Initial Deficit Research Articles

Contrasting Weather and Stocking Effects on Eucalyptus Initial Coppice Response in Brazil.

In Eucalyptus plantations, coppice rotations often yield less than initial rotations. The TECHS project (Tolerance of Eucalyptus Clones to Hydric, Thermal and Biotic Stresses) studied short rotation coppicing across a 3000 km gradient. The main objective of this work was to compare the survival, sprouting, and initial growth of Eucalyptus clones managed and to examine factors that might influence the productivity of the coppice rotation: climate, genotypes, and stocking. Eight of the TECHS sites spread from latitudes 6° S to 30° S were included in the coppice study, with 17 genotypes at each site. The initial rotation had been planted at a 3 m × 3 m spacing and also in a spacing trial at densities from 500 to 3500 trees ha-1. Six months after harvesting the initial Eucalyptus rotation, average survival was 88%, with tropical clones showing over twice the sprouting biomass (6.7 vs. 2.9 Mg ha-1) and four times the woody biomass compared to subtropical clones (4.7 vs. 1.1 Mg ha-1). Greater initial water deficits had stronger sprouting and growth. Clones with higher belowground carbon allocation in the initial rotation performed better in coppicing, and precipitation became more influential after 12 months. Drought and spacing trials significantly affected growth.

An evaluation of 30 years’ experience in the use of botulinum toxin injections in the management of sixth nerve palsies

ABSTRACT Intrroduction Sixth nerve palsy is the most common type of extraocular muscle palsy. The therapy options in sixth nerve palsies include monitoring with or without conservative treatment, botulinum toxin injections or strabismus surgery. The aim of this retrospective study was to compare botulinum toxin (BT) injections into the medial rectus to conservative treatment in sixth nerve palsies. The rate of patients improved after intervention and treatment outcomes for the two treatment options were be evaluated at a German tertiary referral center. Methods A service evaluation was conducted on adult patients with sixth nerve palsy. Patient files were reviewed and data including abduction deficit and size of deviation were collected retrospectively. Patients which presented between January 1987 and April 2022 were considered. Patients were allocated into two treatment groups: BT injected into medial rectus or conservative treatment, which included observation, providing occlusion and Fresnel prisms. Inclusion criteria were attendance of two visits with orthoptic assessment. Exclusion criteria included presence of further oculomotor palsies, strabismus, strabismus surgery and suppression. Non-parametric statistical analysis was conducted using IBM® SPSS Statistics. Results A total of 606 adult patients with unilateral or bilateral sixth nerve palsy attended during the named period. A total of 137 adult patients met the inclusion criteria. Of which, 36 had a bilateral palsy, 101 had a unilateral palsy. 45.26% (n = 62) were treated with BT injections and 54.75% (n = 75) were treated conservatively. The median initial abduction deficit was greater in the BT group, (−4 to −5 after Scott and Kraft) than in the conservative treatment group (−1). The initial angle of deviation at distance was significantly larger in the BT group than in the conservative treatment group (p = <0.001). The rate of improvement in the BT group was 24.19% (n = 15) and 20% (n = 15) in the conservative treatment group. When excluding longstanding palsies rates of improvement in both groups increased to 28.85%. The improvement of the angle of deviation at distance in all patients was greater in the BT group (p = <.001). The improvement of abduction in bilateral palsies were greater in the BT group (p = .016), but in unilateral palsies, there was no significant difference in abduction improvement in the two treatment groups (OD p = .3, OS p = .406). Conclusion This service evaluation found that BT injection into medial rectus in unilateral and bilateral sixth nerve palsies did not increase the rate of improvement compared to conservative treatment. But BT injections reduced the angle of deviation to a greater extent than conservative treatment. Additionally, BT was able to improve abduction in bilateral palsies to a greater extent than conservative treatment. It is recommended a BT injection is considered in symptomatic bilateral sixth nerve palsies to enable fixation and improved ocular motility. More research is needed to verify reliable clinical guidelines for the use of BT in sixth nerve palsies.

Frontoparietal Structural Network Disconnections Correlate With Outcome After a Severe Stroke.

Structural disconnectome analyses have provided valuable insights into how a stroke lesion results in widespread network disturbances and how these relate to deficits, recovery patterns, and outcomes. Previous analyses have primarily focused on patients with relatively mild to moderate deficits. However, outcomes vary among survivors of severe strokes, and the mechanisms of recovery remain poorly understood. This study assesses the association between lesion-induced network disconnection and outcome after severe stroke. Thirty-eight ischaemic stroke patients underwent MRI brain imaging early after stroke and longitudinal clinical follow-up. Lesion information was integrated with normative connectome data to infer individual disconnectome profiles on a localized regional and region-to-region pathway level. Ordinal logistic regressions were computed to link disconnectome information to the modified Rankin Scale after 3-6 months. Disconnections of ipsilesional frontal, parietal, and temporal cortical brain areas were significantly associated with a worse motor outcome after a severe stroke, adjusted for the initial deficit, lesion volume, and age. The analysis of the underlying pathways mediating this association revealed location-specific results: For frontal, prefrontal, and temporal brain areas, the association was primarily driven by relatively sparse intrahemispheric disconnections. In contrast, the ipsilesional primary motor cortex, the dorsal premotor cortex, and various parietal brain regions showed a remarkable involvement of either frontoparietal intrahemispheric or additionally interhemispheric disconnections. These results indicate that localized disconnection of multiple regions embedded in the structural frontoparietal network correlates with worse outcomes after severe stroke. Specifically, primary motor and parietal cortices might gain particular importance as they structurally link frontoparietal networks of both hemispheres. These data shed novel light on the significance of distinct brain networks for recovery after a severe stroke.

Results of Carotid Endarterectomy Performed at Different Times During the Acute Period of Ischemic Stroke

AIM OF STUDY. To compare the results of carotid endarterectomy performed at different times (1st, 2nd and 3rd week) of the acute period of ischemic stroke.MATERIAL AND METHODS. In the acute period of ischemic stroke (1–21 days), 92 patients with symptomatic stenosis of the internal carotid artery of 50% or more were operated on using carotid endarterectomy . There were 66 men and 26 women. The average age was 65.7±8.4 years. All patients were divided into three groups depending on the timing of the operation: Group 1, where the operation was performed on the 1st week of stroke (n=48); Group 2, where the operation was performed on the 2nd week after stroke (n=28); Group 3, where carotid endarterectomy was performed on the 3rd week after stroke (n=16). In-hospital endpoints of the study in each group were ipsilateral ischemic stroke, any other stroke (contralateral ischemic or hemorrhagic), myocardial infarction, wound hemorrhagic complications requiring repeated operation and surgical hemostasis, death, and major adverse cardiovascular events (stroke + myocardial infarction + fatal outcome).RESULTS. There were no postoperative ipsilateral ischemic strokes, myocardial infarctions, or deaths in the study group (92 patients). In the overall group of patients (n = 92), the incidence of any postoperative stroke was 2.2% (2 patients): one hemorrhagic stroke on the side of carotid endarterectomy (group 3) and one contralateral ischemic stroke on the first postoperative day in a patient with bilateral critical stenosis of the internal carotid artery (group 1). Postoperative wound hematoma, which required revision and bleeding arrest in the early postoperative period, developed in one (1.1%) patient in Group 1. The overall incidence of major adverse cardiovascular events was 2.2% or 2 patients. In all three groups, a statistically significant and positive effect in regression of the initial neurological deficit was obtained at discharge. In patients operated in the first week after stroke, the neurological deficit at discharge according to the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin scale was the lowest. In general, 31.3%, 17.9% and 12.5% of patients in groups 1, 2 and 3 were discharged without neurological deficit (0 points according to the NIHSS scale), respectively.CONCLUSIONS. Carotid endarterectomy performed in the acute period of ischemic stroke is a safe surgical intervention in the prevention of recurrent ipsilateral ischemic events. The most positive neurological dynamics and the least neurological deficit at discharge were achieved after operations performed in the first week of ischemic stroke.

New Insights into Freezing of Gait in Parkinson's Disease from Spectral Dynamic Causal Modeling.

Freezing of gait is one of the most disturbing motor symptoms of Parkinson's disease (PD). However, the effective connectivity between key brain hubs that are associated with the pathophysiological mechanism of freezing of gait remains elusive. The aim of this study was to identify effective connectivity underlying freezing of gait. This study applied spectral dynamic causal modeling (DCM) of resting-state functional magnetic resonance imaging in dedicated regions of interest determined using a data-driven approach. Abnormally increased functional connectivity between the bilateral dorsolateral prefrontal cortex (DLPFC) and the bilateral mesencephalic locomotor region (MLR) was identified in freezers compared with nonfreezers. Subsequently, spectral DCM analysis revealed that increased top-down excitatory effective connectivity from the left DLPFC to bilateral MLR and an independent self-inhibitory connectivity within the left DLPFC in freezers versus nonfreezers (>99% posterior probability) were inversely associated with the severity of freezing of gait. The lateralization of these effective connectivity patterns was not attributable to the initial dopaminergic deficit nor to structural changes in these regions. We have identified novel effective connectivity and an independent self-inhibitory connectivity underlying freezing of gait. Our findings imply that modulating the effective connectivity between the left DLPFC and MLR through neurostimulation or other interventions could be a target for reducing freezing of gait in PD. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

Median nerve lesions in pediatric displaced supracondylar humerus fracture: A prospective neurological, electrodiagnostic and ultrasound characterization.

Supracondylar humerus fractures (SCHFs) are the most common elbow fractures in children. Traumatic median nerve injury and isolated lesions of its pure forearm motor branch, anterior interosseus nerve (AIN), have both been independently reported as complications of displaced SCHFs. Our main objectives were to characterize the neurological syndrome to distinguish median nerve from AIN lesions and to determine the prognosis of median nerve lesions after displaced SCHFs. Ten children were prospectively followed for an average of 11.6 months. Patients received a standardized clinical examination and high-resolution ultrasound of the median nerve every 1-3 months starting 1-2 months after trauma. Electrodiagnostic studies were performed within the first 4 months and after complete clinical recovery. All children shared a clinical syndrome with predominant but not exclusive affection of AIN innervated muscles. High-resolution ultrasound uniformly excluded persistent nerve entrapment and neurotmesis requiring revision surgery but visualized post-traumatic median nerve neuroma at the fracture site in all patients. Electrodiagnostic studies showed axonal motor and sensory median nerve neuropathy. All children achieved complete functional recovery under conservative management. Motor recovery required up to 11 months and differed between involved muscles. It was shown that neurological deficits of the median nerve in displaced SCHFs exceeded an isolated AIN lesion. Notably, detailed neurological follow-up examinations and sonographic exclusion of persistent nerve compression were able to guide conservative therapy in affected children. Under these conditions the prognosis of median nerve lesions was excellent despite severe initial deficits, development of neuroma and axonal injury.

Information search under uncertainty across transdiagnostic psychopathology and healthy ageing

When making decisions in everyday life, we often rely on an internally generated sense of confidence to help us revise and direct future behaviours. For instance, confidence directly informs whether further information should be sought prior to commitment to a final decision. Many studies have shown that aging and both clinical and sub-clinical symptoms of psychopathology are associated with systematic alterations in confidence. However, it remains unknown whether these confidence distortions influence information-seeking behaviour. We investigated this question in a large general population sample (N = 908). Participants completed a battery of psychiatric symptom questionnaires and performed a perceptual decision-making task with confidence ratings in which they were offered the option to seek helpful information (at a cost) before committing to a final decision. Replicating previous findings, an ‘anxious-depression’ (AD) symptom dimension was associated with systematically low confidence, despite no detriment in objective task accuracy. Conversely, a ‘compulsive behaviour and intrusive thoughts’ (CIT) dimension was associated with impaired task accuracy but paradoxical over-confidence. However, neither symptom dimension was significantly associated with an increased or decreased tendency to seek information. Hence, participants scoring highly for AD or CIT did not use the option to information seek any more than average to either increase their confidence (AD) or improve the accuracy of their decisions (CIT). In contrast, older age was associated with impaired accuracy and decreased confidence initially, but increased information seeking behaviour mediated increases in both accuracy and confidence for final decisions. Hence, older adults used the information seeking option to overcome initial deficits in objective performance and to increase their confidence accordingly. The results show an appropriate use of information seeking to overcome perceptual deficits and low confidence in healthy aging which was not present in transdiagnostic psychopathology.

Neuronal rhythmicity and cortical arousal in a mouse model of absence epilepsy

Objectives: Absence seizures impair psychosocial function, yet their detailed neuronal basis remains unknown. Recent work in a rat model suggests that cortical arousal state changes prior to seizures and that single neurons show diverse firing patterns during seizures. Our aim was to extend these investigations to a mouse model with studies of neuronal activity and arousal state to facilitate future fundamental investigations of absence epilepsy.Methods: We performed in vivo extracellular single unit recordings on awake head-fixed C3H/HeJ mice. Mice were implanted with tripolar electrodes for cortical electroencephalography (EEG). Extracellular single unit recordings were obtained with glass micropipettes in the somatosensory barrel cortex, while animals ambulated freely on a running wheel. Signals were digitized and analyzed during seizures and at baseline.Results: Neuronal activity was recorded from 36 cortical neurons in 19 mice while EEG showed characteristic 7–8 Hz spike-wave discharges. Different single neurons showed distinct firing patterns during seizures, but the overall mean population neuronal firing rate during seizures was no different from pre-seizure baseline. However, the rhythmicity of neuronal firing during seizures was significantly increased (p < 0.001). In addition, beginning 10s prior to seizure initiation, we observed a progressive decrease in cortical high frequency (>40 Hz) EEG and an increase in lower frequency (1–39 Hz) activity suggesting decreased arousal state.Significance: We found that the awake head-fixed C3H/HeJ mouse model demonstrated rhythmic neuronal firing during seizures, and a decreased cortical arousal state prior to seizure onset. Unlike the rat model we did not observe an overall decrease in neuronal firing during seizures. Similarities and differences across species strengthen the ability to investigate fundamental key mechanisms. Future work in the mouse model will identify the molecular basis of neurons with different firing patterns, their role in seizure initiation and behavioral deficits, with ultimate translation to human absence epilepsy.

Abstract task sequence initiation deficit dissociates anxiety disorders from obsessive-compulsive disorder and healthy controls.

In everyday life, humans perform sequences of tasks. These tasks may be disrupted in people with obsessive-compulsive disorder (OCD). Symptoms, such as compulsions, can be considered sequential and often cause repetitions of tasks that disrupt daily living (e.g., checking the stove while cooking). Motor sequences have been used to study behavioral deficits in OCD. However, not all sequences are motor sequences. Some are more "abstract" in that they are composed of a series of tasks (e.g., chopping and stirring) rather than being dependent on individual actions or stimuli. These abstract task sequences require cognitive control mechanisms for their execution. Although theory has proposed deficits in these sequences in OCD as well, they have not been directly investigated. We tested the hypotheses that OCD participants exhibit deficits in the control mechanisms specific to abstract task sequences and more general flexible behavior (measured with task switching within the sequences), relative to health controls (HCs) and clinical controls (participants with anxiety disorders [ANX]). A total of 112 participants completed abstract task sequences consisting of simple categorization tasks. Surprisingly, participants with OCD did not perform worse than HCs or ANX. However, ANX participants showed impairments specific to sequential control that did not extend to more general flexible control. Thus, we showed a novel behavioral dissociation between OCD and ANX specific to abstract task sequential control. These results also implicate deficits in specific frontal sequential control neural circuitry in ANX and not in OCD, where implicit sequential deficits may more closely align with striatal circuits.

Critical Illness Corticosteroid Insufficiency after Blunt Abdominal Trauma: A Case Report

A 60-year-old man with a history of a previous colon resection presented after a motor vehicle collision. He was hypotensive in the field. A systolic pressure of 58 was noted on admission to the trauma bay. The remaining vital signs revealed a pulse of 99 and respirations 18. The temperature was 98 degrees. The patient was alert with a GCS of 15. He was given 2 liters of crystalloids and his systolic pressure increased to 100. His initial hemoglobin was 12.3 with hematocrit of 37. The initial base deficit was -12 and a venous lactate was 3.3. Work up revealed a left femur fracture, a right tibial plateau fracture and right radius and ulna fractures. An abdominal CT revealed a possible small bowel injury and the patient was taken to the operating room for exploration. The operative findings included small bowel injury and blunt colon injuries requiring jejunal resection and a primary anastomosis along with a segmental colon resection and end-colostomy. The left femur fracture was fixed along with the radius and ulna fractures at a separate operative intervention.

Outcome in acute ischemic stroke patients with large-vessel occlusion and initial mild deficits

BackgroundThe management of patients with initially mild acute ischemic stroke (AIS), defined by the National Institutes of Health Stroke Scale (NIHSS) scores 0–5, remains ambiguous despite advances in stroke treatment. The early identification of patients likely to deteriorate is critical in preventing lasting disability.AimsWe investigated the frequency and early predictors of poor functional outcomes in AIS patients with large-vessel occlusion (LVO) and initial mild deficits.MethodsWe performed a retrospective observational study of consecutive AIS patients admitted to a single comprehensive stroke center between 2018 and 2021. The inclusion criteria were a diagnosis of AIS, an arrival NIHSS score of 0–5, imaging-confirmed LVO, and arrival within 24 h of the last-known-well time. The primary outcome was the change in the discharge-modified Rankin Score (ΔmRS) from baseline, categorized as 0–1 (stable outcome) or &amp;gt;1 (poor outcome). Early neurological deterioration was defined as a mean NIHSS score increase of &amp;gt;1 in the first 24-h period. Univariate and multivariable regression analyses were performed. The mean daily NIHSS scores were compared between groups using an analysis of variance (ANOVA).ResultsOf 4,410 stroke admissions, 120 patients met the study inclusion criteria, with 71 (59.2%) patients having a ΔmRS of 0–1 and 49 (40.8%) patients having a ΔmRS of &amp;gt; 1. The mean arrival NIHSS score was similar between groups. However, the mean first-24-h NIHSS score was significantly higher in the poor outcome group vs. the stable outcome group (2.13 vs. 0.95, p &amp;lt; 0.001). A demographic-adjusted multivariable logistic regression revealed that a higher mean first-24-h NIHSS score was the sole early predictor of poor outcome (odds ratio [OR] of 1.65 and a 95% confidence interval [CI] of [1.18, 2.48]). The only association with early neurological deterioration was vertebral artery occlusion, with an OR of 0.35 and a 95% CI of [0.14, 0.81]. The trending mean daily NIHSS scores revealed that patients with poor outcomes deteriorate within 24 h, a significant difference from the stable group (p &amp;lt; 0.001).ConclusionPoor outcomes occurred in a significant proportion of LVO patients with initial mild deficits. The only association was early neurological deterioration. To prevent poor outcomes, rapid identification of any clinical deterioration should prompt consideration of thrombectomy.

Repeated courses of electrical stimulation for traction neuropathies of the sciatial and femoral nerves after endoprosthetics

Objective: to substantiate the indications for repeated courses of electrical stimulation using a temporary implanted epidural electrode in patients with traction neuropathies after hip replacement. Material and methods. A method of puncture implantation of epidural electrodes was used to conduct a course of electrical stimulation. An analysis of 162 electrode implantations was performed. The results of treatment of 73 patients with neuropathies of the sciatic (n=65) and femoral (n=8) nerves after hip replacement are presented. The follow-up period was 5.5 years. Results. There was a 2-fold increase in the number of hospitalizations for every 4.5 months of interval between endoprosthetics and the first course of electrical stimulation. Depending on the initial neurological deficit, an increase in the number of hospitalizations by an average of half is predicted to increase muscle strength by 1 point. The maximum number of hospitalizations in this category of patients is 8, the average number of hospitalizations is 3. Conclusion. Indications for repeated courses of electrical stimulation using a temporary implanted epidural electrode in patients with traction neuropathies after hip replacement are substantiated. Epidural electrical stimulation allows you to relieve pain associated with traction damage to nerve axons; repeated courses of electrical stimulation contribute to a more complete restoration of nerve function.

QOL-08. THE LONG-TERM UTILITY OF METHYLPHENIDATE FOR THE PRESERVATION OF INTELLECTUAL DEVELOPMENT IN CHILDHOOD SURVIVORS OF BRAIN TUMOUR

Abstract BACKGROUND Enduring neurocognitive late effects are a common consequence of childhood brain tumour survivorship. Conceptual modelling of intelligence suggests initial deficits to processing speed and attention lead to the subsequent plateauing of intellectual and academic development. The utility of methylphenidate in improving attentional and processing speed deficits within the early phase of recovery has been previously reported. The longer-term contribution of methylphenidate in preserving intellectual ability through ameliorating these early deficits is yet to be evaluated. METHODS Twenty-nine childhood survivors were matched retrospectively with a no-treatment synthetic control. Intellectual assessments were conducted prior to starting methylphenidate and a minimum of 12 months thereafter. For the no-treatment control group, intellectual data were collected retrospectively from archival records, employing a similar assessment period. Linear Mixed Models were used to assess the influence of methylphenidate on intellectual trajectories between groups and fatigue scores over time. RESULTS Methylphenidate was associated with raw score improvements across all intellectual indices compared to no-treatment controls. Linear Mixed Modelling reported a borderline significant improvement in Processing Speed (t = 1.98, p =.05) for the methylphenidate group. In comparison, a borderline significant (p =.05) within-group decrease in Working Memory scores was reported for the no-treatment group. There was a significant within-group decrease in pooled PedsQL MFS scores between assessments for the treatment group (t = -4.01, p &amp;lt;.01), with the most notable decrease observed in Sleep/Rest Fatigue (t = -10.17, p &amp;lt;.01). CONCLUSIONS Methylphenidate may pose a valuable long-term rehabilitative strategy in preserving Processing Speed in childhood survivors of brain tumour. Whilst our sample size is small, there is tentative evidence for the utility of methylphenidate in alleviating fatigue experienced by childhood survivors.

Functional trajectories before and after loss of ambulation in Duchenne muscular dystrophy and implications for clinical trials.

This study examined functional trajectories of subjects during the transition phase between ambulatory and non-ambulatory Duchenne muscular dystrophy (DMD) to inform clinical trial designs for new therapeutics. Ambulatory, pulmonary, and upper limb function leading up to loss of ambulation (LoA) and non-ambulatory measures following LoA were quantified; time ordering of pulmonary and upper limb milestones relative to LoA were determined; and the 10-second time threshold for 10-meter walk/run (10MWR) as a marker of approaching LOA was explored. Included in this analysis were 51 subjects aged between 7 and 18 years who experienced LoA during follow-up in the PRO-DMD-01 natural history study. Mean age at LoA was 12.7 (7.1-18.6) years. Mean annual rates of decline in forced vital capacity (FVC) <80%-predicted and performance of upper limb (PUL) 1.2 total score were smaller before than after LoA, but not significantly (FVC %-predicted: 5.6% vs. 10.1%, p = 0.21; PUL 1.2 total score: 2.3 vs. 3.8 units, p = 0.20). More than half of patients experienced clinically significant deficits in FVC %-predicted and PUL 1.2 before experiencing LoA. Among subjects with baseline 10MWR >10 s, those with <1 year to LoA had similar mean ages but significantly worse mean ambulatory function at baseline compared to those with ≥1 year to LoA. Enriching DMD clinical trials for patients with declining pulmonary or upper limb function is achievable without restricting enrollment to non-ambulatory patients. The sequencing of LoA and initial deficits in pulmonary and upper limb function varied across patients and highlights the potential for composite outcomes or multi-outcome trial designs to assess disease-modifying therapies more comprehensively.

Mortality predictors in earthquake victims admitted to intensive care unit in Kahramanmaraş earthquakes

BackgroundThe purpose of this study is to report the data for patients followed-up in our intensive care unit due to the 6th February 2023, earthquake in Kahramanmaraş, Türkiye, and to investigate parameters affecting mortality. MethodsThe demographic characteristics of patients followed-up in intensive care due to trauma following the earthquake, the treatments administered, developing complications, lengths of stay in the hospital and intensive care, and laboratory data were scanned retrospectively and recorded. These data were then compared between the surviving and non-surviving patients. ResultsTwenty-six patients, 13 (50 %) male, were followed-up in our intensive care, 24 (92 %) due to being buried under earthquake debris, and 2 (8 %) due to falling from heights. Increased Sequential Organ Failure Assessment (SOFA) (p = 0.027), higher initial serum potassium (p = 0.043), higher initial serum phosphorus (p = 0.035), higher initial and peak serum magnesium (p = 0.004 and p = 0.001), lower initial and peak bicarbonate (p = 0.021 and p = 0.012) and higher initial and peak serum base deficit values (p = 0.012 and p = 0.009) were associated with mortality. In the subgroup with crush injuries, higher initial and peak serum potassium (p = 0.001 and p = 0.025), higher initial and peak serum magnesium (p = 0.005 and p = 0.004), lower initial and peak bicarbonate (p = 0.019 and p = 0.021) and higher initial and peak serum base deficit values (p = 0.017 and p = 0.025) were associated with mortality. Multiorgan dysfunction failure developed in nine patients, sepsis in seven, dissemine intravascular coagulation in four, and acute respiratory distress syndrome in two. Fasciotomy was performed on 2 (8 %) patients and amputation on 8 (31 %). Extremity injuries were most frequently observed. 10 (38.5 %) of the 12 (46 %) patients developing acute kidney injury required renal replacement therapy. 7 (27 %) patients died during follow-up. In logistic regression analysis, higher SOFA scores, lower initial bicarbonate and BE levels, higher serum initial potassium and magnesium levels were a risk factor for mortality. Higher SOFA scores, lower initial bicarbonate and base deficit and higher initial phosphorus values affected mortality in patients with crush syndrome. ConclusionNot only increased SOFA, serum potassium, serum phosphorus, and serum magnesium, but also decreased bicarbonate, and base deficit were associated with mortality in earthquake victims with crush syndrome in ICU.

Effect of early clinical management on metabolic acidemia in neonates with hypoxic-ischemic encephalopathy.

To determine the safety and effectiveness of sodium bicarbonate administration in the management of metabolic acidemia and short-term outcomes in neonates with hypoxic-ischemic encephalopathy (HIE). Retrospective cohort study of neonates born at ≥35 weeks of gestation and receiving therapeutic hypothermia. Demographics, pH, lactate, base deficit, treatment, MRI findings, seizure incidence, death prior to discharge were collected. There was higher mortality (p = 0.010) and injury on MRI (p = 0.008)-primarily deep gray matter (p < 0.001) and cortical injury (p = 0.003)-in the bicarbonate groupcompared to controls in univariate analysis. The combined outcome of death or abnormal MRI was not significantly associated (OR 1.97, 95% CI 0.80-4.87, p = 0.141) with bicarbonate administration when adjusting for sex, 5-minute Apgar, and initial base deficit. This study demonstrated association between bicarbonate use after HIE and negative short-term outcomes. Future prospective trials could overcome the treatment bias limitation demonstrated in this retrospective study.

X-ray endovascular surgery for in-hospital acute ischemic stroke

The OBJECTIVE was to determine the efficacy of endovascular surgery for in-hospital acute ischemic stroke (AIS) and to identify predictors of unfavorable AIS outcome.METHODS AND MATERIALS. We performed 42 endovascular thrombectomies for in-hospital AIS in patients treated in the hospital for another pathology. Neurological defiCIT was determined by NIHSS scale, thrombectomy efficacy was evaluated by the degree of cerebral revascularization by mTICI scale, functional outcome was determined by Rankin scale (mRS). Multivariate analysis with evaluation of clinical and laboratory, neuroimaging data, and analysis of surgical technique was performed to identify factors contributing to adverse stroke outcome.RESULTS. The mean age of patients was 73.8±11.8 years old. Neurological defiCIT before surgery was 12.8±6.7 points by to NIHSS. Thrombolytic therapy was used in one third of cases, thrombectomy in 92.9 %, and carotid artery stent ing in 2 cases. Successful revascularization (mTICI2b-3) was achieved in 83.3 % of cases. The significant reduction in neurological defiCIT after surgery was achieved to NIHSS 6.0±5.9 points, mRS 2.7±2.1. The mortality rate amounted to 16.7 % of cases. Poor functional outcome (mRS3-5) was significantly associated with: female gender, older age, presence of cardiovascular pathology, recurrent stroke, postoperative tachycardia, low renal tubular filtration rate, hypocoagulation, low cardiac ejection fraction, low aortic valve opening amplitude, high pulmonary hypertension, large left atrial volume, initial severe neurological defiCIT, poor collaterals in the area of cerebral ischemia, proximal internal carotid artery occlusion, hemorrhagic saturation, increased operation time, low degree of revascularization (mTICI0-2a).CONCLUSION. Endovascular surgery has demonstrated its safety and high efficacy in the treatment of in-hospital AIS in surgical hospitalized patients. Endovascular thrombectomies allow to significantly reduce neurological defiCIT and decrease mortality in the severe category of patients with cardioembolic AIS. clinical, laboratory, hemodynamic and neuroimaging factors influencing on poor functional outcome of in-hospital AIS have been determined.

Dopaminergic mesolimbic structural reserve is positively linked to better outcome after severe stroke.

The concept of brain reserve capacity has emerged in stroke recovery research in recent years. Imaging-based biomarkers of brain health have helped to better understand outcome variability in clinical cohorts. Still, outcome inferences are far from being satisfactory, particularly in patients with severe initial deficits. Neurorehabilitation after stroke is a complex process, comprising adaption and learning processes, which, on their part, are critically influenced by motivational and reward-related cognitive processes. Amongst others, dopaminergic neurotransmission is a key contributor to these mechanisms. The question arises, whether the amount of structural reserve capacity in the dopaminergic system might inform about outcome variability after severe stroke. For this purpose, this study analysed imaging and clinical data of 42 severely impaired acute stroke patients. Brain volumetry was performed within the first 2 weeks after the event using the Computational Anatomy Toolbox CAT12, grey matter volume estimates were collected for seven key areas of the human dopaminergic system along the mesocortical, mesolimbic and nigrostriatal pathways. Ordinal logistic regression models related regional volumes to the functional outcome, operationalized by the modified Rankin Scale, obtained 3-6 months after stroke. Models were adjusted for age, lesion volume and initial impairment. The main finding was that larger volumes of the amygdala and the nucleus accumbens at baseline were positively associated with a more favourable outcome. These data suggest a link between the structural state of mesolimbic key areas contributing to motor learning, motivational and reward-related brain networks and potentially the success of neurorehabilitation. They might also provide novel evidence to reconsider dopaminergic interventions particularly in severely impaired stroke patients to enhance recovery after stroke.

Caste Differences in Child Growth: Disentangling Endowment and Investment Effects

Using the fourth round of the Indian National Family Health Survey (NFHS-4), and subsequently replicating our results using the fifth round (NFHS-5), we document differential child physical growth patterns across caste groups in India, demonstrating that lower caste children are born shorter and grow less quickly than children from higher-caste households. We then show that, in line with work from previous rounds of the NFHS, these differences are largely explainable by observable covariates, particularly maternal characteristics and household wealth variables. Our research also reveals a previously undocumented dynamic, that the influence of these variables changes as children develop, and suggests that caste-gaps are the result of multiple mechanisms impacting the child growth process at different stages of development. Using age-disaggregated decomposition methods, we demonstrate that health endowment related variables (e.g. maternal height) largely explain birth length gaps, and that variables related to health investments (e.g. household wealth, health care usage) become increasingly influential as children age. Children from lower caste households thus face two margins generating height gaps as they age: a persistent endowment disparity present from birth, and a post birth investment differential that exacerbates the initial deficit.

Case Report: 14 Years-Old Boy with Paraplegia and Aneurysmal Bone Cysts of Neck who Responded to Anti-Tuberculosis Treatment

This article discusses a rare case of Aneurysmal Bone Cyst (ABC) affecting the cervical spine, presenting with neck pain and progressive weakness in all extremities. A 14-year-old boy experienced these symptoms for three years without any history of trauma. Physical examination revealed weakness and tenderness in the cervical vertebrae. MRI showed cervical compression, paravertebral abscess, spinal nerve swelling, and canal stenosis, suggestive of tuberculosis spondylitis. The surgical intervention involved laminectomy and tumor debulking, confirming the diagnosis of a aneurysmal bone cyst. Despite initial motor deficits, anti-tuberculosis treatment significantly improves motor function and neck mobility over several weeks. This case underscores the rarity of cervical spine involvement in aneurysmal bone cyst and highlights the importance of prompt diagnosis and treatment to prevent neurological complications and achieve favorable outcomes. The study emphasizes considering aneurysmal bone cyst as a potential differential diagnosis for lytic lesions involving the spine in young patients, emphasizing the need for vigilance in clinical practice.