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Objective In this systematic review, preoperative educational interventions for patients undergoing neurosurgical treatment are identified and their impact on patient knowledge acquisition and satisfaction is assessed. Methods The review was conducted in accordance with the PRISMA guidelines and used PubMed, Google Scholar, and MEDLINE databases. Studies evaluating before and after cohort or control group comparison were identified between 2007 and 2019 and were independently scored and evaluated by 3 authors. Results Eighty-one articles were assessed for eligibility and 15 met the inclusion criteria. Patient educational interventions were text-based (2 studies), multimedia/video-based (3), mobile/tablet-based (5), or used virtual reality (2) or three-dimensional printing (3). Interventions were disease-specific for cerebrovascular lesions (5), degenerative spine disease (2), concussion/traumatic brain injury (2), movement disorders (1), brain tumor (1), adolescent epilepsy (1), and other cranial/spinal elective procedures (3). Eleven studies (n = 18–175) documented patient knowledge acquisition using self-reported knowledge questionnaires (5) or more objective assessments based on true/false or multiple-choice questions (6). Most studies (10/11) reported statistically significant increases in patient knowledge after implementation of the intervention. Ten studies (n = 14–600) documented patient satisfaction using validated satisfaction surveys (2), Likert scale surveys (6), or other questionnaires (2). Although all studies reported increases in patient satisfaction after the intervention, only 4 were statistically significant. Conclusions Patient educational interventions using various modalities are broadly applicable within neurosurgery and ubiquitously enhance patient knowledge and satisfaction. Interventions should be implemented when possible.

A 13-year-old female patient was diagnosed with a tectal glioma (TG), a subgroup of astrocytoma that can result in obstructive hydrocephalus secondary to aqueductal stenosis. Endoscopic third ventriculostomy (ETV) is used to treat this type of hydrocephalus with a good success rate. Our institution performs ETV and Ommaya reservoir (OR) placement in these cases. The OR allows measurement of intracranial pressure (ICP) and cerebrospinal fluid (CSF) access and a method for performing ventricular dye studies to evaluate third ventricular stoma (TVS) patency. In this case, a porencephalic cyst (PC) developed around the OR’s ventricular catheter (OVC) two and a half months after surgery. The PC is thought to have developed in association with TVS stoma closure and resolved after ETV revision.

The study described here was aimed at investigating the feasibility of using the ultrasonic through-transmission technique to estimate human musculoskeletal and fat properties. Five hundred eighty-two volunteers were assessed by dual-energy X-ray absorptiometry (DXA) and ultrasonic transmission techniques. Bone mineral density (BMD), muscle and fat mass were measured for both legs and the whole body. Hip BMD and spine BMD were also measured. Ultrasonic transmission measurements were performed on the heel, and the measured parameters were broadband ultrasound attenuation (BUA), speed of sound (SOS), ultrasonic stiffness index (SI), T-score and Z-score, which were significantly correlated with all measured BMDs. The optimal correlation was observed between SI and left-leg BMD (p0.001) before and after adjustment for age, sex and body mass index (BMI). The linear and partial correlation analyses revealed that BUA and SOS were closely associated with muscle and fat mass, respectively. Multiple regressions revealed that muscle and fat mass significantly contributed to the prediction of transmission parameters, explaining up to 17.83% (p0.001) variance independently of BMD. The results suggest that the ultrasonic through-transmission technique could help in the clinical diagnosis of skeletal and muscular system diseases.

Neuroimaging studies have identified both brain structural and functional abnormalities in patients with idiopathic cervical dystonia (iCD), but often yield diverse results. We aim to find the specific and common neurostructural/functional abnormalities in iCD by conducting separate and multimodal meta-analyses across structural and functional neuroimaging studies.A systematic literature search was conducted to identify relevant publications. Separate meta-analysis for whole-brain voxel-based morphometry (VBM) studies and for functional imaging studies, and a multimodal meta-analysis across VBM and functional studies in iCD were conducted using anisotropic effect size-based signed differential mapping.We included twenty-seven studies, including nine structural datasets comprising 152 iCD patients and 188 healthy controls, and seventeen functional datasets describing 352 iCD patients and 296 healthy controls. The multimodal analysis showed overlap between anatomic and functional changes in bilateral precentral and postcentral gyri, bilateral paracentral lobules, right supplementary motor area, bilateral median cingulate/paracingulate gyri, right caudate nucleus and thalamus, right cerebellum and lingual gyrus. We also found gray matter alterations alone in bilateral dorsolateral superior frontal gyri, left middle temporal gyrus, right inferior parietal gyrus, and left cerebellum; and altered functional activity alone in right fusiform gyrus, bilateral precuneus.The current meta-analyses revealed significant conjoint and dissociated brain structural and functional abnormalities in iCD, and emphasized the involvement of cortico-thalamo-basal ganglia circuit and cerebellum.

Percutaneous transhepatic cholangioscopic lithotripsy (PTCSL) is a minimally invasive treatment for hepatolithiasis. But it may make a long cycle of treatment so that it was further improved to complete the percutaneous hepatic choledochotomy and choledochoscopic lithotripsy in phase I surgery. The aim of this study was to evaluate the efficacy of the modified technique comparing with laparoscopic choledochotomy.Retrospective analysis of the clinical data of patients with hepatolithiasis or choledocholithiasis consulted at our hospital from February 2018 to December 2021. The cases were divided into two groups according to surgical modality, intraoperative ultrasound-guided percutaneous transhepatic cholangioscopic lithotripsy (IUG-PTCSL) and laparoscopic choledochotomy lithotripsy (LC-L). Contrast analysis determined the advantages of the two approaches.IUG-PTCSL was performed in 44 patients, aged 58.14 ± 14.01 years, including 9 male and 35 female. There were 15 patients underwent LC-L, aged 62.13 ± 15.03 years, including 1 male and 14 female. There was not statistically significant difference in the composition of patients' age and sex between the two groups (p = 0.356, 0.219). The success rate of intraoperative ultrasound-guided percutaneous hepatic bile duct puncture was 100% followed with the success rate of hepatocholangiostomy was 100%. Although 1 (1/44) patient showed significant bleeding during choledochoscopic lithotripsy and was converted to open choledochotomy for stone extraction, 43 patients completed IUG-PTCSL with the rate of phase I surgical stones removal was 81.40% (35/43), whereas the stones removal rate of LC-L was 66.67% (10/15). There was not statistically significant difference between them (p = 0.067). Both the groups showed no significant complications with the postoperative hospital stay of 8 (6, 10) days and 10 (8, 11) days, respectively, and the difference was statistically significant (p = 0.028).Intraoperative ultrasound-guided percutaneous transhepatic cholangioscopy might be a safe and reliable ideal method for bile duct stones with the advantages of rapid recovery for patients. Intraoperative ultrasound-guided percutaneous hepatocholangiostomy may be the key technique for the successful completion of the surgery.

Metabolic bone disease of prematurity remains a significant problem for preterm infants. Quantitative ultrasound (QUS) has potential as a non-invasive tool for assessing bone health of newborns. The aim of this study was to assess bone health in preterm and term newborns using ultrasonic backscatter difference measurement. This study analyzed a total of 493 neonates, including 239 full-term infants (gestational age [GA]37 wk), 201 preterm I infants (GA: 32-37 wk) and 53 extreme preterm II infants (GA32 wk). Ultrasonic backscatter measurements were performed on the calcaneus of infants at birth, and the normalized mean of the backscatter difference spectrum (nMBD) was calculated as an ultrasonic index of neonatal bone status. Simple and multiple linear regressions were performed to determine the association of ultrasonic nMBD with GA, anthropometric characteristics and biochemical markers. Statistically significant differences in GA, anthropometric characteristics (birth weight, birth length [BL], birth head circumference and body mass index [BMI]) and biochemical markers (alkaline phosphatase, serum calcium and serum phosphate) were observed among preterm and term infants. The nMBD for term infants (median = 3.72 dB/μs, interquartile range [IR] = 1.95 dB/μs) was significantly higher than that for preterm I infants (median = 1.95 dB/μs, IR = 3.12 dB/μs), which was, in turn, significantly higher than that for preterm II infants (median = 0.19 dB/μs, IR = 3.50 dB/μs). The nMBD yielded moderate correlations (ρ = 0.57-0.62, p0.001) with GA and anthropometric characteristics and weak correlations (|ρ| = 0.08-0.21, p0.001 or not significant) with biochemical markers. Multivariate regressions revealed that only BL (p = 0.002) and BMI (p = 0.032) yielded significantly independent contributions to the nMBD measurement, and combinations of BL and BMI could explain up to 42% of the variation of nMBD in newborn infants. This study found that ultrasonic backscatter difference measurement might be helpful in bone health evaluation in preterm and term newborns. The utility of ultrasonic backscatter measurement in diagnosis of metabolic bone disease in infants should be investigated further.

BACKGROUND: The traditional Chinese medicine (TCM) patent medicine Huangjing Zanyu capsule (HJZY capsule) has achieved satisfactory clinical effects in the treatment of oligoasthenospermia (OAS). This study aimed to elucidate the impact of HJZY capsule on the reproductive system, focusing on oxidative stress and metabolism profiling during the intervention, to clarify the therapeutic mechanism of HJZY capsule in treating OAS. METHODS: Cyclophosphamide was used to establish OAS model rats. Time-sequence specimen collection was applied to monitor the dynamic development of the pharmacological effect of HJZY capsule. Superoxide dismutase (SOD), glutathione peroxidase (GPX), and malonaldehyde (MDA) were evaluated by biochemistry kits to examine the impact of HJZY capsule on oxidative stress. Non-targeted metabolomics was conducted for urine and testis samples, respectively, to investigate metabolic pathways through which the HJZY capsule takes effect. RESULTS: The HJZY capsule elevated sperm density from 62.1±8.28, passing 68.4±7.52, to 75.9±8.48×10(6)/mL, and sperm motility from 62.0%±3.94%, passing 70.8%±9.72%, to 68.8%±4.37%. Meanwhile, SOD (P

Background: Measurement of the posterior tibial slope (PTS) angle has important applications in total knee replacement surgery, high tibial osteotomy, and anterior cruciate ligament reconstruction. The aim of this study was to determine the mean PTS of knee joints in healthy Chinese adults, and to provide data to guide knee surgery in China.Methods: A retrospective analysis was performed using 1,257 (n=1,233, 50.4% male) DR radiograph (X-ray) plain films of participants aged 25-59 years. The picture archiving and communication system (PACS) system was used for the PTS measurement. The PTS was defined as the angle between the vertical line of the tangent of the anterior tibial cortex of the proximal tibia, and the tangent line of the tibial cortex. Two imaging physicians conducted the PTS measurements independently, and both the inter- and intraclass correlation coefficients (ICCs) were estimated.Results: The interobserver ICC was 0.91 (95% confidence interval [CI]: 0.85-0.94), and the intraobserver ICC was 0.90 (95% CI: 0.82-0.94). The mean PTS value was 7.68±3.84° (range: 0-21°). The left PTS was significantly smaller in males than in females (7.22±3.89 vs 8.05±3.60;P=0.005). Additionally, the PTS in participants aged 25-29 years was significantly larger than that in the other age groups(Left side:8.64±3.73 vs 6.92±3.42,7.42±3.75,7.53±3.98;P< 0.001 and Right side:8.68±3.84 vs 7.48±4.21,7.13±3.64,7.66±3.80;P=0.004). There were no significant differences in PTS between the left and right sides. The two-way ANOVA suggested that the differences in PTS between age groups were not affected by sex. Conclusions: This study has provided valuable information regarding the normal PTS values in Chinese adults and it has provided regionalised data to guide knee surgery. Furthermore, this study demonstrated that there were significant differences in PTS based on sex and age, highlighting the need to provide individualized treatment for knee surgery.

Pediatric subdural hematomas (SDH) are associated with arachnoid cysts (AC), particularly in the middle cranial fossa (MCF). Operative management of these hemorrhages is a mainstay of treatment. Conservative management may be an option if there is minimal mass effect and the patient is mildly symptomatic. A 14-year-old male presented with right frontal headaches that worsened with activity. He was found to have a large right MCF AC. Scheduled routine outpatient follow-up CT of the head demonstrated bilateral SDH. There was no history of significant head trauma. He was admitted for close observation and his inpatient scans remained stable. Outpatient follow-up imaging over the course of three and a half years demonstrated resolution of SDH and decreased AC size. He denied headaches and continued doing well in school. ACs are a risk factor for the development of SDH in young male patients after minor trauma. Development of intracranial hypotension secondary to AC rupture may have contributed to the development of bilateral SDH in our patient. We demonstrate here that close clinical follow up with serial imaging may be considered a management strategy in these patients.

Sinus pericranii (SP) are abnormal vascular connections between extracranial scalp venous channels and intracranial dural sinuses. This vascular abnormality rarely results in significant sequelae, but in select cases, it can be symptomatic. We describe the case of a 7-year-old girl with an SP who experienced intermittent visual, motor, and sensory symptoms not previously described in the literature. Her symptoms resolved after surgical treatment of the SP. We propose a mechanism for her symptoms and the rationale for the role of neurosurgical intervention along with a review of the literature.

Wireless technologies based on electromagnetic wave are crucial in the modern industry but nonoptimal in electromagnetic-restricted conditions such as underwater applications, where acoustic wave has been proposed as an indispensable approach. However, most of the current acoustic wireless methods could support single wireless function and control single device. A converged wireless infrastructure that simultaneously supports the mainstream wireless functions remains inaccessible for acoustics. The difficulty lies in constructing the dynamic control network consisting of multiple nodes with acoustic method. Here, we develop the converged wireless infrastructure based on the acoustic holographic array, which serves as the central hub of the system. The holographic array allows for simultaneous control of multiple targets and integrates multiple mainstream wireless functions. We experimentally present the acoustic version of the converged wireless system that realizes a series of functions, including (i) selective wireless power transfer, (ii) stable remote monitoring, (iii) dynamic programmable logic control, and (iv) wireless acoustic communication. The wireless system is capable of powering and controlling free-moving devices. The unique immunity against electromagnetic and biological interferences is further demonstrated. The acoustic-based wireless infrastructure provides a route to wireless technologies, especially for those in electromagnetic-restricted conditions.

The ultrasonic backscatter (UB) has the advantage of non-invasively obtaining bone density and structure, expected to be an assessment tool for early diagnosis osteoporosis. All former UB measurements were based on exciting a short single-pulse and analyzing the ultrasonic signals backscattered in bone. This study aims to examine amplitude modulation (AM) ultrasonic excitation with UB measurements for predicting bone characteristics. The AM multiple lengths excitation and backscatter measurement (AM-UB) functions were integrated into a portable ultrasonic instrument for bone characterization. The apparent integrated backscatter coefficient in the AM excitation (AIBAM) was evaluated on the AM-UB instrumentation. The correlation coefficients of the AIBAM estimating volume fraction (BV/TV), structure model index (SMI), and bone mineral density (BMD) were then analyzed. Significant correlations (|R| = 0.82–0.93, p < 0.05) were observed between the AIBAM, BV/TV, SMI, and BMD. By growing the AM excitation length, the AIBAM values exhibit more stability both in 1.0-MHz and 3.5-MHz measurements. The recommendations in AM-UB measurement were that the avoided length (T1) should be lower than AM excitation length, and the analysis length (T2) should be enough long but not more than AM excitation length. The authors conducted an AM-UB measurement for cancellous bone characterization. Increasing the AM excitation length could substantially enhance AIBAM values stability with varying analyzed signals. The study suggests the portable AM-UB instrument with the integration of real-time analytics software that might provide a potential tool for osteoporosis early screening.

Most ultrasonic backscatter method excites a short single-pulse and then analyses the bone's response for diagnosing osteoporosis. However, the bone responses to the ultrasound excitation have not been fully understood, such as the response to amplitude modulation (AM) excitation, which may contain more information about bone characteristics for diagnosing. The objectives of this study were to observe the response that the cancellous bones to the AM excitation, and then to investigate extracting AM backscatter parameter for estimating bone mineral density (BMD) and structure. An innovative instrument was developed and realized both AM excitation and real-time calculation parameter AIB AM . The results showed that AIB AM has strong and stable correlations with BMD and structure model index (SMI) ( $\vert \mathrm{R}\vert =0.82-0.91, \mathrm{p} ). These results indicate that AM ultrasonic backscatter method combined with the portable device might have the potential for screening and diagnosing osteoporosis.

Background and purpose Historically, overall outcomes for patients with high-grade subarachnoid hemorrhage (SAH) have been poor. Generally, between physicians, either reluctance to treat, or selectivity in treating such patients has been the paradigm. Recent studies have shown that early and aggressive care leads to significant improvement in survival rates and favorable outcomes of grade V SAH patients. With advancements in both neurocritical care and end-of-life care, non-treatment or selective treatment of grade V SAH patients is rarely justified. Current paradigm shifts towards early and aggressive care in such cases may lead to improved outcomes for many more patients. Materials and methods We performed a detailed review of the current literature regarding neurointensive management strategies in high-grade SAH, discussing multiple aspects. We discussed the neurointensive care management protocols for grade V SAH patients. Results Acutely, intracranial pressure control is of utmost importance with external ventricular drain placement, sedation, optimization of cerebral perfusion pressure, osmotherapy and hyperventilation, as well as cardiopulmonary support through management of hypotension and hypertension. Conclusions Advancements of care in SAH patients make it unethical to deny treatment to poor Hunt and Hess grade patients. Early and aggressive treatment results in a significant improvement in survival rate and favorable outcome in such patients.

Objective: the purpose of this paper was to investigate the effect of spectral computation methods on the estimation of the four ultrasonic backscatter parameters, namely, the apparent integrated backscatter (AIB), the zero frequency intercept of apparent backscatter (FIAB), the frequency slope of apparent backscatter (FSAB), and the backscatter spectral centroid shift (SCS) from the backscattered signal of interest (SOI), and their subsequent correlations with cancellous bone parameter [bone volume/total volume (BV/TV)]. Methods: ultrasonic backscatter measurements were performed on 26 bovine cancellous bone specimens using a 1.0-MHz focused transducer. Four spectral estimation algorithms, including the classical periodogram, the autoregressive (AR) Burg algorithm, the AR covariance algorithm, and the AR modified covariance algorithm, were used to calculate the ultrasonic parameters. Influence of the signal's delay time (T1) and its length (T2) on the strength of correlation between BV/TV and backscatter parameters was also studied. Results: the results have demonstrated that the AR-based estimators provide much more reliable and stronger correlations between the BV/TV and backscatter parameters than the classical periodogram. Recommendations for choosing SOI were also suggested. Conclusion: these results indicate that the AR-based method has a promising potential to enhance the performance of evaluation and diagnosis of the cancellous bone using the ultrasonic backscatter method. Significance: the enhancement of the correlation may provide a positive impact on the ultrasonic backscatter method to diagnose and monitor the bone quantity.

Cavernous malformations (CMs) account for approximately 5% to 10% of all CNS vascular malformations, and intraventricular CMs (IVCMs) are a rare subtype, accounting for 2.5% to 10.8% of all intracranial CMs. IVCMs can expand rapidly, leading to compression of adjacent structures, intraventricular hemorrhage, and obstructive hydrocephalus. Diagnosis is challenging because it can mimic a variety of other lesions.A 71-year-old man presented after a fall because of imbalance. MRI of the head showed a homogenously enhancing 2-cm mass in the posterior aspect of the right lateral ventricle, with blood layering in the right occipital horn and adjacent parietal edema and leptomeningeal enhancement, as well as a pituitary lesion.The patient underwent a right parietal craniotomy for resection of the mass. The ventricle was accessed through a transsulcal approach through the intraparietal sulcus using a tubular retractor system. The mass was arising from the choroid plexus and dissected free in a piecemeal fashion. Postoperative imaging confirmed gross total resection, and the patient had an uneventful recovery.Here, we present the first case of a choroid plexus IVCM removed using a tubular retractor system. We demonstrate that this is a safe and effective approach for this rare lesion given the minimal traction on brain parenchyma and enhanced visualization of a deep-seated cavernoma in the lateral ventricle.

Objective: Through the bioinformatic analysis of gene chips related to advanced diabetic nephropathy in the GEO database, the key genes of advanced diabetic nephropathy are screened, whose biological functions and signal pathways are predicted as well. Methods: The gene chips related to advanced diabetic nephropathy from the GEO expression profile database was downloaded, and the differentially expressed genes in patients with advanced diabetic nephropathy and normal people were analyzed through R. For the screened differentially expressed genes, the biological function of GO and the enrichment analysis of KEGG signal pathway were used to predict their biological functions and related signal pathways. In addition, a protein-protein interaction network was constructed, so as to screen core pathogenic genes utilizing STRING database and Cytoscape. Results: By analyzing the chip GSE142025, 301 differential genes were obtained, including 197 up-regulated genes and 104 down-regulated genes. Both GO annotation and enrichment analysis suggested that differential genes were mainly involved in immune-inflammatory response and cytokine action. Furthermore, KEGG pathway analysis suggested that the most important pathway related to advanced diabetic nephropathy was MAPK signaling pathway. Through protein-protein interaction network and module analysis, C3, CCR2, CCL19, and SAA1 were selected as the core sites of the interaction. Conclusions: Differential genes participate in the pathogenesis of advanced diabetic nephropathy through the KEGG pathway, the immune inflammatory response and cytokine action, which provides new ways for the diagnosis and treatment of advanced diabetic nephropathy.

Aneurysmal subarachnoid hemorrhage (aSAH) is an emergent neurosurgical condition associated with high morbidity and mortality. The prognostic significance of baseline frailty status in aSAH patients has not been previously evaluated in a large, nationally representative sample.Clinical outcomes data from the National Inpatient Sample from 2010-2018 were compared among sub-cohorts stratifying admissions by increasing frailty thresholds [(assessed using the 11-point modified frailty index (mFI-11)]. The previously validated NIS-SAH Severity Score (NIS-SSS) and NIS-SAH Outcome Measure (NIS-SOM) were utilized. Complex samples multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed to assess adjusted associations and discrimination of frailty for endpoints.Among 64,102 aSAH hospitalizations (mean age 55.4 years), 20.4% of admissions were classified as robust (mFI=0), 43.4% as pre-frail (mFI = 1), 24.9% as frail (mFI = 2), and 11.2% as severely frail (mFI ≥ 3). Following multivariable analysis adjusting for age and aSAH severity, increasing frailty was independently associated with NIS-SOM (OR = 1.15, 95% CI 1.09-1.21; p0.001), extended length of hospital stay (eLOS) (OR = 1.08, 1.02-1.13; p = 0.008), neurological complications (OR = 1.08, 1.03-1.13; p0.001), and medical complications (OR = 1.14, 1.08-1.21; p0.001). Based on ROC curve analysis, frailty achieved an AUC of 0.59 (0.58-0.60) and 0.54 (0.53-0.55) for NIS-SOM and eLOS, respectively. Age and NIS-SSS demonstrated significantly greater discrimination for NIS-SOM [AUC 0.69 (0.68-0.70) and 0.79 (0.78-0.80), respectively), while NIS-SSS achieved significantly greater discrimination for eLOS [(AUC 0.74 (0.73-0.75)] in comparison to both age and frailty.This national database evaluation of frailty in aSAH patients demonstrates an independent association between increasing frailty and poor functional outcome. Age and aSAH severity, however, may be more robust prognostic factors.

A 13-year-old female patient was diagnosed with a tectal glioma (TG), a subgroup of astrocytoma that can result in obstructive hydrocephalus secondary to aqueductal stenosis. Endoscopic third ventriculostomy (ETV) is used to treat this type of hydrocephalus with a good success rate. Our institution performs ETV and Ommaya reservoir (OR) placement in these cases. The OR allows measurement of intracranial pressure (ICP) and cerebrospinal fluid (CSF) access and a method for performing ventricular dye studies to evaluate third ventricular stoma (TVS) patency. In this case, a porencephalic cyst (PC) developed around the OR's ventricular catheter (OVC) two and a half months after surgery.The PC is thought to have developed in association with TVS stoma closure and resolved after ETV revision.

False localizing signs (FLS) and other misleading neurological signs have long been an intractable aspect of neurocritical care. Because they suggest an incorrect location or etiology of the pathological lesion, they have often led to misdiagnosis and mismanagement of the patient. Here, we reviewed the existing literature to provide an updated, comprehensive descriptive review of these difficult to diagnose signs in neurocritical care. For each sign presented, we discuss the non-false localizing presentation of symptoms, the common FLS or misleading presentation, etiology/pathogenesis of the sign, and diagnosis, as well as any other clinically relevant considerations. Within cranial neuropathies, we cover cranial nerves III, IV, V, VI, VII, VIII, as well as multiple cranial nerve involvement of IX, X, and XII. FLS ophthalmologic symptoms indicate diagnostically challenging neurological deficits, and here we discuss downbeat nystagmus, ping-pong-gaze, one-and-a-half syndrome, and wall-eyed bilateral nuclear ophthalmoplegia (WEBINO). Cranial herniation syndromes are integral to any discussion of FLS and here we cover Kernohan's notch phenomenon, pseudo-Dandy Walker malformation, and uncal herniation. FLS in the spinal cord have also been relatively well documented, but in addition to compressive lesions, we also discuss newer findings in radiculopathy and disc herniation. Finally, pulmonary syndromes may sometimes be overlooked in discussions of neurological signs but are critically important to recognize and manage in neurocritical care, and here we discuss Cheyne-Stokes respiration, cluster breathing, central neurogenic hyperventilation, ataxic breathing, Ondine's curse, and hypercapnia. Though some of these signs may be rare, the framework for diagnosing and treating them must continue to evolve with our growing understanding of their etiology and varied presentations.

Although hyperglycemia is associated with worse outcomes after aneurysmal subarachnoid hemorrhage (aSAH), there is no consensus on the optimal glucose control metric, acceptable in-hospital glucose ranges, or suitable insulin regimens in this population. In this single-center retrospective cohort study of aSAH patients, admission glucose, and hospital glucose mean (MHG), minimum (MinG), maximum (MaxG), and variability were compared. Primary endpoints (mortality, complications, and vasospasm) were assessed using multivariate logistic regressions. Of the 217 patients included, complications occurred in 83 (38.2%), 124 (57.1%) had vasospasm, and 41 (18.9%) died. MHG was independently associated with (p

Aneurysmal subarachnoid hemorrhage (aSAH) is devastating, with delayed cerebral ischemia (DCI) significantly contributing to the high morbidity and mortality rates. Cholesterol has been studied as a measure of nutritional status in other neurological pathologies, but reports examining cholesterol's effects on aSAH outcomes are sparse. This study aimed to elucidate the effect of low total cholesterol (TC) and high density lipoprotein (HDL) on mortality and DCI following aSAH.We performed a retrospective cohort study at a quaternary academic medical center between June 2014 and July 2018. All patients had aSAH confirmed by digital subtraction angiography and had TC measured on admission. Primary outcomes were mortality and DCI. Secondary outcome was radiographic vasospasm. Univariate and multivariate logistic regressions were performed.There were 75 aSAH patients, with an average age of 58.7 ± 1.7 (range: 14-89) and HuntHess score of 2.8 ± 0.1, included for analysis. Those with a low TC 160 mg/dL had 3 times increased odds of DCI (OR = 3.4; 95 %CI: 1.3-9.0; p = 0.0175) and a nearly 5 times increased odds of death (OR = 4.9; 95 %CI: 1.1-18.3; p = 0.0339). Low HDL 40 mg/dL was associated with 12 times increased odds of DCI (OR = 12.3; 95 %CI: 2.7-56.4; p = 0.0003) but no significant differences in death (p = 0.2205). In multivariate analysis, low TC was an independent risk factor for increased mortality (OR = 5.6; 95 %CI: 1.2-27.6; p = 0.0335) while low HDL was associated with increased risk for DCI (OR = 17.9; 95 %CI: 3.1-104.4; p = 0.0013). There was no effect of TC or HDL on radiographic vasospasm.Low TC and HDL are independent predictors of increased mortality and DCI, respectively, following aSAH. Low TC and HDL may be markers of poor overall health, in addition to having some pathophysiological effect on cerebral vasculature. These results may have practical implications for the improvement of aSAH prognostication and management.

The moments (a.k.a., mean and standard deviation) of latent features are often removed as noise when training image recognition models, to increase stability and reduce training time. However, in the field of image generation, the moments play a much more central role. Studies have shown that the moments extracted from instance normalization and positional normalization can roughly capture style and shape information of an image. Instead of being discarded, these moments are instrumental to the generation process. In this paper we propose Moment Exchange, an implicit data augmentation method that encourages the model to utilize the moment information also for recognition models. Specifically, we replace the moments of the learned features of one training image by those of another, and also interpolate the target labels -- forcing the model to extract training signal from the moments in addition to the normalized features. As our approach is fast, operates entirely in feature space, and mixes different signals than prior methods, one can effectively combine it with existing augmentation approaches. We demonstrate its efficacy across several recognition benchmark data sets where it improves the generalization capability of highly competitive baseline networks with remarkable consistency., Comment: CVPR 2021. Code is available at https://github.com/Boyiliee/MoEx

Metabolic bone disease (MBD) is one of the major complications of prematurity. Ultrasonic backscatter technique has the potential to be a portable and noninvasive method for early diagnosis of MBD. This study firstly applied CAS to neonates, which was defined as a linear combination of the apparent integrated backscatter coefficient (AIB) and spectral centroid shift (SCS). The objective was to evaluate the feasibility of ultrasonic backscatter technique for assessing neonatal bone health using AIB, SCS, and CAS. Ultrasonic backscatter measurements at 3.5 MHz, 5.0 MHz, and 7.5 MHz were performed on a total of 505 newborns within 48 hours after birth. The values of backscatter parameters were calculated and compared among gestational age groups. Correlations between backscatter parameters, gestational age, anthropometric indices, and biochemical markers were analyzed. The optimal predicting models for CAS were determined. The results showed term infants had lower SCS and higher AIB and CAS than preterm infants. Gestational age and anthropometric indices were negatively correlated with SCS (|r| = 0.45 – 0.57, P r| = 0.36 – 0.60, P r| = 0.56 – 0.69, P P P P = 0.002), and serum calcium (P = 0.037) explained up to 40.3% of CAS variation. This study suggested ultrasonic backscatter technique was feasible to evaluate neonatal bone status. CAS was a promising parameter to provide more information about bone health than AIB or SCS alone.

Background Heparin induced thrombocytopenia Type II (HIT-II) is a dangerous thromboembolic complication of heparin therapy. The current literature on incidence and outcomes of HIT-II in aneurysmal subarachnoid hemorrhage (aSAH) patients remains sparse. Objective We report our institution's incidence and outcomes of HIT-II in aSAH patients. Methods We performed a retrospective cohort study at an academic medical center between June 2014 and July 2018. All patients had aSAH confirmed by digital subtraction angiography. Diagnosis of HIT-II was determined by positive results on both heparin PF4-platelet antibody ELISA (anti-PF4) and serotonin release assay (SRA). Results 204 patients met inclusion criteria. Seven patients (7/204, 3.5%) underwent laboratory testing, three of whom met clinical criteria. HIT-II incidence was confirmed in two of these seven patients (2/204, 0.98%), who had high BMI and T4 scores. Conclusion Our institution's report of HIT-II incidence in aSAH patients is lower than previously reported in this population and more closely parallels HIT-II incidence in the general and surgical ICU setting. Widely-accepted American College of Chest Physicians (ACCP) clinical diagnostic criteria in conjunction with anti-PF4 and SRA testing is the gold standard of clinical diagnosis of HIT-II in aSAH patients.

Building accurate knowledge of the identity, the geographic distribution and the evolution of living species is very essential for sustainable development of the biodiversity as well as the whole society. However, basic information is often partially accessible for scientists to do research, plant data collection is one of the problems. To make plants collection become more available especially in the field environment with weak network signal, this paper proposed a novel method that combines plant recognition with distributed location information and designed a corresponding method based on Bayesian estimation to analyze plants with sick disease and unknown parts. A mobile application system has been designed and implemented which uploads plant photos to the cloud server for recognition based on the established plant library and speed up the process with the distributed location information. Meanwhile, to solve weak signal problem in the wild field, the library buffer of neighboring area where recent searching items exist are proposed in the mobile client be therefore that the application can finish matching locally and reduce the network bandwidth requirement. To illustrate the availability and practicability, different set of plants with leaves or flowers have been collected and the results show that the average recognizing accuracy via traditional method is larger than 84% and recognition time is less than 1.5 s, and the accuracy will soar to more than 90% if neural network is used.

We explore the emerging body of research focusing on business ecosystems (BEs). The study of inter-organizational relationships has evolved from a focus at the level of firm, to the supply chain, the platform, and now towards the BE. The co-evolution of inter-related organizations is an essential element of BE research, rather than static structure. The success of leading internet companies in Asia, such as Alibaba in China, Naver in South Korea, Baharti Airtel in India, and Rakuten in Japan, reflects their strategies and practices of leveraging BEs within a fast-changing age. In order to better understand the mechanisms of BEs, in particular within the Asian context, we propose three key research directions within BEs, including dynamics, embeddedness, and internationalization.

Background: Arachnoid cysts (AC) may cause hydrocephalus and neurological symptoms, necessitating surgical intervention. Cyst drainage may result in postoperative complications, however, these interventions are not normally associated with the subsequent development of acute hydrocephalus. Herein, we present two unique cases of AC drainage with postoperative development of acute communicating hydrocephalus. Case Description: Case 1. A 75-year-old female presented with progressive headaches, cognitive decline, and questionable seizures. Her neurological examination was non-focal, but a head computed tomography scan (CT) identified a large right frontal AC with mass effect. She subsequently underwent craniotomy and decompression of the cyst. Postoperatively, her neurological examination deteriorated, and a head CT demonstrated new communicating hydrocephalus. The opening pressure was elevated upon placement of an external ventricular drain. Her hydrocephalus improved on follow-up imaging, but her neurological examination failed to improve, and she ultimately expired. Case 2. A 61-year-old female presented with headache and seizures attributed to a left parietal AC. She underwent open craniotomy for fenestration of the cyst into the Sylvian fissure. Postoperatively, her neurologic examination deteriorated, and she developed acute communicating hydrocephalus. She was initially managed with external ventricular drainage (EVD). The hydrocephalus resolved after several days, and the EVD was subsequently removed. Late follow-up imaging at 2 years showed that the regression of the AC was maintained. Conclusion: Acute development of hydrocephalus is a potential complication of intracranial AC fenestration. A better understanding of intracranial cerebrospinal fluid flow dynamics may better inform as to the underlying cause of this complication.

Photoacoustic tomography (PAT) is an emerging biomedical imaging technology that can realize high contrast imaging with a penetration depth of the acoustic. Recently, deep learning (DL) methods have also been successfully applied to PAT for improving the image reconstruction quality. However, the current DL-based PAT methods are implemented by the supervised learning strategy, and the imaging performance is dependent on the available ground-truth data. To overcome the limitation, this work introduces a new image domain transformation method based on cyclic generative adversarial network (CycleGAN), termed as PA-GAN, which is used to remove artifacts in PAT images caused by the use of the limited-view measurement data in an unsupervised learning way. A series of data from phantom and in vivo experiments are used to evaluate the performance of the proposed PA-GAN. The experimental results show that PA-GAN provides a good performance in removing artifacts existing in photoacoustic tomographic images. In particular, when dealing with extremely sparse measurement data (e.g., 8 projections in circle phantom experiments), higher imaging performance is achieved by the proposed unsupervised PA-GAN, with an improvement of ∼14% in structural similarity (SSIM) and ∼66% in peak signal to noise ratio (PSNR), compared with the supervised-learning U-Net method. With an increasing number of projections (e.g., 128 projections), U-Net, especially FD U-Net, shows a slight improvement in artifact removal capability, in terms of SSIM and PSNR. Furthermore, the computational time obtained by PA-GAN and U-Net is similar (∼60 ms/frame), once the network is trained. More importantly, PA-GAN is more flexible than U-Net that allows the model to be effectively trained with unpaired data. As a result, PA-GAN makes it possible to implement PAT with higher flexibility without compromising imaging performance.

Bone fatigue accumulation is a factor leading to bone fracture, which is a progressive process of microdamage deteriorating under long-term and repeated stress. Since the microdamage of the early stage in bone is difficult to be investigated by linear ultrasound, the second harmonic generation method in nonlinear ultrasound technique is employed in this paper, which is proved to be more sensitive to microdamage. To solve the deficiency that the second harmonic component is easily submerged by noise in traditional nonlinear measurement, a weighted chirp coded sinusoidal signal was applied as the ultrasonic excitation, while pulse inversion is implemented at the receiving side. The effectiveness of this combination to improve the signal-to-noise ratio has been demonstrated by in vitro experiment. Progressive fatigue loading experiments were conducted on the cortical bone plate in vitro for microdamage generation. There was a significant increase in the slope of the acoustic nonlinearity parameter with the propagation distance (increased by 8% and 24% respectively) when the bone specimen was at a progressive level of microdamage. These results indicate that the coded nonlinear ultrasonic method might have the potential in diagnosing bone fatigue.

As fluorescence is the major limitation in Raman scattering, near-infrared excitation wavelength ( > 780 n m ) is preferred for fluorescence suppression in Raman spectroscopy. To reduce the risk of fluorescence interference, we developed a dual-wavelength excitation combined Raman spectroscopy (DWECRS) system at 785 and 830 nm. By a common optical path, each laser beam was focused on the same region of the sample by a single objective lens, and the dual-wavelength excitation Raman spectra were detected by a single CCD detector; in addition, 785 and 830 nm excitation Raman spectra can be directly constructed as combined Raman spectrum in the DWECRS system. The results of pure peanut oil and glycerol indicate that the combined Raman spectrum cannot only reduce fluorescence interference but also keep a high signal-to-noise ratio in the high-wavenumber region. The results of dye-ethanol solutions with different concentrations show that the handheld DWECRS system can be used as a smart method to dodge strong fluorescence. Furthermore, we developed a peak intensity ratio method with the DWECRS system to distinguish different types of edible oils. The peak intensity ratio distribution chart of edible oils showed each oil normalized center was relatively independent and nonoverlapped, which can be used as the basis of edible oil classification analysis. In the future, the DWECRS system has potential to be used as a tool for more complex applications.

Sharing Economy Platforms (SEPs) are, in general, easily challenged by social ethics and culture, and are vulnerable to social and institutional uncertainties. Drawing from the Creating Shared Value (CSV) concept (Porter and Kramer, 2011), this article investigates whether CSV activities assist SEPs in retaining sustainable innovation at a business ecosystem level. Based on the Polanyian embeddedness framework, we specifically examine how SEPs’ CSV co-evolves and aligns with virtue ethics and local culture across three growth stages: Community stage, Scaling-up stage, and Legitimation stage. Data for this research were collected from multiple case studies from two major sectors: the bike-sharing platform sector and the ride-sharing platform sector. Our findings indicate that SEPs should co-create shared values by embedding virtue ethics and local culture into their work with key ecosystem partners in order to preserve sustainable innovation. The research contributes to an evolving understanding of CSV activities in the sharing economy literature on SEPs, as well as proposing some practical implications for industrial practitioners and policymakers.

The ultrasonic backscatter technique holds the promise of characterizing bone density and microstructure. This paper conducts ultrasonic backscatter parametric imaging based on measurements of apparent integrated backscatter (AIB), spectral centroid shift (SCS), frequency slope of apparent backscatter (FSAB), and frequency intercept of apparent backscatter (FIAB) for representing trabecular bone mass and microstructure. We scanned 33 bovine trabecular bone samples using a 7.5 MHz focused transducer in a 20 mm × 20 mm region of interest (ROI) with a step interval of 0.05 mm. Images based on the ultrasonic backscatter parameters (i.e., AIB, SCS, FSAB, and FIAB) were constructed to compare with photographic images of the specimens as well as two-dimensional (2D) μ-CT images from approximately the same depth and location of the specimen. Similar structures and trabecular alignments can be observed among these images. Statistical analyses demonstrated that the means and standard deviations of the ultrasonic backscatter parameters exhibited significant correlations with bone density (|R| = 0.45-0.78, p < 0.01) and bone microstructure (|R| = 0.44-0.87, p < 0.001). Some bovine trabecular bone microstructure parameters were independently associated with the ultrasonic backscatter parameters (Δ R2 = 4.18%-44.45%, p < 0.05) after adjustment for bone apparent density (BAD). The results show that ultrasonic backscatter parametric imaging can provide a direct view of the trabecular microstructure and can reflect information about the density and microstructure of trabecular bone.

© 1992-2012 IEEE. We present a comprehensive study and evaluation of existing single-image dehazing algorithms, using a new large-scale benchmark consisting of both synthetic and real-world hazy images, called REalistic Single-Image DEhazing (RESIDE). RESIDE highlights diverse data sources and image contents, and is divided into five subsets, each serving different training or evaluation purposes. We further provide a rich variety of criteria for dehazing algorithm evaluation, ranging from full-reference metrics to no-reference metrics and to subjective evaluation, and the novel task-driven evaluation. Experiments on RESIDE shed light on the comparisons and limitations of the state-of-the-art dehazing algorithms, and suggest promising future directions.