-excited electron transfer process, and alkaline phosphatase (ALP) activity can be determined for its catalysis toward dephosphorylation of ATP. The preparation of CdTe QDs, construction of TNA/QD PEC biosensor and the mechanism of photo-excited electron transfer are investigated in the present work. Under the optimal experimental conditions, the TNA/QD PEC biosensor shows a low limits of detection (LODs) (0.05 U L⁻¹) and limits of quantification detection (LOQs) (0.15 U L⁻¹), wide linear range from 0.2 to 15 U L⁻¹, and good selectivity towards ALP determination, which has been successfully applied for human serum analysis with good precision (RSD ≤ 5.4%) and high accuracy (recovery rate, 91–112%).

Graphical abstract

from A via a.sfakia on Inoreader http://bit.ly/2Qd7ePp

Modifying the reactivity of copper (II) by its encapsulation into polydimethylsiloxane: A selective sensor for ephedrine-like compounds

Publication date: 1 May 2019

Source: Talanta, Volume 196

Author(s): N. Jornet-Martínez, M. Samper-Avilés, R. Herráez-Hernández, P. Campíns-Falcó

Abstract

This paper demonstrates that the reactivity of copper (II) can be modified through its entrappment in a polymeric matrix of polydimethylsiloxane (PDMS), which makes possible the reaction into the support instead of in solution. Amino-containing compounds such as amino acids, proteins and sugars, which react with Cu (II) in solution, do not react inside the polymer. As a prove of concept, a highly specific Cu (II) PDMS-based sensor for ephedrines has been developed in this work. When the sensors are put into contact with solutions of these drugs under basic conditions, a change in their color from pale green to purple is observed. This change enables the visual identification of ephedrine (Eph) in a few min, as well as its quantification using both reflectance diffuse measurements of the sensors and color intensities of their digitalized images. The sensors show suitable analytical performance for Eph-like compounds, and provide limits of detection (LODs) of 0.3–1.0 mg, and relative standard deviations (RDSs) < 10%. The method has been applied to both the qualitative and quantitative analysis of different types of liquid and solid samples (intravenous injection solution of Eph, dietary supplements and illicit drug-street samples) without the need of any special sample treatment.

Graphical abstract

from A via a.sfakia on Inoreader http://bit.ly/2Vi89BW

A highly selective and sensitive electrochemical sensor for tryptophan based on the excellent surface adsorption and electrochemical properties of PSS functionalized graphene

Publication date: 1 May 2019

Source: Talanta, Volume 196

Author(s): Ling Wang, Ran Yang, Jianjun Li, Lingbo Qu, Peter de B. Harrington

Abstract

A new green method for the synthesis of poly(sodium 4-styrenesulfonate) functionalized graphene (PSS–graphene) in aqueous solution was realized by using graphene oxide nanosheets (GO) functionalized with PSS and ascorbic acid (AA) as an reducing agent. Various techniques, including Fourier transform infrared spectroscopy, X-ray diffraction, scanning electron microscopy and electrochemistry have been utilized to characterize the as-made nanocomposites. The PSS–graphene was used as a modifier to fabricate an electrochemical sensor of tryptophan (Trp). Due to the difference of the adsorption capacity of PSS–graphene for Trp and Tyr, as well as the different charge states of Trp and the other interfering substances, the sensor showed excellent selectivity for Trp. The synergistic amplification of the stronger enrichment and the enhanced electron transfer rate, the signal of Trp on the PSS–graphene modified electrode was about 100-fold enhanced compared to that of the bare GCE. The peak current of Trp is proportional to its concentration in a wide range from 0.04 to 10.0 µmol L⁻¹ with detection limit of 0.02 µmol L⁻¹. Further, the proposed sensor was applied for the detection of Trp in human serum samples. Favorable results revealed that this work provided a new design strategy and a valuable platform for highly selective and sensitive determination of Trp in complex samples.

Graphical abstract

•

A new green method for the synthesis of poly(sodium 4-styrenesulfonate) functionalized graphene (PSS–graphene) in aqueous solution was realized by using graphene oxide nanosheets (GO) functionalized with PSS and ascorbic acid (AA) as an reducing agent.

•

A sensitive and selective electrochemical sensor for the fast determination of tryptophan (Trp) based on PSS–graphene nanocomposite modified GCE was fabricated.

•

Relative to the reported methods, this established method is more simple, selective and sensitive.

from A via a.sfakia on Inoreader http://bit.ly/2VjBpIs

A ratiometric fluorescent probe for the detection of endogenous hydroxyl radicals in living cells

Publication date: 1 May 2019

Source: Talanta, Volume 196

Author(s): Biliu Wu, Jiajun Yang, Jianjian Zhang, Zheng Li, Hua Li, Xiao-Feng Yang

Abstract

A new ratiometric fluorescent probe (4) for monitoring hydroxyl radicals (•OH) has been designed and synthesized. The ratiometric sensing of probe 4 toward •OH is realized by the oxidation of the dicyanovinyl group of probe 4 to afford the corresponding epoxide, which can further reaction with •OH to give a coumarin derivative as the final product. The above reaction interrupts the large π-conjugated system of probe 4 and exhibits a remarkable large blue shift of 160 nm in the emission spectra of the sensing system. Probe 4 exhibits high selectivity toward •OH over other reactive oxygen species and reactive nitrogen species. Preliminary study shows that probe 4 can be employed to monitor endogenous •OH in living cells with a ratiometric fluorescent imaging manner.

Graphical abstract

from A via a.sfakia on Inoreader http://bit.ly/2QbpvfY

Central Nervous System Metastasis in Patients With HER2-Positive Metastatic Breast Cancer: Patient Characteristics, Treatment, and Survival From SystHERs.

Related Articles

Central Nervous System Metastasis in Patients With HER2-Positive Metastatic Breast Cancer: Patient Characteristics, Treatment, and Survival From SystHERs.

Clin Cancer Res. 2018 Dec 28;:

Authors: Hurvitz SA, O'Shaughnessy J, Mason G, Yardley D, Jahanzeb M, Brufsky AM, Rugo HS, Swain SM, Kaufman PA, Tripathy D, Chu L, Li H, Antao V, Cobleigh M

Abstract
Background Patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC) with central nervous system (CNS) metastasis have a poor prognosis. We report treatments and outcomes in patients with HER2-positive MBC and CNS metastasis from the Systemic Therapies for HER2-positive Metastatic Breast Cancer Study (SystHERs). Methods SystHERs (NCT01615068) was a prospective, US-based, observational registry of patients with newly diagnosed HER2-positive MBC. Study endpoints included treatment patterns, clinical outcomes, and patient-reported outcomes (PROs). Results Among 977 eligible patients enrolled (2012-2016), CNS metastasis was observed in 87 (8.9%) at initial MBC diagnosis and 212 (21.7%) after diagnosis, and was not observed in 678 (69.4%) patients. White and younger patients, and those with recurrent MBC and hormone receptor-negative disease, had higher risk of CNS metastasis. Patients with CNS metastasis at diagnosis received first-line lapatinib more commonly (23.0% vs. 2.5%), and trastuzumab less commonly (70.1% vs. 92.8%), than patients without CNS metastasis at diagnosis. Risk of death was higher with CNS metastasis observed at or after diagnosis (median overall survival [OS] 30.2 and 38.3 months from MBC diagnosis, respectively) versus no CNS metastasis (median OS not estimable; hazard ratio 2.86 [95% confidence interval 2.05-4.00] and 1.94 [95% confidence interval 1.52-2.49]). Patients with versus without CNS metastasis at diagnosis had lower quality of life at enrollment. Conclusions Despite advances in HER2-targeted treatments, patients with CNS metastasis continue to have a poor prognosis and impaired quality of life. Observation of CNS metastasis appears to influence HER2-targeted treatment choice.

PMID: 30593513 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2EVYFY0

Increases in Tumor N-glycan Polylactosamines Associated with Advanced HER2 Positive and Triple Negative Breast Cancer Tissues.

Related Articles

Increases in Tumor N-glycan Polylactosamines Associated with Advanced HER2 Positive and Triple Negative Breast Cancer Tissues.

Proteomics Clin Appl. 2018 Dec 28;:e1800014

Authors: Scott DA, Casadonte R, Cardinali B, Spruill L, Mehta AS, Carli F, Simone N, Kriegsmann M, Mastro LD, Kriegsmann J, Drake RR

Abstract
Using a recently developed matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI-IMS) method, we have spatially profiled N-linked glycans in human breast cancer formalin-fixed paraffin-embedded (FFPE) tissue sections and tissue microarrays (TMA). Routinely, 50 or more individual N-glycan species are detected per FFPE tissue, and this number increases significantly with disease severity. Through the combined analysis of breast cancer FFPE tissues and TMAs we have been able to identify histopathology co-localized glycan structural classes specific to stromal, necrotic and tumor regions. N-glycan panels derived from TMAs representing HER2 receptor positive and triple negative breast cancers were compared to identify shared and divergent glycosylation patterns between the two genetic sub-types. Within the tissues, we have identified a series of high-mannose glycans that are predominantly associated with tumor regions, as well as more highly branched and fucosylated glycans in higher grade tumors. In addition to this, we also found a series of polylactosamine glycans with increasing expression in HER2+, triple negative and metastatic breast cancers. The expression of these polylactosamine glycans could provide further mechanistic insights into the development and spread of breast cancer, and provide new research directions for identifying prognostic markers. This article is protected by copyright. All rights reserved.

PMID: 30592377 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2Vl05A7

HSP90 inhibitor, AUY922, debilitates intrinsic and acquired lapatinib-resistant HER2-positive gastric cancer cells.

Related Articles

HSP90 inhibitor, AUY922, debilitates intrinsic and acquired lapatinib-resistant HER2-positive gastric cancer cells.

BMB Rep. 2018 Dec;51(12):660-665

Authors: Park KS, Hong YS, Choi J, Yoon S, Kang J, Kim D, Lee KP, Im HS, Lee CH, Seo S, Kim SW, Lee DH, Park SR

Abstract
Human epidermal growth factor receptor 2 (HER2) inhibitors, such as trastuzumab and lapatinib are used to treat HER2-positive breast and gastric cancers. However, as with other targeted therapies, intrinsic or acquired resistance to HER2 inhibitors presents unresolved therapeutic problems for HER2-positive gastric cancer. The present study describes investigations with AUY922, a heat shock protein 90 (HSP90) inhibitor, in primary lapatinib-resistant (ESO26 and OE33) and lapatinib-sensitive gastric cancer cells (OE19, N87, and SNU-216) harboring HER2 amplification/over-expression. In order to investigate whether AUY922 could overcome intrinsic and acquired resistance to HER2 inhibitors in HER2-positive gastric cancer, we generated lapatinib-resistant gastric cancer cell lines (OE19/LR and N87/LR) by continuous exposure to lapatinib in vitro. We found that activation of HER2 and protein kinase B (AKT) were key factors in inducing intrinsic and acquired lapatinib-resistant gastric cancer cell lines, and that AUY922 effectively suppressed activation of both HER2 and AKT in acquired lapatinib-resistant gastric cancer cell lines. In conclusion, AUY922 showed a synergistic anti-cancer effect with lapatinib and sensitized gastric cancer cells with intrinsic resistance to lapatinib. Dual inhibition of the HSP90 and HER2 signaling pathways could represent a potent therapeutic strategy to treat HER2-positive gastric cancer with intrinsic and acquired resistance to lapatinib. [BMB Reports 2018; 51(12): 660-665].

PMID: 30591093 [PubMed - in process]

from A via a.sfakia on Inoreader http://bit.ly/2EVYzQ8

Massive Pulmonary Embolism as the Initial Presentation of Acromegaly: Is Acromegaly a Hypercoagulable Condition?

Related Articles

Massive Pulmonary Embolism as the Initial Presentation of Acromegaly: Is Acromegaly a Hypercoagulable Condition?

Am J Case Rep. 2018 Dec 29;19:1541-1545

Authors: Elarabi AM, Mosleh E, Alamlih LI, Albakri MM, Ibrahim WH

Abstract
BACKGROUND The clinical presentation in acromegaly is usually insidious, with headaches or visual disturbances being the most common symptoms. Previous studies have shown higher fibrinogen levels, lower protein C and S activity values, and enhanced platelet function in patients with acromegaly compared to a normal population. Nevertheless, the link between hypercoagulability and acromegaly is often overlooked and rarely reported in the literature. CASE REPORT We report a case of a young man with a massive pulmonary embolism as the initial presentation of acromegaly. Extensive workup excluded other causes of thrombophilia. Furthermore, the diagnosis of acromegaly was confirmed by the patient's clinical features as well as laboratory and radiological testing. A literature review on the link between hypercoagulability and acromegaly was performed. CONCLUSIONS This case report shed light on hypercoagulability as an under-recognized serious complication of acromegaly and paves the road for future studies on this topic.

PMID: 30593586 [PubMed - in process]

from A via a.sfakia on Inoreader http://bit.ly/2Vmib4G

An Evaluation of the Clinical and Histological Effects of High Dose Radiosurgery on the Rat Dorsal Root Ganglion.

An Evaluation of the Clinical and Histological Effects of High Dose Radiosurgery on the Rat Dorsal Root Ganglion.

World Neurosurg. 2018 Dec 26;:

Authors: Goldschmidt E, Fellows-Mayle W, Paschel EE, Niranjan A, Flickinger JC, Lunsford LD, Gerszten PC

PMID: 30593969 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2EWE70w

MRI Parameters and Their Impact on the Survival of Patients with Glioblastoma: Tumor Perfusion Predicts Survival.

MRI Parameters and Their Impact on the Survival of Patients with Glioblastoma: Tumor Perfusion Predicts Survival.

World Neurosurg. 2018 Dec 26;:

Authors: Hou BL, Wen S, Katsevman GA, Liu H, Urhie O, Turner RC, Carpenter J, Bhatia S

Abstract
BACKGROUND: Many prognostic factors influence the overall survival (OS) of patients with glioblastoma. Despite gross total resection and Stupp protocol adherence, many patients have poor survival. Magnetic resonance (MR) perfusion imaging may assist in diagnosis, treatment monitoring, and prognostication.
METHODS: This is a retrospective study of 36 patients with glioblastoma assessing pre-operative MR parameters reflecting tumor cell density and vascularity, as well as patient age, on overall survival.
RESULTS: The area under curve (AUC) based on optimal Receiver Operating Characteristic (ROC) curves for perfusion parameters Normalized Relative Tumor Blood Volume (n_rTBV) and Normalized Relative Tumor Blood Flow (n_rTBF) were 0.92 and 0.89, respectively, and the highest among all imaging parameters and age. OS showed strongly negative correlations with n_rTBV_c (R=-0.70; p<0.001) and n_rTBF (R=-0.67; p< 0.001). The Cox model, which included age and imaging parameters, demonstrated that n_rTBV and n_rTBF were most predictive of OS, with hazard ratios of 5.97 (p=0.0001) and 8.76 (p=0.0001), respectively, compared to 1.63 (p=0.19) for age. Eighteen patients with n_rTBV_c≤2.5 (best cutoff value) had a median OS of 15.1 months (confidence interval (CI): 11.34-21.25), compared to 2.8 months (95% CI: 1.48-4.03; p<0.001) for 18 patients with n_rTBV_c>2.5. Twenty-four patients with n_rTBF≤2.79 had a median OS of 12 months (95% CI: 10.46-17.9), compared to 2.8 months for 12 patients with n_rTBF>2.79 (95% CI: 1.31-4.2; p<0.001).
CONCLUSION: The dominant predictors of OS are normalized perfusion parameters n_rTBV and n_rTBF. Pre-operative perfusion imaging may be used as a surrogate to predict glioblastoma aggressiveness and survival independent of treatment.

PMID: 30593971 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2EXH8yD

Implementation of intraoperative computed tomography for deep brain stimulation: pitfalls and optimization of workflow, accuracy, and radiation exposure.

Implementation of intraoperative computed tomography for deep brain stimulation: pitfalls and optimization of workflow, accuracy, and radiation exposure.

World Neurosurg. 2018 Dec 26;:

Authors: Carl B, Bopp M, Gjorgjevski M, Oehrn C, Timmermann L, Nimsky C

Abstract
OBJECTIVE: Deep brain stimulation (DBS) is an effective treatment for movement disorders. Stereotactic electrode placement can be guided by intraoperative imaging, which also allows an immediate intraoperative quality control. This paper is about implementation and refining a workflow applying intraoperative computed tomography (iCT) for DBS.
METHODS: 18 patients underwent DBS with bilateral implantation of directional electrodes applying a 32-slice movable CT scanner in combination with microelectrode recording.
RESULTS: iCT led to a significant decrease in overall procedural time, despite performing multiple scans. In three of the initial 5 cases iCT caused an adjustment of the final electrodes demonstrating the learning curve and the necessity to integrate road mapping for the exchange of microelectrode to final electrode. Implementation of low-dose CT protocols added microelectrode iCT to the refined workflow, resulting in an intraoperative adjustment of a trajectory in one patient. Low-dose protocols lowered the total effective dose to 1.15 mSv, i.e. a reduction by a factor of 3.5 compared to a standard non-iCT DBS procedure, despite repeated iCTs. Intraoperative lead detection based on final iCT revealed a radial error of 1.04 ± 0.58 mm and a vector error of 2.28 ± 0.97 mm compared to the preoperative planning, adjusted by the findings of microelectrode recording.
CONCLUSIONS: iCT can be easily integrated into the surgical workflow resulting in an overall efficient time saving procedure. Repeated intraoperative scanning ensures reliable electrode placement, while low-dose scanning protocols prevent extensive radiation exposure. iCT of microelectrodes is feasible and led to an adjustment of one electrode.

PMID: 30593970 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2EWr5kK

Frontal Sinus Repair Using Polymethyl Methacrylate After Bifrontal Craniotomy.

Frontal Sinus Repair Using Polymethyl Methacrylate After Bifrontal Craniotomy.

World Neurosurg. 2018 Dec 27;:

Authors: Matsuura J, Otsuka T, Nakagawa T, Kai K

Abstract
BACKGROUND: In many cases where bifrontal craniotomy is performed, the frontal sinus is opened and postoperative complications occur. Various methods to close the frontal sinus have been reported. However, all these methods require skills to perform and take time. This study was conducted to report the good results obtained with the closure of the frontal sinus using polymethyl methacrylate, which is a simpler method.
METHOD: From December 2008 to June 2018, 122 patients with ruptured anterior communicating aneurysm were transported to a facility, 52 of whom consecutively underwent bifrontal craniotomy with opening of the frontal sinuses that were filled with polymethyl methacrylate.
RESULTS: The mean follow-up period was 21.8 months. The longest term was 116 months. Complications and cerebrospinal fluid leak were not observed in any case.
CONCLUSION: The method of filling the frontal sinus with PMMA reported in this study is safe and has no complications. Therefore, it needs to be considered as a method of frontal sinus closure.

PMID: 30593968 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2s1u0Qp

Anatomical variation and hemodynamic evolution of vertebrobasilar arterial system may contribute to the development of vascular compression in hemifacial spasm.

Anatomical variation and hemodynamic evolution of vertebrobasilar arterial system may contribute to the development of vascular compression in hemifacial spasm.

World Neurosurg. 2018 Dec 26;:

Authors: Wang QP, Yuan Y, Xiong NX, Fu P, Huang T, Yang B, Liu J, Chu X, Zhao HY

Abstract
BACKGROUND: Hemifacial spasm (HFS) is caused by vascular compression of the facial nerve. However, the definitive mechanism of offending vessel formation remains unclear. The aim of the study was to explore whether the anatomical and hemodynamic characteristics of the vertebral-basilar artery play a role in problematic vessel formation in HFS.
METHODS: Imaging data of 341 patients with a HFS who underwent microvascular decompression were reviewed retrospectively and compared with 360 controls. The hemodynamics of typical anatomical variations of the vertebral artery (VA) were analyzed using computational fluid dynamics (CFD) software.
RESULTS: Asymmetry of the left and right VAs was prevalent, and the left VA was the most dominant VA. A dominant VA was more prevalent in the HFS group than in the control group (p=0.026). A Left HFS had a significantly higher proportion of a left dominant VA, and a right HFS had a significantly higher proportion of right dominant VA (p<0.001). CFD models showed that angulation and tortuosity of vessels caused remarkable pressure difference between vascular walls of opposite sides. Dynamic clinical observations showed the mode of vessel transposition coincided with biomechanical characteristics.
CONCLUSION: Anatomical variations and hemodynamics of the vertebrobasilar arterial system are likely to contribute to vascular compression formation in a HFS.

PMID: 30593967 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2EXe8Hm

Neuroprotective effects of tocilizumab on experimentally induced spinal cord ischemia-reperfusion injury.

Neuroprotective effects of tocilizumab on experimentally induced spinal cord ischemia-reperfusion injury.

World Neurosurg. 2018 Dec 26;:

Authors: Karatas Y, Erdi MF, Kaya B, Keskin F, Cüce G, Kılınc I, Uyar M, Izci EK, Kalkan E

Abstract
STUDY DESIGN: Experimental rabbit spinal cord ischemia-reperfusion (I/R) inury model.
OBJECTIVES: We aimed to evaluate neuroprotective effects of tocilizumab on spinal cord I/R inury.
SETTING: Animal Research Laboratory, Necmettin Erbakan University, Meram School of Medicine, Konya, Turkey.
METHODS: Twenty four adult New Zealand rabbits were randomly divided into three groups: Group 1, control group (n=8); Group 2, ischemia-reperfusion (I/R) group and group 3 (n=8), I/R injury+ tocilizumab (4 mg/kg,ip) treatment group. Spinal cord I/R injury was performed by infrarenal aortic cross clamping. Neurological evaluation, spinal cord tissue and plasma tumor necrosis factor (TNF) alpha, total antioxidant status (TAS), total oxidant status (TOS), thiobarbituric acid reactive substances (TBARS), interleukin 6 (IL 6), interleukin 10 (IL 10) levels were analyzed. Spinal cord neuronal damage score and apoptotic cell count were also investigated.
RESULTS: I/R injury significantly increase the plasma and spinal cord tissue TNF alpha, TOS, TBARS, IL6 levels and decrease the plasma and spinal cord tissue TAS and IL10 levels. Tocilizumab treatment significantly reduce the plasma and spinal cord tissue TNF alpha, TOS, TBARS, IL6 levels and increase plasma and tissue TAS and IL10 levels. I/R injury significantly increase spinal cord neuronal damage score and apoptotic cell count. Tocilizumab treatment significantly reduce spinal cord neuronal damage score and apoptotic cell count. Neurological examination scores at 24., 48. and 72. hours were significantly better in treatment group when compared with the I/R group.
CONCLUSION: This study shows significant neuroprotective effects of tocilizumab on rabbit spinal cord I/R injury.

PMID: 30593966 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2ESe5vD

Lead failure after vagus nerve stimulation implantation: X-ray examination and revision surgery.

Lead failure after vagus nerve stimulation implantation: X-ray examination and revision surgery.

World Neurosurg. 2018 Dec 26;:

Authors: Zhou H, Liu Q, Zhao C, Ma J, Ye X, Xu J

Abstract
OBJECTIVE: This study aimed to assess the most common types of lead failures, identify causes and discuss potential procedures for revision surgery following vagus nerve stimulator implantation in epilepsy patients.
METHODS: In a retrospective study over an 8-year period, 13 patients underwent revision surgery due to lead failure. Lead failure was classified as either lead intrinsic damage or lead pin disengagement from the generator header. In the X-ray image, the authors defined an RC ratio that represented the portion of rear lead connector in the header receptacle. It was used to quantitatively evaluate the mechanical failure of the lead-header interface. Optimal procedures to identify and manage lead failure were established.
RESULTS: All 13 patients presented with high lead impedance ≥ 9 kOhms at the time of revision. Seven of ten patients with lead damage presented with increased seizure frequency after a period of seizure remission. In contrast to lead damages occurring relatively late (> 15 months), lead pin disengagement was usually found within the early months after device implantation. A significant association was found between an elevated RC ratio (≥ 35%) and lead pin disengagement. The microsurgical technique permitted the removal or replacement of the lead without adverse effects.
CONCLUSIONS: The method of measuring the RC ratio developed in this study is feasible for identifying lead disengagement at the generator level. Lead revision was an effective and safe procedure for patients experiencing lead failure.

PMID: 30593965 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2EXGXTZ

Does surgical start time or weekend presentation affect clinical outcome for those presenting with neurosurgical pathology?

Does surgical start time or weekend presentation affect clinical outcome for those presenting with neurosurgical pathology?

World Neurosurg. 2018 Dec 26;:

Authors: Linzey JR, Pandey AS

PMID: 30593964 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2ESe1fn

Coil embolization for cerebral aneurysms using a semi-jailing technique and open-cell stent.

Coil embolization for cerebral aneurysms using a semi-jailing technique and open-cell stent.

World Neurosurg. 2018 Dec 26;:

Authors: Shirakawa M, Yoshimura S, Uchida K, Yamada K, Sakamoto D, Iida T, Takada Y, Ishikura R

PMID: 30593963 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2EVVrDS

Development and validation of prognostic model for patients with acute subdural hematoma-a reliable nomogram.

Development and validation of prognostic model for patients with acute subdural hematoma-a reliable nomogram.

World Neurosurg. 2018 Dec 26;:

Authors: Jin XQ, Du XF, Yang MF, Zhang Q

Abstract
OBJECTIVE: By extracting clinical and CT imaging data of patients with acute subdural hematoma (ASDH) , factors that were significantly associated with poor prognosis were screened and a nomogram model was established and validated.
METHODS: All patients with ASDH who underwent subdural hematoma removal and decompressive craniectomy from January 2014 to March 2018 in Qinghai Provincial People's Hospital were continuously collected. Finally 124 patients were included in the study. According to Glasgow Outcome Scale at 3 months after operation, patients were divided into good prognosis group and poor prognosis group.
RESULTS: Univariate and binary logistic regression analysis were performed to screen out independent predictors that were significantly associated with poor prognosis of ASDH. Based on these factors, a nomogram model was established.
CONCLUSION: The nomogram model had high accuracy for predicting the poor prognosis in patients with ASDH and it was easy to promote. In the future, large sample and multi-center prospective studies are necessary to complement and identify the results.

PMID: 30593962 [PubMed - as supplied by publisher]

from A via a.sfakia on Inoreader http://bit.ly/2EUCGQh