E-Health Ultrasonic Diagnostic Monitoring for Analysis of Cardiac Insufficiency and Neuronal Regulation in Patients with Sepsis in Emergency Department under Image Reconstruction Algorithm

An anisotropic diffusion filtering- (ADF-) ultrasound (ADF-U) for ultrasound reconstruction was constructed based on the ADF to explore the diagnostic application of ultrasound imaging based on electronic health (E-health) for cardiac insufficiency and neuronal regulation in patients with sepsis. The 144 patients with sepsis were divided into an experimental group (78 patients with cardiac insufficiency) and a control group (66 patients with normal cardiac function), and another 58 healthy people were included in a blank control. The ultrasound examination was performed on all patients. In addition, new ultrasound image reconstruction and diagnosis were performed based on ADF and E-health, and its reconstruction effects were compared with those of the Bilateral Filter-ultrasonic (BFU) algorithm and the Wavelet Threshold-ultrasonic (WTU) algorithm. The left and right ventricular parameters and neuropeptide levels were detected and recorded. The results show that the running time, average gradient (AG), and peak signal-to-noise ratio (SNR) (PSNR) of the ADF-U algorithm were greater than those of the Bilateral Filter-ultrasonic (BFU) and Wavelet Threshold-ultrasonic (WTU), but the mean square error (MSE) was opposite (P < 0.05); the left ventricular end-systolic volume (LVESV) and the vertical distance between the mitral valve E-point to septal separation (EPSS) in the experimental group were higher than those in the control and blank group, while the left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), and left ventricular fractional shortening (LVFS) were opposite (P < 0.05); the systolic peak velocity of right ventricular free wall tricuspid annulus (Sm) and pulmonary valve blood velocity (PVBV) in the experimental group were lower than those of the control group and blank group (P < 0.05); the messenger ribonucleic acid (mRNA) of Proopiomelanocortin (POMC) and Cocain and amphetamine-regulated transcript (CART) was higher than the mRNA IN control group and blank group (P < 0.05). In short, the ADF-U algorithm proposed in this study improved the resolution, SNR, and reconstruction efficiency of E-health ultrasound images and provided an effective reference value for the diagnosis of cardiac insufficiency and neuronal adjustment analysis in patients with sepsis in the emergency department.

In vivo Characterization of Four 18F-Labeled S1PR1 Tracers for Neuroinflammation

PURPOSE

The sphingosine-1-phosphate receptor 1 (S1PR1) is an important biomarker for imaging inflammation in the central nervous system (CNS). Herein, we report our recent evaluation of four ¹⁸F-labeled S1PR1 tracers (¹⁸F-TZ43113, ¹⁸F-TZ35104, ¹⁸F-TZ4877, and ¹⁸F-TZ4881) in a rat model of multiple sclerosis (MS).

PROCEDURES

MicroPET studies of each tracer's uptake and kinetics were performed in an experimental autoimmune encephalomyelitis (EAE) rat model of MS to quantify upregulated S1PR1 expression in the lumbar spinal cord of EAE rats. Western blot analysis was conducted to confirm the differences in the expression of S1PR1 protein level between EAE and sham rats. Radiometabolite analysis was performed for the most promising candidate in rats.

RESULTS

All four S1PR1 tracers detected increased S1PR1 levels in response to neuroinflammation in the lumbar spinal cord of EAE rats, which was supported by western blot results. The ranked order of tracer uptake in rat spinal cord was ¹⁸F-TZ4877 > ¹⁸F-TZ4881 > ¹⁸F-TZ35104 > ¹⁸F-TZ43113. ¹⁸F-TZ4877 had the highest uptake of the four tracers and showed good kinetic modeling fits in rat spinal cord using an image-based method of arterial blood input function. Radiometabolite analysis of ¹⁸F-TZ4877 showed good in vivo stability with no major radiometabolite accumulation in the rat brain.

CONCLUSION

Among these four new PET tracers, ¹⁸F-TZ4877 showed the most favorable profile for assessing S1PR1 expression in the EAE rat model of MS. Further characterization of these radiotracers in other models of neuroinflammation is warranted to identify a promising ¹⁸F-labeled tracer for imaging S1PR1 in vivo.

Imaging localized fast optical signals of neural activation with optical coherence tomography in awake mice

We report optical coherence tomography (OCT) imaging of localized fast optical signals (FOSs) arising from whisker stimulation in awake mice. The activated voxels were identified by fitting the OCT intensity signal time course with a response function over a time scale of a few hundred milliseconds after the whisker stimulation. The significantly activated voxels were shown to be localized to the expected brain region for whisker stimulation. The ability to detect functional stimulus-evoked, depth-resolved FOS with intrinsic contrast from the cortex provides a new tool for neural activity studies.

Neuropeptidomics: Improvements in Mass Spectrometry Imaging Analysis and Recent Advancements

Neuropeptides are an important class of endogenous peptides in the nervous system that regulate physiological functions such as feeding, glucose homeostasis, pain, memory, reproduction, and many others. In order to understand the functional role of neuropeptides in diseases or disorders, studies investigating their dysregulation in terms of changes in abundance and localization must be carried out. As multiple neuropeptides are believed to play a functional role in each physiological process, techniques capable of global profiling multiple neuropeptides simultaneously are desired. Mass spectrometry is well-suited for this goal due to its ability to perform untargeted measurements without prior comprehensive knowledge of the analytes of interest. Mass spectrometry imaging (MSI) is particularly useful because it has the capability to image a large variety of peptides in a single experiment without labeling. Like all analytical techniques, careful sample preparation is critical to successful MSI analysis. The first half of this review focuses on recent developments in MSI sample preparation and instrumentation for analyzing neuropeptides and other biomolecules in which the sample preparation technique may be directly applicable for neuropeptide analysis. The benefit offered by incorporating these techniques is shown as improvement in a number of observable neuropeptides, enhanced signal to noise, increased spatial resolution, or a combination of these aspects. The second half of this review focuses on recent biological discoveries about neuropeptides resulting from these improvements in MSI analysis. The recent progress in neuropeptide detection and analysis methods, including the incorporation of various tissue washes, matrices, instruments, ionization sources, and computation approaches combined with the advancements in understanding neuropeptide function in a variety of model organisms, indicates the potential for the utilization of MSI analysis of neuropeptides in clinical settings.

A validation framework for neuroimaging software: The case of population receptive fields

Neuroimaging software methods are complex, making it a near certainty that some implementations will contain errors. Modern computational techniques (i.e., public code and data repositories, continuous integration, containerization) enable the reproducibility of the analyses and reduce coding errors, but they do not guarantee the scientific validity of the results. It is difficult, nay impossible, for researchers to check the accuracy of software by reading the source code; ground truth test datasets are needed. Computational reproducibility means providing software so that for the same input anyone obtains the same result, right or wrong. Computational validity means obtaining the right result for the ground-truth test data. We describe a framework for validating and sharing software implementations, and we illustrate its usage with an example application: population receptive field (pRF) methods for functional MRI data. The framework is composed of three main components implemented with containerization methods to guarantee computational reproducibility. In our example pRF application, those components are: (1) synthesis of fMRI time series from ground-truth pRF parameters, (2) implementation of four public pRF analysis tools and standardization of inputs and outputs, and (3) report creation to compare the results with the ground truth parameters. The framework was useful in identifying realistic conditions that lead to imperfect parameter recovery in all four pRF implementations, that would remain undetected using classic validation methods. We provide means to mitigate these problems in future experiments. A computational validation framework supports scientific rigor and creativity, as opposed to the oft-repeated suggestion that investigators rely upon a few agreed upon packages. We hope that the framework will be helpful to validate other critical neuroimaging algorithms, as having a validation framework helps (1) developers to build new software, (2) research scientists to verify the software's accuracy, and (3) reviewers to evaluate the methods used in publications and grants.

Role of diffusion tensor imaging in analyzing the neural connectivity of the parieto-insular vestibular cortex in pusher syndrome: As case report

RATIONALE

Pusher syndrome is a disorder of postural control. It is associated with unilateral lesions on central vestibular system. In the current study, we attempted to identify and investigate neural connectivity of the parieto-insular vestibular cortex in a patient with pusher syndrome, using diffusion tensor imaging.

PATIENT CONCERNS

A 60-year-old male patient had left hemiplegia due to an infarction on right premotor cortex, primary motor cortex, corona radiata and temporal and occipital lobe. The patient had severe motor weakness in left upper and lower limb, left side neglect and significant pusher syndrome.

DIAGNOSIS

Patient was diagnosed with left hemiplegia due to an infarction in the right middle cerebral artery territory at the neurology department of a university hospital.

INTERVENTIONS

One patient and 5 control subjects of similar age participated. Diffusion tensor imaging data were acquired at 4-month and 12-month after the initial injury.

OUTCOMES

Fractional anisotropy, mean diffusivity, and tract volume (TV) were measured. TV values in both affected and unaffected hemispheres of the patient were significantly decreased at 4-month compared to those of control subjects. In the unaffected hemisphere of the patient, TV value showed significant increase at 12-month compared to that at 4-month. Although the TV value at 12-month of the affected hemisphere was out of reference range, TV was considerably increased compared to that at 4-month. Mean values for fractional anisotropy or mean diffusivity in 2 hemispheres did not show significant difference compared to those of control subjects regardless of month.

LESSONS

Restoration of an injured projection pathway between the vestibular nuclei and parieto-insular vestibular cortex with recovery of pusher syndrome was found in a patient with stroke.

[Research Development of MR Diffusion Tensor Imaging and Track Density Imaging in Central Nervous System]

Diffusion tensor imaging (DTI) is being used more and more widely in the diagnosis of central nervous system. Based on DTI, track density imaging (TDI) is an emerging technique applied to clinical use. This article introduced the principle and clinical application, analyzed pros and cons, and made conclusion and prospect of these two techniques.

Significant Neuroanatomical Variation Among Domestic Dog Breeds

Humans have bred different lineages of domestic dogs for different tasks such as hunting, herding, guarding, or companionship. These behavioral differences must be the result of underlying neural differences, but surprisingly, this topic has gone largely unexplored. The current study examined whether and how selective breeding by humans has altered the gross organization of the brain in dogs. We assessed regional volumetric variation in MRI studies of 62 male and female dogs of 33 breeds. Neuroanatomical variation is plainly visible across breeds. This variation is distributed nonrandomly across the brain. A whole-brain, data-driven independent components analysis established that specific regional subnetworks covary significantly with each other. Variation in these networks is not simply the result of variation in total brain size, total body size, or skull shape. Furthermore, the anatomy of these networks correlates significantly with different behavioral specialization(s) such as sight hunting, scent hunting, guarding, and companionship. Importantly, a phylogenetic analysis revealed that most change has occurred in the terminal branches of the dog phylogenetic tree, indicating strong, recent selection in individual breeds. Together, these results establish that brain anatomy varies significantly in dogs, likely due to human-applied selection for behavior.SIGNIFICANCE STATEMENT Dog breeds are known to vary in cognition, temperament, and behavior, but the neural origins of this variation are unknown. In an MRI-based analysis, we found that brain anatomy covaries significantly with behavioral specializations such as sight hunting, scent hunting, guarding, and companionship. Neuroanatomical variation is not simply driven by brain size, body size, or skull shape, and is focused in specific networks of regions. Nearly all of the identified variation occurs in the terminal branches of the dog phylogenetic tree, indicating strong, recent selection in individual breeds. These results indicate that through selective breeding, humans have significantly altered the brains of different lineages of domestic dogs in different ways.

Early father-infant skin-to-skin contact and its effect on the neurodevelopmental outcomes of moderately preterm infants in China: study protocol for a randomized controlled trial

BACKGROUND

Skin-to-skin contact (SSC) is an evidence-based intervention that benefits low birth weight /preterm infants. However, China's health institutional policy inhibits parents from visiting their baby in the neonatal intensive care unit (NICU). In addition, the Chinese traditional postpartum behavioral practice of confining women to home raises barriers to mother-infant contact. Thus, to shorten the duration of parent-infant separation, father-infant SSC is considered a possible alternative. This study determines whether it is safe to perform father-infant SSC in the NICU and investigates how paternal SSC affects outcomes compared with traditional care (TC) for moderately preterm infants.

METHODS/DESIGN

A randomized controlled trial will be used to investigate the effects of paternal-infant SSC in NICU wards in China. Preterm infants born at a gestational age in the range of 320-346 weeks with a birth weight > 1500 g will be eligible. A simple random sampling method will be used to allocate infants to the SSC group (n = 25) or the TC group (n = 25). After medical stability, infants in the SSC group will be provided SSC by fathers for one hour every day until discharged from hospital. The primary outcome is neurodevelopmental measures, specifically salivary cortisol and Premature Infant Pain Profile (PIPP) during hospitalization. At 40 weeks of corrected age, infants will be assessed using the Infant Neurological International Battery (INFANIB) and neuroimaging. Secondary outcomes include infants' physiological stability during SSC and throughout hospitalization and state observation at discharge. The fathers' mental health will be assessed with the State-Trait Anxiety Inventory (STAI) 1 day to 3 days after the infant's admission to the NICU and at discharge. Father-infant attachment will be evaluated at 4 and 6 months after the infants' discharge, measured by the Paternal Postnatal Attachment Scale (PPAS). Statistical analyses will be conducted using a two-sided significance level of 0.05.

DISCUSSION

The effects of paternal-infant SSC on moderately preterm infants will be assessed. The data gathered in this study may have important implications for medical practice and policy in the NICU regarding the care methods of premature infants in China.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR-IOR-1701274 . Registered on 20 September 2017. Retrospectively registered.

Size and specimen-dependent strategy for x-ray micro-ct and tem correlative analysis of nervous system samples

Correlative approaches are a powerful tool in the investigation of biological samples, but require specific preparation procedures to maintain the strength of the employed methods. Here we report the optimization of the embedding protocol of nervous system samples for a correlative synchrotron X-ray computed microtomography (micro-CT) and transmission electron microscopy (TEM) approach. We demonstrate that it is possible to locate, with the micrometric resolution of micro-CT, specific volumes of interest for a further ultrastructural characterization to be performed with TEM. This approach can be applied to samples of different size and morphology up to several cm. Our optimized method represents an invaluable tool for investigating those pathologies in which microscopic alterations are localized in few confined regions, rather than diffused in entire tissues, organs or systems. We present a proof of concept of our method in a mouse model of Globoid Cells Leukodistrophy.

Neuroproteomics Studies: Challenges and Updates

The Human Genome Project in 2003 has resulted in the complete sequence of ~99% of the human genome paving the road for the Human Proteome Project (HPP) assessing the full characterization of the translated protein map of the 20,300 protein-coding genes. Consequently, the emerging of the proteomics field has successfully been adopted as the method of choice for the proteome characterization. Proteomics is a term that is used to encompass multidisciplinary approaches combining different technologies that aim to study the entire spectrum of protein changes at a specific physiological condition. Proteomics research has shown excellent outcomes in different fields, among which is neuroscience; however, the complexity of the nervous systems necessitated the genesis of a new subdiscipline of proteomics termed as "neuroproteomics." Neuroproteomics studies involve assessing the quantitative and qualitative aspects of nervous system components encompassing global dynamic events underlying various brain-related disorders ranging from neuropsychiatric disorders, degenerative disorders, mental illness, and most importantly brain-specific neurotrauma-related injuries. In this introductory chapter, we will provide a brief historical perspective on the field of neuroproteomics. In doing so, we will highlight on the recent applications of neuroproteomics in the areas of neurotrauma, an area that has benefitted from neuroproteomics in terms of biomarker research, spatiotemporal injury mechanism, and its use to translate its findings from experimental settings to human translational applications. Importantly, this chapter will include some recommendation to the general studies in the area of neuroproteomics and the need to move from this field from being a descriptive, hypothesis-free approach to being an independent mature scientific discipline.

Ultrasonography of Leprosy Neuropathy: A Longitudinal Prospective Study

BACKGROUND

Previous studies have shown that leprosy multi-drug therapy (MDT) does not stop the progression of nerve function impairment. There are no prospective studies investigating the evolution of nerve anatomic abnormalities after treatment. We examined leprosy patients aiming to investigate the evolution of nerve ultrasonography (US) abnormalities and the risk factors for poor outcomes after MDT.

METHODOLOGY/PRINCIPAL FINDINGS

We performed bilateral US of the ulnar (U), median (M) and common fibular (CF) nerves in 9 paucibacillary (PB) and 64 multibacillary (MB) patients before and after MDT. Forty-two patients had leprosy reactions (type 1, type 2, acute neuritis) during the study. We analyzed nerve maximum cross-sectional areas (CSA), echogenicity and Doppler signal. Poor outcomes included a post-treatment CSA above normal limits with a reduction of less than 30% (U, M) or 40% (CF) from the baseline, echogenicity abnormalities or intraneural Doppler in the post-treatment study. We found that PB and patients without reactions showed significant increases in CSA at CF, whereas MB and patients with reactions had CSA reduction in some nerves after treatment (p<0.05). Despite this reduction, we observed a greater frequency of poor CSA outcomes in the MB compared to the PB (77.8% and 40.6%; p>0.05) and in the patients with reactions compared to those without (66.7% and 38.7%; p<0.05). There was significantly higher odds ratio (7.75; 95%CI: 1.56-38.45) for poor CSA outcomes only for M nerve in patients with reactions. Poor echogenicity outcomes were more frequent in MB (59.4%) compared to PB (22.2%) (p<0.05). There was significant association between poor Doppler outcomes and neuritis. Gender, disease duration, and leprosy classification were not significant risk factors for poor outcomes in CSA, echogenicity or Doppler.

CONCLUSIONS/SIGNIFICANCE

US nerve abnormalities can worsen after treatment despite the leprosy classification or the presence of reactions.

Neuroradiological findings in hypogonadotropic hypogonadism

Hypogonadotropic hypogonadism (HH) is a clinical hallmark of a heterogeneous group of acquired and inherited diseases. Patients with HH undergo brain imaging in order to investigate morphological or signal abnormalities at the level of the hypothalamic-pituitary structures. The presence of tumors, lesions or atrophy might be the explanation of the hormone dysfunction. Nonetheless, in most patients both the hypothalamus and the pituitary gland appear normal. In some cases, the presence of ancillary, not necessarily HH-related brain abnormalities might provide significant clues on the underlying condition. We addressed those conditions associated with HH subdividing them into acquired or inherited diseases, highlighting the neuroradiologic features that might help in the diagnosis.

Infliximab therapy for intestinal, neurological, and vascular involvement in Behcet disease: Efficacy, safety, and pharmacokinetics in a multicenter, prospective, open-label, single-arm phase 3 study

Behçet disease (BD) is a multisystem disease associated with a poor prognosis in cases of gastrointestinal, neurological, or vascular involvement. We conducted a multicenter, prospective, open-label, single-arm phase 3 study to determine the efficacy, safety, and pharmacokinetics of infliximab (IFX) in BD patients with these serious complications who had displayed poor response or intolerance to conventional therapy.IFX at 5 mg/kg was administered to 18 patients (11 intestinal BD, 3 neurological BD [NBD], and 4 vascular BD [VBD]) at weeks 0, 2, and 6 and every 8 weeks thereafter until week 46. In patients who showed inadequate responses to IFX after week 30, the dose was increased to 10 mg/kg. We then calculated the percentage of complete responders according to the predefined criteria depending on the symptoms and results of examinations (ileocolonoscopy, brain magnetic resonance imaging, computed tomography angiography, positron emission tomography, cerebrospinal fluid, or serum inflammatory markers), exploring the percentage of complete responders at week 30 (primary endpoint).The percentage of complete responders was 61% (11/18) at both weeks 14 and 30 and remained the same until week 54. Intestinal BD patients showed improvement in clinical symptoms along with decrease in C-reactive protein (CRP) levels after week 2. Consistently, scarring or healing of the principal ulcers was found in more than 80% of these patients after week 14. NBD patients showed improvement in clinical symptoms, imaging findings, and cerebrospinal fluid examinations. VBD patients showed improvement in clinical symptoms after week 2 with reductions in CRP levels and erythrocyte sedimentation rate. Imaging findings showed reversal of inflammatory changes in 3 of the 4 VBD patients. Irrespective of the type of BD, all patients achieved improvement in quality of life, leading to the dose reduction or withdrawal of steroids. IFX dose was increased to 10 mg/kg in 3 intestinal BD patients, resulting in the improvement of clinical symptoms, CRP levels, and visual analogue scale score. Safety and pharmacokinetics profiles were comparable to those in patients with rheumatoid arthritis or Crohn disease. These findings support IFX as a new therapeutic option for patients with intestinal BD, NBD, or VBD.

Estimation of staff lens doses during interventional procedures. Comparing cardiology, neuroradiology and interventional radiology

The purpose of this article is to estimate lens doses using over apron active personal dosemeters in interventional catheterisation laboratories (cardiology IC, neuroradiology IN and radiology IR) and to investigate correlations between occupational lens doses and patient doses. Active electronic personal dosemeters placed over the lead apron were used on a sample of 204 IC procedures, 274 IN and 220 IR (all performed at the same university hospital). Patient dose values (kerma area product) were also recorded to evaluate correlations with occupational doses. Operators used the ceiling-suspended screen in most cases. The median and third quartile values of equivalent dose Hp(10) per procedure measured over the apron for IC, IN and IR resulted, respectively, in 21/67, 19/44 and 24/54 µSv. Patient dose values (median/third quartile) were 75/128, 83/176 and 61/159 Gy cm(2), respectively. The median ratios for dosemeters worn over the apron by operators (protected by the ceiling-suspended screen) and patient doses were 0.36; 0.21 and 0.46 µSv Gy(-1) cm(-2), respectively. With the conservative approach used (lens doses estimated from the over apron chest dosemeter) we came to the conclusion that more than 800 procedures y(-1) and per operator were necessary to reach the new lens dose limit for the three interventional specialties.

Long-term exposure to oral methylphenidate or dl-amphetamine mixture in peri-adolescent rhesus monkeys: effects on physiology, behavior, and dopamine system development

The stimulants methylphenidate and amphetamine are used to treat children with attention deficit/hyperactivity disorder over important developmental periods, prompting concerns regarding possible long-term health impact. This study assessed the effects of such a regimen in male, peri-adolescent rhesus monkeys on a variety of cognitive/behavioral, physiological, and in vivo neurochemical imaging parameters. Twice daily (0900 and 1200 hours), for a total of 18 months, juvenile male monkeys (8 per group) consumed either an unadulterated orange-flavored solution, a methylphenidate solution, or a dl-amphetamine mixture. Doses were titrated to reach blood/plasma levels comparable to therapeutic levels in children. [¹¹C]MPH and [¹¹C]raclopride dynamic PET scans were performed to image dopamine transporter and D₂-like receptors, respectively. Binding potential (BP(ND)), an index of tracer-specific binding, and amphetamine-induced changes in BP(ND) of [¹¹C]raclopride were estimated by kinetic modeling. There were no consistent differences among groups on the vast majority of measures, including cognitive (psychomotor speed, timing, inhibitory control, cognitive flexibility), general activity, physiological (body weight, head circumference, crown-to-rump length), and neurochemical (ie, developmental changes in dopamine transporter, dopamine D₂ receptor density, and amphetamine-stimulated dopamine release were as expected). Cytogenetic studies indicated that neither drug was a clastogen in rhesus monkeys. Thus, methylphenidate and amphetamine at therapeutic blood/plasma levels during peri-adolescence in non-human primates have little effect on physiological or behavioral/cognitive development.

Integration of intraoperative 3D-ultrasound in a commercial navigation system

STUDY AIMS

The purpose of this study was the integration of three-dimensional ultrasound data into a neuronavigation system, in order to allow a guided intraoperative resection control during neurosurgical interventions.

MATERIAL AND METHODS

A system for iterative neuronavigation based on 3D-ultrasound (US) has been developed. The main components of the system are the ultrasound device Voluson 730 (GE Healthcare) with a 5 - 9 MHz probe, the navigation system VectorVision2 (BrainLAB AG) and a standard PC with Windows XP. The ultrasound data are transferred via DICOM from the ultrasound device to an external computer, where they are processed with a C++ program for representation in the neuronavigation coordinate system. The data transfer between the navigation system and the external computer is performed via the VVLink interface from BrainLAB. The feasibility test of the system was performed with an ultrasound phantom RMI 403GS (Gammex-RMI GmbH).

RESULTS

The error of homologous points mapping from US datasets to a CT dataset in the neuronavigation system was determined to be 1.9 +/- 0.97 mm. The maximum time required to technically integrate the ultrasound data into the navigation system was 1.5 min.

CONCLUSIONS

The developed system allows 3D-ultrasound based navigation to be carried out with a commercially available navigation system. The functionality of this system has been proven by technical tests. Recording and integration of the ultrasound data can be repeated at any time during surgery and can be used to update anatomical data and consequently for resection control. Another application is the intraoperative adaptation of preoperative datasets (MRI or CT) in order to compensate for "brain shift" during neurosurgical operations.

Ultrasonographic guidance in pediatric regional anesthesia. Part 2: techniques

The benefits of regional anesthesia are well documented. The downsides of such techniques have been a significant failure rate and a potential for serious complications. Nearly, all regional blocks were first described as essentially 'blind' techniques. The development of high-resolution portable ultrasound (US) has made the use of US for regional anesthesia possible. Improved understanding of sonographic anatomy should lessen both the failure rate and the possibility of incurring serious complications. Natural caution has dictated that only a selection of blocks used in adults has been commonly used in pediatric practice, but with the aid of US, the repertoire of blocks for infants and children may be widened. The second part of this review will concentrate on the practice of both peripheral and central blocks.

Neural correlates of 'functional' symptoms in neurology

Functional symptoms are neurological deficits that are not explained by organic lesions in the nervous system, but usually associated with emotional "psychogenic" disturbances. These symptoms are common and can affect any aspect of elementary neurological function, presenting clinicians with difficulties in definition, diagnosis, and treatment. Although current concepts explain functional symptoms in the context of "psychogenic" stress, the exact nature of these symptoms remains largely unknown. Recent functional neuroimaging studies have shifted understanding of these deficits from a psychological and psychodynamic model to a neurobiological model. This review highlights the advances made using functional neuroimaging techniques in patients suffering from two conditions: unilateral loss of motor function and psychogenic parkinsonism. The evidence suggests that areas including the prefrontal and parietal cortices, anterior cingulate cortex, thalamus, and basal ganglia may be implicated. Future studies, assessing patients at different phases of their illness and using newer techniques such as functional MRI, are needed to extend current findings on functional symptoms.

Internacionalización de la producción científica de España en Radiología y Neuroimagen (1996-2003)

The situation of Research in radiology in Spain is analysed by examining the number of publications by Spanish authors in main stream international journals. The scientific production of Spanish researchers in journals included in the Science Citation Index (SCI) under the headings "Radiology, Nuclear Medicine, and Medical Imaging" and "Neuroimaging" during the years 1996-2003. During this period the scientific production in these fields comprised 1,562 documents (3.5% of the total production for Spanish clinical medicine); scientific production in these fields increased by 40% in this period in comparison to 24% for all clinical medicine. The bulk of the production was concentrated in the autonomous communities of Catalonia (35%), Madrid (28%), and Valencia (10%). The autonomous communities of Navarra and Cantabria had a high relative production after the results were adjusted for population. The healthcare sector is the most active, with the Hospital de la Santa Creu i Sant Pau, the Hospital Clinic de Barcelona, and the Hospital Vall d'Hebron being outstanding in that they not only lead the country in the number of publications but also publish more in journals with high impact factors. Among centers other than hospitals, the Center for Research in Energy, the Environment, and Technologies (CIEMAT) and the Medical School of the Universidad Complutense de Madrid are the most important. A high degree of collaboration is evident: 68% of the documents were produced by more than one institution, foreign centers were involved in 20%, and the documents were signed by an average of six authors. Conclusions. In summary, the data show that Spanish radiological research is becomin increasingly international, although this process is still in the initial stage, with the percentage of documents published in the most prestigious journals for this specialty being lower than in other disciplines. The relative activity and production of Spain is slightly below the average of the European Union, but the country shows a rising trend for both production and impact.

The neural correlates of understanding the other's distress: a positron emission tomography investigation of accurate empathy

The purpose of the present study was to assess the relationship between brain metabolism and empathic response. Six right-handed healthy volunteers were scanned with PET and fluorodeoxyglucose twice: during an interview about neutral story themes and during an empathic response eliciting interview about a story of a character in distress. Metabolic values in the medial and superior frontal gyrus, occipitotemporal cortices, thalamus and the cerebellum were higher during empathic response than during the neutral theme interview. Furthermore, the subjects' empathy scores were positively correlated with metabolism in the medial aspects of the superior frontal gyrus. Our results suggest that empathy consists of both affective and cognitive components and hence may involve cortices that mediate simulation of emotional processing and mental state attribution.

Positron emission tomography imaging of transplant function

In this article, the role of functional imaging for providing objective evidence that grafts of fetal tissue can survive and form connections in Parkinson's and Huntington's disease patients is reviewed. The dissociation between dopamine storage capacity, clinical improvement, and normalization of brain metabolism in PD is discussed, and possible mechanisms underlying the phenomenon of dyskinesias off medication are presented. It is concluded the positron emission tomography and single photon emission computed tomography can provide valuable ancillary information alongside clinical observations but are not currently appropriate modalities for use as surrogate endpoints.

Neuroimaging of gender differences in alcohol dependence: are women more vulnerable?

BACKGROUND

Alcoholic brain damage has been demonstrated in numerous studies using neuropathology and brain imaging techniques. However, gender differences were addressed only in a few studies. Recent research has shown that development, course, and consequences of alcohol dependence may differ between female and male patients. Our investigation was built upon earlier research where we hypothesized that women develop alcoholic brain damage more readily than men do. To further compare the impact of alcohol dependence between men and women, we examined brain atrophy in female and male alcoholics by means of computed tomography (CT).

METHODS

The study group consisted of a total of 158 subjects (76 women: 42 patients, 34 healthy controls; 82 age-matched men: 34 patients, 48 healthy controls). All patients had a DSM-IV and ICD-10 diagnosis of alcohol dependence. CT with digital volumetry was performed twice in patients (at the beginning and end of the 6-week inpatient treatment program) and once in controls.

RESULTS

Patients of both genders had consumed alcohol very heavily. Although the average alcohol consumption in the year before the study was significantly lower in female alcoholics, this gender difference disappeared when controlled for weight. However, women had a significantly shorter duration of alcohol dependence. Despite this fact, both genders developed brain atrophy to a comparable extent. Brain atrophy was reversible in part after 6 weeks of treatment; it did not reach the level in the control groups.

CONCLUSIONS

Gender-specific differences in the onset of alcohol dependence were confirmed. This is in line with the telescoping effect, where a later onset and a more rapid development of dependence in women were described. Under the assumption of a gradual development of consequential organ damage, brain atrophy seems to develop faster in women. As shown in other organs (i.e., heart, muscle, liver), this may confirm a higher vulnerability to alcohol among women.

Cerebral oxygen saturation and electrical brain activity before, during, and up to 36 hours after arterial switch procedure in neonates without pre-existing brain damage: its relationship to neurodevelopmental outcome

OBJECTIVE

To monitor the pattern of cerebral oxygen saturation (rSat), by use of NIRS, in term infants before, during and after the arterial switch operation and to evaluate its relation to neurodevelopmental outcome.

METHODS

In 20 neonates without pre-existing brain damage hemodynamics and arterial oxygen saturation (AO2-Sat) were monitored simultaneously with rSat and amplitude-integrated EEG (aEEG) from 4 h to 12 h before up to 36 h after cardiopulmonary bypass (CPB) and short duration of cardiac arrest during deep hypothermia (DHCA). The Bayleys developmental scale was performed at 30 months.

RESULTS

Before surgery rSat was <50% in 16 patients. During CPB rSat increased to normal values, with a sharp decrease during brief CA (median 6.5 min). Post-CPB rSat showed a transient decrease (30-45%) despite normal PaO2 with sustained normalization after 6-26 h. Recovery time of the rSat seemed longer when pre-operative rSat was below 35%, and for lower minimum nasopharyngeal temperature and longer duration of CPB and of DHCA. Recovery time of the aEEG varied and did not correlate with normalization of rSat. Neurodevelopmental outcome was normal in all but two patients. Patients with lower pre-operative rSat (<35%) tended to have lower DQ (developmental quotient) scores at 30-36 months. (median: mental 102 and motor 101 (range 58-125) compared with mental 100 and motor 110 (range 83-125))

CONCLUSION

Despite prompt normalization of circulation and oxygenation after surgery, recovery of rSat of the brain took 6-26 h, probably because of higher energy demand after CPB. Pre-operative cerebral oxygenation may be underestimated as a possible cause of adverse post-operative outcome.

The phakomatoses

The phakomatoses are a diverse set of disorders related principally by a similar tendency to produce patchy manifestations that affect the nervous system and various other tissues. All of the disorders involve the occurrence of benign neoplasms or hamartomatous growths, and all involve the action of a distinct gene that functions as a tumor suppressor. At present, none of the phakomatoses is amenable to effective medical treatment, so management is limited to surveillance and treatment of progressive lesions. The radiologist plays a key role in this management, participating in diagnosis and follow-up of affected patients.

Beh??et??s syndrome and the nervous system

PURPOSE OF REVIEW

Behçet's syndrome (BS) is a multi-system, vascular-inflammatory disease of unknown origin, involving the nervous system in a subgroup of patients. The syndrome is rare, but as patients with BS are young and frequently present with an acute or subacute brainstem syndrome or hemiparesis, as well as with other various neurological manifestations, the syndrome is often included in the differential diagnosis of multiple sclerosis, stroke of the young adult, and another wide range of neurological disorders. The present review summarizes the neurological involvement in BS, and emphasizes recent clinical concepts and ethiopathogenetic findings.

RECENT FINDINGS

Over the last years the growing clinical and imaging evidence had suggested that neurological involvement in BS may be subclassified into two major forms: one, which is seen in the majority of patients, may be characterized as a vascular-inflammatory CNS disease, with focal or multifocal parenchymal involvement; the other, which has few symptoms and a better neurological prognosis, may be caused by isolated cerebral venous sinus thrombosis and intracranial hypertension. These two types rarely occur in the same individual, and their pathogenesis is likely to be different. A nonstructural vascular type headache is relatively common, whereas isolated behavioral syndromes and peripheral nervous system involvement are rare.

SUMMARY

The involvement of the nervous system in BS is heterogeneous as clinical and imaging data reveal. Currently it is unknown which factors determine or have a role in the development of neurological involvement, but some progress has been achieved in understanding the neurological spectrum of the syndrome, which may lead to a better management of these patients.

Evaluation of the dual route theory of reading: a metanalysis of 35 neuroimaging studies

Numerous studies concerned with cerebral structures underlying word reading have been published during the last decade. A few controversies, however, together with methodological or theoretical discrepancies between laboratories, still contribute to blurring the overall view of advances effected in neuroimaging. Carried out within the dual route of reading framework, the aim of this metanalysis was to provide an objective picture of these advances. To achieve this, we used an automated analysis method based on the inventory of activation peaks issued from word or pseudoword reading contrasts of 35 published neuroimaging studies. A first result of this metanalysis was that no cluster of activations has been found more recruited by word than pseudoword reading, implying that the first steps of word access may be common to word and word-like stimuli and would take place within a left occipitotemporal region (previously referred to as the Visual Word Form Area-VWFA) situated in the ventral route, at the junction between inferior temporal and fusiform gyri. The results also indicated the existence of brain regions predominantly involved in one of the two routes to access word. The graphophonological conversion seems indeed to rely on left lateralized brain structures such as superior temporal areas, supramarginal gyrus, and the opercular part of the inferior frontal gyrus, these last two regions reflecting a greater load in working memory during such an access. The lexicosemantic route is thought to arise from the coactivation of the VWFA and semantic areas. These semantic areas would encompass a basal inferior temporal area, the posterior part of the middle temporal gyrus, and the triangular part of inferior frontal gyrus. These results confirm the suitability of the dual route framework to account for activations observed in nonpathological subjects while they read.

The Cerefy Neuroradiology Atlas: a Talairach–Tournoux atlas-based tool for analysis of neuroimages available over the internet

The article introduces an atlas-assisted method and a tool called the Cerefy Neuroradiology Atlas (CNA), available over the Internet for neuroradiology and human brain mapping. The CNA contains an enhanced, extended, and fully segmented and labeled electronic version of the Talairach-Tournoux brain atlas, including parcelated gyri and Brodmann's areas. To our best knowledge, this is the first online, publicly available application with the Talairach-Tournoux atlas. The process of atlas-assisted neuroimage analysis is done in five steps: image data loading, Talairach landmark setting, atlas normalization, image data exploration and analysis, and result saving. Neuroimage analysis is supported by a near-real-time, atlas-to-data warping based on the Talairach transformation. The CNA runs on multiple platforms; is able to process simultaneously multiple anatomical and functional data sets; and provides functions for a rapid atlas-to-data registration, interactive structure labeling and annotating, and mensuration. It is also empowered with several unique features, including interactive atlas warping facilitating fine tuning of atlas-to-data fit, navigation on the triplanar formed by the image data and the atlas, multiple-images-in-one display with interactive atlas-anatomy-function blending, multiple label display, and saving of labeled and annotated image data. The CNA is useful for fast atlas-assisted analysis of neuroimage data sets. It increases accuracy and reduces time in localization analysis of activation regions; facilitates to communicate the information on the interpreted scans from the neuroradiologist to other clinicians and medical students; increases the neuroradiologist's confidence in terms of anatomy and spatial relationships; and serves as a user-friendly, public domain tool for neuroeducation. At present, more than 700 users from five continents have subscribed to the CNA.

Structured reporting in neuroradiology

We have developed a system to structure free-text neuroradiology reports using a natural language processing program and formatted the output into the digital image and communication in medicine (DICOM) standard for structured reporting (SR). DICOM SR formats the correspondence of pertinent diagnostic images to the radiologist's dictated report of clinical findings. In addition, DICOM SR allows the information to be organized into a tree structure. Individual nodes of the tree can contain individual items or lists. Structuring the content of free-text information allows the creation of hierarchies with defined relationships between the concepts contained within the report.

Bilateral infraorbital nerve involvement in idiopathic orbital myositis

We describe a case of bilateral infraorbital nerve involvement in idiopathic orbital myositis. Computed tomographic scanning of the orbits showed enlargement of extraocular muscles consistent with orbital myositis and enlargement of the ipsilateral infraorbital nerve. With disease progression, infiltration of the contralateral infraorbital nerve also developed. Biopsies of the inferior oblique muscle and infraorbital nerve showed the same inflammatory infiltrate: a mixed population of lymphocytes (B and T) with B cells expressing kappa and lambda light chains. Although orbital myositis may be associated with several conditions, to the best of our knowledge, this is the first time a case of idiopathic orbital myositis with bilateral infraorbital nerve involvement has been described.

[Ultrasound in local anaesthesia. Part I: technical developments and background]

The localisation of the nerve to be blocked is one of the special challenges in local anaesthesia. Since the first time local anaesthesia procedures were carried out approximately 100 years ago, the basic limitations of this method have always been the unsatisfactory success rate and the specific risks involved. Even by variation of the access route to the various nerves and use of different identification methods, no ideal blockade technique has been found which allows a 100% success rate and at the same time reduces the risks to a minimum. The clinical introduction of various aids, such as nerve stimulation or Doppler sonography, have brought no statistically significant advantages despite showing clear improvements. In recent years there has been a trend towards local anaesthesia in perioperative care due to the proven advantages and range of possibilities. Several working groups have developed methods for the sonographic identification of nerves or the epidural space and to an exact placing of needles or catheters from the information obtained. In this way the application of catheters and the injection of local anaesthetic agents can be carried out in an accurate and controlled manner. Although sonography is a procedure which has been used in local anaesthesia for over 10 years, there are at present only few practising local anaesthetists who can use this method. However, interest in this method is growing especially due to the aspect of quality assurance. Organising committees have established that this method will be the future direction. Perhaps even the prediction of Alon P. Winnie for ultrasound-guided local anaesthesia will become true: "Sooner or later someone will make a sufficiently close examination of the anatomy involved, so that exact techniques will be developed."

Improved method of magnification factor calculation for the angiographic measurement of neurovascular lesion dimensions

Accurately evaluating the size of a neurovascular lesion is essential for properly devising treatment strategies. The magnification factor must be considered in order to measure the dimension of a lesion from an angiogram. Although a method to calculate the magnification of the lesion by linear interpolation of the measurable magnification factors of two markers has been in use, this paper shows that it can be inaccurate. By deriving the exact formula for calculating the magnification factor at the level of the lesion, the error generated by the linear interpolation of magnification factor has been evaluated. This error was found to depend on source-to-skin distance (SSD), the location of the lesion in the head, and the head size. The closer the head is to the focal spot and the nearer the lesion is to the center of the head, the larger is the error. Since clinicians tend to use high geometric magnification (i.e., small SSD) in interventional procedures, there exists a possible consequential error of more than 3% in lesion sizing if the linear-interpolation calculation method is used. It is thus recommended that the exact formula derived here be used to calculate the magnification factor to improve accuracy.

Perineural tumor spread along the auriculotemporal nerve

BACKGROUND AND PURPOSE

Evaluation of images of perineural tumor spread in patients with head and neck malignancies is essential for planning treatment and determining the patient's prognosis. Although the communications between the facial and trigeminal nerves are not widely known, they may provide a route for tumor growth. The purpose of this study was to elucidate the course of the auriculotemporal nerve, as well as the clinical and imaging findings that suggest involvement of the communication between the facial nerve and the mandibular division (V(3)) of the trigeminal nerve.

METHODS

Images in 15 patients with clinical or radiologic findings suggestive of perineural tumor spread along the auriculotemporal nerve were reviewed. Involvement of the main trunk of the facial nerve, auriculotemporal nerve, V(3), trigeminal cistern, and ganglion and adjacent anatomic structures were noted in each patient.

RESULTS

The course of the auriculotemporal nerve was described in detail. More than 50% of patients with perineural tumor spread along the auriculotemporal nerve had clinical signs of auriculotemporal nerve dysfunction, including periauricular pain and temporomandibular joint (TMJ) dysfunction or tenderness. Images in 13 of 15 patients with such tumor spread demonstrated findings of tumor growth along V(3.).

CONCLUSION

Knowledge of the course of the auriculotemporal nerve is critical in evaluating images for findings of tumor spread along this nerve. Periauricular pain, TMJ dysfunction or tenderness, and imaging signs of V(3) involvement are important indicators of potential involvement of the auriculotemporal nerve.

Probing targets for antipsychotic drug action with PET and SPET receptor imaging

The use of in vivo receptor imaging by positron emission tomography (PET) and single photon emission tomography (SPET) has permitted exploration of targets for antipsychotic drug action in living patients. Early PET and SPET studies focused on striatal D2 dopamine receptors. There is broad agreement that unwanted extrapyramidal (parkinsonian) side effects of antipsychotic drugs result from high striatal dopamine D2/D3 receptor blockade by these drugs. The dopamine hypothesis of antipsychotic drug action suggests that clinical response is directly related to the level of striatal D2/D3 receptor occupancy of antipsychotic drugs. This may be true for classical antipsychotic drugs, but recent evidence suggests that novel, atypical antipsychotic drugs produce efficacy in association with modest and transient striatal D2/D3 receptor occupancy levels. Furthermore, atypical antipsychotic drugs appear to show preferential occupancy of limbic cortical dopamine D2 receptors. Cortical dopamine D2/D2-like receptors may be a common site of action for all antipsychotic drugs. Data from receptor challenge paradigms has highlighted the need to explore the neurotransmitter systems involved in regulating or stabilising dopamine transmission, either via dopamine autoreceptors or non-dopaminergic pathways. These may be promising targets for drug development. In vivo PET and SPET imaging has produced unique data contributing to the design of better, less toxic drugs for schizophrenia.

Neuroimaging consortium workshop: development of novel PET and SPECT ligands for brain imaging

It was clear from the levels of participation in this panel discussion and from the levels of interest expressed in the upcoming NIMH tracer Consortium Workshop that there is a great deal of potential benefit to public health from the development of new PET and SPECT (and, perhaps, MRI?) tracers. For extramural NIH programs, the tool guidelines for grantees are in fact only that--guidelines--but they could become specific regulations if unacceptable threats to basic research are perceived. This is because the benefits of collaboration among basic scientists are considered essential for the success of research programs. On the other hand, intramural programs at NIH are considered by some to be the "beta test site" for emerging issues and policies, regardless of the specific scientific topic. This may well be true for research tools and presents an opportunity to find new ways of working. As for the industry, threats to intellectual property arise from myriad sources. The magnitude of these threats can only be appreciated from the perspective of long-term investment in research-based industries with significant regulation. In particular, the pharmaceutical industry enjoys only a relatively short period of time during which investments in the last medicament can be recouped to support the development of the next. A great deal of commitment and sophistication will be required if the United States shall succeed in finding new ways of translating basic into applied science for the practical benefit of currently underserved patient populations.

Interventional neuroradiology--anesthetic management

Interventional Neuroradiology is a rather young department, that asks for an appropriate anesthesia management. This article highlights mainly the practical approach, with special directions for a thorough premedication, monitoring and patient positioning and extra attention to heparinisation and allergic reactions. Different anesthetic techniques are dealt with, namely conscious sedation and general anesthesia, as well as directives concerning potential complications.

Functional neuroimaging of the olfactory system in humans

Positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) have begun to provide unique information regarding the neural underpinnings of olfactory functioning in humans. We review the relative strengths and weaknesses of PET and fMRI techniques for studying olfaction. We then review PET and fMRI studies relating to the olfactory functions of the pyriform cortex, orbitofrontal cortex, amygdala and the entorhinal/hippocampal region. A pixelwise correlational analysis of PET data is also presented in order to clarify the relationship between blood flow in the medial temporal lobes and psychoperceptual variables.

Interventional neuroradiology. Recent developments and anaesthesiologic aspects

AIM

To summarise recent developments in interventional neuroradiology (INR) and to discuss related anaesthesiologic considerations.

SUMMARY

Important Procedures: embolisation of cerebral aneurysms with Guglielmi detachable coils (GDC) as well as intra-arterial thrombolysis and angioplasty for acute ischaemic stroke and chronic atherosclerotic stenosis of cerebral arteries have been recently introduced into clinical practice. Their role in the management of aneurysms and cerebral ischaemia still remains to be defined. Embolisation of strongly vascularised neoplasms, arteriovenous malformations or fistulas and percutaneous transluminal angioplasty of refractory vasospasms after subarachnoid haemorrhage are standard procedures with established indications. The balloon occlusion test of the carotid artery and the WADA test are also frequently performed interventions in INR.

ANAESTHETIC CONSIDERATIONS

The role of the anaesthetist in INR consists in providing patient comfort by analgesia and sedation, adequate monitoring, maintenance of vital functions and (if required) the management of systemic heparinisation. The patient's underlying condition, the duration and the kind of intervention have to be considered to decide on the anaesthetic management. Most of the procedures can safely be performed under light sedation, which allows continuous neurological evaluation of the patient. Knowledge of the risks and hazards of the different procedures and close collaboration with the neuroradiologist form the basis for appropriate management in case of a potentially fatal ischaemic or haemorrhagic complication that may occur in 1 to 8% of interventions. For prompt control of airway, respiration and blood pressure in these emergencies experienced anaesthesia staff is required.

In vitro and in vivo characterization of (+)-3-[11C]cyano-dizocilpine

(+)-3-[11C]Cyano-5-methyl-10,11 -dihydro-5H-dibenzo[a,d]-cyclohepten-5,10-imine ([11C]MKC) was successfully synthesized as a potential radiotracer for PET studies on the NMDA receptor channel complex. In vitro binding properties of [11C]MKC were investigated with newly developed techniques for efficient evaluation of 11C-labeled compounds. The association curve of [11C]MKC binding in rat forebrain membranes showed that the specific binding reached an equilibrium within 30 min. Specific binding was saturable with affinity constant KD=8.2+/-0.4nM and Bmax=1.62+/-0.04 pmol/mg protein with glutamate and glycine included in the incubation medium. The binding of [11C]MKC was decreased by extensive washing of the membrane preparation. (+)- and (-)-Dizocilpine, 3-cyano-dizocilpine, and ketamine inhibited the specific binding of [11C]MKC with IC50 values of 37.3, 445.0, 65.8nM and 3.91 microM, respectively. High specific binding in in vitro autoradiography was distributed predominantly in telencephalic regions (the hippocampus, cerebral cortex, and striatum) followed by thalamus. PET studies using rhesus monkeys under anesthesia showed high uptake of [11C]MKC in the temporoparietal and frontal cerebral cortices, striatum, and thalamic regions, although it is problematic to verify the specific binding in vivo by PET.

Neonatal risk factors and risk scores including auditory evoked responses

In a prospective study, 81 preterm infants and 25 healthy term infants were neurologically and neurophysiologically evaluated in the neonatal period. At 5-7 years of age the neurodevelopmental outcome was assessed. The validity and predictive value of the Neonatal Neurological Inventory (NNI) and the Neurobiological Risk Score (NBRS), including an additional gestational age factor (GAF) and an auditory evoked response factor (AERF) were assessed. Three of the 53 surviving preterm infants showed major neurological abnormalities at 5-7 years. Five infants showed neuropsychological abnormalities and 12 infants showed both neurological and neuropsychological abnormalities. An important subgroup of preterm infants could be identified as high-risk using the NNI and NBRS. The low sensitivity and negative predictive value resulted in a number of false-negative results. Logistic regression showed that intraventricular haemorrhage (IVH) and bilirubin levels contributed highly to the prediction of neurological outcome. For neuropsychological outcome these factors were IVH and assisted ventilation. Addition of the GAF and AERF as separate items to the NBRS did not affect the predictive power. Combined addition of the GAF and AERF showed improvement of both validity and predictive value.

CONCLUSION

This study shows that IVH, bilirubin and assisted ventilation contribute most to the validity and predictive value of the NBRS. Furthermore, regarding neurological outcome addition of a GAF in combination with an AERF resulted in a substantial improvement of the validity and predictive value. The shortcomings of the current neonatal risk scores require a careful interpretation of clinical perinatal data regarding the prediction of neurodevelopmental outcome in preterm infants.

Patient-controlled sedation using propofol during interventional neuroradiologic procedures

Patient-controlled sedation (PCS) using propofol has been reported to provide safe and effective sedation during a variety of procedures performed under regional or local anesthesia. In a prospective, randomized fashion, this study evaluated propofol PCS compared to anesthesiologist-administered midazolam-fentanyl sedation during interventional neuroradiologic (INR) procedures. Nineteen patients undergoing 24 INR procedures received propofol PCS (PCS dose, 0.5 mg/kg; lockout interval, 3 min) or anesthesiologist-administered midazolam-fentanyl sedation. Study parameters included discomfort, sedation and anxiety visual analogue scores (VAS), cognitive function, patient satisfaction, and complications. No difference was found between the two sedation techniques with respect to the levels of sedation and anxiolysis. Cognitive function was well preserved in both groups. Patient satisfaction was similarly high in both groups. Complications were similar between groups. These included ventilatory depression (two patients in each group) and excessive sedation (two patients in each group). Three patients in the propofol group became excessively restless, resulting in brief interruptions during the respective procedures. Propofol PCS offers a safe sedation technique during INR procedures with a sedation and anxiolysis profile that was not distinguishable from anesthesiologist-administered midazolam-fentanyl sedation.