Mcleodmcpherson0955

This study aims to investigate recurrence risk factors of simply coiled unruptured paraclinoid aneurysms based on a porous medium model (POM).

Twenty unruptured coiled paraclinoid aneurysms with digital subtract angiography (DSA) follow-up were enrolled to analyze morphological and hemodynamic variables to predict recurrence.

Recurrent aneurysms have larger neck areas than stable aneurysms (34.43±21.46mm

vs. 16.12±7.10mm

 ; p=0.048). For hemodynamic variables, recurrent aneurysms had larger preoperative (16.40±11.38mm

vs. 7.87±3.75mm

 ; p=0.048) and postoperative inflow areas (14.07±6.80mm

versus 6.73±4.20mm

 ; p=0.021) than the stable group. Only the postoperative inflow area (p=0.031, OR=1.289; 95% CI 1.024-1.624) was an independent predictor of recurrence after multivariate regression analysis. The receiver operating characteristic (ROC) curve analysis efficiently predicted recurrence (AUC=0.833, p=0.021) with an inflow area cutoff value (9.15mm

 ; sensitivity, 0.833; specificity, 0.857).

Neck area along with pre- and postoperative inflow areas were associated with aneurysm recurrence. These findings suggest that a large postoperative inflow area independently predicts the recurrence of coiled paraclinoid aneurysms.

Neck area along with pre- and postoperative inflow areas were associated with aneurysm recurrence. These findings suggest that a large postoperative inflow area independently predicts the recurrence of coiled paraclinoid aneurysms.

Indocyanine green (ICG) has been used in endoscopic surgery in the neurosurgical field, but it has been challenging to determine the associated efficiency due to limitations with visualization in the previous endoscopic system. A new endoscopic system was recently introduced; therefore, we summarize our experiences with the application and integration of the system.

From March to June 2021, a newly introduced endoscopic system was used in 10 patients. (8 pituitary adenomas, and 2 tuberculum sellae meningiomas) and 12.5mg of ICG was injected for each study.

Six pituitary adenomas, including one acromegaly, were well identified with ICG. However, two pituitary adenomas, presented with apoplexy and two meningiomas were not visualized with ICG.

The ICG provides real-time information during endoscopic endonasal surgery. We suggest that the pituitary adenoma can be stained with an ICG using the fusion-fluorescence imaging endoscopic system. This approach will enhance the surgeon's ability to remove the tumor with preserve the normal gland more safely.

The ICG provides real-time information during endoscopic endonasal surgery. We suggest that the pituitary adenoma can be stained with an ICG using the fusion-fluorescence imaging endoscopic system. This approach will enhance the surgeon's ability to remove the tumor with preserve the normal gland more safely.

Obstructive sleep apnea syndrome (OSAS) has mostly been examined using in-laboratory polysomnography (Lab-PSG), which may overestimate severity. This study compared sleep parameters in different environments and investigated the association between the plasma levels of neurochemical biomarkers and sleep parameters.

Thirty Taiwanese participants underwent Lab-PSG while wearing a single-lead electrocardiogram patch. Participants' blood samples were obtained in the morning immediately after the recording. Participants wore the patch for the subsequent three nights at home. Sleep disorder indices were calculated, including the apnea-hypopnea index (AHI), chest effort index, and cyclic variation of heart rate index (CVHRI). The 23 eligible participants' derived data were divided into the normal-to-moderate (N-M) group and the severe group according to American Association of Sleep Medicine (AASM) guidelines (Lab-PSG) and the recommendations of a previous study (Rooti Rx). selleck screening library Spearman's correlation was used to examine the correlations between sleep parameters and neurochemical biomarker levels.

The mean T-Tau protein level was positively correlated with the home-based CVHRI (r=0.53, p<0.05), whereas no significant correlation was noted between hospital-based CVHRI and the mean T-tau protein level (r=0.25, p=0.25). The home-based data revealed that the mean T-Tau protein level in the severe group was significantly higher than that in the N-M group (severe group 24.75±6.16pg/mL, N-M group 19.65±3.90pg/mL; p<0.05). Furthermore, the mean in-hospital CVHRI was higher than the mean at-home values (12.16±13.66 events/h).

Severe OSAS patients classified by home-based CVHRI demonstrated the higher T-Tau protein level, and CVHRI varied in different sleep environments.

Severe OSAS patients classified by home-based CVHRI demonstrated the higher T-Tau protein level, and CVHRI varied in different sleep environments.Transcranial motor evoked potential (MEP) monitoring, intended to assess cerebral cortical ischemia, may produce false negative results when the stimulation inadvertently activates the deep, subcortical motor pathways. This study examined hand MEP onset latency as a potential means to differentiate superficial versus deep stimulus penetration in surgical patients monitored for cerebral ischemia. Intraoperative MEP data were prospectively collected from 40 patients treated for intracranial aneurysm or carotid stenosis. Onset latencies of hand MEP responses were measured over a range of stimulation intensities from both the contralateral and ipsilateral hand (crossover responses). At the threshold for superficial, cortical stimulation of the contralateral hand, the MEP latency was 26.9 ± 0.4 ms. MEP onset latencies measurements became shorter as stimulation intensities were increased. At the maximum intensity (when crossover response was usually generated), the contralateral hand MEP latency of 22.5 ± 0.3 ms was significantly shorter than at threshold stimulation (p less then 0.001). Latency-stimulus intensity plots best fit a 3 parameter hyperbolic decay function (r2 = 0.85 ± 0.02) and revealed a narrow window of acceptable MEP stimuli to obtain superficial cortical activation. Our analysis refutes the utility of the crossover response in reliably gauging depth of activation. Additionally, we found that differentiation between long and short MEP onset latency times may serve as a dependable marker for depth of stimulation. Attention to hand MEP onset latency may reduce inadvertent stimulation of the deep corticospinal tract pathways and avoid false negative MEP recordings during cerebrovascular surgeries.

Assess role of ADC in differentiating benign and malignant skull lesions and to evaluate the added value of ADC over conventional MRI in facilitating the differentiation.

53 patients (24 males, 29 females; age 3-75years) were subjected to both conventional and Diffusion weighted (DWI) MR imaging. DWI was performed using a single-shot SE EPI sequence with b-values of 0& 1000s/mm

on 1.5T MR scanner. Margins of the lesion, number, soft-tissue component, local extension, periosteal reaction and enhancement pattern were the parameters used for differentiating benign & malignant lesions by conventional MRI. ADC values (mean of 3 ROIs over solid component) were calculated. Conventional MRI characteristics and ADC value of lesions were evaluated & compared using statistical analysis. These findings were compared and correlated with histopathology of the skull lesions.

24 malignant and 29 benign lesions were identified on HPE (Histopathological examination) in 53 patients. ADC cut-off value of 0.96skull lesions. It is a robust biomarker to narrow differentials when conventional imaging features are indeterminate.

The use of extracranial internal carotid artery (ICA) stents after mechanical thrombectomy (MT) may be a source of morbidity and mortality. Studies comparing patients who received stenting to patients who do not receive stenting have a higher number of patients with failed intracranial reperfusion in the non-stenting cohort. In this study, we analyzed the impact of extracranial ICA stenting in tandem occlusion stroke in patients with successfully intracranial reperfusion.

This monocentric, retrospective cohort observational study reviewed all consecutive MT patients from January 2013 to January 2018. All patients with occlusions in the anterior circulation due to ICA atherosclerotic plaque embolus, TOAST 1, and were successfully reperfusion of at least 50% of the initially occluded target territory were included. Patients with a concomitant extracranial, or tandem, ICA occlusion which required MT and permanent stenting (stenting cohort) were compared to patients with extracranial atheromatous ICA plaques, 1.21-7.25, P=0.03). Stenting was not associated with a significant difference in functional independence at 90 days or rate of sICH compared to the non-stenting cohort.

Stroke patients with successful intracranial reperfusion after MT had a higher probability of mortality within 90 days when concomitant stenting of the extracranial ICA was performed compared those patients who did not receive stenting.

Stroke patients with successful intracranial reperfusion after MT had a higher probability of mortality within 90 days when concomitant stenting of the extracranial ICA was performed compared those patients who did not receive stenting.Statins may improve outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH) but randomized controlled trials, including all patients with aSAH whatever their clinical severity, were negative. We studied whether pravastatin improved neurologic outcome in patients with early good neurological status, whose prognosis is related to secondary lesions as delayed cerebral ischemia (DCI). We conducted a single-center study of cases and historical controls in a neurocritical care unit. We included consecutive patients with aSAH from 2011 to 2016 with early good neurological status defined by a WFNS score ≤ 3 on the third day. Patients treated before 2014 with oral pravastatin (40 mg/day for 14 days) as a standard of care were matched using propensity score to patients treated after 2014 without pravastatin. Good neurologic outcome was defined by a Glasgow Outcome Scale ≥ 4 at neurocritical care unit discharge. We included 270 patients (135 patients with pravastatin), mostly treated with coiling (94.1%). Demographic, initial and subacute features were the same in the 2 groups. More patients experienced good outcome in the pravastatin group than in the control group (94.8% vs 74.2%; OR 7.16 95% CI [3.07 - 16.72], p less then 0.001). There was no difference in the occurrence of DCI in the 2 groups. In our study, outcome on neurocritical care discharge was better in patients with early good neurological status treated with pravastatin. Another randomized controlled trial should be conducted on this subtype of population.

Patients with early-onset severe COPD are often female and characterized by severe emphysema. Extrapulmonary disease manifestations have not yet been investigated in this clinical phenotype. Therefore, this study aimed to study the physical and mental health profile of patients with early-onset severe COPD.

This is a cross-sectional analysis including 1058 patients with COPD who were referred for pulmonary rehabilitation between July 2013 and August 2018. Based on a forced expiratory volume in 1s (FEV

) <50%predicted and age <55 years, 78 patients were identified having early-onset severe COPD. Using propensity score matching, these patients were matched to 54 early-onset mild-to-moderate, 158 older severe and 103 older mild-to-moderate COPD patients based on FEV

 %predicted, age and gender. An extensive panel of pulmonary and extrapulmonary disease markers (i.e. body composition, physical performance and mental health) was compared between these groups.

Pulmonary manifestations as well as physical and mental health were similar in patients with early-onset severe COPD compared to older severe patients, despite a mean age difference of 15.