Adlerandersen7871

We showed for the first time (through portmortem dissection) fibers directly connecting the anterior thalamic nucleus and the subgenual cingulate via the septal area.

The description of the anatomy of the Papez circuit through cadaveric dissection and comparisons with advanced neuroimaging studies allow a better understanding of its three-dimensional spatial layout, in addition to showing new areas of connectivity with adjacent structures and possibilities for surgical approaches or stimulation.

The description of the anatomy of the Papez circuit through cadaveric dissection and comparisons with advanced neuroimaging studies allow a better understanding of its three-dimensional spatial layout, in addition to showing new areas of connectivity with adjacent structures and possibilities for surgical approaches or stimulation.

Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSH) is characterized by a typical pattern of localized pretruncal hemorrhage on head computed tomography. PNSH is usually associated with a benign clinical course and a lower incidence of complications. The etiology is unknown, but many explanations have been proposed, including venous injury or rupture followed by thrombosis of a ruptured microaneurysm.

A 48-year-old man on apixaban for multiple venous thromboembolisms presented with the worst headache of his life associated with blurry vision, nausea, and neck stiffness. Computed tomography demonstrated a perimesencephalic pattern of blood (Hunt and Hess grade 2, Fisher grade 3). Computed tomography angiography and 6-vessel digital subtraction angiography demonstrated no precipitating cause. Systemic tissue plasminogen activator (tPA) was administered on postbleed day 8 owing to obstructive shock from saddle pulmonary embolism and pulseless electrical activity. He was safely discharged to rehabists and neurosurgeons should be aware that intravenous tPA was used safely for life-threatening pulmonary embolism in the setting of PNSH. Additionally, the use of tPA without resultant rebleeding in this case opposes the theory of the presence of a thrombosed ruptured microaneurysm.

Generally, asymptomatic epidermoid cysts (ECs) or ECs with minor symptoms controlled by medication are not treated further. Although epidermoid carcinomas are only sporadically reported, the possibility of malignant transformation of ECs is of concern.

A 77-year-old man under observation for a left cerebellopontine angle tumor presented with no symptoms, including headache, dizziness, or other cranial nerve abnormalities typical of cerebellopontine angle tumors. The tumor manifested as an extra-axial mass in the left cerebellopontine angle and measured 24× 16 mm (length× width) on magnetic resonance imaging (MRI). As he was asymptomatic, his primary physician did not pursue invasive treatment but ordered follow-up MRI every 2 years. The tumor decreased in size 2 years after the initial MRI, and no tumor fragmentation was observed on the patient's spinal MRI. Ultimately, the tumor shrank to 19× 11 mm over 22 years.

The reduction of an EC is extremely rare. We report a case of spontaneous regression of an EC and consider similar previous cases.

The reduction of an EC is extremely rare. We report a case of spontaneous regression of an EC and consider similar previous cases.Biochemical remission of adrenocorticotropic hormone (ACTH)-secreting macroadenomas can be challenging to achieve.1,2 Staying outside the adenoma pseudocapsule is an important technique to achieve gross total resection.1-3 Dural invasion is an important recognized factor that can prevent biochemical remission. In particular, invasion of the medial wall of the cavernous sinus has been implicated as an important determinant in remission and/or recurrence of ACTH-secreting macroadenoma.4,5 A 27-year-old patient presented with severe clinical features and biochemical workup consistent with ACTH-dependent hypercortisolism. Urinary free cortisol was nearly 10 times the upper limit of normal, and prolactin and insulin-like growth factor 1 were moderately elevated at 405 ng/mL and 577 ng/mL, respectively. Magnetic resonance imaging of the brain revealed a 2.4-cm pituitary macroadenoma contacting the left medial wall of the cavernous sinus (CS) and a compressed pituitary gland covering the right medial wall CS. The video demonstrates the technique for resection of the macroadenoma using a pseudocapsular technique with intermittent controlled central debulking to soften the tumor. The tumor had significant adherence to the left medial CS wall, and therefore the left CS was opened from a lateral-to-medial approach. Care must be taken to identify parasellar ligaments and watch for the inferior hypophyseal artery.1-3 The medial wall CS specimen revealed focal invasion of adenoma cells. The tumor stained for ACTH, prolactin, and growth hormone, and Ki-67 index was 1%. The patient went into biochemical remission postoperatively and had significant improvement in preoperative symptoms.

Management of symptomatic brain metastases often includes surgical resection with postoperative radiotherapy. Postoperative whole-brain radiotherapy (WBRT) improves intracranial control but detrimentally impacts quality of life and neurocognition. We sought to characterize the use in the United States of postoperative stereotactic radiosurgery (SRS), an evolving standard-of-care associated with reduced cognitive effects.

With the MarketScan Commercial Claims and Encounters Database from 2007 to 2015, we identified patients aged 18-65 years treated with resection of a brain metastasis followed by SRS or WBRT within 60 days of surgery. Logistic regression estimated associations between co-variables (treatment year, age, sex, geographic region, place of service, insurance type, disease histology, comorbidity score, and median area household income and educational attainment) and SRS receipt.

Of 4007 patients included, 1506 (37.6%) received SRS and 2501 (62.4%) received WBRT. Postoperative SRS increased frogation of barriers to SRS adoption.

This study aimed to summarize the experience with the management of transorbital brain injury (TOBI) at our institution that may help inform surgical decision-making.

Four adults with TOBIs were admitted to our hospital and received surgical treatment. The patients' clinical manifestations, physical findings, imaging data, surgical treatment, and postoperative outcome were prospectively collected and subject to retrospective analysis.

All patients were male. In 2 patients, the entry point of the cranium was the superior orbital fissure, whereas in the other 2, the entry point was the orbital roof. Thorough physical examination and comprehensive diagnostic imaging were performed preoperatively in all patients for careful assessment of the foreign body and its surrounding important structures. In collaboration with our multidisciplinary trauma team, individualized surgeries were successfully designed and performed in the 4 patients to remove the foreign bodies along the path of their trajectories. Three patients had uneventful postoperative courses, whereas 1 patient died because of severe cerebral ischemia and refractory brain swelling after decompressive craniectomy.

A comprehensive understanding of the regional anatomy of the trajectory is the cornerstone for surgical management of TOBIs. Adequate preoperative imaging examinations are essential for the evaluation of surgical risks and for making a tailored management strategy. Early surgical exploration through multidisciplinary collaboration is highly recommended for achieving a favorable outcome.

A comprehensive understanding of the regional anatomy of the trajectory is the cornerstone for surgical management of TOBIs. Adequate preoperative imaging examinations are essential for the evaluation of surgical risks and for making a tailored management strategy. Early surgical exploration through multidisciplinary collaboration is highly recommended for achieving a favorable outcome.

Persistent poorly-controlled type 2 diabetes mellitus (PPDM), or maintenance of a hemoglobin A1c (HbA1c) ≥8.5% despite receiving clinic-based diabetes care, contributes disproportionately to the national diabetes burden. Comprehensive telehealth interventions may help ameliorate PPDM, but existing approaches have rarely been designed with clinical implementation in mind, limiting use in routine practice. We describe a study testing a novel telehealth intervention that comprehensively targets clinic-refractory PPDM, and was explicitly developed for practical delivery using existing Veterans Health Administration (VHA) clinical infrastructure.

Practical Telehealth to Improve Control and Engagement for Patients with Clinic-Refractory Diabetes Mellitus (PRACTICE-DM) is an ongoing randomized controlled trial comparing two 12-month interventions 1) standard VHA Home Telehealth (HT) telemonitoring/care coordination; or 2) the PRACTICE-DM intervention, a comprehensive HT-delivered intervention combining telemonit may be well suited to lower the complications and costs of PPDM in routine practice.Sclerotinia sclerotiorum is a model necrotrophic pathogen causing great economic losses worldwide. Sclerotia are dormant structures that play significant biological and ecological roles in the life and disease cycles of S. sclerotiorum and other species of sclerotia-forming fungi. microRNA-like RNAs (milRNAs) as non-coding small RNAs play regulatory roles in fungal development and pathogenicity. Therefore, milRNAs associated with sclerotial development in S. sclerotiorum were investigated in this study. A total of 275 milRNAs with induced expression during sclerotia development were identified, in which 51 were differentially expressed. The target genes of all milRNAs were predicted. The putative functions of the targets regulated by milRNAs were annotated by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses. The expression levels of six selected milRNAs that coordinated with their corresponding targets were validated by qRT-PCR. Among these six milRNAs, Ssc-milR-240 was potentially associated with sclerotial development by epigenetic regulation of its target histone acetyltransferase. This study will facilitate the better understanding of the milRNA regulation associated with sclerotial development in S. sclerotiorum and even other sclerotia-forming fungi. This work will provide novel insights into the molecular regulations of fungal morphogenesis and the candidate targets of milRNAs used for the sustainable management of plant diseases caused by S. sclerotiorum.Topic modeling refers to a suite of probabilistic algorithms for extracting popular topics from a collection of documents. A common approach involves the use of the Latent Dirichlet Allocation (LDA) algorithm, and, although free implementations are available, their deployment in general requires a certain degree of programming expertise. This paper presents a user-friendly web-based application, specifically designed for the biomedical professional, that supports the entire process of topic modeling and comparative trends analysis of scientific literature. The application was evaluated for its efficacy and usability by intended users with no programming expertise (15 biomedical professionals). Results of evaluation showed a positive acceptance of system functionalities and an overall usability score of 76/100 in the System Usability Score (SUS) scale. This suggests that literature topic modeling can become more popular amongst biomedical professionals via the use of a user-friendly application that fully supports the entire workflow, thus opening new perspectives for literature review and scientific research.