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Kagialis A, Simos N, Manolitsi K, Vakis A, Simos P, Papadaki E. Functional connectivity-hemodynamic (un)coupling changes in chronic mild brain injury are associated with mental health and neurocognitive indices: a resting state fMRI study. Neuroradiology 2024:10.1007/s00234-024-03352-9. [PMID: 38605104 DOI: 10.1007/s00234-024-03352-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/02/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE To examine hemodynamic and functional connectivity alterations and their association with neurocognitive and mental health indices in patients with chronic mild traumatic brain injury (mTBI). METHODS Resting-state functional MRI (rs-fMRI) and neuropsychological assessment of 37 patients with chronic mTBI were performed. Intrinsic connectivity contrast (ICC) and time-shift analysis (TSA) of the rs-fMRI data allowed the assessment of regional hemodynamic and functional connectivity disturbances and their coupling (or uncoupling). Thirty-nine healthy age- and gender-matched participants were also examined. RESULTS Patients with chronic mTBI displayed hypoconnectivity in bilateral hippocampi and parahippocampal gyri and increased connectivity in parietal areas (right angular gyrus and left superior parietal lobule (SPL)). Slower perfusion (hemodynamic lag) in the left anterior hippocampus was associated with higher self-reported symptoms of depression (r = - 0.53, p = .0006) and anxiety (r = - 0.484, p = .002), while faster perfusion (hemodynamic lead) in the left SPL was associated with lower semantic fluency (r = - 0.474, p = .002). Finally, functional coupling (high connectivity and hemodynamic lead) in the right anterior cingulate cortex (ACC)) was associated with lower performance on attention and visuomotor coordination (r = - 0.50, p = .001), while dysfunctional coupling (low connectivity and hemodynamic lag) in the left ventral posterior cingulate cortex (PCC) and right SPL was associated with lower scores on immediate passage memory (r = - 0.52, p = .001; r = - 0.53, p = .0006, respectively). Uncoupling in the right extrastriate visual cortex and posterior middle temporal gyrus was negatively associated with cognitive flexibility (r = - 0.50, p = .001). CONCLUSION Hemodynamic and functional connectivity differences, indicating neurovascular (un)coupling, may be linked to mental health and neurocognitive indices in patients with chronic mTBI.
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Affiliation(s)
- Antonios Kagialis
- Department of Psychiatry, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
- Department of Radiology, School of Medicine, University of Crete, University Hospital of Heraklion, 71003, Crete, Greece
| | - Nicholas Simos
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Katina Manolitsi
- Department of Neurosurgery, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
| | - Antonios Vakis
- Department of Neurosurgery, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
| | - Panagiotis Simos
- Department of Psychiatry, School of Medicine, University of Crete, University Hospital of Heraklion, Crete, Greece
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece
| | - Efrosini Papadaki
- Department of Radiology, School of Medicine, University of Crete, University Hospital of Heraklion, 71003, Crete, Greece.
- Institute of Computer Science, Foundation for Research and Technology - Hellas, Heraklion, Crete, Greece.
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Theodoropoulos D, Karabetsos DA, Vakis A, Papadaki E, Karantanas A, Marias K. The current status of noninvasive intracranial pressure monitoring: A literature review. Clin Neurol Neurosurg 2024; 239:108209. [PMID: 38430649 DOI: 10.1016/j.clineuro.2024.108209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Elevated intracranial pressure (ICP) is a life-threatening condition that must be promptly diagnosed. However, the gold standard methods for ICP monitoring are invasive, time-consuming, and they involve certain risks. To address these risks, many noninvasive approaches have been proposed. This study undertakes a literature review of the existing noninvasive methods, which have reported promising results. The experimental base on which they are established, however, prevents their application in emergency conditions and thus none of them are capable of replacing the traditional invasive methods to date. On the other hand, contemporary methods leverage Machine Learning (ML) which has already shown unprecedented results in several medical research areas. That said, only a few publications exist on ML-based approaches for ICP estimation, which are not appropriate for emergency conditions due to their restricted capability of employing the medical imaging data available in intensive care units. The lack of such image-based ML models to estimate ICP is attributed to the scarcity of annotated datasets requiring directly measured ICP data. This ascertainment highlights an active and unexplored scientific frontier, calling for further research and development in the field of ICP estimation, particularly leveraging the untapped potential of ML techniques.
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Affiliation(s)
| | - Dimitrios A Karabetsos
- Department of Neurosurgery, Heraklion University Hospital, Voutes, Heraklion, Crete 715 00, Greece.
| | - Antonios Vakis
- University of Crete, Medical School, Andrea Kalokerinou 13, Heraklion, Crete 715 00, Greece; Department of Neurosurgery, Heraklion University Hospital, Voutes, Heraklion, Crete 715 00, Greece
| | - Efrosini Papadaki
- University of Crete, Medical School, Andrea Kalokerinou 13, Heraklion, Crete 715 00, Greece; Department Of Radiology, Heraklion University Hospital, Voutes, Heraklion, Crete 715 00, Greece; FORTH-ICS, Computational Biomedicine Laboratory, Vassilika Vouton, Heraklion
| | - Apostolos Karantanas
- University of Crete, Medical School, Andrea Kalokerinou 13, Heraklion, Crete 715 00, Greece; Department Of Radiology, Heraklion University Hospital, Voutes, Heraklion, Crete 715 00, Greece; FORTH-ICS, Computational Biomedicine Laboratory, Vassilika Vouton, Heraklion
| | - Kostas Marias
- FORTH-ICS, Computational Biomedicine Laboratory, Vassilika Vouton, Heraklion; Department of Electrical and Computer Engineering, Hellenic Mediterranean University, Estavromenos, Heraklion, Crete 71410, Greece
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Simos NJ, Manolitsi K, Luppi AI, Kagialis A, Antonakakis M, Zervakis M, Antypa D, Kavroulakis E, Maris TG, Vakis A, Stamatakis EA, Papadaki E. Chronic Mild Traumatic Brain Injury: Aberrant Static and Dynamic Connectomic Features Identified Through Machine Learning Model Fusion. Neuroinformatics 2022; 21:427-442. [PMID: 36456762 PMCID: PMC10085953 DOI: 10.1007/s12021-022-09615-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/25/2022] [Accepted: 11/13/2022] [Indexed: 12/04/2022]
Abstract
AbstractTraumatic Brain Injury (TBI) is a frequently occurring condition and approximately 90% of TBI cases are classified as mild (mTBI). However, conventional MRI has limited diagnostic and prognostic value, thus warranting the utilization of additional imaging modalities and analysis procedures. The functional connectomic approach using resting-state functional MRI (rs-fMRI) has shown great potential and promising diagnostic capabilities across multiple clinical scenarios, including mTBI. Additionally, there is increasing recognition of a fundamental role of brain dynamics in healthy and pathological cognition. Here, we undertake an in-depth investigation of mTBI-related connectomic disturbances and their emotional and cognitive correlates. We leveraged machine learning and graph theory to combine static and dynamic functional connectivity (FC) with regional entropy values, achieving classification accuracy up to 75% (77, 74 and 76% precision, sensitivity and specificity, respectively). As compared to healthy controls, the mTBI group displayed hypoconnectivity in the temporal poles, which correlated positively with semantic (r = 0.43, p < 0.008) and phonemic verbal fluency (r = 0.46, p < 0.004), while hypoconnectivity in the right dorsal posterior cingulate correlated positively with depression symptom severity (r = 0.54, p < 0.0006). These results highlight the importance of residual FC in these regions for preserved cognitive and emotional function in mTBI. Conversely, hyperconnectivity was observed in the right precentral and supramarginal gyri, which correlated negatively with semantic verbal fluency (r=-0.47, p < 0.003), indicating a potential ineffective compensatory mechanism. These novel results are promising toward understanding the pathophysiology of mTBI and explaining some of its most lingering emotional and cognitive symptoms.
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Affiliation(s)
- Nicholas J. Simos
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology–Hellas, 70013 Heraklion, Greece
| | - Katina Manolitsi
- Department of Neurosurgery, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
- Department of Psychiatry, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Andrea I. Luppi
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, CB2 0SP Cambridge, UK
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, CB2 0SP Cambridge, UK
| | - Antonios Kagialis
- Department of Psychiatry, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Marios Antonakakis
- Digital Image and Signal Processing Laboratory, School of Electrical and Computer Engineering, Technical University of Crete, Chania, Greece
| | - Michalis Zervakis
- Digital Image and Signal Processing Laboratory, School of Electrical and Computer Engineering, Technical University of Crete, Chania, Greece
| | - Despina Antypa
- Department of Psychiatry, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Eleftherios Kavroulakis
- Department of Radiology, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Thomas G. Maris
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology–Hellas, 70013 Heraklion, Greece
- Department of Radiology, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Antonios Vakis
- Department of Neurosurgery, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
| | - Emmanuel A. Stamatakis
- Division of Anaesthesia, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, CB2 0SP Cambridge, UK
- Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Hills Rd, CB2 0SP Cambridge, UK
| | - Efrosini Papadaki
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology–Hellas, 70013 Heraklion, Greece
- Department of Radiology, School of Medicine & University Hospital of Heraklion, University of Crete, Crete, Greece
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Clark D, Joannides A, Adeleye AO, Bajamal AH, Bashford T, Biluts H, Budohoski K, Ercole A, Fernández-Méndez R, Figaji A, Gupta DK, Härtl R, Iaccarino C, Khan T, Laeke T, Rubiano A, Shabani HK, Sichizya K, Tewari M, Tirsit A, Thu M, Tripathi M, Trivedi R, Devi BI, Servadei F, Menon D, Kolias A, Hutchinson P, Abdallah OI, Abdel-Lateef A, Abdifatah K, Abdullateef A, Abeygunaratne R, Aboellil M, Adam A, Adams R, Adeleye A, Adeolu A, Adji NK, Afianti N, Agarwal S, Aghadi IK, Aguilar PMM, Ahmad SR, Ahmed D, Ahmed N, Aizaz H, Aji YK, Alamri A, Alberto AJM, Alcocer LA, Alfaro LG, Al-Habib A, Alhourani A, Ali SMR, Alkherayf F, AlMenabbawy A, Alshareef A, Aminullah MAS, Amjad M, Amorim RLOD, Anbazhagan S, Andrade A, Antar W, Anyomih TT, Aoun S, Apriawan T, Armocida D, Arnold P, Arraez M, Assefa T, Asser A, Athiththan S, Attanayake D, Aung MM, Avi A, Ayala VEA, Azab M, Azam G, Azharuddin M, Badejo O, Badran M, Baig AA, Baig RA, Bajaj A, Baker P, Bala R, Balasa A, Balchin R, Balogun J, Ban VS, Bandi BKR, Bandyopadhyay S, Bank M, Barthelemy E, Bashir MT, Basso LS, Basu S, Batista A, Bauer M, Bavishi D, Beane A, Bejell S, Belachew A, Belli A, Belouaer A, Bendahane NEA, Benjamin O, Benslimane Y, Benyaiche C, Bernucci C, Berra LV, Bhebe A, Bimpis A, Blanaru D, Bonfim JC, Borba LAB, Borcek AO, Borotto E, Bouhuwaish AEM, Bourilhon F, Brachini G, Breedon J, Broger M, Brunetto GMF, Bruzzaniti P, Budohoska N, Burhan H, Calatroni ML, Camargo C, Cappai PF, Cardali SM, Castaño-Leon AM, Cederberg D, Celaya M, Cenzato M, Challa LM, Charest D, Chaurasia B, Chenna R, Cherian I, Ching'o JH, Chotai T, Choudhary A, Choudhary N, Choumin F, Cigic T, Ciro J, Conti C, Corrêa ACDS, Cossu G, Couto MP, Cruz A, D'Silva D, D'Aliberti GA, Dampha L, Daniel RT, Dapaah A, Darbar A, Dascalu G, Dauda HA, Davies O, Delgado-Babiano A, Dengl M, Despotovic M, Devi I, Dias C, Dirar M, Dissanayake M, Djimbaye H, Dockrell S, Dolachee A, Dolgopolova J, Dolgun M, Dow A, Drusiani D, Dugan A, Duong DT, Duong TK, Dziedzic T, Ebrahim A, El Fatemi N, El Helou AE, El Maaqili RE, El Mostarchid BE, El Ouahabi AE, Elbaroody M, El-Fiki A, El-Garci A, El-Ghandour NM, Elhadi M, Elleder V, Elrais S, El-shazly M, Elshenawy M, Elshitany H, El-Sobky O, Emhamed M, Enicker B, Erdogan O, Ertl S, Esene I, Espinosa OO, Fadalla T, Fadelalla M, Faleiro RM, Fatima N, Fawaz C, Fentaw A, Fernandez CE, Ferreira A, Ferri F, Figaji T, Filho ELB, Fin L, Fisher B, Fitra F, Flores AP, Florian IS, Fontana V, Ford L, Fountain D, Frade JMR, Fratto A, Freyschlag C, Gabin AS, Gallagher C, Ganau M, Gandia-Gonzalez ML, Garcia A, Garcia BH, Garusinghe S, Gebreegziabher B, Gelb A, George JS, Germanò AF, Ghetti I, Ghimire P, Giammarusti A, Gil JL, Gkolia P, Godebo Y, Gollapudi PR, Golubovic J, Gomes JF, Gonzales J, Gormley W, Gots A, Gribaudi GL, Griswold D, Gritti P, Grobler R, Gunawan R, Hailemichael B, Hakkou E, Haley M, Hamdan A, Hammed A, Hamouda W, Hamzah NA, Han NL, Hanalioglu S, Haniffa R, Hanko M, Hanrahan J, Hardcastle T, Hassani FD, Heidecke V, Helseth E, Hernández-Hernández MÁ, Hickman Z, Hoang LMC, Hollinger A, Horakova L, Hossain-Ibrahim K, Hou B, Hoz S, Hsu J, Hunn M, Hussain M, Iacopino G, Ideta MML, Iglesias I, Ilunga A, Imtiaz N, Islam R, Ivashchenko S, Izirouel K, Jabal MS, Jabal S, Jabang JN, Jamjoom A, Jan I, Jarju LBM, Javed S, Jelaca B, Jhawar SS, Jiang TT, Jimenez F, Jiris J, Jithoo R, Johnson W, Joseph M, Joshi R, Junttila E, Jusabani M, Kache SA, Kadali SP, Kalkmann GF, Kamboh U, Kandel H, Karakus AK, Kassa M, Katila A, Kato Y, Keba M, Kehoe K, Kertmen HH, Khafaji S, Khajanchi M, Khan M, Khan MM, Khan SD, Khizar A, Khriesh A, Kierońska S, Kisanga P, Kivevele B, Koczyk K, Koerling AL, Koffenberger D, Kõiv K, Kõiv L, Kolarovszki B, König M, Könü-Leblebicioglu D, Koppala SD, Korhonen T, Kostkiewicz B, Kostyra K, Kotakadira S, Kotha AR, Kottakki MNR, Krajcinovic N, Krakowiak M, Kramer A, Krishnamoorthy S, Kumar A, Kumar P, Kumar P, Kumarasinghe N, Kuncha G, Kutty RK, Laeke T, Lafta G, Lammy S, Lapolla P, Lardani J, Lasica N, Lastrucci G, Launey Y, Lavalle L, Lawrence T, Lazaro A, Lebed V, Leinonen V, Lemeri L, Levi L, Lim JY, Lim XY, Linares-Torres J, Lippa L, Lisboa L, Liu J, Liu Z, Lo WB, Lodin J, Loi F, Londono D, Lopez PAG, López CB, Lotbiniere-Bassett MD, Lulens R, Luna FH, Luoto T, M.V. VS, Mabovula N, MacAllister M, Macie AA, Maduri R, Mahfoud M, Mahmood A, Mahmoud F, Mahoney D, Makhlouf W, Malcolm G, Malomo A, Malomo T, Mani MK, Marçal TG, Marchello J, Marchesini N, Marhold F, Marklund N, Martín-Láez R, Mathaneswaran V, Mato-Mañas DJ, Maye H, McLean AL, McMahon C, Mediratta S, Mehboob M, Meneses A, Mentri N, Mersha H, Mesa AM, Meyer C, Millward C, Mimbir SA, Mingoli A, Mishra P, Mishra T, Misra B, Mittal S, Mohammed I, Moldovan I, Molefe M, Moles A, Moodley P, Morales MAN, Morgan L, Morillo GDC, Moustafa W, Moustakis N, Mrichi S, Munjal SS, Muntaka AJM, Naicker D, Nakashima PEH, Nandigama PK, Nash S, Negoi I, Negoita V, Neupane S, Nguyen MH, Niantiarno FH, Noble A, Nor MAM, Nowak B, Oancea A, O'Brien F, Okere O, Olaya S, Oliveira L, Oliveira LM, Omar F, Ononeme O, Opšenák R, Orlandini S, Osama A, Osei-Poku D, Osman H, Otero A, Ottenhausen M, Otzri S, Outani O, Owusu EA, Owusu-Agyemang K, Ozair A, Ozoner B, Paal E, Paiva MS, Paiva W, Pandey S, Pansini G, Pansini L, Pantel T, Pantelas N, Papadopoulos K, Papic V, Park K, Park N, Paschoal EHA, Paschoalino MCDO, Pathi R, Peethambaran A, Pereira TA, Perez IP, Pérez CJP, Periyasamy T, Peron S, Phillips M, Picazo SS, Pinar E, Pinggera D, Piper R, Pirakash P, Popadic B, Posti JP, Prabhakar RB, Pradeepan S, Prasad M, Prieto PC, Prince R, Prontera A, Provaznikova E, Quadros D, Quintero NJR, Qureshi M, Rabiel H, Rada G, Ragavan S, Rahman J, Ramadhan O, Ramaswamy P, Rashid S, Rathugamage J, Rätsep T, Rauhala M, Raza A, Reddycherla NR, Reen L, Refaat M, Regli L, Ren H, Ria A, Ribeiro TF, Ricci A, Richterová R, Ringel F, Robertson F, Rocha CMSC, Rogério JDS, Romano AA, Rothemeyer S, Rousseau GRG, Roza R, Rueda KDF, Ruiz R, Rundgren M, Rzeplinski R, S.Chandran R, Sadayandi RA, Sage W, Sagerer ANJ, Sakar M, Salami M, Sale D, Saleh Y, Sánchez-Viguera C, Sandila S, Sanli AM, Santi L, Santoro A, Santos AKDD, Santos SCD, Sanz B, Sapkota S, Sasidharan G, Sasillo I, Satoskar R, Sayar AC, Sayee V, Scheichel F, Schiavo FL, Schupper A, Schwarz A, Scott T, Seeberger E, Segundo CNC, Seidu AS, Selfa A, Selmi NH, Selvarajah C, Şengel N, Seule M, Severo L, Shah P, Shahzad M, Shangase T, Sharma M, Shiban E, Shimber E, Shokunbi T, Siddiqui K, Sieg E, Siegemund M, Sikder SR, Silva ACV, Silva A, Silva PA, Singh D, Skadden C, Skola J, Skouteli E, Słoniewski P, Smith B, Solanki G, Solla DF, Solla D, Sonmez O, Sönmez M, Soon WC, Stefini R, Stienen MN, Stoica B, Stovell M, Suarez MN, Sulaiman A, Suliman M, Sulistyanto A, Sulubulut Ş, Sungailaite S, Surbeck M, Szmuda T, Taddei G, Tadele A, Taher ASA, Takala R, Talari KM, Tan BH, Tariciotti L, Tarmohamed M, Taroua O, Tatti E, Tenovuo O, Tetri S, Thakkar P, Thango N, Thatikonda SK, Thesleff T, Thomé C, Thornton O, Timmons S, Timoteo EE, Tingate C, Tliba S, Tolias C, Toman E, Torres I, Torres L, Touissi Y, Touray M, Tropeano MP, Tsermoulas G, Tsitsipanis C, Turkoglu ME, Uçkun ÖM, Ullman J, Ungureanu G, Urasa S, Ur-Rehman O, Uysal M, Vakis A, Valeinis E, Valluru V, Vannoy D, Vargas P, Varotsis P, Varshney R, Vats A, Veljanoski D, Venturini S, Verma A, Villa C, Villa G, Villar S, Villard E, Viruez A, Voglis S, Vulekovic P, Wadanamby S, Wagner K, Walshe R, Walter J, Waseem M, Whitworth T, Wijeyekoon R, Williams A, Wilson M, Win S, Winarso AWW, Ximenes AWP, Yadav A, Yadav D, Yakoub KM, Yalcinkaya A, Yan G, Yaqoob E, Yepes C, Yılmaz AN, Yishak B, Yousuf FB, Zahari MZ, Zakaria H, Zambonin D, Zavatto L, Zebian B, Zeitlberger AM, Zhang F, Zheng F, Ziga M. Casemix, management, and mortality of patients rreseceiving emergency neurosurgery for traumatic brain injury in the Global Neurotrauma Outcomes Study: a prospective observational cohort study. Lancet Neurol 2022; 21:438-449. [PMID: 35305318 DOI: 10.1016/s1474-4422(22)00037-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/19/2021] [Accepted: 01/17/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) is increasingly recognised as being responsible for a substantial proportion of the global burden of disease. Neurosurgical interventions are an important aspect of care for patients with TBI, but there is little epidemiological data available on this patient population. We aimed to characterise differences in casemix, management, and mortality of patients receiving emergency neurosurgery for TBI across different levels of human development. METHODS We did a prospective observational cohort study of consecutive patients with TBI undergoing emergency neurosurgery, in a convenience sample of hospitals identified by open invitation, through international and regional scientific societies and meetings, individual contacts, and social media. Patients receiving emergency neurosurgery for TBI in each hospital's 30-day study period were all eligible for inclusion, with the exception of patients undergoing insertion of an intracranial pressure monitor only, ventriculostomy placement only, or a procedure for drainage of a chronic subdural haematoma. The primary outcome was mortality at 14 days postoperatively (or last point of observation if the patient was discharged before this time point). Countries were stratified according to their Human Development Index (HDI)-a composite of life expectancy, education, and income measures-into very high HDI, high HDI, medium HDI, and low HDI tiers. Mixed effects logistic regression was used to examine the effect of HDI on mortality while accounting for and quantifying between-hospital and between-country variation. FINDINGS Our study included 1635 records from 159 hospitals in 57 countries, collected between Nov 1, 2018, and Jan 31, 2020. 328 (20%) records were from countries in the very high HDI tier, 539 (33%) from countries in the high HDI tier, 614 (38%) from countries in the medium HDI tier, and 154 (9%) from countries in the low HDI tier. The median age was 35 years (IQR 24-51), with the oldest patients in the very high HDI tier (median 54 years, IQR 34-69) and the youngest in the low HDI tier (median 28 years, IQR 20-38). The most common procedures were elevation of a depressed skull fracture in the low HDI tier (69 [45%]), evacuation of a supratentorial extradural haematoma in the medium HDI tier (189 [31%]) and high HDI tier (173 [32%]), and evacuation of a supratentorial acute subdural haematoma in the very high HDI tier (155 [47%]). Median time from injury to surgery was 13 h (IQR 6-32). Overall mortality was 18% (299 of 1635). After adjustment for casemix, the odds of mortality were greater in the medium HDI tier (odds ratio [OR] 2·84, 95% CI 1·55-5·2) and high HDI tier (2·26, 1·23-4·15), but not the low HDI tier (1·66, 0·61-4·46), relative to the very high HDI tier. There was significant between-hospital variation in mortality (median OR 2·04, 95% CI 1·17-2·49). INTERPRETATION Patients receiving emergency neurosurgery for TBI differed considerably in their admission characteristics and management across human development settings. Level of human development was associated with mortality. Substantial opportunities to improve care globally were identified, including reducing delays to surgery. Between-hospital variation in mortality suggests changes at an institutional level could influence outcome and comparative effectiveness research could identify best practices. FUNDING National Institute for Health Research Global Health Research Group.
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Affiliation(s)
- David Clark
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK; Neurosurgery Division, University Teaching Hospital, Lusaka, Zambia.
| | - Alexis Joannides
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Amos Olufemi Adeleye
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Abdul Hafid Bajamal
- Department of Neurosurgery, Dr Soetomo Hospital, Surabaya, Jawa Timur, Indonesia
| | - Tom Bashford
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Hagos Biluts
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Karol Budohoski
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Ari Ercole
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Rocío Fernández-Méndez
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Anthony Figaji
- Division of Neurosurgery and Neurosciences Institute, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Deepak Kumar Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Corrado Iaccarino
- Neurosurgery Division, University Hospital of Parma, Parma, Emilia-Romagna, Italy
| | - Tariq Khan
- Department of Neurosurgery, North West General Hospital & Research Center, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Tsegazeab Laeke
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Andrés Rubiano
- Department of Neurosurgery, Universidad El Bosque, Bogota, Colombia
| | - Hamisi K Shabani
- Department of Neurological Surgery, Muhimbili Orthopaedic Institute and Muhimbili University College of Allied Health Sciences, Dar es Salaam, Tanzania
| | | | - Manoj Tewari
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Abenezer Tirsit
- Neurosurgery Unit, Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Oromia, Ethiopia
| | - Myat Thu
- Department of Neurosurgery, Yangon General Hospital, Yangon, Yangon Region, Myanmar
| | - Manjul Tripathi
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research Chandigarh, Chandigarh, India
| | - Rikin Trivedi
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Bhagavatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Franco Servadei
- Humanitas Clinical and Research Center-IRCCS and Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - David Menon
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Angelos Kolias
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Peter Hutchinson
- National Institute of Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
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Karabetsos DA, Tsitsipanis C, Koutserimpas C, Chaniotis V, Vakis A, Samonis G, Alpantaki K. Acute paraplegia due to thoracolumbar schwannoma following trauma: A case report and literature review. Mol Clin Oncol 2021; 15:204. [PMID: 34462660 DOI: 10.3892/mco.2021.2366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/26/2021] [Indexed: 11/05/2022] Open
Abstract
Spinal schwannomas account for one third of primary spinal neoplasms. Clinical presentation is related to the tumor location. An atypical case of acute paraplegia following a fall, on the ground of a thoracolumbar schwannoma, without intratumoral hemorrhage, in a previously asymptomatic patient is reported. A 58-year-old male patient presented with acute paraplegia, and urinary and bowel incontinence, following a fall. The patient had no previous history of back and/or leg pain or neurological symptoms. Magnetic resonance imaging revealed a subdural mass, as well as a fracture of the right T12-L1 facet joint and the right transverse process. The patient underwent emergency T11-L1 wide laminectomy, exploration of the subdural space and T10-L2 posterolateral transpedicular stabilization and fusion. An intradural, extramedullary mass, causing severe cord compression, was found and excised. Pathology revealed schwannoma, without intratumoral hemorrhage. The patient recovered completely 6 months postoperatively. To the best of our knowledge, this is the first report of spinal intradural schwannoma causing sudden paraplegia in a previously asymptomatic patient in the setting of trauma, without intratumoral hemorrhage. Emergency canal decompression and complete excision of the tumor represent the optimal management of such cases.
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Affiliation(s)
| | - Christos Tsitsipanis
- Department of Neurosurgery, University Hospital of Crete, Heraklion 71500, Greece
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, '251' Hellenic Air Force General Hospital of Athens, Athens 11525, Greece
| | - Vrettos Chaniotis
- Department of Pathology, General Hospital of Chania, Chania 73300, Greece
| | - Antonios Vakis
- Department of Neurosurgery, University Hospital of Crete, Heraklion 71500, Greece
| | - George Samonis
- Department of Internal Medicine, University Hospital of Crete, Heraklion 71500, Greece
| | - Kalliopi Alpantaki
- Department of Orthopaedics and Trauma, Venizeleion General Hospital of Heraklion, Heraklion 71409, Greece
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6
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Kalogeraki A, Tamiolakis D, Zoi I, Segredakis J, Vakis A. Intraoperative squash Cytology of diffuse glioma not otherwise specified, of the Cerebellum. Acta Biomed 2021; 92:e2021108. [PMID: 34212924 PMCID: PMC8343735 DOI: 10.23750/abm.v92i3.10392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/17/2020] [Indexed: 12/05/2022]
Abstract
OBJECTIVE Diffuse glioma arises anywhere in the CNS, but most frequent in the cerebral hemispheres. The tumor tends to be seen in children and in younger adults aged 20-30. We report one such case in an older female patient presenting the intraoperative cytology of the tumor. CASE REPORT A 48-year-old female was diagnosed by MRI with a tumor of cerebellum. Cytologic material was obtained during the resection of the tumor and diagnosed cytologically as glioma. CONCLUSION This case is presented to focus the ability of the intraoperative cytology in diagnosis of the glioma, using immunocytology and confirmed by histo- immunohistology.
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7
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Kalogeraki A, Tamiolakis D, Moustou E, Panayiotides I, Yannopoulos A, Vakis A, Katzilakis N, Stiakaki E. Cerebrospinal fluid and intraoperative squash cytology of childhood ependymoma. Acta Biomed 2021; 92:e2021107. [PMID: 33988164 PMCID: PMC8182596 DOI: 10.23750/abm.v92i2.9996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/16/2020] [Indexed: 11/23/2022]
Abstract
Ependymomas are glial neoplasms of central nervous system originated from the ependymal lining of the brain ventricles and spinal cord central canal, and rarely exfoliated into cerebrospinal fluid (CSF). In this case we report the cytomorphological and immunocytomorphological features of ependymoma in CSF and intraoperative squash preparations, confirmed by histology.
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8
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Daboudi M, Papadaki E, Vakis A, Chlouverakis G, Makrakis D, Karageorgou D, Simos P, Koukouraki S. Brain SPECT and perfusion MRI: do they provide complementary information about the tumour lesion and its grading? Clin Radiol 2019; 74:652.e1-652.e9. [PMID: 31164195 DOI: 10.1016/j.crad.2019.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/22/2019] [Indexed: 10/26/2022]
Abstract
AIM To evaluate the relative and combined utility of 99mTc-tetrofosmin (99mTc-TF) brain single-photon-emission computed tomography (SPECT) and dynamic susceptibility contrast (DSC) perfusion magnetic resonance imaging (MRI) in grading brain gliomas. MATERIALS AND METHODS Thirty-six patients with clinically suspected brain tumours were assessed by 99mTc-TF SPECT and DSC-MRI. Brain tumour malignancy was confirmed in all patients at histopathology. On both techniques brain lesions were evaluated via visual and semi-quantitative analysis methods (deriving tetrofosmin index [T-index] and relative cerebral blood volume [rCBV] ratios, respectively). RESULTS 99mTc-TF SPECT showed abnormally elevated tracer uptake in 31/36 patients whereas MRI detected the brain tumour in all patients. Optimal cut-off values of each index for discriminating between low- and high-grade gliomas were obtained through receiver operating characteristic (ROC) analyses. A T-index cut-off of 6.35 ensured 82% sensitivity and 71% specificity for discriminating between high- and low-grade gliomas, whereas a relative rCBV ratio cut-off of 1.80 achieved 91% sensitivity and 100% specificity. Requiring a positive result on either technique to characterise a high-grade glioma was associated with similar specificity and slightly increased sensitivity. CONCLUSION Both imaging techniques, 99mTF SPECT and DSC MRI, may provide complementary indices of tumour grade and have an independent diagnostic value for high-risk tumours.
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Affiliation(s)
- M Daboudi
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece.
| | - E Papadaki
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Crete, Greece; Institute of Computer Science, Foundation of Research and Technology, Heraklion, Crete, Greece
| | - A Vakis
- Department of Neurosurgery, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - G Chlouverakis
- Biostatistics Lab., Department of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - D Makrakis
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - D Karageorgou
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - P Simos
- Institute of Computer Science, Foundation of Research and Technology, Heraklion, Crete, Greece; Department of Psychiatry, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - S Koukouraki
- Department of Nuclear Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
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Oraiopoulou ME, Tzamali E, Tzedakis G, Liapis E, Zacharakis G, Vakis A, Papamatheakis J, Sakkalis V. Integrating in vitro experiments with in silico approaches for Glioblastoma invasion: the role of cell-to-cell adhesion heterogeneity. Sci Rep 2018; 8:16200. [PMID: 30385804 PMCID: PMC6212459 DOI: 10.1038/s41598-018-34521-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 10/01/2018] [Indexed: 01/08/2023] Open
Abstract
Glioblastoma cells adopt migration strategies to invade into the brain parenchyma ranging from individual to collective mechanisms, whose role and dynamics are not yet fully understood. In this work, we explore Glioblastoma heterogeneity and recapitulate its invasive patterns both in vitro, by utilizing primary cells along with the U87MG cell line, and in silico, by adopting discrete, individual cell-based mathematics. Glioblastoma cells are cultured three-dimensionally in an ECM-like substrate. The primary Glioblastoma spheroids adopt a novel cohesive pattern, mimicking perivascular invasion in the brain, while the U87MG adopt a typical, starburst invasive pattern under the same experimental setup. Mathematically, we focus on the role of the intrinsic heterogeneity with respect to cell-to-cell adhesion. Our proposed mathematical approach mimics the invasive morphologies observed in vitro and predicts the dynamics of tumour expansion. The role of the proliferation and migration is also explored showing that their effect on tumour morphology is different per cell type. The proposed model suggests that allowing cell-to-cell adhesive heterogeneity within the tumour population is sufficient for variable invasive morphologies to emerge which remain originally undetectable by conventional imaging, indicating that exploration in pathological samples is needed to improve our understanding and reveal potential patient-specific therapeutic targets.
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Affiliation(s)
- M-E Oraiopoulou
- Department of Medicine, University of Crete, Heraklion, Crete, Greece
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Crete, Greece
| | - E Tzamali
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Crete, Greece
| | - G Tzedakis
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Crete, Greece
| | - E Liapis
- Institute of Electronic Structure and Laser, Foundation for Research and Technology-Hellas, Heraklion, Crete, Greece
- Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - G Zacharakis
- Institute of Electronic Structure and Laser, Foundation for Research and Technology-Hellas, Heraklion, Crete, Greece
| | - A Vakis
- Department of Medicine, University of Crete, Heraklion, Crete, Greece
- Neurosurgery Clinic, University General Hospital of Heraklion, Crete, Greece
| | - J Papamatheakis
- Gene Expression Laboratory, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, Heraklion, Crete, Greece
- Department of Biology, University of Crete, Heraklion, Crete, Greece
| | - V Sakkalis
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Crete, Greece.
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10
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Kalogeraki A, Tamiolakis D, Zoi I, Segredakis J, Kafousi M, Vakis A. Schwannoma of right cerebellopontine angle. A cytologic diagnosis. Acta Biomed 2018; 89:411-414. [PMID: 30333469 PMCID: PMC6502132 DOI: 10.23750/abm.v89i3.5437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 06/09/2016] [Indexed: 11/23/2022]
Abstract
Schwannomas affect mainly head and neck peripheral nerves, are benign tumors and derive from Schwann cells. Schwannoma of right cerebellopontine angle is extremely rare to diagnose by cytology. We report one such rare case presenting the cytological features in material obtained during the resection of the tumor. Case report: A 47-year-old female was diagnosed by MRI with a tumor of right cerebellopontine angle.. Cytologic material from the tumor was obtained intraoperatively and diagnosed cytologically as a neurilemoma. Conclusion: This case is presented here to focus the ability of cytology in diagnosis of schwannoma in intraoperative material of the tumor, using immunohistochemistry and confirmed by histology-immunohistochemistry. (www.actabiomedica.it)
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11
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Oraiopoulou ME, Tzamali E, Tzedakis G, Vakis A, Papamatheakis J, Sakkalis V. In Vitro/In Silico Study on the Role of Doubling Time Heterogeneity among Primary Glioblastoma Cell Lines. Biomed Res Int 2017; 2017:8569328. [PMID: 29226151 PMCID: PMC5684616 DOI: 10.1155/2017/8569328] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/18/2017] [Indexed: 12/14/2022]
Abstract
The application of accurate cancer predictive algorithms validated with experimental data is a field concerning both basic researchers and clinicians, especially regarding a highly aggressive form of cancer, such as Glioblastoma. In an aim to enhance prediction accuracy in realistic patient-specific environments, accounting for both inter- and intratumoral heterogeneity, we use patient-derived Glioblastoma cells from different patients. We focus on cell proliferation using in vitro experiments to estimate cell doubling times and sizes for established primary Glioblastoma cell lines. A preclinically driven mathematical model parametrization is accomplished by taking into account the experimental measurements. As a control cell line we use the well-studied U87MG cells. Both in vitro and in silico results presented support that the variance between tumor staging can be attributed to the differential proliferative capacity of the different Glioblastoma cells. More specifically, the intratumoral heterogeneity together with the overall proliferation reflected in both the proliferation rate and the mechanical cell contact inhibition can predict the in vitro evolution of different Glioblastoma cell lines growing under the same conditions. Undoubtedly, additional imaging techniques capable of providing spatial information of tumor cell physiology and microenvironment will enhance our understanding regarding Glioblastoma nature and verify and further improve our predictability.
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Affiliation(s)
- M.-E. Oraiopoulou
- Department of Medicine, University of Crete, Heraklion, Greece
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - E. Tzamali
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - G. Tzedakis
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Greece
| | - A. Vakis
- Department of Medicine, University of Crete, Heraklion, Greece
- Neurosurgery Clinic, University General Hospital of Heraklion, Heraklion, Greece
| | - J. Papamatheakis
- Gene Expression Laboratory, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology-Hellas, Heraklion, Greece
- Department of Biology, University of Crete, Heraklion, Greece
| | - V. Sakkalis
- Computational Bio-Medicine Laboratory, Institute of Computer Science, Foundation for Research and Technology-Hellas, Heraklion, Greece
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Papathoma P, Thomopoulos TP, Karalexi MA, Ryzhov A, Zborovskaya A, Dimitrova N, Zivkovic S, Eser S, Antunes L, Sekerija M, Zagar T, Bastos J, Demetriou A, Cozma R, Coza D, Bouka E, Dessypris N, Kantzanou M, Kanavidis P, Dana H, Hatzipantelis E, Moschovi M, Polychronopoulou S, Pourtsidis A, Stiakaki E, Papakonstantinou E, Oikonomou K, Sgouros S, Vakis A, Zountsas B, Bourgioti C, Kelekis N, Prassopoulos P, Choreftaki T, Papadopoulos S, Stefanaki K, Strantzia K, Cardis E, Steliarova-Foucher E, Petridou ET. Childhood central nervous system tumours: Incidence and time trends in 13 Southern and Eastern European cancer registries. Eur J Cancer 2015; 51:1444-55. [PMID: 25971531 DOI: 10.1016/j.ejca.2015.04.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 04/17/2015] [Accepted: 04/21/2015] [Indexed: 12/28/2022]
Abstract
AIM Following completion of the first 5-year nationwide childhood (0-14 years) registration in Greece, central nervous system (CNS) tumour incidence rates are compared with those of 12 registries operating in 10 Southern-Eastern European countries. METHODS All CNS tumours, as defined by the International Classification of Childhood Cancer (ICCC-3) and registered in any period between 1983 and 2014 were collected from the collaborating cancer registries. Data were evaluated using standard International Agency for Research on Cancer (IARC) criteria. Crude and age-adjusted incidence rates (AIR) by age/gender/diagnostic subgroup were calculated, whereas time trends were assessed through Poisson and Joinpoint regression models. RESULTS 6062 CNS tumours were retrieved with non-malignant CNS tumours recorded in eight registries; therefore, the analyses were performed on 5191 malignant tumours. Proportion of death certificate only cases was low and morphologic verification overall high; yet five registries presented >10% unspecified neoplasms. The male/female ratio was 1.3 and incidence decreased gradually with age, apart from Turkey and Ukraine. Overall AIR for malignant tumours was 23/10(6) children, with the highest rates noted in Croatia and Serbia. A statistically significant AIR increase was noted in Bulgaria, whereas significant decreases were noted in Belarus, Croatia, Cyprus and Serbia. Although astrocytomas were overall the most common subgroup (30%) followed by embryonal tumours (26%), the latter was the predominant subgroup in six registries. CONCLUSION Childhood cancer registration is expanding in Southern-Eastern Europe. The heterogeneity in registration practices and incidence patterns of CNS tumours necessitates further investigation aiming to provide clues in aetiology and direct investments into surveillance and early tumour detection.
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Affiliation(s)
- Paraskevi Papathoma
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece
| | - Thomas P Thomopoulos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece
| | - Maria A Karalexi
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, National Institute of Cancer, Kyiv, Ukraine
| | - Anna Zborovskaya
- Belarusian Research Center for Pediatric Oncology, Hematology and Immunology , Childhood Cancer Subregistry of Belarus, Minsk, Belarus
| | - Nadya Dimitrova
- Bulgarian National Cancer Registry, National Oncology Hospital, Sofia, Bulgaria
| | | | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub, Izmir & Hacettepe University Institute of Public Health, Ankara, Turkey
| | - Luís Antunes
- North Region Cancer Registry of Portugal (RORENO), Portuguese Oncology Institute of Porto, Portugal
| | - Mario Sekerija
- Croatian National Cancer Registry, Croatian Institute of Public Health, Zagreb, Croatia
| | - Tina Zagar
- Cancer Registry of Republic of Slovenia, Institute of Oncology, Ljubljana, Slovenia
| | - Joana Bastos
- Registo Oncológico Regional do Centro, Instituto Português de Oncologia de Coimbra, Francisco Gentil E.P.E, Coimbra, Portugal
| | - Anna Demetriou
- Cyprus Cancer Registry-Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | - Raluca Cozma
- Northeast Regional Cancer Registry, Regional Center of Public Health, 14 Victor Babes Street, 700465 Iasi, Romania
| | - Daniela Coza
- Regional Cancer Registry of Cluj, Oncological Institute "Ion Chiricuta", Cluj-Napoca, Romania
| | - Evdoxia Bouka
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece
| | - Prodromos Kanavidis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece
| | - Helen Dana
- Oncology Department, "Mitera" Childrens Hospital, ErythrouStavrou 6 Marousi, Athens, Greece
| | - Emmanuel Hatzipantelis
- 2nd Department of Pediatrics, Aristotelion University of Thessaloniki, AHEPA General Hospital, Thessaloniki, Greece
| | - Maria Moschovi
- Haematology-Oncology Unit, First Department of Pediatrics, Athens University Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Haematology-Oncology, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Apostolos Pourtsidis
- Department of Pediatric Hematology-Oncology, "Pan. & Agl. Kyriakou" Children's Hospital, Athens, Greece
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, University Hospital of Heraklion, Heraklion, Greece
| | | | | | - Spyros Sgouros
- Department of Neurosurgery, "Mitera" Childrens Hospital, Erythrou Stavrou 6 Marousi, Athens, Greece
| | - Antonios Vakis
- Department of Neurosurgery, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Basilios Zountsas
- Department of Neurosurgery, St. Luke's Hospital, Panorama, Thessaloniki, Greece
| | - Charis Bourgioti
- First Department of Radiology, Aretaieion Hospital, Medical School, University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- 2nd Department of Radiology, Radiotherapy Unit, Medical School, National Kapodistrian University of Athens, Athens, Greece
| | - Panos Prassopoulos
- Department of Radiology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Theodosia Choreftaki
- Department of Pathology, "G. Gennimatas" Athens General Hospital, Athens, Greece
| | | | - Kalliopi Stefanaki
- Histopathology Department, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Katerina Strantzia
- Histopathology Department, "Pan. & Agl. Kyriakou" Children's Hospital, Athens, Greece
| | - Elisabeth Cardis
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Eva Steliarova-Foucher
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, University of Athens, Greece.
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Zaganas I, Halpin AP, Oleinik A, Alegakis A, Kotzamani D, Zafiris S, Chlapoutaki C, Tsimoulis D, Giannakoudakis E, Chochlidakis N, Ntailiani A, Valatsou C, Papadaki E, Vakis A, Furie KL, Greenberg SM, Plaitakis A. A comparison of acute hemorrhagic stroke outcomes in 2 populations: the Crete-Boston study. Stroke 2011; 42:3640-2. [PMID: 22020030 DOI: 10.1161/strokeaha.111.632174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Although corticosteroid use in acute hemorrhagic stroke is not widely adopted, management with intravenous dexamethasone has been standard of care at the University Hospital of Heraklion, Crete with observed outcomes superior to those reported in the literature. To explore this further, we conducted a retrospective, multivariable-adjusted 2-center study. METHODS We studied 391 acute hemorrhagic stroke cases admitted to the University Hospital of Heraklion, Crete between January 1997 and July 2010 and compared them with 510 acute hemorrhagic stroke cases admitted to Massachusetts General Hospital, Boston, from January 2003 to September 2009. Of the Cretan cases, 340 received a tapering scheme of intravenous dexamethasone, starting with 16 to 32 mg/day, whereas the Boston patients were managed without steroids. RESULTS The 2 cohorts had comparable demographics and stroke severity on admission, although anticoagulation was more frequent in Boston. The in-hospital mortality was significantly lower on Crete (23.8%, n=340) than in Boston (38.0%, n=510; P<0.001) as was the 30-day mortality (Crete: 25.4%, n=307; Boston: 39.4%, n=510; P<0.001). Exclusion of patients on anticoagulants showed even greater differences (30-day mortality: Crete 20.8%; n=259; Boston 37.0%; n=359; P<0.001). The improved survival on Crete was observed 3 days after initiation of intravenous dexamethasone and was pronounced for deep-seated hemorrhages. After adjusting for acute hemorrhagic stroke volume/location, Glasgow Coma Scale, hypertension, diabetes mellitus, smoking, coronary artery disease and statin, antiplatelet, and anticoagulant use, intravenous dexamethasone treatment was associated with better functional outcomes and significantly lower risk of death at 30 days (OR, 0.357; 95% CI, 0.174-0.732). CONCLUSIONS This study suggests that intravenous dexamethasone improves outcome in acute hemorrhagic stroke and supports a randomized clinical trial using this approach.
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Affiliation(s)
- Ioannis Zaganas
- Neurology Department, University Hospital of Heraklion, Voutes, 71021, Heraklion, Crete, Greece
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Tsirka V, Simos PG, Vakis A, Kanatsouli K, Vourkas M, Erimaki S, Pachou E, Stam CJ, Micheloyannis S. Mild traumatic brain injury: graph-model characterization of brain networks for episodic memory. Int J Psychophysiol 2010; 79:89-96. [PMID: 20863861 DOI: 10.1016/j.ijpsycho.2010.09.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 09/06/2010] [Accepted: 09/14/2010] [Indexed: 11/26/2022]
Abstract
Episodic memory is among the cognitive functions that can be affected in the acute phase following mild traumatic brain injury (MTBI). The present study used EEG recordings to evaluate global synchronization and network organization of rhythmic activity during the encoding and recognition phases of an episodic memory task varying in stimulus type (kaleidoscope images, pictures, words, and pseudowords). Synchronization of oscillatory activity was assessed using a linear and nonlinear connectivity estimator and network analyses were performed using algorithms derived from graph theory. Twenty five MTBI patients (tested within days post-injury) and healthy volunteers were closely matched on demographic variables, verbal ability, psychological status variables, as well as on overall task performance. Patients demonstrated sub-optimal network organization, as reflected by changes in graph parameters in the theta and alpha bands during both encoding and recognition. There were no group differences in spectral energy during task performance or on network parameters during a control condition (rest). Evidence of less optimally organized functional networks during memory tasks was more prominent for pictorial than for verbal stimuli.
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Affiliation(s)
- Vasso Tsirka
- Department of Medicine, Clinical Research Laboratory Widén, University of Crete, 71409 Iraklion/Crete Greece.
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Tsirka V, Simos P, Vakis A, Vourkas M, Arzoglou V, Syrmos N, Stavropoulos S, Micheloyannis S. Material-specific difficulties in episodic memory tasks in mild traumatic brain injury. Int J Neurosci 2010; 120:184-91. [PMID: 20374085 DOI: 10.3109/00207450903585308] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The study examines acute, material-specific secondary memory performance in 26 patients with mild traumatic brain injury (MTBI) and 26 healthy controls, matched on demographic variables and indexes of crystallized intelligence. Neuropsychological tests were used to evaluate primary and secondary memory, executive functions, and verbal fluency. Participants were also tested on episodic memory tasks involving words, pseudowords, pictures of common objects, and abstract kaleidoscopic images. Patients showed reduced performance on episodic memory measures, and on tasks associated with visuospatial processing and executive function (Trail Making Test part B, semantic fluency). Significant differences between groups were also noted for correct rejections and response bias on the kaleidoscope task. MTBI patients' reduced performance on memory tasks for complex, abstract stimuli can be attributed to a dysfunction in the strategic component of memory process.
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Lymbouridou R, Soufla G, Chatzinikola AM, Vakis A, Spandidos DA. Down-regulation of K-ras and H-ras in human brain gliomas. Eur J Cancer 2009; 45:1294-1303. [PMID: 19179066 DOI: 10.1016/j.ejca.2008.12.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 12/17/2008] [Accepted: 12/19/2008] [Indexed: 10/21/2022]
Abstract
Ras genes, a class of nucleotide-binding proteins that regulate normal and transformed cell growth, have been scarcely investigated in human brain tumours. We evaluated the mutational, mRNA and protein expression profile of the ras genes in 21 glioblastomas multiforme (grade IV), four fibrillary astrocytoma (grade II), four anaplastic astrocytoma (grade III) and 15 normal specimens. K-, H- and N-ras transcript levels were determined by real-time RT-PCR and mutational status by PCR-restriction fragment length polymorphism (RFLP) and direct sequencing. p21 protein was evaluated by Western blot analysis. Two K-ras mutations were found in codons 16 and 26 in one pathological and one normal sample, respectively. Glioblastoma multiforme cases exhibited significantly lower K- and H-ras mRNA levels compared to controls (P < 10(-4)). K- and H-ras mRNA down-regulation was not associated with patient outcome or survival. K-ras was positively correlated with H-ras in glioblastomas (P = 0.005), but not in normal specimens. p21 protein was absent in all samples. Our findings provide evidence of K- and H-ras involvement in brain malignant transformation through transcriptional down-regulation, while N-ras seems to contribute less to brain carcinogenesis.
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Affiliation(s)
- Rena Lymbouridou
- Department of Virology, Faculty of Medicine, Medical School, University of Crete, P.O. Box 1527, Heraklion 710 03, Crete, Greece
| | - Giannoula Soufla
- Department of Virology, Faculty of Medicine, Medical School, University of Crete, P.O. Box 1527, Heraklion 710 03, Crete, Greece
| | - Anthoula M Chatzinikola
- Department of Virology, Faculty of Medicine, Medical School, University of Crete, P.O. Box 1527, Heraklion 710 03, Crete, Greece
| | - Antonios Vakis
- Department of Neurosurgery, University Hospital of Heraklion, Crete, Greece
| | - Demetrios A Spandidos
- Department of Virology, Faculty of Medicine, Medical School, University of Crete, P.O. Box 1527, Heraklion 710 03, Crete, Greece.
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Fröhler M, Saito Y, Ackenheil M, Bak R, Bondy B, Feistenauer E, Hofschuster E, Vakis A, Welter D. Catecholaminergic Binding Sites on Blood Cells of Healthy Volunteers with Special Respect to Circadian Rhythms. Pharmacopsychiatry 2008. [DOI: 10.1055/s-2007-1017349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Vakis A, Krasoudakis A, Koutendakis D. Transient post-traumatic hemiballism. Report of a case. J Neurosurg Sci 2006; 50:21-3; discussion 23. [PMID: 16557197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Hemiballism is a rare movement disorder which is due to lesion or malfunction of the subthalamic nucleus (STN) and its connections, according to various neurophysiological data. Various causes of this condition have been described, usually related to basal ganglia dysfunction. There are only three references in the literature of traumatic hemiballism. We report a case of post-traumatic hemiballism, due to a contusion of the subthalamic regional area, and review the relevant literature.
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Affiliation(s)
- A Vakis
- Heraklion University Hospital, Neurosurgical Department, Crete, Hellas.
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Ackenheil M, Bondy B, Fröhler M, Vakis A. [Catecholaminergic receptors of the blood cells of schizophrenics]. Encephale 1985; 11:95-100. [PMID: 2992909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The simultaneous determination of serum CA and their receptors in blood cells offers a possibility to evaluate disturbances of the DA and NA neuronal systems in man. High affinity binding sites for 3H-yohimbine in platelets, 3H-DHA on granulocytes and 3H-spiperone in lymphocytes from healthy control persons, unmedicated (n = 28), and medicated (n = 8) schizophrenics as well as from an unmedicated psychiatric control (n = 14) were investigated. Furthermore, the actual concentration of the circulating CA was determined with HPLC-ECD. In unmedicated schizophrenics as compared to controls, specific binding of 3H-spiperone to lymphocytes was markedly elevated in capacity and less in affinity as compared to controls. For beta2-receptors a significant decrease was found in capacity with no change in affinity. The changes in alpha2-receptors with a slight decrease in capacity were less distinct. The concentrations of circulating CA ranged from normal values up to a more than 3 fold increase in NA and DA, whereas A concentrations were practically unchanged. No overall change in these data was found in the medicated schizophrenic patients. 3H-spiperone binding was characteristically increased only in schizophrenics, but did not elevate above control data in the non-schizophrenic psychiatric control group. Preliminary experiments of family studies suggest that this model could be valuable as a vulnerability marker.
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Abstract
The noradrenaline, dopamine and serotonin metabolites methoxyhydroxyphenylglycol (MHPG), homovanillic acid (HVA), and 5-hydroxyindoleacetic acid (5-HIAA), as well as the cyclic nucleotides c-AMP and c-GMP were estimated in urine samples of five normal volunteers. Ten control samples and two samples after cannabis use were analyzed for each volunteer. Cannabis use caused significant decreases in MHPG and c-AMP, and increases in HVA, while 5-HIAA and c-GMP excretion remained unchanged. The results indicate that cannabis use interferes with catecholaminergic mechanisms in man, decreasing the noradrenaline and increasing dopamine turnover, probably through action on presynaptic receptors.
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