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https://www.readbyqxmd.com/read/27913539/prevention-of-central-nervous-system-sequelae-in-sickle-cell-disease-without-evidence-from-randomized-controlled-trials-the-case-for-a-team-based-learning-collaborative
#1
Michael R DeBaun, Allison A King
Since 1998, the National Institutes of Health has funded 5 randomized controlled trials (RCTs) for primary and secondary prevention of strokes in children with sickle cell anemia (SCA). In a systematic fashion, these trials have significantly advanced the care of children with SCA. In the absence of an RCT, clinicians are often compelled to make decisions at the bedside, based on experience, observational studies, and principles of hematology. We will provide an initial example that describes how a team-based, learning collaborative developed a multisite standard care protocol with a low budget (<$10 000 per year) to overcome the intrinsic limitations of advancing the care of neurologic complications in sickle cell disease (SCD)...
December 2, 2016: Hematology—the Education Program of the American Society of Hematology
https://www.readbyqxmd.com/read/27909651/hybrid-decompression-and-fixation-technique-for-the-treatment-of-multisegmental-cervical-spondylotic-myelopathy
#2
Barón Zárate-Kalfopulos, Walter Araos-Silva, Alejandro Reyes-Sánchez, Luis Miguel Rosales-Olivarez, Armando Alpizar-Aguirre, Francisco Lopez Melendez
BACKGROUND: Cervical spondilotic myelopathy (CSM) is defined as the compromise of the spinal cord due to degenerative changes of the cervical spine. It is the most common cause of spinal cord dysfunction in patients over 55 years. An early surgical management it is paramount to achieve better neurological outcome. There is still controversy regarding the appropriate surgical treatment for multisegmental CSM involving three or more levels. The hybrid decompression and fixation technique combines one or two level corpectomy and a single level discectomy in order to obtain optimum decompression and fixation in patients with multilevel cervical myelopathy...
2016: International Journal of Spine Surgery
https://www.readbyqxmd.com/read/27903177/follow-up-results-of-brain-metastasis-patients-undergoing-repeat-gamma-knife-radiosurgery
#3
Takao Koiso, Masaaki Yamamoto, Takuya Kawabe, Shinya Watanabe, Yasunori Sato, Yoshinori Higuchi, Tetsuya Yamamoto, Akira Matsumura, Hidetoshi Kasuya
OBJECTIVE Stereotactic radiosurgery (SRS) without upfront whole-brain radiotherapy (WBRT) has influenced recent treatment recommendations for brain metastasis patients. However, in brain metastasis patients who undergo SRS alone, new brain metastases inevitably appear with relatively high incidences during post-SRS follow-up. However, little is known about the second SRS results. The treatment results of second SRS were retrospectively reviewed, mainly for newly developed or, uncommonly, for recurrent brain metastases in order to reappraise the efficacy of this treatment strategy with a special focus on the maintenance of neurological status and safety...
December 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27861447/diagnostic-accuracy-of-neuromonitoring-for-identification-of-new-neurologic-deficits-in-pediatric-spinal-fusion-surgery
#4
Victor M Neira, Kamyar Ghaffari, Srinivas Bulusu, Paul J Moroz, James G Jarvis, Nicholas Barrowman, William Splinter
BACKGROUND: Intraoperative neuromonitoring (IONM) modalities, transcranial motor-evoked potentials (TcMEPs), and somatosensory-evoked potentials (SSEPs) are accepted methods to identify impending spinal cord injury during spinal fusion surgery. Debate exists over sensitivity and specificity of these modalities. Our purpose was to measure the incidence of new neurologic deficits (NNDs) and estimate sensitivity and specificity of IONM modalities. METHODS: Institutional Ethics Board approval was obtained to review charts of patients younger than 22 years undergoing scoliosis surgery from 2007 to 2014 retrospectively...
December 2016: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/27767401/-awake-clipping-of-cerebral-aneurysms-report-of-initial-series
#5
Saleem I Abdulrauf, Peter Vuong, Ritesh Patel, Raghu Sampath, Ahmed M Ashour, Lauren M Germany, Jonathon Lebovitz, Colt Brunson, Yuvraj Nijjar, J Kyle Dryden, Maheen Q Khan, Mihaela G Stefan, Evan Wiley, Ryan T Cleary, Connor Reis, Jodi Walsh, Paula Buchanan
OBJECTIVE Risk of ischemia during aneurysm surgery is significantly related to temporary clipping time and final clipping that might incorporate a perforator. In this study, the authors attempted to assess the potential added benefit to patient outcomes of "awake" neurological testing when compared with standard neurophysiological testing performed under general anesthesia. The procedure is performed after the induction of conscious sedation, and for the neurological testing, the patient is fully awake. METHODS The authors conducted an institutional review board-approved prospective study of clipping unruptured intracranial aneurysms (UIAs) in 30 consecutive adult patients who underwent awake clipping...
October 21, 2016: Journal of Neurosurgery
https://www.readbyqxmd.com/read/27751795/the-limits-of-electronic-fetal-heart-rate-monitoring-in-the-prevention-of-neonatal-metabolic-acidemia
#6
Steven L Clark, Emily Hamilton, Thomas J Garite, Audra Timmins, Philip A Warrick, Samuel Smith
BACKGROUND: Despite intensive efforts directed at initial training in fetal heart rate interpretation, continuing medical education, board certification/recertification, team training and the development of specific protocols for the management of abnormal fetal heart rate patterns, the goals of consistently preventing hypoxia-induced fetal metabolic acidemia and neurologic injury remain elusive. OBJECTIVE: To validate a recently published algorithm for the management of category II fetal heart rate tracings , examine reasons for the birth of infants with significant metabolic acidemia despite the use of electronic fetal heart rate monitoring and critically examine the limits of EFHRM in the prevention of neonatal metabolic acidemia...
October 14, 2016: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27729811/prolongation-of-greater-occipital-neural-blockade-with-10-lidocaine-neurolysis-a-case-series-of-a-new-technique
#7
David Daewhan Kim, Nabil Sibai
INTRODUCTION: Greater occipital nerve blocks (GONB) have been used for headache but their benefit may be short. Ready et al performed intrathecal injections on rabbits and reported neurologic/histologic changes that required concentrations of at least 8%. Our study tests the hypothesis that the neurolytic effects of GONB with 10% lidocaine can prolong relief. METHODS: After an approval from Henry Ford Hospital Institutional Review Board, a chart review was performed for patients who had GONB with 10% lidocaine...
2016: Journal of Pain Research
https://www.readbyqxmd.com/read/27722805/role-of-computed-tomography-at-a-cancer-center-emergency-department
#8
Jessyca Couto Otoni, Julia Noschang, Thábata Yaedu Okamoto, Diego Rosseman Vieira, Michel Souto Mayor Petry, Lucas de Araujo Ramos, Paula Nicole Vieira Pinto Barbosa, Almir Galvão Vieira Bitencourt, Rubens Chojniak
To evaluate the imaging methods used at the emergency department (ED) of a cancer center, with emphasis on computed tomography (CT). A descriptive, retrospective, single-center study was conducted by reviewing imaging exams and medical records, after approval of the institution's Ethics Review Board. The demographic data, cancer history, and imaging exam requested were evaluated for all patients and the indications and results of head, chest, and abdominopelvic CT scans were also evaluated. During the study period, there were 8710 visits to the ED, and 5999 imaging studies were requested in 3788 patients (43...
October 8, 2016: Emergency Radiology
https://www.readbyqxmd.com/read/27670660/interpretations-of-diffusion-weighted-mr-imaging-by-radiology-residents-in-the-emergency-department-is-diagnostic-performance-influenced-by-the-level-of-residency-training
#9
Sungjae Lee, Hye Jin Baek, Hyun Kyung Jung, Jin Il Moon, Soo Buem Cho, Bo Hwa Choi, Kyungsoo Bae, Kyung Nyeo Jeon, Dae Seob Choi, Hwa Seon Shin, Dong Wook Kim
BACKGROUND: To evaluate the diagnostic performance of radiology residents' interpretations for diffusion-weighted MR imaging (DWI) in the emergency department at different levels of residency training. METHOD AND MATERIALS: A total of 160 patients who underwent DWI with acute neurologic symptoms were included in this retrospective study with an institutional review board approval. Four radiology residents with different training years and one attending neuroradiologist independently assessed the DWI results...
September 26, 2016: La Radiologia Medica
https://www.readbyqxmd.com/read/27633169/microembolization-is-associated-with-transient-cognitive-decline-in-patients-undergoing-carotid-interventions
#10
Elizabeth Hitchner, Brittanie D Baughman, Salil Soman, Becky Long, Allyson Rosen, Wei Zhou
OBJECTIVE: Carotid interventions are important in helping to reduce the risk of stroke for patients with high-grade carotid artery stenosis; however, subclinical cerebral microemboli can occur during these procedures. Associations have been found between the incidence of microemboli and postoperative decline in memory. We therefore sought to determine whether this decline persisted long-term and to assess changes in other cognitive domains. METHODS: Patients were prospectively recruited under an Institutional Review Board-approved protocol at a single academic center...
September 12, 2016: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/27618632/clinical-neuropsychology-in-south-korea
#11
Myung-Sun Kim, Jeanyung Chey
OBJECTIVE: Clinical neuropsychology in South Korea, albeit its relatively short history, has advanced dramatically. We review a brief history and current status of clinical neuropsychology in South Korea. METHOD: The history, the educational pathway, the training pathway, the certification process, and careers in clinical neuropsychology in South Korea are reviewed. RESULTS: We have reviewed the neuropsychological services, including assessment and treatment, research on neurological and psychiatric populations, and neuropsychology education and the requirements related to education, training, and board examinations of those providing neuropsychological services in South Korea...
November 2016: Clinical Neuropsychologist
https://www.readbyqxmd.com/read/27603197/soft-tissue-injury-severity-is-associated-with-neurovascular-injury-in-pediatric-supracondylar-humerus-fractures
#12
Christine A Ho, David A Podeszwa, Anthony I Riccio, Robert L Wimberly, Brandon A Ramo
BACKGROUND: Neurovascular injury in pediatric supracondylar fractures (SCHFx) has been associated with fracture classification but not with soft tissue injury. The purpose of this study is to correlate clinical soft tissue damage to neurovascular injuries in SCHFx. METHODS: This is an institutional review board approved prospective study from January 2010 through December 2013 of 748 operatively treated pediatric SCHFx. Prospective data were gathered both preoperatively and intraoperatively regarding detailed neurovascular examination as well as soft tissue status, with qualitative descriptives for swelling (mild/moderate/severe), ecchymosis, abrasions, skin tenting, and skin puckering...
September 3, 2016: Journal of Pediatric Orthopedics
https://www.readbyqxmd.com/read/27599997/p2y12-hyporesponse-pru-200-is-not-associated-with-increased-thromboembolic-complications-in-anterior-circulation-pipeline
#13
Matthew T Bender, Li-Mei Lin, Geoffrey P Colby, Daniel Lubelski, Judy Huang, Rafael J Tamargo, Alexander L Coon
INTRODUCTION: Recent reports suggest that thromboembolic complications are associated with Pipeline embolization device (PED) placement cluster in P2Y12 hyporesponders. OBJECTIVE: To evaluate the role of P2Y12 hyporesponse in PED placement by retrospectively reviewing a single-center series of patients. METHODS: We retrospectively reviewed an institutional review board-approved database of patients with an aneurysm at a single institution and identified all patients with a measured P2Y12 reaction unit (PRU)>200 who had undergone anterior circulation PED placement...
September 6, 2016: Journal of Neurointerventional Surgery
https://www.readbyqxmd.com/read/27591775/a-case-matched-study-of-stereotactic-radiosurgery-for-patients-with-brain-metastases-comparing-treatment-results-for-those-with-versus-without-neurological-symptoms
#14
Takao Koiso, Masaaki Yamamoto, Takuya Kawabe, Shinya Watanabe, Yasunori Sato, Yoshinori Higuchi, Tetsuya Yamamoto, Akira Matsumura, Hidetoshi Kasuya, Bierta E Barfod
We aimed to reappraise whether post-stereotactic radiosurgery (SRS) results for brain metastases differ between patients with and without neurological symptoms. This was an institutional review board-approved, retrospective cohort study using our prospectively accumulated database including 2825 consecutive BM patients undergoing gamma knife SRS alone during the 15-year period since July 1998. The 2825 patients were divided into two groups; neurologically asymptomatic [group A, 1374 patients (48.6 %)] and neurologically symptomatic [group B, 1451 (51...
September 3, 2016: Journal of Neuro-oncology
https://www.readbyqxmd.com/read/27580518/quantifying-global-brain-metabolite-level-changes-with-whole-head-proton-mr-spectroscopy-at-3t
#15
Matthew S Davitz, William E Wu, Brian J Soher, James S Babb, Ivan I Kirov, Jeffrey Huang, Girish Fatterpekar, Oded Gonen
BACKGROUND AND PURPOSE: To assess the sensitivity of non-localized, whole-head (1)H-MRS to an individual's serial changes in total-brain NAA, Glx, Cr and Cho concentrations - metabolite metrics often used as surrogate markers in neurological pathologies. MATERIALS AND METHODS: In this prospective study, four back-to-back (single imaging session) and three serial (successive sessions) non-localizing, ~3min (1)H-MRS (TE/TR/TI=5/10(4)/940ms) scans were performed on 18 healthy young volunteers: 9 women, 9 men: 29...
January 2017: Magnetic Resonance Imaging
https://www.readbyqxmd.com/read/27576212/visual-determination-of-conjugate-eye-deviation-on-computed-tomography-scan-predicts-diagnosis-of-stroke-code-patients
#16
Ilana Spokoyny, James Y Chen, Rema Raman, Karin Ernstrom, Kunal Agrawal, Royya F Modir, Dawn M Meyer, Brett C Meyer
BACKGROUND: Head computed tomography (CT) is critical for stroke code evaluations and often happens prior to completion of the neurological exam. Eye deviation on neuroimaging (DeyeCOM sign) has utility for predicting stroke diagnosis and correlates with National Institutes of Health Stroke Scale (NIHSS) gaze score. We further assessed the utility of the DeyeCOM sign, without complex caliper-based eye deviation calculations, but simply with a visual determination method. METHODS: Patients with initial head CT and final diagnosis from an institutional review board-approved consecutive prospective registry of stroke codes at the University of California, San Diego, were included...
August 26, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27554691/modifiable-factors-leading-to-increased-length-of-stay-after-carotid-endarterectomy
#17
James H Mehaffey, Damien J LaPar, Margret C Tracci, Kenneth J Cherry, John A Kern, Irving Kron, Gilbert R Upchurch
BACKGROUND: Carotid endarterectomy (CEA) is a commonly performed vascular operation. Yet, postoperative length of stay (LOS) varies greatly even within institutions. In this study, the morbidity and mortality, as well as financial impact of increased LOS were reviewed to establish modifiable factors associated with prolonged hospital stay. METHODS: The Society for Vascular Surgery Vascular Quality Initiative database was used to identify all patients undergoing primary CEA at a single institution between June 1, 2011 and November 28, 2014...
August 20, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27554343/the-spectrum-of-epilepsy-and-electroencephalographic-abnormalities-due-to-shank3-loss-of-function-mutations
#18
J Lloyd Holder, Michael M Quach
OBJECTIVE: The coincidence of autism with epilepsy is 27% in those individuals with intellectual disability.(1) Individuals with loss-of-function mutations in SHANK3 have intellectual disability, autism, and variably, epilepsy.(2-5) The spectrum of seizure semiologies and electroencephalography (EEG) abnormalities has never been investigated in detail. With the recent report that SHANK3 mutations are present in approximately 2% of individuals with moderate to severe intellectual disabilities and 1% of individuals with autism, determining the spectrum of seizure semiologies and electrographic abnormalities will be critical for medical practitioners to appropriately counsel the families of patients with SHANK3 mutations...
October 2016: Epilepsia
https://www.readbyqxmd.com/read/27548346/dynamic-contrast-enhanced-magnetic-resonance-imaging-suggests-normal-perfusion-in-normal-appearing-white-matter-in-multiple-sclerosis
#19
Michael Ingrisch, Steven Sourbron, Sina Herberich, Moritz Jörg Schneider, Tania Kümpfel, Reinhard Hohlfeld, Maximilian F Reiser, Birgit Ertl-Wagner
OBJECTIVES: Multiple sclerosis (MS) is a chronic, inflammatory disease of the central nervous system and has been associated with reduced perfusion in normal-appearing white matter (NAWM). The magnitude of this hypoperfusion is unclear. The present study aims to quantify NAWM perfusion with dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in patients with relapsing-remitting (RR) MS and in a control group. MATERIALS AND METHODS: The statistical power of a DCE-MRI acquisition to reveal hypoperfusion in MS was estimated using a Monte Carlo simulation: synthetic tissue curves with a contrast-to-noise ratio of 8 were generated for MS patients and control group using perfusion values reported in previous studies...
August 19, 2016: Investigative Radiology
https://www.readbyqxmd.com/read/27466236/scissor-spinal-cord-injury-study-on-small-molecule-derived-rho-inhibition-a-clinical-study-protocol
#20
Marcel A Kopp, Thomas Liebscher, Ralf Watzlawick, Peter Martus, Stefan Laufer, Christian Blex, Ralf Schindler, Gerhard J Jungehulsing, Sven Knüppel, Martin Kreutzträger, Axel Ekkernkamp, Ulrich Dirnagl, Stephen M Strittmatter, Andreas Niedeggen, Jan M Schwab
INTRODUCTION: The approved analgesic and anti-inflammatory drugs ibuprofen and indometacin block the small GTPase RhoA, a key enzyme that impedes axonal sprouting after axonal damage. Inhibition of the Rho pathway in a central nervous system-effective manner requires higher dosages compared with orthodox cyclooxygenase-blocking effects. Preclinical studies on spinal cord injury (SCI) imply improved motor recovery after ibuprofen/indometacin-mediated Rho inhibition. This has been reassessed by a meta-analysis of the underlying experimental evidence, which indicates an overall effect size of 20...
2016: BMJ Open
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