Mild Drop Research Articles

Ruptured Popliteal Artery Aneurysm Complicated with Acute Respiratory Distress Syndrome Secondary to SARS-CoV-2 Infection

We herein report a rare case of the ruptured popliteal artery aneurysm in an 89-year-old man, whose recovery after surgical treatment was complicated with acute respiratory distress syndrome secondary to confirmed infection with SARS-CoV-2. Presenting symptoms, patient's comorbidities, and postoperative course complicated with cardiac and respiratory failure leading to adverse outcome are discussed in this case report.

Flow cytometric evaluation of CD38 expression levels in the newly diagnosed T-cell acute lymphoblastic leukemia and the effect of chemotherapy on its expression in measurable residual disease, refractory disease and relapsed disease: an implication for anti-CD38 immunotherapy

BackgroundRecently, anti-CD38 monoclonal antibody (Mab) therapy has become a focus of attention as an additional/alternative option for many hematological neoplasms including T-cell acute lymphoblastic leukemia (T-ALL). It has been shown...

Computed dynography, a method for evaluation of gait pattern in treated cases of congenital talipes equino varus

<p class="abstract"><strong>Background:</strong> Club foot is characterized by inversion, adduction and equinus. Currently, evaluation of children treated for congenital talipes equino varus (CTEV) includes clinical and radiological examination as well as assessment of function. However, none of the methods is ideal. There should<strong> </strong>be objective methods for better evaluation of function in treated CTEV. Gait analysis is the emerging method in objectively assessing the functional outcome. The aim of the study was to compare the selected measures from vertical ground reaction force variables and gait parameters of treated CTEV children with plantigrade feet, to healthy age and gender matched control group.</p><p class="abstract"><strong>Methods:</strong> We took 31 children with treated CTEV with mean age 8.21 years<strong> </strong>and compared with 31 age and gender matched controls. The patients were initially treated under a standard protocol. Gait cycle properties, step time parameters and vertical ground reaction force variables were recorded and comparison of unilateral and bilateral cases of treated CTEV was done with that of controls.<strong></strong></p><p class="abstract"><strong>Results:</strong> Data showed that despite good clinical results and overall function, residual intoeing, lateral foot walking, mild foot drop, weak plantar flexor power, possible residual inversion deformity of the foot, increased frequency and decreased duration of cycle and asymmetry in gait were the main characteristics of gait of children with treated CTEV. In unilateral cases single and double support times were decreased and in bilateral CTEV double support times are increased.</p><p class="abstract"><strong>Conclusions:</strong> The study confirms that in clubfoot patients who underwent full treatment, gait parameters do not reach normal levels. Gait analysis can be used to quantify gait pattern characteristics and is helpful in evaluation and further development of treatment of patients.</p>

Confidence collapse in a multihousehold, self-reflexive DSGE model

We investigate a multihousehold dynamic stochastic general equilibrium (DSGE) model in which past aggregate consumption impacts the confidence, and therefore consumption propensity, of individual households. We find that such a minimal setup is extremely rich and leads to a variety of realistic output dynamics: high output with no crises; high output with increased volatility and deep, short-lived recessions; and alternation of high- and low-output states where a relatively mild drop in economic conditions can lead to a temporary confidence collapse and steep decline in economic activity. The crisis probability depends exponentially on the parameters of the model, which means that markets cannot efficiently price the associated risk premium. We conclude by stressing that within our framework, narratives become an important monetary policy tool that can help steer the economy back on track.

ASIC1a channels regulate mitochondrial ion signaling and energy homeostasis in neurons.

Acid-sensing ion channel 1a (ASIC1a) is well-known to play a major pathophysiological role during brain ischemia linked to acute acidosis of ~pH 6, whereas its function during physiological brain activity, linked to much milder pH changes, is still poorly understood. Here, by performing live cell imaging utilizing Na+ and Ca2+ sensitive and spatially specific fluorescent dyes, we investigated the role of ASIC1a in cytosolic Na+ and Ca2+ signals elicited by a mild extracellular drop from pH 7.4 to 7.0 and how these affect mitochondrial Na+ and Ca2+ signaling or metabolic activity. We show that in mouse primary cortical neurons, this small extracellular pH change triggers cytosolic Na+ and Ca2+ waves that propagate to mitochondria. Inhibiting ASIC1a with Psalmotoxin 1 or ASIC1a gene knockout blocked not only the cytosolic but also the mitochondrial Na+ and Ca2+ signals. Moreover, physiological activation of ASIC1a by this pH shift enhances mitochondrial respiration and evokes mitochondrial Na+ signaling even in digitonin-permeabilized neurons. Altogether our results indicate that ASIC1a is critical in linking physiological extracellular pH stimuli to mitochondrial ion signaling and metabolic activity and thus is an important metabolic sensor.

P249 Iatrogenic aortic cusp laceration causing severe acute traumatic aortic regurgitation secondary to complex percutaneous coronary intervention using rotablator;3DTEE-anatomic correlates

Abstract Clinical case 59 years old male known case of long standing diabetes and dyslipidemia presented to our institute with Non-STEMI.His past history was significant for multiple admissions with acute coronary syndromes and percutaneous coronary interventions(PCI). Echocardiogram in this presentation showed preserved biventricular systolic function with no valvulopathies. He was taken up for coronary angiogram which showed significant calcified angulated lesion in LAD/LCX(Left anterior descending and circumflex) with diffuse disease in Ramus/RCA. Mode of revascularisation was discussed in detail with the patient for Rotablation-guided PCI to LAD/LCX vs CABG.He preferred and underwent complex PCI to LAD. During the procedure he developed acute heart failure which was managed conservatively. Immediate TTE showed new severe aortic regurgitation(AR) with probable left coronary cusp(LCC) perforation and preserved LVEF.After stabilization, he was scheduled for TEE which showed tear in the LCC with complex fragmented jet of holodiastolic AR filling the entire LVOT.There was new late diastolic to early systolic MR.3DTEE Enface view of the aortic valve was evident of ovoid shaped laceration in LCC extending till the free margin (Fig 1C). There were additional tears in Non-coronary cusp(NCC) extending till the free margin of right coronary cusp(RCC).3DTEE colour was notable for regurgitant jet origin from LCC/NCC (Fig 2B). Based on above findings,He was offered aortic valve intervention but was reluctant initially.He presented 2 months later with exertional dyspnoea, mild LV dilatation and drop in LVEF to 50%.He consented for surgery and underwent bioprosthetic Aortic valve replacement because of extensive cusp tear and deformation of the valve along with complete revascularisation of the remaining diseased coronaries.Post-operative course was complicated by vasoplegic arrest and acute renal failure which was successfully managed conservatively. Discussion We report this case for the rarity of this post-PCI iatrogenic complication and the incremental role of 3DTEE in identifying the exact pathology.It was proposed that during PCI multiple stalling of rotatbur in calcified LAD caused traction and eventually disengagement of guide causing rotabur to freely hang in ascending aorta close to the cusps.Possibly this rotablator with very high speed(180000rpm) would have momentarily come in contact with the aortic cusps causing cuspal perforation and heart failure in Cath lab.3DTEE correlated very well with the anatomo-pathology and matched with intraoperative finding as shown in figures 2A & 2C.These findings prior to aortic cross clamp could significantly reduce time of surgery as he had an additional CABG procedure to be performed.There are few isolated case reports of post PCI aortic valve perforation but probably ours is the first one secondary to the use of rotablator with near involvement of all the cusps and reasonably accurate 3DTEE-anatomic characterisation. Abstract P249 Figure.

Benefit and Safety of Isovolemic Hemodilution Prior to Red Cell Exchange in Chronically Transfused Sickle Cell Patients

Background: Isovolemic hemodilution (IHD-RCE), an add-on to standard red cell exchange (RCE), was recently FDA-approved on select apheresis devices. Equipoise exists as to the degree of red cell unit reduction and time interval extension between procedures with IHD-RCE. Also, concern has been raised that the transient hematocrit (Hct) decrease and potential hypotension with IHD-RCE causes ischemic brain injury, especially with Moya Moya disease. Again, there is equipoise, with only one of 4 studies reporting increased hypotension and no studies of ischemic brain injury with IHD-RCE. We therefore conducted a retrospective crossover study of efficacy and safety of IHD-RCE in our sickle cell disease patients, three of whom had Moya Moya, and report follow-up brain MRI/MRA data, heretofore not reported in the literature. Study design: This was a retrospective review of patients who crossed over from standard RCE (Cobe Spectra) to IHD-RCE (Spectra Optia). The IHD phase used normal saline for replacement fluid. Minimum (post-IHD) hematocrits (Hcts) and post-procedure Hcts were based upon pre-procedure Hcts as per Matevosyan et al, JCA 2012. Pre-procedure CBCs, reticulocyte counts, and serum ferritins were drawn within 72 hours of the procedure and post-procedure CBCs drawn immediately post-procedure. All red cell units were leuko-reduced, CEK matched, and less than 15 days old when possible. Methods: The same number of procedures were analyzed for standard RCE and IHD-RCE, with the RCE procedures most recent to crossover to IHD-RCE used for comparison. Means of continuous variables were calculated for each patient; means and standard deviations of the patient means are shown, unless otherwise indicated. Paired t-testing was used to compare IHD-RCE to RCE († in tables indicates p-value < 0.05) Results: Patients: All 6 patients (3 M, 3 F) were black; 5 had HbSS and 1 had SB+thal. The indication for RCE was stroke prophylaxis in four, 3 of whom had Moya-Moya disease, and frequent vaso-occlusive crisis (VOC) in two. Mean patient age at the time of first IHD-RCE was 15 ± 2 years, and a mean 26 ± 12 procedures of each procedure type was analyzed for IHD-RCE to RCE comparisons. Patient total blood volume (TBV) significantly increased from the RCE to IHD-RCE periods and was accounted for in the analysis. Procedure-centric measures (Table 1). Despite increasing TBV, red cell unit usage did not increase, and the volume of donor red cells transfused per mL TBV significantly decreased with IHD-RCE. There was no increase in inter-procedural interval. Patient-centric efficacy measures (Table 2): Despite the decreased volume of donor red cells transfused per mL TBV, and similar post- and pre-procedure HbS %s between IHD-RCE and RCE, the pre-procedure Hct was slightly (5%) increased with IHD-RCE. Procedural safety-related measures (Table 3): Although there were statistically significant drops in systolic and diastolic blood pressures (BP) post-IHD compared to pre-procedure BP, the degrees (about -6%) were mild. By procedure end, there were no overall significant differences in BP from pre-procedure BP. In addition, there was no overall significant change in heart rate post-IHD or post-procedure. Actual patient adverse events (Table 4): One patient had a single possibly IHD-related Grade 2 symptomatic (dizziness) vasovagal event, occurring at procedure end and resolved with normal saline bolus. All 4 patients on IHD-RCE for stroke prophylaxis had follow-up MRI/MRA after switching to IHD-RCE. One patient showed new silent strokes and vasculopathy but her prior MRI/MRA predated her standard RCE period. One patient who had progressed on standard RCE had no progression on IHD-RCE. The other two patients had stable MRI/MRA. Conclusion: When reducing pre-procedure Hct by 20-24% during the IHD phase, our data confirm the 11-13% reduction in red cell unit usage with IHD-RCE reported by Sarode et al, JCA 2011 and Hequet et al, Transfusion 2019, but do not support an increased inter-procedural interval of 16 days as per Sarode et al. Most patients had a mild (< 15%) and asymptomatic drop in systolic and diastolic BPs with IHD-RCE; a minority also had a very mild (<5%) HR increase; use of 5% albumin rather than saline replacement may mitigate these drops. MRI/MRA follow-up did not show any definitive ischemic brain injury associated with IHD-RCE. Disclosures No relevant conflicts of interest to declare.

Monitoring aboveground forest biomass dynamics over three decades using Landsat time-series and single-date inventory data

Understanding forest biomass dynamics is crucial for carbon and environmental monitoring, especially in the context of climate change. In this study, we propose a robust approach for monitoring aboveground forest biomass (AGB) dynamics by combining Landsat time-series with single-date inventory data. We developed a Random Forest (RF) based kNN model to produce annual maps of AGB from 1988 to 2017 over 7.2 million ha of forests in Victoria, Australia. The model was internally evaluated using a bootstrapping technique. Predictions of AGB and its change were then independently evaluated using multi-temporal Lidar data (2008 and 2016). To understand how natural and anthropogenic processes impact forest AGB, we analysed trends in relation to the history of disturbance and recovery. Specifically, change metrics (e.g., AGB loss and gain, Years to Recovery - Y2R) were calculated at the pixel level to characterise the patterns of AGB change resulting from forest dynamics. The imputation model achieved a RMSE value of 132.9 Mg ha−1 (RMSE% = 46.3%) and R2 value of 0.56. Independent assessments of prediction maps in 2008 and 2016 using Lidar-based AGB data achieved relatively high accuracies, with a RMSE of 108.6 Mg ha−1 and 135.9 Mg ha−1 for 2008 and 2016, respectively. Annual validations of AGB maps using un-changed, homogenous Lidar plots suggest that our model is transferable through time (RMSE ranging from 109.65 Mg ha−1 to 112.27 Mg ha−1 and RMSE% ranging from 25.38% to 25.99%). In addition, changes in AGB values associated with forest disturbance and recovery (decrease and increase, respectively) were captured by predicted maps. AGB change metrics indicate that AGB loss and Y2R varied across bioregions and were highly dependent on levels of disturbance severity (i.e., a greater loss and longer recovery time were associated with a higher severity disturbance). On average, high severity fire burnt from 200 Mg ha−1 to 550 Mg ha−1 of AGB and required up to 15 years to recover while clear-fell logging caused a reduction in 250 Mg ha−1 to 600 Mg ha−1 of AGB and required nearly 20 years to recover. In addition, AGB within un-disturbed forests showed statistically significant but monotonic trends, suggesting a mild gradual drop over time across most bioregions. Our methods are designed to support forest managers and researchers in developing forest monitoring systems, especially in developing regions, where only a single date forestry inventory exists.

A De Novo Heterozygous Variant (HBB: c.379delG, p.Val127Cysfs*32) Associated with a Mild β-Thalassemia Intermedia Phenotype in a Turkish Child

We report a de novo heterozygous variant of the β-globin chain that showing a mild β-thalassemia intermedia (β-TI) phenotype. He presented with mild anemia, splenomegaly, reticulocytosis, and poikilocytosis and tear drop cells on the blood smear; Immune mediated hemolysis, red cell membrane and enzyme defects, were excluded; hemoglobin (Hb) electrophoresis showed an elevation of Hb F. Molecular analysis of the β-globin gene showed a heterozygous variation in exon 3 (HBB: c.379delG, p.Val127Cysfs*32) in the absence of an α-globin gene mutation or mutations that modulate Hb F expression.

Confidence Collapse in a Multi-Household, Self-Reflexive DSGE Model

We investigate a multi-household DSGE model in which past aggregate consumption impacts the confidence, and therefore consumption propensity, of individual households. We find that such a minimal setup is extremely rich, and leads to a variety of realistic output dynamics: high output with no crises; high output with increased volatility and deep, short lived recessions; alternation of high and low output states where relatively mild drop in economic conditions can lead to a temporary confidence collapse and steep decline in economic activity. The crisis probability depends exponentially on the parameters of the model, which means that markets cannot efficiently price the associated risk premium. We conclude by stressing that within our framework, narratives become an important monetary policy tool, that can help steering the economy back on track.

Seafloor subsidence induced by gas recovery from a hydrate-bearing sediment using multiple well system

Abstract The response behavior of the methane exploitation from natural gas hydrate (NGH) using multiple well system is complex and needs to be investigated, as gas production from a single vertical well generally cannot meet commercial demand. This study numerically investigates the production performance and geomechanical response of an unconfined hydrate deposit in Shenhu area, South China Sea, under single and multiple vertical well conditions. For a single vertical well with a mild constant bottom-hole pressure, gas production is relatively stable. However, seafloor subsidence exhibits an initial rapid drop and a subsequent mild drop stage. The vertical displacement is highly developed at the top and bottom of the production zone. The results from doublet and triplet vertical wells indicate that both the gas and water production and seafloor subsidence increase with the increase in number of production wells. The superimposition of subsidence leads to a deterioration in subsidence and the change in location for the largest subsidence, which may affect the risk location of well instability. The interference of pore pressure and subsidence increases with the decrease in well spacing. However, gas production decreases and water production changes insignificantly. Furthermore, a same subsidence at seafloor cannot indicate the same evolution of subsidence in the vertical and lateral direction. The results presented in this study help in balancing the production and subsidence of the NGH exploitation in complex well configurations.

GIS Based Flood Flow Assessment in Small Catchments for Flood Mapping in Bosnia and Herzegovina

Abstract An initial step in flood hazard mapping is hydrological modelling. We present a recent river flood modelling approach in Bosnia and Herzegovina (BiH) for small ungauged catchments of drainage area up to 32 km2. To estimate peak flow of required probability in small catchments, we use the rational method. The paper focus is GIS based procedure for producing the runoff coefficient map for BiH from the DTM and land cover map. For validation of the peak flow modelling results in small ungauged catchments we use diagrams of peak flow per catchment area (specific runoff) versus catchment area in medium and large gauged catchments. The results indicate agreement in specific runoff for 100 and 500 years return period compared to reference runoff in gauged catchments and a mild drop in specific runoff for 20 years.

Provision of ancillary services by renewable hybrid generation in low frequency AC systems to the grid

Wind energy high penetration levels in power systems lead to continuous power imbalance due to the intermittent nature of wind power. This paper proposes and investigates different methods to enable a hybrid generation system to provide frequency support to the grid. The hybrid generation is 100% renewable and composed of a wind farm and hydropower plant (HPP) of comparable generation capacities, and they are interconnected through a Low Frequency AC system (LFAC). The grid–tie is composed of a Voltage-Source Converter based High-Voltage, Direct Current (VSC-HVDC) junction that acts as frequency changer to maintain the grid nominal frequency. The HPP provides two types of ancillary services: wind power smoothing and frequency drops mitigation to avoid the use of thermal generation and battery energy storage. The paper offers different control methods to provide the two AS with improved coordination between the different controls in the hybrid generation system and complying with the common requirements of Grid Codes. The results obtained show that the frequency at the LFAC can tolerate mild drops to provide frequency support to the grid. The controllers’ parameters have a clear impact on the frequency response at both systems. Simulation environment is MATLAB and Simulink.

Species Pervasiveness Within the Group of Coagulase-Negative Staphylococci Associated With Meat Fermentation Is Modulated by pH.

During spontaneous meat fermentations, Staphylococcus equorum, Staphylococcus saprophyticus, and Staphylococcus xylosus are generally the most prevailing species within the communities of coagulase-negative staphylococci (CNS). There is an interest to introduce CNS isolates from artisan-style spontaneous meat fermentations as starter cultures in more industrialized processes, as to confer additional quality benefits. However, staphylococcal competitiveness within the meat matrix is affected by the processing conditions, which vary considerably among product types. A major factor of variability relates to the intensity of acidification, driven by the concentration of added carbohydrates. The effect of pH on CNS prevalence was studied in both a mince-based meat fermentation model and in fermented sausages produced on pilot scale. Roughly, from all experiments combined, it appeared that a pH of 5.3 corresponded with a breakpoint for CNS selection. Above this value, a general prevalence by S. xylosus was found, even overruling the addition of starter cultures consisting of S. equorum and S. saprophyticus strains. At pH values below 5.3, S. xylosus was also accompanied by S. equorum (following a mild pH drop) and S. saprophyticus (following a stronger pH drop). Still, addition of starter cultures affected the volatile profile compared to the control batch, even if those starter cultures were not able to dominate during the ripening process. This study nonetheless provides a warning for an overly confident use of specific CNS species as starter cultures, especially when in a given processing context the prevailing conditions do not allow superior growth compared to the CNS from the background microbiota.

The Characteristics of the Oxide Films Formed on Ni-base Alloy Cladding in Simulated Pressurized Water Reactor Primary Water Environment

The microstructure and the oxide films formed on Ni-base alloy cladding in simulated pressurized water reactor (PWR) primary water environments at 325°C were characterized. There was a steep drop of iron content and increase of Ni and Cr content in the Ni-base alloy cladding near the fusion line, and a relatively mild drop of iron content and the resultant increase of Ni and Cr contents at the location about 3.8 mm away from the fusion line. The surface oxide morphologies were observed by scanning electron microscopy and the cross-section morphologies and chemical composition of the oxide films were measured by transmission electron microscopy (TEM) and energy dispersive spectrometer. After 146 h immersion in PWR primary water, there were more oxide particles on the cladding alloy at the location closer to the cladding fusion line. After 1860 h immersion in PWR primary water, fine oxide particles on the specimen surface were covered with sparsely distributed large oxide particles. The oxide film after 1860h immersion exhibited a duplex structure, which was thicker at the location closer to the fusion zone, according to TEM results. The outer layer was rich in iron and the inner layer was rich in chromium. Both the inner and the outer oxide films were depleted in Ni, despite of the high Ni content in the alloy matrix.

Mild Traumatic Brain Injury in Adolescent Mice Alters Skull Bone Properties to Influence a Subsequent Brain Impact at Adulthood: A Pilot Study.

Mild traumatic brain injuries (mTBI) are common during adolescence, and limited clinical evidence suggests that a younger age at first exposure to a mTBI may lead to worse long-term outcomes. In this study, we hypothesized that a mTBI during adolescence would predispose toward poorer neurobehavioral and neuropathological outcomes after a subsequent injury at adulthood. Mice received a mild weight drop injury (mTBI) at adolescence (postnatal day 35; P35) and/or at adulthood (P70). Mice were randomized to 6 groups: ‘sham’ (sham-surgery at P35 only); ‘P35’ (mTBI at P35 only); ‘P35 + sham’ (mTBI at P35 + sham at P70); ‘sham + P70’ (sham at P35 + mTBI at P70); ‘sham + sham’ (sham at both P35 and P70); or ‘P35 + P70’ (mTBI at both P35 and P70). Acute apnea and an extended righting reflex time confirmed a mTBI injury at P35 and/or P70. Cognitive, psychosocial, and sensorimotor function was assessed over 1-week post-injury. Injured groups performed similarly to sham controls across all tasks. Immunofluorescence staining at 1 week detected an increase in glial activation markers in Sham + P70 brains only. Strikingly, 63% of Sham + P70 mice exhibited a skull fracture at impact, compared to 13% of P35 + P70 mice. Micro computed tomography of parietal skull bones found that a mTBI at P35 resulted in increased bone volume and strength, which may account for the difference in fracture incidence. In summary, a single mTBI to the adolescent mouse brain did not exacerbate the cerebral effects of a subsequent mTBI in adulthood. However, the head impact at P35 induced significant changes in skull bone structure and integrity. These novel findings support future investigation into the consequences of mTBI on skull bone.

Small intraneuronal acidification via short-chain monocarboxylates: First evidence of an inhibitory action on over-excited human neocortical neurons

AimsIn cortical mammalian neurons, small fluctuations of intracellular pH (pHi) play a crucial role for inter- and intracellular signaling as well as for cellular and synaptic plasticity. Yet, there have been no respective data about humans. Thus, we investigated the interrelation of pHi and excitability of human cortical neurons. Materials and methodsIntracellular electrophysiological and pH-recordings were made in neurons in slices taken from brain tissue resected from the middle temporal gyrus of two male children (26 months and 35 months old) who suffered from pharmacotherapy-resistant temporal lobe epilepsy. To excite the tissue (n = 13), we used the 0-Mg2+/high-K+-in vitro epilepsy model producing robust epileptiform discharges (ED). To evoke an intracellular acidification (n = 12), we used the well-established propionate-model and applied 10 mM propionate to the bath solutions. In addition, we recorded the effects of other strongly related short-chain monocarboxylates (l-lactate (10 mM) and the ketone body DL-β-hydroxybutyrate (10 mM)) on ED and pHi. Key findingsThe ED-frequency was reversibly reduced by propionate (n = 5), l-lactate (n = 5), or DL-β-hydroxybutyrate (n = 3), while the durations of EDs and their after-depolarizations increased. In parallel experiments, all three short-chain monocarboxylates (each n = 4) lowered the pHi of the neurons (n = 12) by 0.05–0.07 pH units which was temporally related to the reported changes in bioelectric activity. SignificanceA mild drop of the intraneuronal pH was associated with the control of even over-excited human neocortical tissue. This is identical with prior observations in non-human mammalian cortical neurons. Possible implications for neuroplasticity and the treatment of neuropsychiatric disorders are discussed.

F192. Role of multimodal extra and intraoperative Stereoelectroencephalography (sEEG) monitoring in tailoring staged surgical resection in patients with eloquent cortex (Rolandic) pharmacoresistant epilepsy

Introduction To describe the feasibility, safety and seizure outcome of patients with medically intractable rolandic epilepsy(RE) who underwent staged resections guided by multimodal extra and intraoperative SEEG recordings. Methods We retrospectively studied and analyzed patients, who underwent extra and intraoperative intracranial invasive stereoEEG monitoring, data related to semiology, non-invasive electrophysiology, imaging, type of resection, complications, surgical pathology results and seizure outcome from January 2015 through September 2017, under Cleveland Clinic IRB. Results Five patients were identified as having intractable RE based on analysis of pre-surgical evaluation using 3T magnetic resonance imaging (MRI), magnetoencephalography(MEG) and positron emission tomography (PET). Preoperative magnetic resonance imaging were considered nonlesional in all five patients but after the pre-surgical evaluation, there were abnormal sulcation pattern or increased signal in white matter were noticed which are of unknown significance. All five patients were underwent sEEG implantation with hypothesis of peri-rolandic or paracentral lobule regions being epileptogenic. Extra-operative sEEG data in all patients showed ictal onset zone involving rolandic cortex (hand knob and paracentral lobule), premotor and/or supplementary motor area (SMA). In two patients, hand knob rolandic cortex was the region of interest The other three being paracentral lobule (leg motor). Given all the data (semiology, sEEG data and pre-sugical evaluation), the conclusion of epileptogenic zone (EZ) being close proximity to eloquent cortex. Given the semiology, staged resection approach with continuous sEEG recording was performed in the operating room. Resection of interictally active non-eloquent cortex electrodes was performed first guided by real-time intraoperative sEEG (electrophysiology) data. The resection was also guided by the sEEG electrode in three dimensions. Resolution of rolandic hand motor spike activities was documented after resection of SMA in three patients, cingulate and pre-motor areas in one patient. In the last patient, hand sensory area was resected sparing motor cortex. Three out of five patients did not have any deficit but two had mild foot drop. Pathology showed focal cortical dysplasia type (IB, IIA, and IIB) and a possible vascular malformation in another. All patients were reported to be seizure free at follow up period of 6–28 months. Conclusion Taken into account of hyper-synchronous connectivity in frontal and parietal rolandic regions, we present a case series of patients who underwent staged resections guided by a novel multimodal method of invasive monitoring. The results of this highly selected group of patients testify for the feasibility and safety of a novel multimodal method of invasive monitoring, combining the benefits of both intra and extra-operative SEEG recording, especially operating around the central lobule near hand knob regions.

Transcranial Motor Evoked Potential Alarm Criteria to Predict Foot Drop Injury During Lumbosacral Surgery.

A retrospective cohort analysis. This study aims to investigate whether waveform alterations in transcranial motor evoked potentials (TCMEPs) can reliably predict postoperative foot drop. Nerve injury leading to foot drop is a potential complication of lumbosacral surgery. Very limited data exist on the use of intraoperative TCMEPs to identify iatrogenic foot drop. We retrospectively reviewed neuromonitoring data from 130 consecutive spine surgeries with instrumentation involving L4-S1. TCMEP waveform analysis included amplitude (A), area under the curve (AUC), latency (L), and duration (D). Patient outcomes were correlated with neuromonitoring results. Intraoperative alert criteria were established on the basis of observed intraoperative changes. Three patients developed severe foot drop with a muscle weakness functional grade ranging from 0/5 to 3/5. Two patients developed a mild foot drop with functional grade 4/5. Twenty-three patients had preoperative weakness in an L5 distribution. One-hundred two patients who had neither preoperative nor postoperative neurological complications served as a control group. Amplitude significantly decreased in patients with a severe postoperative deficit (P = 0.005) as did AUC and duration (P < 0.05). Intraoperative alert criteria defined as a >65% decrease in AUC resulted in a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 100%, 91.4%, 12%, and 100%, respectively. When defining an alert criteria as a >50% decrease in amplitude, sensitivity, specificity, PPV, and NPV were 100%, 87.9%, 8.8%, and 100%, respectively. Reduction of TCMEP waveform associated with postoperative severe foot drop can be detected during lumbar surgery. Other waveform parameters such as AUC may predict foot drop better than the amplitude. Additional examinations in larger samples of foot drops are needed to validate these alert threshold findings. 4.

Epidemiological investigation of avian influenza in regions of Northern Greece

The results of an avian influenza viruses surveillance program in chicken and turkey industrial flocks, as well as in some wild birds from regions of N. Greece during 1999-2000 are presented in this paper. For this purpose, avian influenza virus isolation was attempted by inoculation of samples from chickens and wild birds into embryonated chicken eggs. The samples originated from 35-60 week-old layers and breeders with mild respiratory signs and drop in egg production. 34 wild birds (sparrows, chaffinchs, gulls), that were brought dead to the laboratory of Veterinary Research Institute of Thessaloniki, were also examined in order to investigate the cause of their death. At the same time, 720 serum samples from 30 chicken and 6 turkey flocks were examined by Agar Gel Immunodiffusion (AGID) test. During the same period and in the framework of a surveillance program for avian influenza viruses in Greece, 2580 paired serum samples from chicks were tested by AGID test. Chicks were imported from Italy, where a Highly Pathogenic Avian Influenza was in progress during 1999-2000. All virus isolation attempts and serological tests were negative.