Serial Recordings Research Articles

Abstract 9452: Artificial Intelligence for Predicting Human Age in ECG

Background: Previous research has shown that age is highly correlated to ECG findings, and machine learning (ML) can be used to predict the age of a patient based on the findings on a 12-lead ECG. We structured a state-of-the-art deep ML model to correlate with age, which may be used to detect changes following the trends. Methods: We composed a 40-layers self-definite ResNet model. The model was trained with 10-second 12-lead ECG of 25,915 records from 23,625 patients. We then validated the accuracy of age prediction using 6,479 records from a separate dataset. Once the model was validated, we tested the model using randomly selected ECG records, including 20 records from a weight loss center and 20 records from cardiology clinic patients. Results: After the model was developed and validated, we tested it on 40 patients with ages 52.2 ±13.7 years, ranging from 17 to 76 years. The mean absolute error (MAE) was 8.0 years and the root mean square error (RMSE) was 9.7 years. Among these 40 patients, 21 patients (52.5%) had ECG-predicted age within 7 years difference from their chronological age. When we selected the age range of 42-75 years old (29 records), the result of MAE decreased to 7.4 years, with 70% of the prediction results within 7 years and the RMSE decreased to 9.1 years. The average difference between chronological and ECG-predicted ages decreased to 3 years when serial recordings of ECG of the same patients were used. Conclusions: Using ML models, ECGs can be used to correlate with a patient’s age and may be useful to track the changes longitudinally. “ECG-predicted age” may be an important measurement to follow the trend for comprehensive health assessment over time.

The great reset: Transcranial pulse stimulation reduces global EEG-entropy in Alzheimer's Disease

Abstract Background: Transcranial Pulse Stimulation (TPS) is a new therapy that uses shockwaves for the treatment of Alzheimer's Disease (AD). In humans, there is first evidence for beneficial clinical effects after a series of six TPS sessions. Magnetic resonance imaging studies suggest up-regulation of memory networks as well as increased cortical thickness after stimulation. Effects on oscillatory electrical brain activity measured with resting state electroencephalography (EEG) have not been reported so far. Methods: A consecutive number of four pilot TPS-treated AD-patients was examined. TPS-naïve resting EEGs were recorded before treatment and compared with EEG-recordings directly after first stimulation. All patients received 4Hz TPS of about 6000 pulses of 0.2 mJ/mm2 (navigated bifrontally, biparietally, bitemporally and praecuneus) using the Neurolith System (Storz Medical). Frontal, parietal, central and temporal channel clusters were analyzed with regard to their alpha, theta delta and gamma power and for a measure of Tsallis entropy. Results: The immediate effect after first TPS on grand-average EEG resting state showed an increase of power in all frequency bands and for total power, although a significant difference between pre- and post-stimulation was not revealed due to power variability. However, the grand-average across patients and channels of Tsallis entropy showed a significant reduction after a single stimulation session. Discussion / Conclusion: Limited due to a high variability (and possibly due to underpower) we found power increase across frequency bands and channels which failed signifance. On the other hand Tsallis entropy was a more sensitive measure for change on EEG activity after stimulation. This might reflect a global reset of uncoordinated and thus pathological neural activity after TPS stimulation. More measurements should be added including longitudinal serial recordings over the treatment course of six sessions with correlations of clinical treatment effects. Keywords: transcranial pulse stimulation, shock wave , Alzheimer, EEG

Association Between Increased Seizures During Rewarming After Hypothermia for Neonatal Hypoxic Ischemic Encephalopathy and Abnormal Neurodevelopmental Outcomes at 2-Year Follow-up

Compared with normothermia, hypothermia has been shown to reduce death or disability in neonatal hypoxic ischemic encephalopathy but data on seizures during rewarming and associated outcomes are scarce. To determine whether electrographic seizures are more likely to occur during rewarming compared with the preceding period and whether they are associated with abnormal outcomes in asphyxiated neonates receiving hypothermia therapy. This prespecified nested cohort study of infants enrolled in the Optimizing Cooling (OC) multicenter Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Research Network trial from December 2011 to December 2013 with 2 years' follow-up randomized infants to either 72 hours of cooling (group A) or 120 hours (group B). The main trial included 364 infants. Of these, 194 were screened, 10 declined consent, and 120 met all predefined inclusion criteria. A total of 112 (90%) had complete data for death or disability. Data were analyzed from January 2018 to January 2020. Serial amplitude electroencephalography recordings were compared in the 12 hours prior and 12 hours during rewarming for evidence of electrographic seizure activity by 2 central amplitude-integrated electroencephalography readers blinded to treatment arm and rewarming epoch. Odds ratios and 95% CIs were evaluated following adjustment for center, prior seizures, depth of cooling, and encephalopathy severity. The primary outcome was the occurrence of electrographic seizures during rewarming initiated at 72 or 120 hours compared with the preceding 12-hour epoch. Secondary outcomes included death or moderate or severe disability at age 18 to 22 months. The hypothesis was that seizures during rewarming were associated with higher odds of abnormal neurodevelopmental outcomes. A total of 120 newborns (70 male [58%]) were enrolled (66 in group A and 54 in group B). The mean (SD) gestational age was 39 (1) weeks. There was excellent interrater agreement (κ, 0.99) in detection of seizures. More infants had electrographic seizures during the rewarming epoch compared with the preceding epoch (group A, 27% vs 14%; P = .001; group B, 21% vs 10%; P = .03). Adjusted odd ratios (95% CIs) for seizure frequency during rewarming were 2.7 (1.0-7.5) for group A and 3.2 (0.9-11.6) for group B. The composite death or moderate to severe disability outcome at 2 years was significantly higher in infants with electrographic seizures during rewarming (relative risk [95% CI], 1.7 [1.25-2.37]) after adjusting for baseline clinical encephalopathy and seizures as well as center. Findings that higher odds of electrographic seizures during rewarming are associated with death or disability at 2 years highlight the necessity of electroencephalography monitoring during rewarming in infants at risk. ClinicalTrials.gov Identifier: NCT01192776.

First-recruited motor units adopt a faster phenotype in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disorder of motor neurons, carrying a short survival. High-density motor unit recordings permit analysis of motor unit size (amplitude) and firing behaviour (afterhyperpolarization duration and muscle fibre conduction velocity). Serial recordings from biceps brachii indicated that motor units fired faster and with greater amplitude as disease progressed. First-recruited motor units in the latter stages of ALS developed characteristics akin to fast-twitch motor units, possibly as a compensatory mechanism for the selective loss of this motor unit subset. This process may become maladaptive, highlighting a novel therapeutic target to reduce motor unit vulnerability. Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder with a median survival of 3 years. We employed serial high-density surface electromyography (HDSEMG) to characterize voluntary and ectopic patterns of motor unit (MU) firing at different stages of disease. By distinguishing MU subtypes with variable vulnerability to disease, we aimed to evaluate compensatory neuronal adaptations that accompany disease progression. Twenty patients with ALS and five patients with benign fasciculation syndrome (BFS) underwent 1-7 assessments each. HDSEMG measurements comprised 30min of resting muscle and 1min of light voluntary activity from biceps brachii bilaterally. MU decomposition was performed by the progressive FastICA peel-off technique. Inter-spike interval, firing pattern, MU potential area, afterhyperpolarization duration and muscle fibre conduction velocity were determined. In total, 373 MUs (ALS=287; BFS=86) were identified from 182 recordings. Weak ALS muscles demonstrated a lower mean inter-spike interval (82.7ms) than strong ALS muscles (96.0ms; P=0.00919) and BFS muscles (95.3ms; P=0.0039). Mean MU potential area (area under the curve: 487.5 vs. 98.7μV ms; P<0.0001) and muscle fibre conduction velocity (6.2 vs. 5.1m/s; P=0.0292) were greater in weak ALS muscles than in BFS muscles. Purely fasciculating MUs had a greater mean MU potential area than MUs also under voluntary command (area under the curve: 679.6 vs. 232.4 μV ms; P=0.00144). These results suggest that first-recruited MUs develop a faster phenotype in the latter stages of ALS, likely driven by the preferential loss of vulnerable fast-twitch MUs. Inhibition of this potentially maladaptive phenotypic drift may protect the longevity of the MU pool, stimulating a novel therapeutic avenue.

Visualising oxytocin neurone activity in vivo: The key to unlocking central regulation of parturition and lactation.

During parturition and lactation, oxytocin neurones in the supraoptic and paraventricular nuclei fire high-frequency bursts of action potentials that are coordinated across the entire population. Each burst generates a large pulse of oxytocin release into the circulation to induce uterine contraction for parturition and mammary duct contraction for milk ejection. Bursts are stimulated by cervical stretch during parturition and by suckling during lactation. However, the mechanisms by which these stimuli are translated into episodic bursts are poorly understood, as are the mechanisms that coordinate bursts across the oxytocin neurone population. An elegant series of experiments conducted in the 1980s and 1990s used serial paired recordings to show that oxytocin neurones do not act as a syncytium during bursts; rather, they start each burst within a few hundred milliseconds of each other but with no distinct "leaders" or "followers". In addition to afferent noradrenergic inputs that relay the systemic stimuli to oxytocin neurones, bursts depend on somato-dendritic oxytocin release within the hypothalamus. Hence, bursts are considered to be an emergent property of oxytocin neurones that is bootstrapped by appropriate afferent stimulation. Although much progress was made using traditional electrophysiological recordings in head-fixed anaesthetised animals, research has effectively stalled in the last few decades. However, the emergence of new technologies to monitor neuronal activity in freely-behaving animals has reinvigorated efforts to understand the biology underpinning burst firing in oxytocin neurones. Here, we report the use of fibre photometry to monitor the dynamics of milk ejection bursts in the oxytocin neurone population of freely-behaving mice. This approach will shed light on the neural mechanisms that control the oxytocin bursts underpinning parturition and lactation.

Effect of Acute Aerobic Exercise on Diastolic blood Pressure in Preclinical Medical Students of Services Institute of Medical Sciences, Lahore

Objectives: To evaluate the response of acute bout of moderate exercise on DBP in preclinical medical students of Services Institute of Medical Sciences (SIMS), Lahore and to compare it with gender, family history, lifestyle and waist-hip-ratio of the study participants. Methods: This cross-sectional study was performed in the Department of Physiology, SIMS from May to December 2019. Ninety-three (93) healthy male and female MBBS students were recruited through nonprobability convenient sampling. Socio-demographic components were gathered using a ques-tionnaire. Anthropometric data (height, weight and waist-hip-ratio) and resting DBP was recorded before the exercise. All participants underwent exercise challenge on a treadmill. Post-exercise DBP was measured by taking serial recordings at zero minutes, 2 minutes and 5 minutes after exercise cessation. Data was analyzed using SPSSv20. Results: Within the 93 participants, 87(93.5%) were physically inactive, with only 6(6.5%) were physically active. In comparison with the baseline DBP, the DBP at zero and 2 minutes post exercise was statistically significant (p&lt;0.001) in study participants. There was no significant correlation between DBP immediately after exercise and gender (p = 0.751); family history of hypertension and diabetes mellitus (p = 0.603); and lifestyle (p = 0.954). A non-significant (p = 0.636) yet positive correlation was observed between post exercise DBPand waist-hip-ratio among males. Conclusion: Our study revealed that an acute bout of exercise significantly raised the DBPimmediately after exercise. This rise in BP was not significantly related to gender, lifestyle and family history of diabetes mellitus and hypertension. Keywords: Diastolic blood pressure, aerobic exercise, waist-hip-ratio, medical students, treadmill How to cite: Shafiq M., Qutab M., Javaid S., Fatima R., Ijaz M., Shafiq A. Effect of acute aerobic exercise on diastolic blood pressure in preclinical medical students of Services Institute of Medical Sciences, Lahore. Esculapio 2021;17(02):170-174.

Early Use of Transcranial Doppler Ultrasonography to Stratify Neonatal Encephalopathy

BackgroundThe dynamic nature of neonatal hypoxic-ischemic encephalopathy (HIE) after birth necessitates reliable biomarkers to identify infants with evolving brain injury. This prospective cohort aims to use serial Doppler ultrasonography (US) to measure cerebral blood flow velocity and resistance index (RI) to help detect the time and evolution of the clinical encephalopathy. MethodsA total of 60 neonates were enrolled all ≥36 weeks’ gestation with perinatal acidemia, defined as a blood gas pH ≤ 7.0 or base deficit ≥16 mmol/L and encephalopathy including a matched control group without encephalopathy. Each neonate received one to three serial Doppler recordings starting at six to 24 hours of life. Mean RI ≤ 0.55 was considered abnormal. ResultsMean RIs obtained shortly after birth were significantly lower with increasing severity of encephalopathy. On the first Doppler recordings, abnormal mean RIs were seen in 11 of 18 (61%) neonates with mild, 13 of 17 (76%) with moderate, and two of two (100%) with severe HIE. Of the neonates with mild HIE and abnormal mean RIs, congruity abnormal amplitude electroencephalography (45%), brain magnetic resonance imaging (45%), and abnormal head ultrasound (44%) are here reported. ConclusionsDoppler measurements can provide bedside adjunct biomarkers indicating the time and severity of neonatal HIE.

Remote and Long-Term Self-Monitoring of Electroencephalographic and Noninvasive Measurable Variables at Home in Patients With Epilepsy (EEG@HOME): Protocol for an Observational Study.

BackgroundEpileptic seizures are spontaneous events that severely affect the lives of patients due to their recurrence and unpredictability. The integration of new wearable and mobile technologies to collect electroencephalographic (EEG) and extracerebral signals in a portable system might be the solution to prospectively identify times of seizure occurrence or propensity. The performances of several seizure detection devices have been assessed by validated studies, and patient perspectives on wearables have been explored to better match their needs. Despite this, there is a major gap in the literature on long-term, real-life acceptability and performance of mobile technology essential to managing chronic disorders such as epilepsy.ObjectiveEEG@HOME is an observational, nonrandomized, noninterventional study that aims to develop a new feasible procedure that allows people with epilepsy to independently, continuously, and safely acquire noninvasive variables at home. The data collected will be analyzed to develop a general model to predict periods of increased seizure risk.MethodsA total of 12 adults with a diagnosis of pharmaco-resistant epilepsy and at least 20 seizures per year will be recruited at King’s College Hospital, London. Participants will be asked to self-apply an easy and portable EEG recording system (ANT Neuro) to record scalp EEG at home twice daily. From each serial EEG recording, brain network ictogenicity (BNI), a new biomarker of the propensity of the brain to develop seizures, will be extracted. A noninvasive wrist-worn device (Fitbit Charge 3; Fitbit Inc) will be used to collect non-EEG biosignals (heart rate, sleep quality index, and steps), and a smartphone app (Seer app; Seer Medical) will be used to collect data related to seizure occurrence, medication taken, sleep quality, stress, and mood. All data will be collected continuously for 6 months. Standardized questionnaires (the Post-Study System Usability Questionnaire and System Usability Scale) will be completed to assess the acceptability and feasibility of the procedure. BNI, continuous wrist-worn sensor biosignals, and electronic survey data will be correlated with seizure occurrence as reported in the diary to investigate their potential values as biomarkers of seizure risk.ResultsThe EEG@HOME project received funding from Epilepsy Research UK in 2018 and was approved by the Bromley Research Ethics Committee in March 2020. The first participants were enrolled in October 2020, and we expect to publish the first results by the end of 2022.ConclusionsWith the EEG@HOME study, we aim to take advantage of new advances in remote monitoring technology, including self-applied EEG, to investigate the feasibility of long-term disease self-monitoring. Further, we hope our study will bring new insights into noninvasively collected personalized risk factors of seizure occurrence and seizure propensity that may help to mitigate one of the most difficult aspects of refractory epilepsy: the unpredictability of seizure occurrence.International Registered Report Identifier (IRRID)PRR1-10.2196/25309

Postnatal Maturation of Amplitude Integrated Electroencephalogram in Preterm SGA and Preterm AGA Neonates: A Prospective Observational Study

Introduction: Maturation of the brain is affected by various biological and environmental factors encountered by the infant during the intensive care period in Neonatal Intensive Care Unit (NICU) due to the medical treatments, procedures, and the noisy environment that disrupts the normal brain development process. Severe neurological sequelae of preterm infants are common because of the immature central nervous system. Cerebral Function Monitor (CFM) or Amplitude integrated Electroencephalogram (a-EEG) is a device for monitoring the background neurological activity. Aim: To assess postnatal maturation of a-EEG in clinically stable and neurologically normal preterm Small for Gestational Age (SGA) and preterm Appropriate for Gestational Age (AGA) neonates from 30 weeks 0/7 days to 34 weeks 6/7 days of gestation admitted in a tertiary care NICU at J. K. Lon Mother and Child Hospital, attached to Government Medical College, Kota. Materials and Methods: This prospective observational study was conducted over a one year duration, from January 2020 to December 2020 on 60 preterm neonates that were admitted in NICU of a tertiary care hospital. The serial a-EEG recording was done on haemodynamically stable, included preterm neonates after taking consent, on 3rd, 7th, and 14th postnatal day of life during the course of admission. The postnatal maturation of amplitude integrated EEG of Preterm Small for Gestational Age (PSGA) neonates was compared with their Preterm Appropriate for Gestational Age (PAGA) neonates based on a validated a-EEG scoring. The analysis was done by using Statistical Package for Social Sciences (SPSS) version 21.0. Student t-test was applied. Results: The total a-EEG scores for 3rd, 7th, and 14th day of SGA group neonates were 7.55±1.45, 7.25±1.02 and 10.22±1.05 and were delayed from the AGA group of neonates with 7.86±1.55, 8.68±1.00 and 10.62±1.01, with mean difference (95% CI), 0.30 (-0.49 to 1.13), 1.43 (0.88 to 1.97) and 0.39 (-0.15 to 0.95) respectively. Only the total a-EEG scores for day 7 were significantly delayed in SGA group. Conclusion: All the maturation a-EEG scores of clinically stable and neurologically normal PSGA neonates was found to be significantly delayed at any point of life on postnatal day 7th of life.

Quantitative burst suppression on serial intermittent EEG in refractory status epilepticus

ObjectivesIn refractory status epilepticus (RSE), the optimal degree of suppression (EEG burst suppression or merely suppressing seizures) remains unknown. Many centers lacking continuous EEG must default to serial intermittent recordings where uncertainty from lack of data may prompt more aggressive suppression. In this study, we sought to determine whether the quantitative burst suppression ratio (QBSR) from serial intermittent EEG recording is associated with RSE patient outcome. MethodsWe screened the EEG database to identify non-anoxic adult RSE patients for EEG and chart review. QBSR was calculated per 10-second EEG epoch as the percentage of time during which EEG amplitude was <3 µV. Patients who survived 1–3 months after discharge from ICU and hospital comprised the favorable group. Further to initial unadjusted univariate analysis of all pooled QBSR, we conducted multivariate analyses to account for individual patient confounders (“per-capita analysis”), uneven number of EEG recordings (“per-session analysis”), and uneven number of epochs (“per-epoch analysis”). We analyzed gender, anesthetic number, and adjusted status epilepticus severity score (aSTESS) as confounders. ResultsIn 135,765 QBSR values over 160 EEG recordings (median 2.17 h every ≥24 h) from 17 patients on Propofol, Midazolam, and/or Ketamine, QBSR was deeper in the favorable group (p < 0.001) on initial unadjusted analysis. However, on adjusted multivariate analysis, there was consistently no association between QBSR and outcome. Higher aSTESS consistently associated with unfavorable outcome on per-capita (p = 0.033), per-session (p = 0.048) and per-epoch (p < 0.001) analyses. Greater maximal number of non-barbiturate anesthetic associated with favorable outcome on per-epoch analysis (p < 0.001). ConclusionsThere was no association between depth of EEG suppression using non-barbiturate anesthetic and RSE patient outcome based on QBSR from serial intermittent EEG. A per-epoch association between non-barbiturate anesthetic and favorable outcome suggests an effect from non-suppressive time-varying EEG content. SignificanceTargeting and following deeper burst suppression through non-barbiturate anesthetics on serial intermittent EEG monitoring of RSE is of limited utility.

Effect of Dexmedetomidine on Perioperative Haemodynamic Fluctuations in Untreated Stage 1 Hypertensive Patients Undergoing Laparoscopic Cholecystectomy- A Randomised Controlled Trial

Introduction: Eighth Joint National Committee (JNC 8) has reclassified earlier prehypertension {Systolic Blood Pressure (SBP) 130-139 mm of Hg and/or Diastolic Blood Pressure (DBP) 80-89 mmHg} as stage 1 HTN. These patients may be at greater risk of perioperative haemodynamic instability, more so in case of laparoscopic surgeries and alpha-2 agonists premedication may be useful in such patients. Aim: To assess perioperative haemodynamic fluctuations in untreated stage 1 hypertension (HTN) patients and the role of Dexmedetomidine (Dexmed) in it. Materials and Methods: This prospective, randomised, double blind study was conducted at Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India from March 2019 to September 2020. Sixty-five patients with stage 1 HTN not on any anti-hypertensive drugs undergoing laparoscopic cholecystectomy were enrolled and randomly divided into group D (dexmedetomidine) and group NS (Normal Saline). Group D received Dexmed 1 μg/kg over 10 minutes before induction, followed by continuous infusion of Dexmed at 0.2 μg/ kg/h and Group NS received similar volume of normal saline. Serial recording of pulse rate, Mean Arterial Pressure (MAP) and oxygen saturation was done. Postoperative sedation scores, extubation time and time to first rescue analgesia were also assessed. For analysis, quantitative variables were expressed as mean±SD and compared using unpaired and paired t-test. Mann-Whitney test was used for quantitative data that did not follow a normal distribution. Qualitative variables were expressed as frequencies/percentages and compared using Chi-square test. A p-value &lt;0.05 was considered statistically significant. Results: A total of 60 patients (30 in group NS, mean age 38.40±10.32 years and 30 in group D, mean age 42.5±11.72 years) were analysed in the present study. In NS group, haemodynamic variations were seen at induction, Laryngoscopy and Intubation (L&amp;I), creation and release of Pneumoperitoneum (PNP) and extubation but actual changes were within 10-12% of baseline value, whereas in group D, pulse rate and MAP remained stable and moderately lower than baseline throughout the perioperative period. An increase in extubation time was observed in group D (15.57±3.16 vs.9.15±1.60 min). Group D also had significantly higher sedation scores postextubation. Group NS patients demanded rescue analgesia early (18.33±7.46 min vs.43.53±8.57 min) (p=0.001). Conclusion: It was concluded that the administration of i.v. Dexmed 1 μg/kg over 10 minutes followed by infusion at 0.2 μg/Kg/h results in haemodynamic stability during surgical stress, slightly delayed but smooth extubation, delayed demand of postoperative rescue analgesia and mild sedation of short duration. Dexmed induced effects help in improving the recovery profile of the patient and keeping the patient more comfortable in the postoperative period.

Compressed FTIR spectroscopy using low-rank matrix reconstruction.

Fourier transform infrared (FTIR) spectroscopy is a powerful technique in analytical chemistry. Typically, spatially distributed spectra of the substance of interest are conducted simultaneously using FTIR spectrometers equipped with array detectors. Scanning-based methods such as near-field FTIR spectroscopy, on the other hand, are a promising alternative providing higher spatial resolution. However, serial recording severely limits their application due to the long acquisition times involved and the resulting stability issues. We demonstrate that it is possible to significantly reduce the measurement time of scanning methods by applying the mathematical technique of low-rank matrix reconstruction. Data from a previous pilot study of Leishmania strains are analyzed by randomly selecting 5% of the interferometer samples. The results obtained for bioanalytical fingerprinting using the proposed approach are shown to be essentially the same as those obtained from the full set of data. This finding can significantly foster the practical applicability of high-resolution serial scanning techniques in analytical chemistry and is also expected to improve other applications of FTIR spectroscopy and spectromicroscopy.

Optic nerve sheath diameter sonography during the acute stage of intracerebral hemorrhage: a potential role in monitoring neurocritical patients

BackgroundOptic nerve sheath diameter (ONSD) sonography has been proposed as a reliable bedside tool for the detection of increased intracranial pressure (ICP). ONSD reacts almost simultaneously to oscillations in ICP. The aim of this study was to investigate the ONSD dynamics in the acute stage of intracerebral hemorrhage (ICH) and to compare ONSD dynamics to the clinical outcome.MethodsWe enrolled 35 acute ICH patients and 20 healthy volunteers in this prospective study. At the admission, all patients underwent brain CT scan and ONSD sonography. We repeated the ONSD on the second and the third day in all patients while CT scan was repeated if a patient condition deteriorated. The changes in serial ONSD measurements were termed as stable or unstable ONSD trend. ONSD trend was considered as unstable if variations of average ONSD were above 5%. The outcome of the patient was assessed with the Modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS).ResultsIn healthy volunteers serial ONSD recordings for 3 days revealed a stable trend in 100%. However, in the study group, 23 patients had unstable and 12 had stable ONSD trend during the acute stage of ICH. The patients with unstable ONSD trend were more likely to have worse outcomes (p value 0.003).ConclusionIn patients with ICH, the acute-phase ONSD dynamics can help in predicting the clinical outcome.

4D Scanning - Dynamic View on Body Measurements

Fitting test in movement are an important issue not only in work and sports wear since garment should not restrict the range of motion. Therefore, dynamic anthropometry is a major research topic. Until now, only static position could be captured. Still, it is not known how body geometry changes in dynamic movement. In IGF project “Mobilityrestrictions” photogrammetry scanner “Little Alice” was investigated regarding 4D. It enables serial recording in seconds. The aim of the research project was beside other to identify differences between static and dynamic body measurements. &#x0D; Scanner “Little Alice” has never been utilized for body form analysis. Therefore, a basic research was performed. Several parameters were examined by iterative tests before scan procedure was defined. Three work or sport related movements were defined and compared to standard position: Biceps curl, leg flex and squat. The changes in scan surface were investigated by a three-step analysis: body measurements, cross sections and a 3D analysis. Scan procedure was performed by six test subjects German sizes 50 and 58, age group 25 – 55 years. &#x0D; The results show that photogrammetry can be utilized to investigate body geometry changes due to movement. Body surface deviations have been investigated. Thus, not in all cases there were differences between static and dynamic scans. Yet, body geometry alters. 4D scanning enables comprehensive analysis of body geometry changes due to movement. Body measurement and surface alterations can be visualized and quantified. Scans of motions may be used to validate 3D simulation avatars.

Creutzfeldt-Jacob Disease, As a Rare Cause of Dementia Should Not be Forgotten: Single-Center Experience

Introduction: Dementia, which is an important public health problem, is divided into two groups as primary and secondary dementia. Creutzfeldt–Jakob disease (CJD), which is rarely seen, is a secondary cause of dementia with a rapidly progressive course. It is a fatal neurodegenerative disorder of infectious spongiform encephalopathy that can affect humans and animals. Sporadic CJD is the most common type that can present in four forms and has typical clinical presentations of progressive cognitive impairment, myoclonus, and ataxia. We aimed to discuss the demographic, clinical, and laboratory findings of CJD cases diagnosed in the neurointensive care unit. Methods: Sixteen patients were included in this retrospective study. Age, sex, complaints on admission, duration from symptom onset to mortality, neurologic examination, brain magnetic resonance imaging (MRI), electroencephalography (EEG), and the protein 14.3.3 status of the cerebrospinal fluid (CSF) were recorded. Results: The mean age was 61.18 ± 9.1 years (range, 37–73 years), and the most common complaints on admission were cognitive impairment, disturbance in consciousness, ataxia, and gait disturbance. CSF protein 14-3-3 was positive in 100% of patients. The most common findings were periodic sharp and wave complexes on EEG, cortical or putamen and caudate nucleus hyperintensity, cortical and cerebellar atrophy on MRI. One of the patients was diagnosed as variant CJD, and the others were diagnosed as the sporadic form. Conclusions: CJD should be kept in mind in patients with myoclonus or ataxia accompanied by progressive cognitive impairment. Neuroimaging, serial EEG recordings, CSF analysis, and histopathologic examination should be performed for diagnosis.

Blood pressure excursions in acute ischemic stroke patients treated with intravenous thrombolysis.

To investigate the association of blood pressure BP excursions, defined as greater than 185 SBP or greater than 105 DBP, with the probability of intracranial hemorrhage (ICH) and worse functional outcomes in patients with acute ischemic stroke (AIS) treated with tissue plasminogen activator (tPA). We performed a post hoc analysis of the CLOTBUST-ER trial. Serial BP measurements were conducted using automated cuff recording according to the recommended BP protocol guidelines for tPA administration. The outcomes were prespecified efficacy and safety endpoints of CLOTBUST-ER. The mean number of serial BP recordings per patient was 37. Of the 674 patients, 227 (34%) had at least one BP excursion (>185/105 mmHg) during the first 24 h following tPA-bolus. The majority of BP excursions (46%) occurred within the first 75 min from tPA-bolus. Patients with at least one BP excursion in the first 24 h following tPA bolus had significantly lower rates of independent functional outcome at 90 days (31 vs. 40.1%, P = 0.028). The total number of BP excursions was associated with decreased odds of 24-h clinical recovery (OR = 0.88, 95% CI:0.80-0.96), 24-h neurological improvement (OR = 0.87, 95% CI: 0.81-0.94), 7-day functional improvement (common OR = 0.92, 95% CI: 0.87-0.97), 90-day functional improvement (common OR = 0.94, 95% CI: 0.88-0.98) and 90-day independent functional outcome (OR = 0.90, 95% CI: 0.82-0.98) in analyses adjusted for potential confounders. DBP excursions were independently associated with increased odds of any intracranial hemorrhage (OR = 1.26, 95% CI: 1.04-1.53). BP excursions above guideline thresholds during the first 24 h following tPA administration for AIS are common and are independently associated with adverse clinical outcomes.

Should we still monitor QTc duration in frail older patients on low-dose haloperidol? A prospective observational cohort study.

Haloperidol at high dosage is associated with QTc prolongation and polymorphic ventricular arrhythmia but the effects of low-dose haloperidol remain unknown. To evaluate the effects of low-dose haloperidol on QTc-duration in frail hospitalized elderly patients with delirium. A prospective observational study including hospitalized patients aged ≥70years with Groningen Frailty Index-score > 3. We included 150 patients who received haloperidol and 150 age- and frailty-matched control patients. Serial ECG recordings were performed at hospital admission and during hospitalization. QT-interval was corrected according to Framingham (QTc). Patients were grouped according to baseline QTc in normal (nQTc), borderline (bQTc) or abnormal (aQTc). Primary outcome was change in QTc-duration between first and second ECG. Potentially dangerous QTc was defined as QTc >500ms or an increase of >50ms. Patients in the haloperidol group (48% male, mean age 85y, nQT n = 98, bQT n = 31, aQT n = 20) received an average dose of 1.5mg haloperidol per 24hours. QTc decreased in patients with borderline (mean-15 ± 29ms, P< 0.05) or abnormal (-19 ± 27ms, P< 0.05) QTc at baseline, no patients developed dangerous QTc-duration. In the control group (41% male, mean age 84y, nQT n = 99 bQT n = 29, aQT n = 22) QTc decreased to a similar extent (bQT -7 ± 16ms, aQTc -23 ± 20ms). A trend to QTc shortening was seen, especially in patients with borderline or abnormal QTc at baseline, regardless of haloperidol use. These findings suggest that ECG monitoring of frail elderly patients who receive low-dose haloperidol, may not be necessary.

Deep learning for estimation of functional brain maturation from EEG of premature neonates.

EEG monitoring of early brain function and development in neonatal intensive care units may help to identify infants with high risk of serious neurological impairment and to assess brain maturation for evaluation of neurodevelopmental progress. Automated analysis of EEG data makes continuous evaluation of brain activity fast and accessible. A convolutional neural network (CNN) for regression of EEG maturational age of premature neonates from marginally preprocessed serial EEG recordings is proposed. The CNN was trained and validated using 141 EEG recordings from 43 preterm neonates born below 28 weeks of gestation with normal neurodevelop-mental outcome at 12 months of corrected age. The estimated functional brain maturation between the first and last EEG recording increased in each patient. On average over 96% of repeated measures within an infant had an increasing EEG maturational age according to the post menstrual age at EEG recording time. Our algorithm has potential to be deployed to support neonatologists for accurate estimation of functional brain maturity in premature neonates.

Low-Frequency Oscillations Are a Biomarker of Injury and Recovery After Stroke.

Background and Purpose- Low-frequency oscillations reflect brain injury but also contribute to normal behaviors. We examined hypotheses relating electroencephalography measures, including low-frequency oscillations, to injury and motor recovery poststroke. Methods- Patients with stroke completed structural neuroimaging, a resting-state electroencephalography recording and clinical testing. A subset admitted to an inpatient rehabilitation facility also underwent serial electroencephalography recordings. The relationship that electroencephalography measures (power and coherence with leads overlying ipsilesional primary motor cortex [iM1]) had with injury and motor status was assessed, focusing on delta (1-3 Hz) and high-beta (20-30 Hz) bands. Results- Across all patients (n=62), larger infarct volume was related to higher delta band power in bilateral hemispheres and to higher delta band coherence between iM1 and bilateral regions. In chronic stroke, higher delta power bilaterally correlated with better motor status. In subacute stroke, higher delta coherence between iM1 and bilateral areas correlated with poorer motor status. These coherence findings were confirmed in serial recordings from 18 patients in an inpatient rehabilitation facility. Here, interhemispheric coherence between leads overlying iM1 and contralesional M1 was elevated at inpatient rehabilitation facility admission compared with healthy controls (n=22), declining to control levels over time. Decreases in interhemispheric coherence between iM1 and contralesional M1 correlated with better motor recovery. Conclusions- Delta band coherence with iM1 related to greater injury and poorer motor status subacutely, while delta band power related to greater injury and better motor status chronically. Low-frequency oscillations reflect both injury and recovery after stroke and may be useful biomarkers in stroke recovery and rehabilitation.

Electro-clinical and neurodevelopmental outcome in six children with early diagnosis of tuberous sclerosis complex and role of the genetic background

BackgroundSeizures in individuals affected by tuberous sclerosis complex (TSC) commonly develop in the first year of life, are often preceded by a progressive deterioration of the electroencephalogram (EEG), and likely influence developmental outcome. Although early diagnosis of TSC has offered a tremendous opportunity to monitor affected patients before seizure onset, reports of the neurological manifestations of TSC in infants before seizure onset are still scarce. Here we describe early EEG activity, clinical and genetic data and developmental assessment in a group of TSC infants, with the aim of identifying possible prognostic factors for neurodevelopmental outcome.MethodsWe report on six infants diagnosed with TSC pre- or perinatally, who underwent serial Video-EEG recordings during the first two years of life. EEGs were classified based on distribution and intensity of interictal epileptiform discharges, and Vigabatrin was introduced in case of ictal discharges. Psychomotor development, cognitive functioning and behavioral problems were assessed through standardized scales. Molecular testing included analysis for point mutations and deletions/duplications in TSC1 and TSC2.ResultsEEG abnormalities appeared at a mean age of 4 months. Four of the six patients developed seizures. EEG abnormalities preceded the onset of clinical seizures in all of them. The two individuals with good seizure control showed normal development, while the other two exhibited psychomotor delays. The patients who did not develop seizures had normal development. A pathogenic variant in the TSC2 gene was detected in all patients but one. The one without a mutation identified did not develop seizures and showed normal neurodevelopment. Of note, the two patients presenting with the worst outcome (that is, poor seizure control and intellectual/behavioral disability) both carried pathogenic variants in the GAP domain of TSC2.ConclusionOur report supports the importance of EEG monitoring before seizure onset in patients with TSC, and the correlation between prompt seizure control and positive neurodevelopmental outcome, regardless of seizure type. Our results also indicate a possible role of the genetic background in influencing the outcome.