03). Radiologically, cyst associated ventriculomegaly was seen in 97% (P=0.78) was a notable feature. Even more, the cyst size (p=0.01) and associated hemorrhage (p=0.02) were also major notable feature preceding sudden death in both gender group.

Acute deterioration in colloid cysts is rare, but can be fatal. Associated symptoms include severe headache and vomiting. Seizures are commonly seen in patients in the first two decades. Given the risk of acute deterioration and mortality, headaches should be thoroughly investigated and all patients diagnosed with a colloid cyst>1cm should be offered surgical management regardless of symptom profile.

1 cm should be offered surgical management regardless of symptom profile.There has been a growing anxiety in carrying out awake craniotomy surgeries during the SARS-CoV-2 pandemic, not only due to airway management but also close proximity to the team in theatre. We set out to safely perform the first documented awake craniotomy in the UK since the beginning of lockdown. We performed a thorough workup of the patient with minimal hospital visits, using remote communication wherever possible. We modified our existing awake craniotomy protocol/technique guided by local/national policies. An asleep-awake-asleep craniotomy for tumour resection was performed successfully without compromising patient and staff safety with excellent post-operative outcome. With appropriate pre- and peri-operative modifications to established protocols, awake craniotomies with functional mapping can be safely carried out. By incorporating novel aspects to our technique, we believe that this service can safely resume in carefully selected patients.Cavernous malformations (CMs) of cranial nerves (CN) III, IV, and VI are extremely rare, and limited studies have assessed functional outcomes after treatment. This systematic review investigated the clinical features of CMs in ocular motor CNs, including the treatment results, and compared different surgical methods for functional preservation of ocular motor CNs. 'PubMed’, 'SCOPUS’, 'Web of Science’, and 'Google Scholar’ databases were searched to identify case reports and studies published between January 1980 and December 2018. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Twenty-seven patients were identified (median age, 46 years; range, 3 months-71 years). CN III was involved in 17 patients (63.0%), CN IV in 8 (29.6%), and CN VI in 2 (7.4%). Treatments included gross total resection (GTR) and nerve transection in 6 patients (22.2%), GTR and nerve continuity preservation in 7 (25.9%), subtotal resection (STR) and nerve continuity preservation in 4 (14.8%), GTR and end-to-end anastomosis in 5 (18.5%), and conservative care in 3 (11.1%), while the treatment method for 2 (7.4%) patients has not been described in the literature. In 22 patients who underwent surgical treatment, functional changes included improvement in 9 patients (40.9%), no change in 10 (45.5%), and worsening symptoms in 3 (13.6%). Functional preservation was achieved in 12 (54.5%) of the 22 patients; the nerve continuity preservation method conferred a significant advantage for functional preservation compared with other surgical methods (p = 0.004). Functional preservation of ocular motor CNs can be achieved by nerve continuity preservation.Primary intraosseous meningioma (PIM) is a rare subtype of extradural meningiomas that originates within bone. We aimed to characterize the clinical, radiographic, and pathologic features of PIM and the resulting outcomes following resection. Herein we examined a retrospective case series of all patients with a pathologically confirmed WHO grade I PIM that were managed at one of three tertiary care centers. Patients with tumors that demonstrated extraosseous extension or involvement of the dura mater were excluded. The main outcomes included surgical safety and duration of local tumor control. Nine patients were identified with benign PIMs, presenting with headaches or painless enlarging subcutaneous masses if involving the calvarium or with neurologic deficits if involving the skull base, or otherwise incidentally identified. Surgery was pursued for symptomatic relief and/or tissue diagnosis. Lesions were evaluated by radiographic imaging – including sensitive detection by plain X-ray films – and definitive diagnosis ascertained by histopathological examination. Maximal resection of both calvarial and skull base lesions was safely tolerated. PIM represents a rare benign skull lesion, whose identification depends on the integration of radiographic findings with intraoperative findings and histopathological confirmation; it should be considered in the differential for slow-growing expansile intraosseous lesions of the skull.

Migraine pathogenesis still remains uncertain. Studies have found contradictory results regarding NO, S100B and NSE parameters in migraine patients. Therefore, in our study, we aimed to measure NO, S100B and NSE concentrations in migraine patients, compare them with the control group and find the relationship between these parameters.

Fifty-two patients (35 women and 17 men) diagnosed with migraine according to the International Headache Classification II criteria were included in the study. 30 healthy participants without any history of disease were included in the control group. Serum NO, S100B and NSE levels were determined in all participants.

It was found that NO, S100B parameters increased compared to the control group, and NSE parameter decreased compared to the control group in the migraine patients participating in this study (p=0,004, p=0,002, p=0,000) It was found that there was a moderate positive linear correlation between serum S100B and NSE in the migraine patients in our study (r=442, p=0.011).

In our study, the fact that there was a statistically significant difference in the NO, S100b and NSE parameters of migraine and control group patients indicates that these molecules can be effective in the pathogenesisof migraine. The moderate positive linear correlation found between serum S100B and NSE in migraine patients in our study demonstrates that these molecules together can be effective in the pathogenesis.

In our study, the fact that there was a statistically significant difference in the NO, S100b and NSE parameters of migraine and control group patients indicates that these molecules can be effective in the pathogenesisof migraine. The moderate positive linear correlation found between serum S100B and NSE in migraine patients in our study demonstrates that these molecules together can be effective in the pathogenesis.

This technical note illustrates microscope integrated optical coherence tomography (iOCT) as an imaging technique to delineate concealed micro anatomical structures not displayable by conventional intraoperative imaging methods in the context of a cerebral arachnoid cyst.

iOCT was used for the first time to scan a cerebral arachnoid cyst in vivo. Scanning sites were defined at the outer membrane of the arachnoid cyst, the inner membrane at the temporal cortex as well as at the fenestration site to the basal cisterns – a point out of reach and resolution for conventional intraoperative imaging methods like e. g. ultrasound or neuroendoscopy.

iOCT was feasible during microsurgical fenestration of an arachnoid cyst. A clear delineation of the arachnoid cyst membrane was possible. The differentiation of the arachnoid cyst membrane and underlying arachnoid barrier cell membrane was possible. Trans cystic scanning at the temporal cortex could delineate the content of the subarachnoid space like subarachnoid blood vessels, trabecular sytem and vessel wall morphology of a M4 middle cerebral artery branch. Scanning of the inner membrane of the arachnoid cyst at site of fenestration to the basal cisterns excluded underlying micro anatomical structures.

This case demonstrates that iOCT achieved to delineate concealed micro anatomical structures which are occult to conventional intraoperative imaging methods. Further studies are necessary to value iOCT as a tool to improve intraoperative security.

This case demonstrates that iOCT achieved to delineate concealed micro anatomical structures which are occult to conventional intraoperative imaging methods. Further studies are necessary to value iOCT as a tool to improve intraoperative security.Tuberous sclerosis complex (TSC) is a multisystem autosomal dominant hamartoma syndrome caused by mutations in TSC1 or TSC2 genes, leading to upregulation of cell growth signalling pathways. Subependymal giant cell astrocytomas (SEGAs) are seen almost exclusively in TSC patients. We report a 'solitary SEGA’ in an adult patient, with confirmed deletion of the entire TSC2 gene on tumour tissue DNA, in the absence of detectable constitutional mutation or clinical manifestations of TSC. These rare cases may be secondary to somatic mosaicism and provide an opportunity to explore the genetic basis of the syndrome and its related tumours.

The optimal timing for glioma patients to stop taking antiepileptic drugs (AEDs) and the risk factors of seizure relapse have not been determined. Here, we explored the short-term outcomes and risk factors of seizure relapse in glioma patients after withdrawal of AEDs.

91 patients with gliomas who had no seizures at least 2years after surgery were enrolled in the study. The patients were followed up for 1year or until the relapse of seizure after AEDs withdrawal. The risk factors of seizure relapse were analyzed by univariate and multivariate analysis. The optimal discrimination point was determined by plotting a receiver operating characteristic (ROC) curve to explore the relationship between the number of risk factors and seizure relapse.

28 patients (30.8%) relapsed during the follow-up period while 63 patients (69.2%) remained seizure-free. Of the 28 relapsed patients, 20 (71.4%) relapsed within the first 6months after the AEDs withdrawal. Multivariate analyses revealed that subtotal resection (p=0.026), IDH1 mutation (p=0.019), and combined use of AEDs (p=0.037) were independent risk factors for seizure relapse in glioma patients. ROC curve based on the seizure relapse showed that the sensitivity was 0.821 and 1-specificity was 0.238, corresponding to 1.5 independent risk factors for each patient.

To obtain a favorable outcome for glioma patients with preoperative seizures, only patients with less than two independent risk factors for seizure relapse should consider discontinuing AEDs.

To obtain a favorable outcome for glioma patients with preoperative seizures, only patients with less than two independent risk factors for seizure relapse should consider discontinuing AEDs.To explore the demographic characteristics and main types of memory impairment in the Memory Clinic of China and to provide references for future research. Demographic, cognitive, and etiological data of 2,742 cognitive impairment (CI) patients who were in the Memory Clinic at Tianjin Huanhu Hospital from January 2011 to October 2018 were analyzed. The main subtypes of CI were AD (38.33%), MCI (19.55%), VaD (8.57%), FTLD (7.37%) and DLB/PDD (5.91%). The mean age was 68.5 ± 9.97, with 82.13% older than 60 years. There were slightly more females (50.58%) than males (49.42%). There were a relatively equal number of patients who were educated less than (55.12%) and more than nine years (44.88%). Most patients (82.91%) were married and only 23.63% patients had a family history of CI. CI occurred primarily in the elderly, namely those who were between 60 and 79 years old. More than half of those with AD, DLB, PDD, and FTLD were categorized at mild or moderate levels. The bvFTD (n = 127, 62.9%) was the primary subtype of FTLD. Standardized diagnostic procedures, detailed neuropsychological assessments, molecular biology tests, and follow-ups are important for the early diagnosis and treatment of cognitive impairment diseases.

To compare baseline physical and cognitive performance, neurophysiological, and magnetic resonance imaging (MRI) outcomes and examinetheir interrelationship inparticipants with Multiple Sclerosis (MS), already established aseither responder or non-responder to Fampridine treatment, andto examine associationswiththe expanded disability status scale (EDSS) and 12-item MS walking scale (MSWS-12).

Baseline data from an explorative longitudinal observational study were analyzed. Participants underwent the Timed 25-Foot Walk Test (T25FW), Six Spot Step Test (SSST), Nine-Hole Peg Test, Five Times Sit-to-Stand Test, Symbol Digit Modalities Test (SDMT), neurophysiological testing, including central motor conduction time (CMCT), peripheral motor conduction time (PMCT), motor evoked potential (MEP) amplitudesand electroneuronographyof the lower extremities, and brain MRI (brain volume, number and volume of T2-weighted lesions and lesion load normalized to brain volume).

41 responders and 8 non-responders were examlogical or MRI outcomes. The results call for cautious interpretation and further large-scale studies are needed to expand ourunderstanding of underlying mechanisms discriminating Fampridine responders and non-responders.CMCT may be used as a marker of disability and walking impairment, while SDMT was associated with white matter lesions estimated by MRI. ClinicalTrials.gov identifier NCT03401307.Noisy galvanic vestibular stimulation (nGVS) involves the application of a weak, noisy, electrical current to the vestibular end organs and their afferent nerves, through electrodes placed bilaterally over the mastoid process. Center of pressure (COP) sway was shown to decrease during nGVS under conditions of static standing posture. However, whether nGVS can improve balance functions other than the static standing posture remains unclear. This study aimed to elucidate the effects of nGVS on COP sway during one-legged standing. We randomly assigned 36 participants to either a control group (sham stimulation), a 0.2 mA group (nGVS at 0.2 mA), or a 0.4 mA group (nGVS at 0.4 mA). All participants were measured for COP sway standing on one leg, with open eyes, both before and during stimulation. In the 0.2 mA group, the sway path length, mediolateral mean velocity, and anteroposterior mean velocity decreased during stimulation compared with before stimulation. Conversely, no significant differences in COP sway were detected for either the control group or the 0.4 mA group. The stimulation effects for all COP sway parameters were significantly higher in the 0.2 mA group than in either the control group or the 0.4 mA group. The results of this study suggested that nGVS not only decreases COP sway during static standing postures but can also reduce COP sway during one-legged standing.

Over the past decade, the endoscopic transnasal transsphenoidal approach for pituitary adenomas has been widely adopted among neurosurgeons. However, olfactory disturbances have been observed after this procedure, and few studies on long-term (>6 mo) olfactory disturbance after endoscopic transnasal transsphenoidal pituitary adenoma surgery have been conducted. Although we perform minimally invasive endoscopic surgery, some patients continue to experience hyposmia, with some even experience long-term hyposmia. This impairment results in a considerable loss in quality of life. We present a series of patients who underwent minimally invasive single-nostril TSS for pituitary adenoma, including evaluation of their olfactory function. We further investigated the related risk factors for long-term olfactory dysfunction.

One hundred sixty-one consecutive patients who met the study criteria underwent the single-nostril endoscopic transsphenoidal approach by the senior author. The Smell Diskettes Olfaction Test disease and smoking appear to be risk factors for long-term olfactory dysfunction. Physicians should address clinical findings related to olfactory function and provide appropriate care.Hemangioblastomas (HB) are benign low grade vascular tumors most frequently occurring in the cerebellum, brain stem, and spinal cord. Often associated with Von Hippel Lindau disease (VHL), the lesions are often multifocal requiring complex resection and are difficult to control. Linear Accelerator (LINAC) Stereotactic Radiosurgery (SRS) has been demonstrated to provide additional tumor control. In this case series, we present our multi-center experience utilizing LINAC SRS in fourteen patients with 23 lesions. We observed a tumor control rate of 87% and found interval changes in the peritumoral enhancement to correlate with treatment outcome. In our study, SRS treatment was also well-tolerated in both cystic and noncystic patients with multifocal disease. Disease control was achieved in all but three patients post-resection and no longitudinal radiation-induced secondary malignancy was observed. SRS response correlated highly with lesion size and radiation dose. We conclude that LINAC SRS is safe and effective for patients with HB and should be considered in addition to surgery in asymptomatic, VHL patients, deep seated lesions and isolated lesions.

Following surgical resection of oligometastatic disease to the brain there is a high rate of local relapse which is reduced by the addition of focal radiation therapy, often delivered as single fraction stereotactic radiosurgery (SRS) to the surgical cavity. This study audited the outcomes of an alternative approach using hypofractionated radiation therapy (HFRT) to the surgical resection cavity.

Seventy-nine patients who received surgical resection and focal radiation therapy to the surgical cavity using HFRT with intensity modulated radiation therapy with or without stereotactic radiotherapy were identified. Doses were delivered in five fractions every second day for 10days. Follow-up involved MRI surveillance with three-monthly MRI scans post resection. The major endpoints were local control at the surgical cavity site, and presence of radiation necrosis at the treated site.

Seventy-nine patients were included for the analysis with a median follow-up of 10.8months. Of the cohort, 56% experienced intracranial progression, with all patients progressing distant to the resection cavity, and 7% progressing locally in addition. The one-year local control rate was 89.8%. The median progression-free survival was 10.0months and median overall survival was 14.3months. There was one CTCAE grade 3 toxicity of symptomatic radiation necrosis with no grade 4-5 toxicities seen.

The rate of local relapse following HFRT to the surgical cavity is low with minimal risk of radiation necrosis. HFRT can be considered as an alternative to SRS for focal radiotherapy after brain metastasis resection.

The rate of local relapse following HFRT to the surgical cavity is low with minimal risk of radiation necrosis. HFRT can be considered as an alternative to SRS for focal radiotherapy after brain metastasis resection.Chronic subdural haemorrhage (CSDH) is a common neurosurgical entity with complex pathophysiological pathways. The generally favourable surgical outcome may be affected by its associated risks including recurrence rates. We performed a prospective randomized multi-center clinical trial comparing the addition of tranexamic acid (TXA) to standard neurosurgical procedures for patients with symptomatic CSDH. The primary endpoint was CSDH requiring repeat surgery within 6-month post-operatively. Secondary endpoints were comparison of post-operative volumes between the treatment arms and safety evaluation of the dosing regime. 90 patients were analyzed with 49 patients in the observation arm and 41 patients in the TXA arm. The observation arm had five (10.2%) recurrences compared to two (4.8%, p = 0.221) in the TXA arm. Patients in the TXA arm demonstrated a greater reduction of their CSDH volume at 6 weeks follow up (36.6%) compared to the observation arm (23.3%, p = 0.6648). There were no reportable serious adverse events recorded in the observation arm, compared to 4 (9.8%) patients in the TXA arm. The addition of TXA treatment to standard surgical drainage of CSH did not significantly reduce symptomatic post-operative recurrence. Patients in the TXA arm had a delay in the CSDH recurrence with a comparative reduction of residual hematoma volume at the 6-week follow up although the effect was unsustained. Larger randomized trials with dose adjustments should be considered to investigate subgroups of patients that may benefit from this medical adjunct.Many institutions have developed shared decision-making conferences as a mechanism for reducing treatment costs and improving patient outcomes. Little is known about the process of shared decision-making that takes place in these conferences, and there is the possibility of bias among surgeons and nonsurgeons for treatment within their respective specialties. This study was conducted to determine who is contributing to the decision-making process in a multidisciplinary spine conference and to what extent treatment biases exist among the surgical and nonsurgical members of this conference. Voting data were collected during weekly multidisciplinary spine conferences. Descriptive statistics were calculated on the cases presented and the number and type of physicians voting for each case. The likelihood of a particular vote in the surgeon and nonsurgeon cohorts was evaluated using relative risk calculation and multinomial logistic regression. A total of 262 consecutive cases were analyzed. No significant differences in treatment recommendation were observed between surgery and nonsurgical management (relative risk, 1.1; 95% CI, 0.97-1.25) when comparing votes from the surgeon and nonsurgeon cohorts. Multinomial logistic regression showed the odds of nonsurgeons recommending nonsurgical management over surgery was 20% greater than receiving that recommendation from their surgeon colleagues. Individual surgeon and nonsurgeon voters were evenly distributed above and below the mean for treatment recommendation. Individual and group biases exist among surgeons and nonsurgeons treating degenerative spine diseases. Multidisciplinary conferences may or may not level these biases, depending on how they are conducted.

At L5-S1, anterior access can be performed with a supine anterior lumbar interbody fusion (ALIF) or lateral position oblique lumbar interbody fusion (LOLIF). We compared clinical and radiographic features of both approaches.

A retrospective study of L5-S1 ALIF and LOLIF patients (2013-2018) by 3 spine surgeons and a vascular surgeon at our hospital was performed. Inclusion criteria were patients undergoing L5-S1 anterior surgery only without other anterior or lateral fusion levels, and data collected were patient demographics, cage parameters, perioperative variables, and radiographic parameters. 58 patients were included (33 ALIF and 25 LOLIF).

The average surgical time was 211.94min for ALIF and 154.86min for LOLIF (p<0.001). The average blood loss was 214ml for ALIF and 74ml for LOLIF (p<0.001). The average number of days to solid food was 2.55 for ALIF and 0.8 for LOLIF (p<0.001). The average anterior L5-S1 disc height increase was 8.52mm for ALIF and 5.02mm LOLIF (p=0.018), and the average posterior L5-S1 disc height increase was 3.34mm for ALIF and 1.30mm for LOLIF (p=0.034). The average L5-S1 segmental lordosis increase was 6.82 degrees for ALIF and 7.63 degrees for LOLIF (p=0.638).

The LOLIF is a feasible option for L5-S1 anterior access compared to ALIF. However, supine ALIF afforded larger cages to be placed, resulting in greater postoperative disc height. There did not appear to be a significant difference in postoperative L5-S1 segmental lordosis between the two approaches.

The LOLIF is a feasible option for L5-S1 anterior access compared to ALIF. However, supine ALIF afforded larger cages to be placed, resulting in greater postoperative disc height. There did not appear to be a significant difference in postoperative L5-S1 segmental lordosis between the two approaches.The study aimed to investigate the role of serum homocysteine in hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH) within 24 h of intravenous (IV) recombinanttissueplasminogenactivator(rt-PA) in acute ischemic stroke (AIS) patients. 236 consecutive AIS patients (169 men, median 65 years old) who underwent to IV rt-PA within 4.5 h of symptom onset were retrospectively recruited and analyzed. The serum homocysteine levels ranged from 4.45 to 67.71 (median 12.05) μmol/L. HT was observed in 28 (11.9%) patients, including 7 (3.0%) sICH patients within 24 h of IV rt-PA. Multiple parameters were compared between HT and non-HT patients as well as sICH and non-sICH patients. The serum homocysteine levels were higher in patients with HT than in those without HT (13.00 vs. 11.70 μmol/L, P = 0.025) and an independent association between serum homocysteine level and HT within 24 h of IV rt-PA was identified via multivariable logistic regression analysis (odds ratio [OR] = 1.103, 95% confidence interval [CI] = 1.021-1.191, P = 0.013). Moreover, serum homocysteine levels were also significantly higher in patients with sICH than in those without sICH (15.19 vs. 11.73 μmol/L, P = 0.005).Our study suggests that serum homocysteine level is an independent predictor for HT within 24 h of IV rt-PA in AIS patients.

To reduce procedural thromboembolisms, tailored antiplatelet drug preparation has been used according to antiplatelet resistance for endovascular coiling of unruptured aneurysms. We compared an aspirin plus clopidogrel group with a ticagrelor group using diffusion-weighted imaging (DWI) after stent-assisted coiling for unruptured aneurysms.

From October 2018 to April 2019, 72 patients with 78 aneurysms underwent stent-assisted coiling, with aspirin plus clopidogrel (n=20 patients with 22 aneurysms) or ticagrelor (n=52 patients with 56 aneurysms) as an antiplatelet preparation, and were enrolled in our study. All patients were evaluated using DWI 2h after coiling to detect procedural thromboembolisms.

Postprocedure infarction was observed on DWI in 37 procedures (47.4%), and symptomatic infarction occurred in 1 procedure (1.28%). Postprocedure infarction was significantly lower in the aspirin plus clopidogrel than in ticagrelor group (27.3% vs. 55.4%, p=0.043). Postprocedure infarction was associated witstudy suggests that postprocedure infarction is more associated with aneurysm type than antiplatelet medication.Cerebellar glioblastoma (GB) is much rarer than its supratentorial counterpart, and potentially of different molecular origin. Prior database studies are of limited size and reported on patients who preceded the validation of temozolomide. Thus, we provide an updated population-based analysis of the treatment trends and outcomes since the standardization of GB adjuvant chemoradiation. Patients diagnosed with primary cerebellar and supratentorial GB were identified from the National Cancer Database spanning 2005-2015. Patients were characterized by demographics, extent of resection, and adjuvant chemotherapy or radiation status. Cohorts were primarily and secondarily assessed for overall survival by tumor site and treatment history, respectively. A total of 655 patients with cerebellar GB were identified (0.6%). Cerebellar GB patients, compared to supratentorial GB were more likely to undergo a biopsy or subtotal resection (13.4% vs 9.3% and 16.0% vs 13.4%, p-value less then 0.001), and less likely to pursue adjuvant therapy (48.4% vs 52.7%, p-value less then 0.001). Overall median survivals were 9.3 and 9.4 months, respectively. On multivariable analysis, gross total resection, radiation, and chemotherapy were found to be predictors of improved overall survival (HR 0.77, p = 0.038; HR 0.67, p less then 0.001; and HR = 0.77, p = 0.030, respectively). While many management principles are currently shared between cerebellar and supratentorial GB, aggressive regimens appear less frequently prescribed. Survival continues to match supratentorial outcomes and may benefit from future, systemic guidance by distinguishing molecular features.Continuous measurement of cerebral blood flow velocity (CBFV) of the middle cerebral artery (MCA) using transcranial Doppler (TCD) and arterial blood pressure (ABP) monitoring enables assessment of cerebrovascular haemodynamics. Further indices describing cerebrovascular function can be calculated from ABP and CBFV, such as the mean index (Mxa) of cerebrovascular autoregulation, the 'time constant of the cerebral arterial bed’ (tau), the 'critical closing pressure’ (CrCP) and a 'non-invasive estimator of ICP’ (nICP). However, TCD is operator-dependent and changes in angle and depth of MCA insonation result in different readings of CBFV. The effect of differing CBFV readings on the calculated secondary indices remains unknown. The aim of this study was to investigate variation in angle and depth of MCA insonation on these secondary indices. In eight patients continuous ABP and ipsilateral CBFV monitoring was performed using two different TCD probes, resulting in four simultaneous CBFV readings at different angles and depths per patient. From all individual recordings, the K-means clustering algorithm was applied to the four simultaneous longitudinal measurements. The average ratios of the between-clusters, sum-of-squares and total sum-of-squares were significantly higher for CBFV than for the indices Mxa, tau and CrCP (p less then 0.001, p = 0.007 and p = 0.016) but not for nICP (p = 0.175). The results indicate that Mxa, tau and CrCP seemed to be not affected by depth and angle of TCD insonation, whereas nICP was.Carpal tunnel syndrome (CTS) is a common entrapment neuropathy of the upper limb. In this cross-sectional study our aim is to investigate the value of Duruöz Hand Index (DHI) in diagnosis and staging of CTS patients and comparing it with Boston Carpal Tunnel Questionnaire (BQ) and provocative tests. Among 423 patients who were referred to the EMG laboratory at the physical medicine and rehabilitation unit with the symptoms of CTS, 294 patients were included in the study. Patients’ demographic data, weight, height, body mass index (BMI) measurements, physical examinations, Tinel and Phalen provocative test results, visual analog scale for pain, DHI and BQ scores were recorded. Electrophysiological examinations were also performed. The mean age was 45.1 ± 11.6 years and 254 (86.4%) patients were women. Based on the results of EMG, 120 (40.8%) patients were found negative for CTS, 57 (19.4%) patients had mild CTS, 89 (30.3%) patients had moderate CTS and 28 (9.5%) patients had severe CTS. Among the parameters evaluated, DHI scores were found to be significantly higher in the severe CTS group. DHI (r 0.306, p less then 0.001) and Boston functional status scale (FSS) (r 0.257p = 0.001) were found to be correlated with CTS severity. Tinel positivity (OR 2.36, p 0.01), Phalen positivity (OR 2.22, p 0.02), Boston symptom severity scale (SSS) scores (OR 1.76, p 0.024), increasing age (OR 1.06, p less then 0.001) and increased BMI (OR 1.07, p 0.03) were found to be associated with increased likelihood of CTS diagnosis. In conclusion, DHI was found to be correlated with CTS severity similar to Boston FSS.Short-term VEEG represents an affordable option in limited resources environments. There are few reports on its use. Its diagnostic yield is variable (7-57%) and can be related to the differences in recording time. The present study analyzes possible predictive factors to support the indication of a short-term VEEG. We analyzed short-term VEEG studies ( less then 24 h) throughout a period of 5 years (2013-2017). The patients were clustered according to the date of last epileptic seizure and the frequency of epileptic events per month and subcategorized depending on the frequency found. Chi square univariate analysis was performed looking for predictive variables to obtain an epileptic short-term EEG. A multivariate logistic regression analysis was performed with statistically significant variables. A total of 1092 VEEG were analyzed from 832 patients. 34.5% were reported as epileptic VEEG. In the multivariate analysis, 3 predictors of epileptic short-term VEEG were identified The use of 2 or more antiepileptic drugs (AEDs) (OR 1.67, CI 1.23-2.25, p = 0.001), the presence of an epileptic event in the last month (OR 1.53, CI 1.07-2.17, p = 0.018) and daily seizures (OR 1.84, CI 1.21-2.78, p = 0.004). Six-month seizure free subjects predict a non-epileptic VEEG (OR 0.58, CI 0.30-0.89, p = 0.013).Diffuse midline gliomas (DMGs) are a diffuse glioma subtype arising from midline brain structures. It is predominantly a disease of childhood; however, it can also occur in adults. Adult DMG has not been previously well described. The aim of this study was to define the characteristics of adult DMG. We described and analyzed the clinical, radiological, and genetic alterations of 9 adult DMGs and compared them with those of 257 non-midline adult high-grade IDH-WT gliomas. The median age of all patients was 38-years old (23-68-years). Most common symptoms were headache, motor/sensory deficit, ataxia, cranial nerve deficit, and confusion. Tumor locations were brainstem (44.5%), thalamus (22.2%), pineal region (22.2%), spinal cord (22.2%), and cerebellum (11.1%). Six-patients (66.7%) were H3 K27M-WT and three (33.3%) were H3 K27M-mutant. In addition to H3 K27M mutations, TP53 gene (55.5%), CDKN2A/B and TERTp (33.3%), PDGFRA (33.3%), PIK3CA, PTEN, KDR, NF1, and MYC (22.2%) were the most frequently mutated genes. Neither IDH1/IDH2 nor EGFR alterations were present. Compared to non-midline high-grade glioma, adult DMG patients were younger (38 vs 61 years, p less then 0.001) and lacked EGFR-alterations (0/9 vs 123/257, p = 0.004). The median survival of DMG and non-midline high-grade gliomas was 19 and 18 months respectively (p = 0.964). Our data support that adult DMGs have different oncogenic drivers compared to non-midline high-grade gliomas. Regardless of H3 K27M mutation status, neither of the nine adult DMG cases demonstrated IDH1/IDH2 or EGFR alterations. Larger multi-institutional studies are needed to further characterize the biology of this rare type of diffuse glioma in adults.

South Asian ethnicity has been associated with increased cardiovascular risk, in the context of a greater burden of traditional cardiovascular disease risk factors. We aimed to identify the 10-year incidence of coronary heart disease (CHD) in South Asians, as compared to other racial-ethnic groups, in a retrospective cohort study, using the Kaiser Permanente Northern California integrated health care system, and to understand whether traditional risk factors could explain differences in outcomes.

A study cohort established in 2006, with 10-year follow-up, identified a total n=341,309 patients, including 5149 South Asians, aged 30-70 years who underwent a screening lipid panel and had no prior history of CHD. There were a total of 460 (8.93%) patients with at least one cardiovascular event, including cardiovascular death, coronary artery revascularization, and myocardial infarction, in South Asians, as compared to 5.66% patients in the total population (p<0.0001). In a multivariable logistic regression analysis, South Asian ethnicity, compared to White race, was associated with an adjusted odds ratio (aOR)=2.04 (95%CI 1.83, 2.28) in predicting the cardiovascular outcomes.

South Asian ethnicity, even after adjustment for traditional risk factors, is associated with an increased risk of coronary heart disease outcomes. This risk was greater than other studied racial-ethnic groups and second only to diabetes in CHD risk prediction.

South Asian ethnicity, even after adjustment for traditional risk factors, is associated with an increased risk of coronary heart disease outcomes. This risk was greater than other studied racial-ethnic groups and second only to diabetes in CHD risk prediction.

Controlling the size and the shape of nanostructures on surfaces is fundamental for various applications while the formation of porous structures such as nanotubes is particularly difficult. The templateless electropolymerization is a choice process that not only forms nanostructured surfaces, but also can tune their morphologies using different monomers.

In this work, we used this soft-template and surfactant free electropolymerization in organic solvent to deposit for the first time carbazole-based monomers. Five different conjugated carbazole-based monomers are tested here.

We show that the shape of surfaces nanostructures is highly dependent on the amount of water present in the organic solvent and on the molecular structure of the carbazole monomers. Different morphologies are obtained from fibers to vertically aligned nanotubes and even porous membranes, depending on the monomer and on the electropolymerization method. The nanostructured surfaces reach superhydrophobic properties and their dynamical non-wetting behavior varies with the monomer and the electrochemical parameters.

We show that the shape of surfaces nanostructures is highly dependent on the amount of water present in the organic solvent and on the molecular structure of the carbazole monomers. Different morphologies are obtained from fibers to vertically aligned nanotubes and even porous membranes, depending on the monomer and on the electropolymerization method. The nanostructured surfaces reach superhydrophobic properties and their dynamical non-wetting behavior varies with the monomer and the electrochemical parameters.

The mechanism for the spontaneous formation of water droplets at oil/solid interfaces immersed in water is currently unclear. We hypothesize that growth and shrinkage of droplets are kinetically controlled by diffusion of water through the oil, driven by differences in chemical potential between the solid substrate and the aqueous reservoir.

The formation, growth and shrinkage of water droplets at an immersed oil/solid interface are investigated theoretically and experimentally with three silicone oils. The surface is hydrophobic and the droplets formed are truncated spheres with radius, a, less than 10μm. The expansion and contraction of the droplets can be controlled by adjusting the difference in chemical potential. The growth kinetics are modelled in terms of water migration through the oil layer which predicts a

∝t.

This is the first study of possible mechanisms for the formation of such interfacial droplets. Several possible causes are shown to be unfavourable, negligible, or are eliminated by careful experiments controlling key parameters (such as oil viscosity, substrate chemistry). The rate constant for mass transport is proportional to difference in chemical potential and an estimate shows dissociation of surface groups on the substrate provides a driving chemical potential of the right magnitude.

This is the first study of possible mechanisms for the formation of such interfacial droplets. Several possible causes are shown to be unfavourable, negligible, or are eliminated by careful experiments controlling key parameters (such as oil viscosity, substrate chemistry). The rate constant for mass transport is proportional to difference in chemical potential and an estimate shows dissociation of surface groups on the substrate provides a driving chemical potential of the right magnitude.In this paper, experimental results on the swelling, dispersion and disintegration of the lamellae composed of the lipid, 1,2-dioleoyl-sn-glycero-3-phosphocholine (DOPC) in contact with excess water are described. Multilamellar structures nucleate and grow at the interface between the pure solvent and the lipid. The system evolves slowly via flow and coalescence of lamellae through a variety of non-equilibrium morphologies demonstrating that their dynamics is complex and non-universal, with no unique kinetic pathway. The tubular structures disintegrate slowly into the bulk water phase, inside the sealed sample chamber.The rapid rise of novel coronavirus disease 2019 (COVID-19) cases led the American Society for Reproductive Medicine (ASRM) to recommend immediate cessation of all new fertility treatment cycles on March 17, 2020. Controversial from the start, providers and patients expressed their opposition through online petitions, surveys, and other forums. While the impact of a delay in access to reproductive care is unknown, previous studies are reassuring that a delay in the timespan of months may not affect clinical outcomes. However, dropout from care during this pandemic remains a serious concern. Effective therapies against the virus and a vaccine are not on the immediate horizon. Accepting COVID-19 will likely be a part of our lives for the near future necessitates the modification of fertility protocols to keep patients, providers, and staff as safe as possible. We believe fertility treatment is an urgent, essential service that can be performed safely and responsibly during this pandemic.

Sprengel’s deformity is a congenital anomaly of the scapula and can be associated with reduced shoulder mobility and esthetic concerns. Controversies remain regarding its natural history, radiographic findings, and optimal treatment strategy.

A total of 74 Sprengel’s shoulders in 71 patients presenting to a pediatric referral hospital were retrospectively reviewed including 24 surgically treated shoulders. Median age at initial presentation was 3.8 years. Median age at the final follow-up was 9.6 years.

Twenty shoulders were analyzed for range of motion across time. The median composite abduction range was initially 105° and at the last time-point 98°, with a median loss of 15° over 5 years (P = .007). A total of 26% of the nonsurgical shoulders reported pain at the latest follow-up, compared with 1 surgical patient (4%) (P = .028). Older age was independently associated with pain (P < .001); this effect was only seen in nonsurgical patients. Radiographically, the glenoid inclination angle (GIA) inde modified Woodward procedure may alter the natural history of the condition by improving motion and reducing risk of pain later in life.

The incidence of total shoulder arthroplasty (TSA) continues to increase. Although researchers expect preoperative depression to influence outcomes following primary hip and knee arthroplasty, there is a paucity of data on this relationship after primary TSA. The purpose of this study was to define the relationship between a preoperative diagnosis of depression and postoperative outcomes following TSA.

This was a level III retrospective cohort study. We identified patients undergoing TSA between 2009 and 2017 from the Truven MarketScandatabase and created 2 cohorts, patients with and without depression. We included patients who were continuously enrolled in the database for 1 year preoperatively and postoperatively. We collected demographic data, complication data, and health care utilization factors and then performed statistical analysis comparing complication and health care utilization between cohorts. This analysis controlled for baseline patient demographic, comorbid, and surgical factors.

We incl.23; 95% CI, 1.12-1.36; P < .001).

Depression prior to TSA is common and is associated with increased risk of complications and increased health care utilization following TSA. Determining whether this is a modifiable risk factor requires further investigation.

Depression prior to TSA is common and is associated with increased risk of complications and increased health care utilization following TSA. Determining whether this is a modifiable risk factor requires further investigation.

Preoperative computed tomography (CT) scans can be used to measure the thickness of the center of the humeral head to identify patients at a higher risk of screw cutout after open reduction-internal fixation.

At an academic medical center, we performed a retrospective review of all patients aged ≥ 18 years who had sustained a proximal humeral fracture that was treated with open reduction-internal fixation between January 1, 2005, and December 31, 2014, and who underwent preoperative shoulder CT. Ninety-four patients were included. Patient charts were reviewed to obtain demographic data, and radiographs were reviewed to assess screw cutout. A standardized method was devised to measure the thickness of the center of the humeral head.

Screw cutout developed in 17 patients (17.7%). The mean humeral head thickness was significantly smaller on the axial (18 mm vs. 21 mm, P = .0031), coronal (18 mm vs. 21 mm, P = .0084), and sagittal (18 mm vs. 21 mm, P = .0033) sections in the patients who experienced screw c fixation methods should be taken when the measurements in all planes are <15 mm. This information may be helpful in counseling patients regarding the possibility of postoperative screw cutout.

25 mm in any one plane is highly protective against cutout; however, extreme caution and consideration of supplemental fixation methods should be taken when the measurements in all planes are less then 15 mm. This information may be helpful in counseling patients regarding the possibility of postoperative screw cutout.

The number of reverse total shoulder arthroplasties (RTSAs) performed annually has increased, and the indications for RTSA have expanded beyond rotator cuff arthropathy to include treatment of complex proximal humeral fractures. No studies exist comparing clinical, functional, and radiographic outcomes in patients receiving RTSA for the treatment of acute fracture vs. those undergoing the procedure for degenerative conditions. This study was designed to fill the void in this knowledge gap. We hypothesized that patients undergoing RTSA for fracture treatment would experience worse clinical outcomes than those undergoing elective RTSA.

A prospectively collected database was queried for patients undergoing RTSA between 2007 and 2016. Patients were sorted based on the indication for RTSA treatment of acute proximal humeral fracture vs. „elective” treatment of degenerative conditions of the shoulder. Baseline demographic characteristics, intraoperative and perioperative complications, and clinical, functional,ditions of the shoulder.

Despite differences in patient demographic characteristics, the outcome and complication profiles are similar between patients undergoing RTSA for acute fracture and those indicated for the treatment of degenerative conditions of the shoulder.

Reverse total shoulder arthroplasty (RTSA) procedures have significantly increased in the last decade as an alternative to the current treatments for cuff-tear arthropathy. Since Grammont’s theory in 1987, few data about the invivo kinetics of the shoulder-girdle musculature in patients with RTSA have been available. The goals of this study are to (1) describe the contribution of principal muscles around the shoulder by electromyographyand (2) access the range of motion of 5 movements of patients with RTSA compared with normal shoulders.

This is an observational prospective cohort study of 21 patients divided into 11 patients with RTSA and 10 controls. The muscular activity was recorded with bipolar cutaneous electrodes, whereas the range of motionwas synchronized and recorded by 8 motion cameras. Five movements (flexion, abduction, neutral external rotation, external rotation in 90° of abduction, and internal rotation in 90° of abduction) were studied.

The upper trapezius is the main activator in all ding those muscles could demonstrate better and more homogeneous results and increase patient satisfaction.

Athletes demonstrate high levels of physical function, leading to difficulties in patient-reported outcome scoring and interpretation. In particular, the ability of patient-reported outcome (PRO) instruments to adequately discriminate between high levels of upper extremity function-that is, the ceiling effect-is limited. This study evaluated performance characteristics of the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) survey and Patient-Reported Outcomes Measurement Information System (PROMIS) metrics in a population of Division 1 intercollegiate athletes, with specific attention to ceiling effects.

At a single institution, Division I intercollegiate athletes cleared for full participation in the 2018-2019 season were eligible. The following PROs were collected prospectively via tablet computer PROMIS upper extremity (UE) computer adaptive test (CAT), PROMIS physical function (PF) CAT, QuickDASH, and QuickDASH Sports/Performing Arts Module. Descriptive statistics, andited in their ability to assess and discriminate upper extremity function in highly functioning individuals such as Division I athletes. The PROMIS PF CAT, a measure of general physical function, did not suffer from a large ceiling effect.

The American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form is one of the most frequently used outcomes score for shoulder pathology. The patient reportsection of the ASES questionnaire (p-ASES) is easy to complete, can be quickly administered, and is applicable to a wide range of shoulder pathologies, yet a validated Spanish translation of this questionnaire does not currently exist for diverse Spanish-speaking populations. The purpose of this study was to translate and culturally adapt the patient reportsection of the ASES to Spanish and to assess its validity and reliability among a culturally diverse group of Spanish-speaking patients, typically seen in the United States.

The p-ASES Standardized Shoulder Assessment Form was translated into Spanish using a universal approach for translation and cultural adaptation of instruments. A total of 127 Spanish-speaking patients with shoulder pain were included in the study and asked to complete the Spanish translated p-ASES form, the ASES is both a valid and reliable tool for assessing shoulder function in Spanish-speaking patients from diverse cultural backgrounds and it demonstrates psychometric properties equivalent to those of the English-language version.

The Spanish p-ASES is both a valid and reliable tool for assessing shoulder function in Spanish-speaking patients from diverse cultural backgrounds and it demonstrates psychometric properties equivalent to those of the English-language version.Storage requirements and outdating of platelets represent a continued challenge for blood banks. These hurdles are confounded for rural area hospitals or in military deployments. Over 60 years of research and development into frozen platelets have generated a stable and reproducible product. Valeri’s method to freeze platelets in 6% dimethyl sulfoxide (DMSO) and storage at -80°C allows for long-term storage alleviating burdens placed on blood banks. Clinical studies show that frozen platelet transfusions are safe with no related thrombotic or other serious adverse events. There are ongoing efforts to demonstrate cryopreserved platelet (CPP) superiority in efficacy studies designed in trauma or cardiac surgery patients. Technical advances in CPP manufacturing including closed system manufacturing, applications of pathogen reduction technology and potency standard characterization add to the appeal of CPP as an alternative to traditional liquid-stored platelets (LP) in settings of supply shortages, mass casualty, active bleeding, rapid provision of HLA-compatible platelets, and remote care.