Degree Of Neurological Deficit Research Articles

Application of mathematical modeling methods in the evaluation of severity of ischemic stroke in patients with arterial hypertension

To study the possibility of applying methods of mathematical modeling in assessing the severity of ischemic stroke in patients with arterial hypertension. The study included 80 patients with ischemic stroke. Blood pressure was measured. Transcutaneous polarography was used to measure the oxygen tension in tissues. Measurements of gas composition of the blood and thickness of the intima-media complex were performed. The level of stable metabolites of nitric oxide in the blood was determined. Measurement of endothelin-1 in the blood was performed by enzyme immunoassay. NIHSS scale was administered to assess the neurological status. Patients were divided into 3 groups according to the degree of neurological deficit. The control group consisted of 10 people without signs of vascular pathology. An increase in the neurological deficit was accompanied by an increase in the level of endothelin-1, a decrease in the level of stable metabolites of nitric oxide, and a reduction in tissue oxygenation. Discriminative functions were developed for each group of patients using discriminant analysis based on the data obtained in the study. The most statistically significant were two signs: the level of systolic blood pressure and the content of stable metabolites of nitric oxide in the blood. Thus, the imbalance in the indices of endothelium-dependent mechanisms of vascular tone regulation reflect the severity of the condition in ischemic stroke. The method of discriminant analysis allows the creation of sufficiently reliable mathematical models that can have practical significance, and can be used as a method of clarifying the severity of the condition in the acute period of ischemic stroke.

Recovery of Neurological Injury in Patients with Thoracolumbar Spine Fracture Relevant to the Fracture Pattern

AbstractBackground: Thoracolumbar fracture is the most common skeletal injury of the axial skeleton and accounts for around 90% of all spinal fractures. Spinal cord injury occurs in about 10-30%of traumatic spinal fractures. Many studies included age of the patients and initial canal compromise as variables associated with neurological recovery after neurologic injury with spinal fracture but little documentation in the literature is found on the relationship between fracture patterns assessed by AO classification and neurologic recovery.Aim of Study: To analyze the relationship between fracture patterns according to AO classification and neurological recovery in patients with thoracolumbar spine fracture who underwent transpedicular screw fixation with or without canal decompression.Patients and Methods: The 60 patients (38 men and 22 women) in this series had a follow-up of 12 months, and they were all managed surgically. AO classification had been used prospectively to determine the fracture pattern. Frankel scale was obtained before surgery, after surgery and at the final follow-up.Results: AO-type B fractures were the commonest. The degree of neurologic deficits seen at admission was the greatest in AO-type C and the least in AO-type A while at final follow-up it was greatest in AO-type C and least in AO-type B. The neurologic recovery was the best in AO-type B, assessed by Frankel grading. The neurologic recovery was greater in the lumbar spinal fractures than the thoracic spinal fractures.Conclusions: In conclusion, there is a significant relation between the AO classification fracture pattern and neurological insult and the percentage of neurological recovery. The fracture level is correlated with the percentage of neurological recovery. There is no relation between the degree of canal compromise and the pre-operative neurological deficit in patient. The percentage of neurological recovery is relatively better in patients undergo canal decompression compared with those don't.

Scalp-cluster acupuncture with electrical stimulation can improve motor and living ability in convalescent patients with post-stroke hemiplegia

OBJECTIVETo determine whether patients with post-stroke hemiplegia could benefit from long-term treatment with scalp cluster (SC) acupuncture combined with electrical stimulation (ES) and to evaluate the feasibility of this treatment to improve motor and living abilities. METHODSTwenty patients were enrolled and divided into two groups: SC acupuncture and SC acupuncture with ES (SC and SC + ES, respectively). All participants also received rehabilitation training. All participants were blindly evaluated using the Fugl-Meyer assessment scale for motor ability, the modified Barthel Index for living ability, and a scale for the degree of neurological deficits. Outcome was assessed at three points before randomized grouping, at the beginning or treatment, and after 4 weeks of treatment. RESULTSFollowing 4 weeks treatment, all the patients exhibited significant improvements in aspects of motor ability, living ability, and the severity of neurological deficits. The experimental group (SC + ES) scored higher on the Fugl-Meyer assessment scale (68 ± 12) and the modified Barthel Index (49 ± 9) than the control (SC) group (50 ± 13, 36 ± 13, respectively). CONCLUSIONWhen patients with post-stroke hemiplegia are treated using SC acupuncture with ES, motor and living ability can improve more than if they were treated with SC acupuncture alone.

Ultra-high-b radial diffusion-weighted imaging (UHb-rDWI) of human cervical spinal cord.

Injury in the cervical spinal cord (CSC) can lead to varying degrees of neurologic deficit and persistent disability. Diffusion tensor imaging (DTI) is a promising method to evaluate white matter integrity and pathology. However, the conventional DTI results are limited with respect to the specific details of neuropathology and microstructural architecture. In this study we used ultrahigh-b radial-DWI (UHb-rDWI) with b-values ranging from 0 to ∼7500 s/mm2 and calculated decay constant (DH ) at the high b-values, which gives much deeper insight about the microscopic environment of CSC white matter. To evaluate a novel diffusion MRI, UHb-rDWI technique for imaging of the CSC. Longitudinal. Four healthy controls, each scanned twice. 3T/2D single shot diffusion-weighted stimulated echo planar imaging with reduced field of view. The signal from each pixel of b0 (b = 0) and b-value (b ≠ 0) images were fitted to a biexponential function and normalized. The signal-b curve is obtained by dividing the latter curve by the former. DH was obtained from the curve at b >4000 s/mm2 . A Monte-Carlo Simulation (MCS) was performed to investigate how DH changes upon the increased water-exchange at the CSC. The signal-b curves plotted at multiple levels of healthy CSC are almost identical on two successive scans and show a biexponential decay behavior: fast exponential decay at lower b-values and much slower decay at UHb-values. The mean values of DH were measured as (0.0607 ± 0.02531) ×10-3 and (0.0357 ± 0.02072) ×10-3 s/mm2 at the lateral funiculus and posterior column, respectively. MCS of diffusion MRI shows that the DH is elevated by increased water exchange between the intra- and extraaxonal spaces. UHb-rDWI signal-b plots of the normal CSC were highly reproducible on successive scans and their biexponential decay behavior can be used to characterize normal spinal white matter. 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;49:204-211.

Evaluation of Transpedicular Surgical Decompression withLong Segment Stabilization in Thoracic and Thoracolumbar SpinalTuberculosis

Pott’s disease is a common cause of neurological complications and kyphotic deformity.When deformity progressed that may lead to painful costo-pelvic impingement, respiratory distress, risk of paralysis of muscle of lower limb and consequent reduction in quality andlongevity oflife. The treatmentstrategy is to avoid neurological complication and achieve a near normal spine. In tuberculosis, spinal column may become unstable. Pathological fracture or dislocation of a diseased vertebral body may occur due to mechanical insult. Surgical decompression causefurther instability.The insertion of a metallic implant is to provide stability. Pedicle screw fixation in kyphotic correction in old Pott’s disease is a most suitable device.This prospective interventionalstudywas conducted in BanglabandhuSheikh Mujib Medical University (BSMMU) for aperiod of 60 monthsfrom July 2011, with at leasttwo years follow-up period. Twentycases (13 males and 7 females) of thoracolumbar spinal tuberculosis with neurological deficit were operated with a transpedicular decompression and screw fixation along with anti-tubercular drug treatment. All of these patients had varying degrees of neurological deficit and single level involvement with vertebral body destruction and mild kyphosis of 9–28 degrees. Long segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage.The mean age of patients was 50.9 and kyphosis improved from 17.85±1.37 degrees to 10.85±2.66 degrees (p=0.0206).Neurological recovery occurred in 18 patients (90%). Bony fusion was achieved in 67.5% cases. At 2-years follow-up mean visual analogue score (VAS) score improved from 5.5 to 0.75 (p=0.0031).So, posterior decompression and transpedicular stabilization with continued chemotherapy is a good treatment option for the management of the thoracic and thoracolumbar TB in patients with vertebral body destruction and <30degree kyphosis.

LONG-TERM RESULTS OF SURGICAL TREATMENT IN PATIENTS WITH INTRADURAL SPINAL TUMORS

Background: Intradural spinal cord tumors include extramedullary and intramedullary tumors. The search for literature sources in the Pubmed, Medline, and E-Library databases detected a little number of researches on the long-term results of the surgical treatment of intradural spinal cord tumors. These clinical series include a small number of patients and do not consider the factors influencing clinical outcomes of surgical treatment.Aim: To evaluate the long-term results of surgical treatment in patients with intradural spinal cord tumors, to identify the main factors influencing the clinical and neurological outcomes of surgical interventions in this group of patients.Materials and methods: The study included 277 medical records of 244 patients with intradural extramedullary and 33 patients with intradural intramedullary tumors of the spinal cord. Clinical-neurological outcomes of surgical treatment in patients with intradural spinal cord tumors and factors influencing the outcomes were analyzed.Results: When comparing the degree of neurologic deficit in patients with intradural extramedullary tumors prior to surgery, no significant differences were found (p=0.241) both in the early postoperative period and 6 months after the surgery. Nevertheless, when comparing these indicators in a period of 12, 24, 36, 48, and 60 months after the surgery, statistically significant differences were revealed (p0.001). There was no statistically significant difference (p=0.437) between the scores in patients with intramedullary tumors on the modified McCormick Scale preoperatively, at the 6-month and one-year follow-up; however, comparison of the clinical and neurological indicators at 24, 26, 48, and 60 months revealed a significant difference (p0.001). The surgery outcomes in considered groups of patients were significantly influenced by the following indicators: the ASA risk level (odds ratio (OS) 2.138; 95% confidence interval (95% CI) 3.346–12.145) and intraoperative neurophysiological monitoring (OR 2.84; 95% CI 1.67–9.56).Conclusion: The study registered good and excellent long-term outcomes in most cases of intradural spinal cord tumors when the maximum possible tumor excision was performed. Analysis of the influence of various factors on the clinical and neurological outcomes in the study group of patients showed that the use of intraoperative neurophysiological monitoring and the degree of operational and anesthetic risk according to the ASA scale have a significant effect.

Post-stroke cognitive impairment (results of a 5-year follow-up)

Prior stroke plays an important role in the development of cognitive impairment (CI), the prevention of which requires detailed study. Patients and methods . A total of 350 patients (mean age, 65±17.7 years; 49% men) who had experienced a stroke with a small degree of neurological deficit were followed up. Cognitive functions were evaluated using the Mini-Mental State Examination (MMSE), Mattis dementia rating scale, the clock drawing test, the test on memorizing 12 words, and the Schulte table. During 5 years of follow-up, 61 (17.4%) patients died, including 45 (12.8%) from recurrent stroke; 89 recurrent strokes developed. Results . The first examination did not reveal CI in 59 (17%) patients; 73 (21%) were found to have marked CI (mild or moderate dementia). After 1, 3, and 5years of follow-up, the proportion of patients with marked CI increased up to 23.2, 29.5, and 34.5%, respectively. Within 5 years, there was an average decline of 2 MMSE scores. The maximum decrease in cognitive functions was seen in patients who had experienced a recurrent stroke, but this also occurred in the absence of a stroke. Cognitive functions were substantially better in a group of patients with blood pressure (BP) normalization. Conclusion . The 5-year follow-up has shown that post-stroke CI gradually progresses, which is associated with the progression of both vascular disease and a concomitant neurodegenerative process. BP normalization during antihypertensive therapy contributes to the prevention of progressive post-stroke CI.

Anaerobic bacterial meningitis in adults

Anaerobic infection is a very uncommon condition in adult bacterial meningitis (ABM), and its clinical characteristics have yet to be clarified. We enrolled 540 patients with culture-proven bacterial meningitis during a study period of 30 years (1986–2015), of whom 13 (2.4%) had anaerobic infections. These 13 patients were eight men and five women, aged 22–77 years. Among them, 53.8% (7/13) had a postneurosurgical state as the preceding event, and 79.6% (10/13) had underlying medical conditions including diabetes mellitus, malignancy, liver cirrhosis, cerebral infarct and alcoholism. Nosocomial and mixed infections were found in 15.5% (2/13) and 46.1% (6/13) of the patients, respectively. A total of 14 anaerobic strains were isolated from cerebrospinal fluid specimens, including nine Gram-negative (G(−)) strains: Fusobacterium nucleatum (3), Prevotella species (3) and Bacteroides fragilis (3), and five Gram-positive (G(+)) strains: Propionibacterium acnes (3) and Peptostreptococcus micros (also known as Parvimonas micra) (2). All of the implicated G(+) anaerobic bacteria were susceptible to penicillin, and no multiple drug-resistant strains were found among the implicated G(−) anaerobic bacteria. Despite treatment, 30.8% (4/13) of the patients died. Of the nine survivors, 22.2% (2/9) had a full recovery, while the other 77.8% (7/9) had varying degrees of neurological deficits. Compared with the good outcome group (n = 6, modified Rankin scale (mRS) scores: 0–2), the poor outcome group (n = 7, mRS scores ≧3) had higher incidence of seizure. These results may offer a preliminary view of the clinical characteristics of anaerobic ABM.

Outcome Analysis of the Flow Diversion with Pipeline Embolization Device for the Surgical Treatment of Unruptured Large and Giant Paraclinoid Carotid Aneurysms

Background: Both the high frequency of recurrence of large or giant paraclinoid aneurysms (PA) of the internal carotid artery and the occurrence of intra- and postoperative complications, leading to unsatisfactory results of surgical treatment of this group of patients, make the stated problem urgent. Flow-diverter embolization devices are actively used in many large international neurosurgical centers for the treatment of cerebral aneurysms of different morphology, size, and localization. Currently, there are very few reports on the effectiveness of the use of flow diverting stents in the surgical treatment of large and giant PA of the internal carotid artery. The results of these studies are controversial and largely contradictory. Aim: Outcome analysis of the use of Pipeline embolization device (PED) for the surgical treatment of large and giant carotid PA. Methods: The study enrolled 37 patients (25 women, 12 men; mean age 51.7±10.7 years) who were divided into those treated with the PED alone versus those treated with the PED and concurrent coil embolization. The average follow-up period was 19.7±3.8 months. Results: In 56.7% of cases, PA caused the development of an insignificant neurological deficit (Modified Rankin Scale 1−2). In 18.9% of patients, PA provoked a gross neurologic deficit (MRS 3−5). 24.3% of patients with PA did not have any clinical-neurological manifestations. After the surgery, neurologic status improved in 32.4% of patients, remained the same — in 45.9% of cases, and the degree of neurologic deficit increased in 21.6%. PED procedure was performed in 70.2% of patients. In 29.7% of cases, the dislocation of large or giant PA of the internal carotid artery from the systemic blood stream was performed using PED and concurrent coil embolization. At the indicated period of patient observation, complete occlusion of large and giant carotid PA was achieved in 75.6% of cases, almost complete and partial occlusion — in 24.3%. The incidence of thromboembolic and hemorrhagic complications was 10.8% and 8.1%, respectively. Mortality rate among patients was 2.7%. Conclusions: The use of PED is an effective method for occluding large or giant PA of the internal carotid artery. Nevertheless, this method of endovascular treatment of PA is associated with a high complication incidence.

Abstract WP258: Unique Properties Associated With the Iron Chelator HBED Reveal Remarkable Beneficial Effect After Brain Trauma

Introduction: Iron is postulated to contribute to secondary injury after brain trauma through many pathways. Iron participates in the oxidative stress and inflammation processes. The N,N’-Bis(2-hydroxybenzyl)ethylenediamine-N,N’-diacetic acid (HBED) is a unique iron chelator as it has ability to cross the blood brain barrier, higher affinity to iron, and longer half-life than most commonly used chelators. Hypothesis: Our study is investigating the efficacy of HBED in protecting brain tissue and improving behavioral outcomes after brain trauma. We are also exploring the histological and biochemical mechanisms behind its beneficial effect. Methods: WT C57BL/6 mice were injected with HBED SQ after TBI and then twice a day till an end point of 3 days. Controlled-cortical impact trauma model was used to inflict injury. Neurobehavioral tests were performed to assess the degree of neurological deficit and short-term recovery over 3 days. We determined cortical Injury volume, hemispheric volume, hippocampal swelling, and corpus callusom volume/thickness. Perls’ and immunohistochemical staining analysis is being performed to assess iron deposits and to inspect microgliosis, oxidative stress injury, and determine the astrocyte roles in regulating brain edema. Results: Thus far, data revealed that HBED treatment significantly decreases motor deficits and improves short term recovery. It also reduces each of cortical injury volume by 36.5±23.5% (p<0.001), hippocampal swelling by 23.3±13.2% (p<0.05), and total hemispheric volume by 13.2±9.5% (p<0.05). Recent data on upcoming results will also be reported. Conclusion: This iron chelator HBED protects against acute traumatic motor deficits and promotes short-term recovery. It reduces cortical injury, hippocampal swelling, and total hemispheric volume after traumatic brain injury. These findings indicate that using HBED in humans may have similar robust effect and ultimately facilitates functional recovery. [This work was supported in part by grants from the McKnight Brain Research Foundation, Brain and Spinal Cord Injury Research Trust Fund, and AHA 33450010, and NIH R21NS095166.]

Effects of serum N-terminal pro B-type natriuretic peptide and D-dimer levels on patients with acute ischemic stroke.

Objective:To detect the serum levels of D-dimer and N-terminal pro B-type natriuretic peptide (NT-pro BNP) in patients with Acute Ischemic Stroke (AIS), and to explore the risk factors of AIS.Methods:A total of 246 AIS patients treated in our hospital from January 2015 to January 2017 were selected. Meanwhile, 240 healthy subjects were selected as a control group. The D-dimer and NT-pro BNP levels of the two groups were compared. Correlations of such levels with age, gender, blood lipid, Intima-Media Thickness (IMT), fibrinogen and degree of neurological deficits were analyzed.Results:The AIS group had significantly higher levels of Triglyceride (TG), Low-Density Lipoprotein (LDL), D-dimer, NT-pro BNP and fibrinogen as well as IMT than those of the control group, but the High-Density Lipoprotein (HDL) level of the AIS group was significantly lower (P<0.05). The patients with different genders and ages had significantly different D-dimer and NT-pro BNP levels (P<0.05). The D-dimer and NT-pro BNP levels were correlated with gender and age. Such levels of females were significantly higher than those of males (P<0.05). The D-dimer and NT-pro BNP levels of the ≥60 years old group significantly exceeded those of the <60 years old group (P<0.05). The levels of D-dimer and NT-pro BNP were negatively correlated with that of HDL (P<0.05), but positively correlated with TG, LDL and fibrinogen levels, IMT, and National Institutes of Health Stroke Scale score (P<0.05). Multivariate Logistic regression analysis showed that the OR values of D-dimer and NT-pro BNP were 3.65 and 6.96 respectively.Conclusion:Serum D-dimer and NT-pro BNP levels usually increased in AIS patients, and the levels were significantly correlated with AIS onset.

Использование ультразвуковой допплерографии для объективной оценки изменений пенильной гемодинамики в генезе эректильной дисфункции у больных рассеянным склерозом

In order to assess the incidence and nature of violations of penile hemodynamics in the genesis of erectile dysfunction in patients with multiple sclerosis, data on pharmacodopplerometry of penile vessels in 151 men divided into 3 groups (patients with multiple sclerosis divided into 2 groups by severity and control group of healthy juniper) we are studied. On the basis of ultrasound dopplerography and spectral analysis, a significant decrease in blood flow along the arteries of the penis was found in patients with severe neurological disorders in 22.5% of cases with preserved functional capabilities of cavernous bodies. With a slight degree of neurological deficit in most patients, disorders of arterial blood supply and functional ability of cavernous bodies were not detected.

Evaluation of Surgical Decompression by Laminectomy and Fusion by Strut Graft 3 with Stabilization by Pedicle Screw and Rod in Lumbar Spinal Tuberculosis

Potts disease is a common cause of neurological complications and kyphotic deformity in our country. When deformity progressed that may leads to painful costo-pelvic impingement, respiratory distress, risk of paralysis of muscle of lower limb and consequent reduction in quality, longevity of life. The treatment strategy is to avoid neurological complication and achieve a near normal spine. In TB, spinal column may become unstable. Pathological fracture/dislocation of a diseased vertebral body may occur due to mechanical insult. Surgical decompression cause further instability. The insertion of a metallic implant is to provide stability. Pedicle screw fixation in kyphotic correction in old polls disease is a most suitable device. This prospective interventional study was done on BSMMU for the period of 60 months with minimum follow up period of 2 years. 20 cases (13 males and 7 females) of lumbar spinal tuberculosis with neurological deficit were operated with a transpedicular decompression and screw fixation along with anti-tubercular drug treatment. All of these patients had varying degrees of neurological deficit and single level involvement with vertebral body destruction and mild kyphosis of 5-15 degrees. Long segment pedicle screw fixation, posterior decompression, and correction of kyphosis were performed in single stage. The mean age of patients was 50.9 and kyphosis improved from 10.4+,2.9 degrees to 4.0±1.2 degrees Neurological recovery occurred in 18 patients (90%). Bony fusion was achieved in 67.5% cases. At 2-years follow-up mean VAS score improved from 5.5 to 0.75. So posterior decompression and transpedicular stabilization with continued chemotherapy is a good treatment option for the management of the lumbar TB in patients with vertebral body destruction.

Observation on the effect of Xuesaitong in treating cerebral infarction

Objective To observe the clinical effect of Xuesaitong on cerebral infarction. Methods A total of 116 patients with cerebral infarction were enrolled in this study.116 patients with cerebral infarction were randomly divided into the conventional group (58 cases) and Xuesaitong group (58 cases) according to the digital table.The conventional group was given conventional treatment.The Xuesaitong group was given Xuesaitong based on the conventional treatment.The changes of neurological deficits, cognitive function improvement and daily life ability score and quality of life scores were compared between the two groups before and after treatment. Results The total effective rate and blood vessel recanalization rate of the Xuesaitong group were 96.55% and 98.28%, respectively, which were higher than those in the conventional group (84.48%, 82.76%, χ2=6.344, 4.723, all P<0.05). The scores of neurological deficits, cognitive function scores, daily life ability scores and quality of life scores of the Xuesaitong group were (77.91±3.13)points, (94.18±4.21)points, (12.42±2.23)points and (27.21±4.71)points, respectively, which of the conventional group were (30.44±3.18)points, (80.01±3.59)points, (20.13±4.19)points, (23.41±3.29)points, respectively.The differences were statistically significant between the two groups (t=5.872, 9.76, 6.145, 9.014, all P<0.05). Conclusion Xuesaitong in the treatment of cerebral infarction is effective, which can significantly improve the clinical efficacy, reduce the degree of neurological deficits, improve the patients' cognitive function and daily living ability. Key words: Brain infarction; Xuesaitong; Treatment outcome

Effects of Dl-3-n-butylphthalide on Cerebral Ischemia Infarction in Rat Model by Mass Spectrometry Imaging.

Dl-3-n-butylphthalide (NBP) is a drug that is used in the treatment of ischaemic stroke. However, to the best of our knowledge, there are no systematic studies investigating the effects of dl-3-n-butylphtalide on the brain metabolism of small molecules. In this study, we first investigated the effects of dl-3-n-butylphthalide on the spatial distribution of small molecules in the brains of rats with permanent middle cerebral artery occlusion (pMCAO) using matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI–TOF–MS) imaging. After pMCAO modelling or a sham operation, rats were given four mg/kg of dl-3-n-butylphthalide through the caudal vein or saline once a day for nine days. The degree of neurological deficit in rats was evaluated using the modified neurological severity score (mNSS). MALDI–TOF–MS imaging was used to observe the content and distribution of small molecules related to metabolism during focal cerebral ischaemia. Multiple reaction monitoring (MRM) mode with liquid chromatography tandem mass spectrometry (LC–MS/MS) was used to verify the results obtained from MALDI–TOF–MS imaging. These small molecules were found to be involved in glucose metabolism, ATP metabolism, the glutamate–glutamine cycle, malate aspartate shuttle, oxidative stress, and inorganic ion homeostasis. Of the 13 metabolites identified by MALDI–TOF–MS imaging, seven compounds, ATP, ADP, AMP, GMP, N-acetylaspartic acid, ascorbic acid and glutathione, were further validated by LC–MS/MS. Taken together, these results indicate that dl-3-n-butylphthalide significantly improved ATP metabolism, level of antioxidants, and sodium-potassium ion balance in a rat model of pMCAO.

Effects of electroacupuncture preconditioning on cerebral infarct volume and contents of TNF-α, IL-10 in serum of rats after cerebral ischemia-reperfusion injury

To explore the effect of electroacupuncture(EA) preconditioning on cerebral infarct volume and the contents of TNF-α, IL-10 in serum of rats with cerebral ischemia-reperfusion injury. Thirty-six rats were randomly divided into a sham operation group, a model group and an EA preconditioning group, 12 rats in each group, which were further divided into 12 h and 24 h after reperfusion subgroups, 6 rats in each one. EA was used before model establishment for 2 weeks in the EA preconditioning group. The model of cerebral ischemia-reperfusion injury in rats was established with modified Longa suture method. 12 h and 24 h after reperfusion, the degree of neurological deficit was assessed by the modified behavioral scoring scale; the cerebral infarct volume was measured by TTC method and the contents of TNF-α, IL-10 in serum were detected by ELISA method. Compared with the model group, the neurological severity scores in the EA preconditioning group significantly reduced 12 h and 24 h after reperfusion (both P<0.05), the cerebral infarct volume in the EA preconditioning group significantly reduced 12 h and 24 h after reperfusion (both P<0.05). Compared with the sham operation group, the serum TNF-α, IL-10 contents in the model group increased 12 h and 24 h after reperfusion (both P<0.05). Compared with the model group, the serum TNF-α content reduced, while the serum IL-10 content increased in the EA preconditioning group 12 h after reperfusion (both P<0.05). Compared with the model group, the serum TNF-α, IL-10 contents reduced in the EA preconditioning group 24 h after reperfusion (both P<0.05). EA preconditioning can improve neurological deficit, reduce cerebral infarct volume after cerebral ischemia-reperfusion injury in rats. The mechanism may be related to the regulation of EA on the dynamic balance between pro-inflammatory cytokine TNF-α and anti-inflammatory cytokine IL-10 in peripheral blood of cerebral ischemia-reperfusion injury in acute phase, thus alleviate acute cerebral ischemia-reperfusion inflammatory response.

The Utility of Local Anesthesia for Neurosurgical Interventions in a Low‐Resource Setting: A Case Series

Trauma is a major contributor to global morbidity and mortality, and injury to the central nervous system is the most common cause of death in these patients. While the provision of surgical services is being recognized as essential to global public health efforts, specialty areas such as neurosurgery remain overlooked. This is a retrospective case review of patients with operable lesions, such as extra-axial hematomas and unstable depressed skull fractures that underwent neurosurgical interventions under local anesthesia. A total of 13 patients underwent neurosurgical intervention under local anesthesia. Two and three patients with burr hole decompression of epidural and subdural hematomas, respectively; seven patients had elevation of depressed skull fractures and lastly one patient had an aspiration of a brain abscess. All patients survived with and without residual neurological deficits. Access to resources and staff required to deliver general anesthesia is challenging in resource-poor settings. We have therefore begun performing emergent interventions under local anesthesia, with or without conscious sedation. While some patients had some minor residual weakness after the procedure, the degree of neurological deficit was improved from that observed before the procedure in all patients.

Effect of Anesthetics on Efficiency of Remote Ischemic Preconditioning.

Remote ischemic preconditioning of hind limbs (RIPC) is an effective method for preventing brain injury resulting from ischemia. However, in numerous studies RIPC has been used on the background of administered anesthetics, which also could exhibit neuroprotective properties. Therefore, investigation of the signaling pathways triggered by RIPC and the effect of anesthetics is important. In this study, we explored the effect of anesthetics (chloral hydrate and Zoletil) on the ability of RIPC to protect the brain from injury caused by ischemia and reperfusion. We found that RIPC without anesthesia resulted in statistically significant decrease in neurological deficit 24h after ischemia, but did not affect the volume of brain injury. Administration of chloral hydrate or Zoletil one day prior to brain ischemia produced a preconditioning effect by their own, decreasing the degree of neurological deficit and lowering the volume of infarct with the use of Zoletil. The protective effects observed after RIPC with chloral hydrate or Zoletil were similar to those observed when only the respective anesthetic was used. RIPC was accompanied by significant increase in the level of brain proteins associated with the induction of ischemic tolerance such as pGSK-3β, BDNF, and HSP70. However, Zoletil did not affect the level of these proteins 24h after injection, and chloral hydrate caused increase of only pGSK-3β. We conclude that RIPC, chloral hydrate, and Zoletil produce a significant neuroprotective effect, but the simultaneous use of anesthetics with RIPC does not enhance the degree of neuroprotection.

A Review of Studies of Tongue Deviations in Korean Stroke Patients

Objectives The aim of this review was to compare the findings of 14 studies of tongue diagnosis in Korean stroke patients. Methods The purpose, subjects, observation methods, statistical methods, classification of tongue diagnosis, significance, and limitations were analyzed and compared Results In Korean stroke patients, tongue diagnosis is significant in pattern identifications, prognosis evaluation, degree of neurological deficit, past history, blood tests, and pulse diagnosis. Interobserver reliability of tongue diagnosis is relatively high. Keywords: stroke, tongue diagnosis, Korean traditional medicine

Diagnosis and management of neuropathies associated with plasma cell dyscrasias.

Neuropathies associated with plasma cell dyscrasias are a major cause of morbidity for patients managed by medical oncologists. Because of similarities in clinical presentation and on nerve conduction studies, identifying the underlying disease leading to a paraproteinemic neuropathy can often be difficult. In addition, the degree of neurologic deficit does not strictly correlate with the extent of abnormalities on common clinical laboratory testing. Fortunately, with increasing understanding into the biologic mechanisms of underlying hematologic diseases, additional biomarkers have recently been developed, thus improving our diagnostic capacity. Neuropathies associated with plasma cells dyscrasias are seen with Monoclonal gammopathy of undetermined significance (MGUS) particularly IgM subtype, followed by IgG and IgA MGUS, multiple myeloma, Waldenström's macroglobulinemia, amyloid, Castleman's disease, and POEMS syndrome. The mechanisms of neuronal injury associated with plasma cell dyscrasia vary based on underlying diagnosis and include malignant infiltration, immune-mediated antibody deposition, or local compression of nerve roots. The polyneuropathies are frequently demyelinating, although axonal and mixed neuropathies can also be seen. As demonstrated by the cases included in this review, patients frequently present with symmetric sensory disturbance, followed by progressive motor weakness. Unfortunately, because of the complexity of diagnostic testing, patients are frequently examined late, often after receiving several ineffective therapies. The aim of this case-based review is to provide clinicians with insight on how to properly recognize these atypical neuropathies and send the appropriate diagnostic work, increasing the likelihood of accurately classify the patient's underlying hematologic disorder.