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Introduction: Executive functions and processing speed have been regarded as core cognitive domains affected in cerebral small vessel disease (SVD). Executive functions, as an umbrella concept, consist of a variety of different subcomponents, yet in research these abilities are often evaluated with single tests or summary scores. Currently, it is unknown whether all executive abilities are equally affected by SVD brain changes and whether some tests are more sensitive in detecting deficits than others. We investigated the associations of white matter hyperintensity (WMH) volume with specific executive abilities (cognitive flexibility, response inhibition, working memory) and processing speed by using an extensive set of paper-and-pencil and computerised neuropsychological tests. Methods: In the Helsinki Small Vessel Disease Study, 152 subjects (age 65-75 years) with varying degrees of WMH but no clinical stroke or dementia were evaluated with quantitative automated MRI analysis and a comprehensive neuropsychological examination. Executive functions and processing speed measures included the Wechsler adult intelligence scale (WAIS-IV) Coding subtest, Stroop test, Hayling sentence completion test, Brixton spatial anticipation test, verbal fluency test, Wechsler memory scale (WMS-III) Digit span and Number-letter sequencing subtasks, and the more experimental Flexible attention test (FAT), Simon task and Sustained attention to response task (SART). Results: Linear regression analyses controlling for age, sex and education revealed significant associations between WMH volume and measures within all evaluated subdomains. However, marked differences were found between individual test Results: The strongest associations were observed for FAT Numbers and Number-letter task (computerised tests based on the Trail making test), FAT Visuospatial span, Simon task and verbal fluency (animals), while some of the widely used tests failed to reach significance. Discussion: WMH are related to significant deficits in processing speed and executive functions subdomains of flexibility, inhibition and working memory. The strength of associations within subdomains is nevertheless highly dependent on the evaluation method in use. Computerised tests providing precise measures of reaction times and response accuracy seem to outperform many of the conventional paper-and-pencil tests. These results have implications for observational studies and intervention trials, where the selection of sensitive outcome measures is crucial.

Introduction: Subjective cognitive complaints are common in patients with cerebral small vessel disease (SVD), yet their correspondence to informant evaluations, objective cognitive functions and severity of brain changes are poorly understood. We studied the associations of subjective and informant reports of cognitive difficulties (executive functions and memory) with findings from a comprehensive neuropsychological assessment and brain MRI (white matter hyperintensities, WMH volume) as well as depressive symptoms and functional abilities (instrumental activities of daily living, IADL). Methods: In the Helsinki SVD Study, 152 older adults with varying degrees of WMH but without stroke or dementia were classified as having normal cognition or mild cognitive impairment (MCI) based on Jak/Bondi neuropsychological criteria. The objective cognitive measures also included continuous domain scores for memory and executive functions. Cognitive complaints were evaluated with the subjective- and informant-versions of Prospective and Retrospective Memory Questionnaire (PRMQ) and Dysexecutive Questionnaire (DEX), functional abilities with the Amsterdam IADL Questionnaire and depressive symptoms with the Geriatric Depression Scale (GDS-15). Results: Subjective cognitive complaints correlated significantly with informant reports (r=0.40-0.50, p0.05). Instead, subjective DEX (OR 1.10, CI 95% 1.05-1.16, p

Abstract Background Post-traumatic headache (PTH) is a common symptom following mild traumatic brain injury (mTBI). Patients at risk to develop acute PTH (aPTH) and further persistent PTH (pPTH) need to be recognized. Methods This is a one-year follow-up of 127 patients with mTBI, aged 18 to 68, referred to outpatient clinic in the Helsinki University Hospital. Symptoms were assessed at the emergency department (ED), with structured interview at outpatient clinic visit and with Rivermead post-concussion symptom questionnaire at one, three, and 12 months after injury. Psychiatric disorders were assessed with Structured Clinical Interview for DSM-IV Axis I disorders at 3-4 months and return to work (RTW) from patient records. Results At one month, 77/127 patients (61%) had aPTH. According to multiple logistic regression analysis, risk factors for aPTH were headache at the emergency department (ED) (OR 5.43), other pain (OR 3.19), insomnia (OR 3.23), and vertigo (OR 5.98). At three months, 17 patients (22% of aPTH patients) had developed pPTH, and at one year, 4 patients (24% of pPTH patients) still presented with pPTH. Risk factors for pPTH at three months were older age (OR 1.06) and current insomnia (OR 12.3). The frequency of psychiatric disorders did not differ between the groups. pPTH patients performed worse on their RTW. Conclusions Risk factors for aPTH were insomnia, headache at ED, other pain, and vertigo and for pPTH, insomnia and older age. RTW rate was lower among pPTH patients.

Objective: Subjective cognitive complaints are common in patients with cerebral small vessel disease (cSVD), yet their relationship with informant evaluations, objective cognitive functions and severity of brain changes are poorly understood. We studied the associations of subjective and informant reports with findings from comprehensive neuropsychological assessment and brain MRI. Method: In the Helsinki SVD Study, 152 older adults with varying degrees of white matter hyperintensities (WMH) but without stroke or dementia were classified as having normal cognition or mild cognitive impairment (MCI) based on neuropsychological criteria. The measures also included continuous domain scores for memory and executive functions. Cognitive complaints were evaluated with the subjective and informant versions of the Prospective and Retrospective Memory Questionnaire (PRMQ) and Dysexecutive Questionnaire (DEX); functional abilities with the Amsterdam Instrumental Activities of Daily Living Questionnaire (A-IADL); and depressive symptoms with the Geriatric Depression Scale (GDS-15). Results: Subjective cognitive complaints correlated significantly with informant reports (r=0.40–0.50, p

BackgroundThe usefulness of neurofilament light (NfL) as a biomarker for small vessel disease has not been established. We examined the relationship between NfL, neuroimaging changes, and clinical findings in subjects with varying degrees of white matter hyperintensity (WMH).MethodsA subgroup of participants (n = 35) in the Helsinki Small Vessel Disease Study underwent an analysis of NfL in cerebrospinal fluid (CSF) as well as brain magnetic resonance imaging (MRI) and neuropsychological and motor performance assessments. WMH and structural brain volumes were obtained with automatic segmentation.ResultsCSF NfL did not correlate significantly with total WMH volume (r = 0.278, p = 0.105). However, strong correlations were observed between CSF NfL and volumes of cerebral grey matter (r = −0.569, p

Alpha-pyrrolidinovalerophenone (α-PVP) is a designer drug, the mechanism of action of which resembles that of cocaine and amphetamine. New data about the side effects of α-PVP are emerging. We present a case report of an acute ischemic stroke following the recreational use of α-PVP. The ischemic lesions were located in the middle cerebral artery and deep watershed areas of the left cerebral hemisphere. Occupational therapy and physiotherapy were initiated, and the patient was discharged with only a mild right hemiparesis.

Aim and scope: A Gradient Echo Plural Contrast Imaging technique (GEPCI) is a post-processing method, which can be used to obtain quantitative T2* values and generate multiple synthetic contrasts from a single acquisition. However, scan duration and image reconstruction from k-space data present challenges in a clinical workflow. This study aimed at optimizing image reconstruction and acquisition duration to facilitate a post-processing method for synthetic image contrast creation in clinical settings. Materials and methods: This study consists of tests using the American College of Radiology (ACR) image quality phantom, two healthy volunteers, four mild traumatic brain injury patients and four small vessel disease patients. The measurements were carried out on a 3.0 T scanner with multiple echo times. Reconstruction from k-space data and DICOM data with two different coil-channel combination modes were investigated. Partial Fourier techniques were tested to optimize the scanning time. Conclusions: Sum of squares coil-channel combination produced artifacts in phase images, but images created with adaptive combination were artifact-free. The voxel-wise median signed difference of T2* between the vendor’s adaptive channel combination and k-space reconstruction modes was 2.9 ± 0.7 ms for white matter and 4.5 ± 0.6 ms for gray matter. Relative white matter/gray matter contrast of all synthetic images and contrast-to-noise ratio of synthetic T1-weighted images were almost equal between reconstruction modes. Our results indicate that synthetic contrasts can be generated from the vendor’s DICOM data with the adaptive combination mode without affecting the quantitative T2* values or white matter/gray matter contrast. Keywords: Magnetic resonance imaging, Image quality, Quantitative MRI, MRI reconstruction, T2* mapping, Synthetic contrasts

Background: We evaluated the prevalence of psychiatric disorders in mild traumatic brain injury (MTBI) patients and investigated psychiatric comorbidity in relation to subjective symptoms and return to work (RTW). Methods: We recruited 103 MTBI patients (mean age 40.8 years, SD 3.1) prospectively from University Hospital. The patients were followed up for one year. The Rivermead Post-Concussion Symptom Questionnaire (RPQ) and Extended Glasgow Outcome Scale (GOSE) were administered one month after MTBI. Three months after MTBI, any psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders. Results: Psychiatric disorders were diagnosed in 26 patients (25.2%). The most common disorders were previous/current depression. At three months, there was no difference between patients with psychiatric disorders versus those without them in RTW (95.7% vs. 87.3%, p = 0.260) or at least in part-time work (100% vs. 94.4%, p = 0.245). In Kaplan–Meier analysis, the median time to RTW was 10 days for both groups. The median RPQ score was 13.0 (Interquartile range (IQR) 6.5–19.0) in patients with a psychiatric disorder compared to 8.5 (IQR 2.3–14.0) in those without one (p = 0.021); respectively, the median GOSE was 7.0 (IQR 7.0–8.0) compared to 8.0 (IQR 7.0–8.0, p = 0.003). Conclusions: Approximately every fourth patient with MTBI had a psychiatric disorder. These patients reported more symptoms, and their functional outcome measured with GOSE at one month after MTBI was worse. However, presence of any psychiatric disorder did not affect RTW. Early contact and adequate follow-up are important when supporting the patient’s return to work.

Musical competence may confer cognitive advantages that extend beyond processing of familiar musical sounds. Behavioural evidence indicates a general enhancement of both working memory and attention in musicians. It is possible that musicians, due to their training, are better able to maintain focus on task-relevant stimuli, a skill which is crucial to working memory. We measured the blood oxygenation-level dependent (BOLD) activation signal in musicians and non-musicians during working memory of musical sounds to determine the relation among performance, musical competence and generally enhanced cognition. All participants easily distinguished the stimuli. We tested the hypothesis that musicians nonetheless would perform better, and that differential brain activity would mainly be present in cortical areas involved in cognitive control such as the lateral prefrontal cortex. The musicians performed better as reflected in reaction times and error rates. Musicians also had larger BOLD responses than non-musicians in neuronal networks that sustain attention and cognitive control, including regions of the lateral prefrontal cortex, lateral parietal cortex, insula, and putamen in the right hemisphere, and bilaterally in the posterior dorsal prefrontal cortex and anterior cingulate gyrus. The relationship between the task performance and the magnitude of the BOLD response was more positive in musicians than in non-musicians, particularly during the most difficult working memory task. The results confirm previous findings that neural activity increases during enhanced working memory performance. The results also suggest that superior working memory task performance in musicians rely on an enhanced ability to exert sustained cognitive control. This cognitive benefit in musicians may be a consequence of focused musical training.

The Environmental Problems and Politics of Power: Review on the African Elite

Background: When MRI images of patients with memory problems are assessed, the presence of lacunar infarcts is evaluated. Lacunar infarcts, fluid‐filled cavities of 3‐15 mm in diameter, are one possible result of cerebral small vessel disease and therefore relevant in dementia diagnostics. In this study, we propose an automated tool for detecting lacunar infarcts on MRI images. Method: We adapted our previous approach [1] in three ways: 1) post‐processing steps were added to the convolutional neural network segmentation pipeline, e.g., to exclude enlarged perivascular spaces and segmentations located inside sulci or ventricles, 2) memory clinic data from the Amsterdam Dementia Cohort and PredictND cohort were included in addition to the LADIS cohort data, and 3) the ground truth was defined by three experienced neuroradiologists (A, B, C) instead of one rater. T1 and T2‐FLAIR images were available for all cases and T2 for a subset in visual rating. The dataset was composed of 393 subjects and each expert rated 1156 potential lacunar infarcts as "1 = no", "2 = probably no", "3 = probably yes" or "4 = yes". A consensus (CO) was created by calculating the average and using a cutoff at 2.5. The agreement was measured between individual raters (A‐B, B‐C, A‐C), between automatic rating and individual raters (AU‐A, AU‐B, AU‐C), and between the automatic rating and the consensus rating (AU‐CO) using Kappa. Correlation coefficient for the number of lacunar infarcts per subject was defined. Cross‐validation was used in training the algorithm. Result: Out of 1156 candidate regions evaluated, 540 were considered as lacunar infarcts based on consensus. The individual raters agreed with each other in 74% of cases whether the shown lesion was lacunar infarct (kappa = 0.48). Correspondingly, automatic rating agreed with the individual raters in 74% of cases (kappa = 0.47). When automatic rating was compared with consensus, agreement/accuracy was 78% (kappa = 0.55). The correlation coefficient for the number of lacunar infarcts detected automatically from the whole image and visually (consensus) was 0.85 (Figure 1). Conclusion: This study suggests that the agreement in detecting lacunar infarcts automatically is comparable to inter‐rater variability between experienced neuroradiologists. [1] Jokinen et al. Stroke 2020 Nov 9; 50(1) [ABSTRACT FROM AUTHOR]

Single-lung ventilation using a double-lumen endobronchial tube is often performed for surgical procedures involving the thorax. Tracheobronchial rupture during use of an endobronchial tube is an uncommon and serious complication. We present the case of a patient undergoing a right pneumonectomy who experienced a bronchial rupture due to a double-lumen endobronchial tube. Institution of veno-venous extracorporeal membrane oxygenation allowed removal of the endobronchial tube, and the repair was successfully performed. We hope that this information can provide further insight into the management of such a complication. [Copyright &y& Elsevier]

Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery with an incidence between 15% and 50% and pathophysiology not fully known. By choosing the method of extracorporeal circulation with focus on the reduction of systemic inflammatory response, one can potentially decrease the risk of POAF. In this prospective, randomized trial, we compared minimal invasive extracorporeal circulation (MiECC) with conventional extracorporeal circulation (CECC) in the prevention of POAF after coronary artery bypass surgery (CABG). A total of 240 patients who were scheduled for their first on-pump CABG, were randomized to MiECC or CECC. The primary outcome measure was the incidence of first POAF during the first 84 hours after surgery. POAF occurred in 42/120 (35.0%) MiECC patients and 43/120 (35.8%) CECC patients with nonsignificant difference between the groups (OR 1.043, 95% CI 0.591-1.843, P = .884). The first postoperative creatine kinase-MB mass (CK-MBm) value was lower in the MiECC group, 13.95 [10.5-16.7] (median [IQR]) than in the CECC group, 15.30 [11.4-18.9] (P = .036), whereas the use of perioperative dobutamine was higher in the MiECC group, 18/120 (15.0%), than in the CECC group 8/120 (6.7%) (P = .038). The incidence of a stroke, perioperative myocardial infarction, and resternotomy caused by bleeding did not differ in the MiECC and CECC groups. Age (OR 1.08, 95% CI 1.04-1.13, P = .000) and peak postoperative CK-MBm (OR 1.57, 95% CI 1.06-2.37, P = .026) were independent predictors of POAF. MiECC compared to CECC was not effective in reducing the incidence of POAF in patients undergoing CABG., (© 2020 International Center for Artificial Organs and Transplantation and Wiley Periodicals LLC.)

Background: Postoperative pain is a major problem in day-case surgery in children. Nonsteroidal antiinflammatory drugs have gained popularity in management of pediatric surgical patients to reduce the need for opioids. The aim of this study was to evaluate the efficacy of different doses of rectal acetaminophen in day-case surgery in children., Methods: A randomized, double-blinded, placebo-controlled study design was used. Patients (n = 120) were randomized to receive a single dose of 0, 20, 40, or 60 mg/kg of rectal acetaminophen after induction of anesthesia. General anesthesia was induced by mask ventilation with sevoflurane (7%) in nitrous oxide and oxygen and maintained with 2.5-4.0% end-tidal sevoflurane. Opioids or local anesthetics were not used. Postoperative pain was evaluated by behavioral assessment and physiologic measurements every 10 min after arrival at the postanesthesia care unit. The pain intensity was scored using a 0-100 visual analog scale used in the authors' clinic. The need for rescue medication, intravenous morphine 0.1 mg/kg, was decided by the nurse, who was unaware of the rectal acetaminophen dose. The parents were interviewed by phone after 24 h regarding pain and its treatment, nausea, and vomiting. Rescue analgesia at home was rectal ibuprofen, 10 mg/kg., Results: In the postanesthesia care unit pain scores were significantly lower in the 40- and 60-mg/kg groups compared with placebo and 20-mg/kg groups. Acetaminophen resulted in a dose-related reduction in the number of children who required postoperative rescue opioid, with significance reached with 40 or 60 mg/kg doses. Calculated dose of acetaminophen at which 50% of the children not requiring a rescue opioid was 35 mg/kg. The need for rescue analgesia at home during the first 24 h after surgery was also significantly less in patients in the 40- or 60-mg/kg groups than in the 0- or 20-mg/kg groups (20-17 vs. 80-63%). Thirty-three percent of patients receiving placebo had postoperative nausea and vomiting, compared with 0-3% in groups receiving 40 or 60 mg/kg acetaminophen., Conclusions: A single dose of 40 or 60 mg/kg of rectal acetaminophen has a clear morphine-sparing effect in day-case surgery in children if administered at the induction of anesthesia. Moreover, children with adequate analgesia with acetaminophen have less postoperative nausea and vomiting.