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Jing-Yang Liou, Hsin-Yi Wang, Mei-Yung Tsou, Wen-Keui Chang, I-Ting Kuo, Chien-Kun Ting
BACKGROUND: Awake craniotomy (AC) is performed to identify cerebral language center. The challenge of anaesthesia is to maintain a calm, comfortable and cooperative patient during the mapping phase. Response surface models (RSMs) are multidrug modeling algorithms. In this pharmacodynamic study, we investigate the first use of RSM with bispectral index (BIS) to predict patient's response to name calling (RNC) and wakefulness (complete neurological tests) during AC. METHODS: The study is performed in two phases...
March 11, 2019: Journal of the Chinese Medical Association: JCMA
Samuel W Moore, Twananani Maluleke, Ayman A El Hosny
BACKGROUND: Hirschsprung disease is a functional obstruction of the gastrointestinal tract due to the congenital absence of ganglion cells in the intermyenteric plexuses of the distal bowel. Gastrointestinal motility requires intact muscular layers as well as neural network connection to function properly. The Actin G2 gene is the main gene encoding actin gamma 2; a smooth muscle actin found in enteric tissues. AIM: This study of the Actin G2 gene in patients with Hirschsprung disease explores a possible molecular basis abnormal muscle function and post-surgical pseudo-obstruction in a group of patients...
March 1, 2019: Journal of Pediatric Surgery
Hoang-Anh Tran, Jessica B O'Connell, Urie K Lee, John C Polanco, Tina I Chang, Arthur H Friedlander
OBJECTIVE: Males with peripheral arterial disease (PAD) are at high risk of ischaemic stroke given that atherogenic risk factors for both diseases are similar. We hypothesized that neurologically asymptomatic males diagnosed with PAD would demonstrate calcified carotid artery plaques (CCAP) on panoramic images (PI) significantly more often than similarly aged males not having PAD. METHODS: Investigators implemented a retrospective cross-sectional study. Subjects were male patients over age 50 diagnosed with PAD by ankle-brachial systolic pressure index results of <mml:math xmlns:mml="http://www...
March 15, 2019: Dento Maxillo Facial Radiology
Guillaume Bayer, Florent von Tokarski, Benjamin Thoreau, Adeline Bauvois, Christelle Barbet, Sylvie Cloarec, Elodie Mérieau, Sébastien Lachot, Denis Garot, Louis Bernard, Emmanuel Gyan, Franck Perrotin, Claire Pouplard, François Maillot, Philippe Gatault, Bénédicte Sautenet, Emmanuel Rusch, Matthias Buchler, Cécile Vigneau, Fadi Fakhouri, Jean-Michel Halimi
BACKGROUND AND OBJECTIVES: Thrombotic microangiopathies constitute a diagnostic and therapeutic challenge. Secondary thrombotic microangiopathies are less characterized than primary thrombotic microangiopathies (thrombotic thrombocytopenic purpura and atypical hemolytic and uremic syndrome). The relative frequencies and outcomes of secondary and primary thrombotic microangiopathies are unknown. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We conducted a retrospective study in a four-hospital institution in 564 consecutive patients with adjudicated thrombotic microangiopathies during the 2009-2016 period...
March 12, 2019: Clinical Journal of the American Society of Nephrology: CJASN
Ilaria Mancini, Silvia Pontiggia, Roberta Palla, Andrea Artoni, Carla Valsecchi, Barbara Ferrari, Danijela Mikovic, Flora Peyvandi
Acquired thrombotic thrombocytopaenic purpura (TTP) is a rare thrombotic microangiopathy caused by the immune-mediated severe deficiency of ADAMTS13. We hereby report the demographic and disease-related data of acquired TTP patients recorded in the Milan TTP Registry ( We performed a cross-sectional study of 302 individuals enrolled in our registry for an acute episode of acquired TTP occurred between 2002 and 2015 (female 77%; median age at onset 40 years, interquartile range: 30-50). Twenty per cent of patients had concomitant autoimmune disorders...
March 12, 2019: Thrombosis and Haemostasis
Luca Pierelli, Vincenzo Iaconianni, Michele Vacca
Therapeutic apheresis (TA) includes a wide range of therapeutic procedures based on the separation of blood components and the collection of cells with therapeutic activity or the removal of unwanted plasma or cellular components involved in the etiology of various hematologic, renal, neurological, and medical diseases. The complexity of these interventions requires an organizing model to assure a proper clinical environment, technology, quality requirements, and personnel as well as an active system for outcome monitoring for safety and efficacy...
February 18, 2019: Journal of Clinical Apheresis
Rute Noiva, Pedro Ruivo, Luís Madeira de Carvalho, Constança Fonseca, Miguel Fevereiro, Paulo Carvalho, Leonor Orge, Madalena Monteiro, Maria Conceição Peleteiro
Halicephalobus gingivalis is a small saprophytic rhabditid nematode, represented only by females with a typical rhabditoid oesophagus and one egg in the uterus, capable of infecting vertebrates. This opportunistic parasite present in the soil, manure and decaying humus, is thought to penetrate through previous injuries to the mouth, eyes and skin of horses and migrate to various organs. The brain is one such organ, where the females lay their eggs, leading to malacia and causing a sudden onset of neurological signs, such as anorexia, ataxia, urinary incontinence, blindness, decreased menace and tonal reflexes, tremors and aggressiveness...
January 22, 2019: Veterinary Medicine and Science
Clark C Chen, Robert C Rennert, Jeffrey J Olson
TARGET POPULATIONS: Adults with solid brain metastases who have not experienced a seizure. QUESTION 1: Do prophylactic antiepileptic drugs (AEDs) decrease the risk of seizures in nonsurgical patients with brain metastases who are otherwise seizure-free? RECOMMENDATION: Level 3: Prophylactic AEDs are not recommended for patients with brain metastases who did not undergo surgical resection and are otherwise seizure-free. QUESTION 2: Do prophylactic AEDs decrease the risk of seizures in patients with brain metastases and no prior history of seizures in the postoperative setting? RECOMMENDATION: Level 3: Routine postcraniotomy AED use for seizure-free patients with brain metastases is not recommended...
January 9, 2019: Neurosurgery
Brian V Nahed, Christopher Alvarez-Breckenridge, Priscilla K Brastianos, Helen Shih, Andrew Sloan, Mario Ammirati, John S Kuo, Timothy C Ryken, Steven N Kalkanis, Jeffrey J Olson
Please see the full-text version of this guideline for the target population of each recommendation listed below.  SURGERY FOR METASTATIC BRAIN TUMORS AT NEW DIAGNOSIS QUESTION: Should patients with newly diagnosed metastatic brain tumors undergo surgery, stereotactic radiosurgery (SRS), or whole brain radiotherapy (WBRT)? RECOMMENDATIONS: Level 1: Surgery + WBRT is recommended as first-line treatment in patients with single brain metastases with favorable performance status and limited extracranial disease to extend overall survival, median survival, and local control...
March 1, 2019: Neurosurgery
Jerome J Graber, Charles S Cobbs, Jeffrey J Olson
TARGET POPULATION: These recommendations apply to adult patients with new or recurrent solitary or multiple brain metastases from solid tumors as detailed in each section. QUESTION 1: Should patients with newly diagnosed metastatic brain tumors undergo stereotactic radiosurgery (SRS) compared with other treatment modalities? RECOMMENDATIONS: Level 3: SRS is recommended as an alternative to surgical resection in solitary metastases when surgical resection is likely to induce new neurological deficits, and tumor volume and location are not likely to be associated with radiation-induced injury to surrounding structures...
January 9, 2019: Neurosurgery
Jonathan H Sherman, Simon S Lo, Tom Harrod, Alia Hdeib, Yiping Li, Timothy Ryken, Jeffrey J Olson
QUESTION 1: Should patients with brain metastases receive chemotherapy in addition to whole brain radiotherapy (WBRT) for the treatment of their brain metastases? TARGET POPULATION: This recommendation applies to adult patients with newly diagnosed brain metastases amenable to both chemotherapy and radiation treatment. RECOMMENDATIONS: Level 1: Routine use of chemotherapy following WBRT for brain metastases is not recommended. Level 3: Routine use of WBRT plus temozolomide is recommended as a treatment for patients with triple negative breast cancer...
January 9, 2019: Neurosurgery
Mario Ammirati, Brian V Nahed, David Andrews, Clark C Chen, Jeffrey J Olson
TARGET POPULATION: These recommendations apply to adult patients newly diagnosed with multiple (more than 1) brain metastases. QUESTION 1: In what circumstances should whole brain radiation therapy be recommended to improve tumor control and survival in patients with multiple brain metastases? RECOMMENDATION: Level 2: It is recommended that whole brain radiation therapy can be added to stereotactic radiosurgery to improve local and distant control keeping in mind the potential for worsened neurocognitive outcomes and that there is unlikely to be a significant impact on overall survival...
January 9, 2019: Neurosurgery
Jeffrey J Olson, Steven N Kalkanis, Timothy C Ryken
BACKGROUND: The Congress of Neurological Surgeons systematic review and evidence-based clinical practice parameter guidelines for the treatment of adults with metastatic brain tumors was first published in 2010. Because of the time elapsed since that publication, an update of this set of guidelines based on literature published since is now indicated. OBJECTIVE: To establish the best evidence-based management of metastatic brain tumors over all commonly used diagnostic and treatment modalities in regularly encountered clinical situations...
January 9, 2019: Neurosurgery
J Bradley Elder, Brian V Nahed, Mark E Linskey, Jeffrey J Olson
QUESTION: What evidence is available regarding emerging and investigational treatment options for metastatic brain tumors? TARGET POPULATION: Adult patients with brain metastases. RECOMMENDATIONS: <AbstractText Label="INTERSTITIAL MODALITIES" NlmCategory="UNASSIGNED">There is insufficient evidence to make a recommendation regarding the routine use of existing local therapies, such as interstitial chemotherapy, brachytherapy, or other local modalities, aside from their use in approved clinical trials...
March 1, 2019: Neurosurgery
Laurie E Gaspar, Roshan S Prabhu, Alia Hdeib, D Jay McCracken, George F Lasker, Michael W McDermott, Steven N Kalkanis, Jeffrey J Olson
TARGET POPULATION: Adult patients (older than 18 yr of age) with newly diagnosed brain metastases. QUESTION: If whole brain radiation therapy (WBRT) is used, is there an optimal dose/fractionation schedule? RECOMMENDATIONS: Level 1:  A standard WBRT dose/fractionation schedule (ie, 30 Gy in 10 fractions or a biological equivalent dose [BED] of 39 Gy10) is recommended as altered dose/fractionation schedules do not result in significant differences in median survival or local control...
March 1, 2019: Neurosurgery
Timothy C Ryken, John S Kuo, Roshan S Prabhu, Jonathan H Sherman, Steven N Kalkanis, Jeffrey J Olson
QUESTION: Do steroids improve neurological symptoms and/or quality of life in patients with metastatic brain tumors compared to supportive care only or other treatment options? If steroids are given, what dose should be used? TARGET POPULATION: These recommendations apply to adults diagnosed with brain metastases. STEROID THERAPY VERSUS NO STEROID THERAPY: Asymptomatic brain metastases patients without mass effect Insufficient evidence exists to make a treatment recommendation for this clinical scenario...
January 9, 2019: Neurosurgery
Chin-Yi Cheng, Shung-Te Kao, Yu-Chen Lee
This study assessed the anti-apoptotic effects of the administration of ferulic acid (FrA) in rats 30 <mml:math xmlns:mml=""> <mml:mspace/> </mml:math> min before middle cerebral artery occlusion (MCAo) followed by 3 d of ischemia and the involvement of 70 <mml:math xmlns:mml=""> <mml:mspace/> </mml:math> kDa heat shock protein (HSP70)-mediated signaling in the penumbral cortex. Our results demonstrated that FrA pretreatment at doses of 80 <mml:math xmlns:mml="http://www...
January 7, 2019: American Journal of Chinese Medicine
Ryosuke Oki, Yuishin Izumi, Hiroyuki Nodera, Yasutaka Sato, Hiroshi Nokihara, Kazuaki Kanai, Masahiro Sonoo, Makoto Urushitani, Kazuto Nishinaka, Naoki Atsuta, Nobuo Kohara, Toshio Shimizu, Hitoshi Kikuchi, Masaya Oda, Ken Ikeda, Makiko Nagai, Kiyonobu Komai, Yasuhiro Kojima, Daisuke Kuzume, Sagiri Isose, Shun Shimohama, Koji Abe, Hidefumi Ito, Kazuyuki Noda, Tomohiko Ishihara, Mitsuya Morita, Takayoshi Shimohata, Satoshi Teramukai, Tatsuo Kagimura, Kensuke Noma, Hiroaki Yanagawa, Satoshi Kuwabara, Ryuji Kaji
BACKGROUND: Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that affects the upper and lower motor neurons. Currently, only riluzole and edaravone are approved as drugs to treat ALS and new agents with larger effect sizes are warranted. Exploratory analyses in our previous study (study ID #E0302-J081-761) have suggested that high-dose methylcobalamin (E0302) prolonged the overall survival of ALS patients and suppressed ALS progression in patients with a disease duration of less than 12 months...
December 21, 2018: JMIR Research Protocols
I Madrazo, O Kopyov, M A Ávila-Rodríguez, F Ostrosky, H Carrasco, A Kopyov, A Avendaño-Estrada, F Jiménez, E Magallón, C Zamorano, G González, T Valenzuela, R Carrillo, F Palma, R Rivera, R E Franco-Bourland, G Guízar-Sahagún
Individuals with Parkinson's disease (PD) suffer from motor and mental disturbances due to degeneration of dopaminergic and non-dopaminergic neuronal systems. Although they provide temporary symptom relief, current treatments fail to control motor and non-motor alterations or to arrest disease progression. Aiming to explore safety and possible motor and neuropsychological benefits of a novel strategy to improve the PD condition, a case series study was designed for brain grafting of human neural progenitor cells (NPCs) to a group of eight patients with moderate PD...
March 2019: Cell Transplantation
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