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Boesen Wrenn posted an update 6 months ago
Graphical abstract.
Non-aneurysmal subarachnoid hemorrhage (NA-SAH) is a clinical-radiological entity with a different prognosis than aneurysmal SAH (A-SAH). The purpose of this study is to assess the predictive value of the modified Fisher Scale (mFS) for neurological complications in patients with this diagnosis.
We recruited patients admitted at our hospital services between 2009 and 2017 who were diagnosed with spontaneous SAH, with either perimesencephalic (PM-SAH) or diffuse pattern (D-SAH), an initial negative angio-CT, and at least one digital subtraction angiography of brain vessels discarding underlying brain aneurysms or other vascular malformations.
The retrospective observational study included 116 patients. The mean age was 54.4, and the sample included predominantly male subjects (62.9%). Hunt and Hess (HH) scores on admission ranged from 3 to 5 in 18.1% of patients. The prevalence of hydrocephalus requiring ventricular drainage was 18.1%. The prevalence of symptomatic vasospasm was 4.3%. A modified Rankin Scale (mRS) 0-2 at discharge was found in 95.6%. In a multivariate logistic regression for the presence of neurological complications including age, sex, admission HH 3-5 compared with < 3, mFS 4 compared with mFS < 4, D-SAH compared with PM-SAH, and mRS score at discharge of 0-2 compared with > 2, the only significant predictors were mFS 4 compared with mFS < 4 (OR 4.47 (95% CI 1.21, 16.66) p value = 0.03) and D-SAH compared with PM-SAH (OR 7.10 (95% CI 1.24, 40.8) p value = 0.03).
In patients with NA-SAH, a mFS score of 4 and/or a D-SAH bleeding pattern in non-contrast cranial CT on admission predicted the development of relevant neurological complications.
In patients with NA-SAH, a mFS score of 4 and/or a D-SAH bleeding pattern in non-contrast cranial CT on admission predicted the development of relevant neurological complications.
Functional MRI is not routinely used for neurosurgical planning despite potential important advantages, due to difficulty of determining quality. We introduce a novel method for objective evaluation of fMRI scan quality, based on activation maps. A template matching analysis (TMA) is presented and tested on data from two clinical fMRI protocols, performed by healthy controls in seven clinical centers. Preliminary clinical utility is tested with data from low-grade glioma patients.
Data were collected from 42 healthy subjects from seven centers, with standardized finger tapping (FT) and verb generation (VG) tasks. Copies of these “typical” data were deliberately analyzed incorrectly to assess feasibility of identifying them as “atypical.” Analyses of the VG task administered to 32 tumor patients assessed sensitivity of the TMA method to anatomical abnormalities.
TMA identified all atypical activity maps for both tasks, at the cost of incorrectly classifying 3.6 (VG)-6.5% (FT) of typical maps as atypical.owing atypical activation patterns for further investigation to determine whether atypicality is caused by poor scan data quality or abnormal functional topography.
Kinematic alignment (KA) total knee arthroplasty (TKA) has proven to be aviable alternative to mechanical alignment (MA) TKA. Like any technique, its validity has to encounter challenges. Two of these are flexion contracture and large deformities of the knee.
Flexion contracture is commonly treated with posterior capsular release. Often, however, this technique is not sufficient. Many surgeons accustomed to MA techniques and guided by traditional femoral instruments manage the problem by proximalizing the distal femoral cut. However, this has proven to be asurgical mistake that often leads to mid-flex knee instability. KA rules limit this mistake but leave the problem of flexion contracture. In these cases, the surgeon acts on the tibia distalizing the cut and, so as not to create instability in flexion, decreasing the slope. The technique is effective to obtain full extension but often leaves instability at 90°of knee flexion. To avoid this, it is useful to use the so-called “virtuous mistake” strategy, which strictly follows the KA guidelines but undercuts the posterior femoral condyles by 2 mm.
Another problem that often limits the use of KA is large deformities. It is necessary to distinguish whether they are intra or extra-articular. In the first case, it is possible to decide whether to use the pure KA technique or to restrict the indication at the level of the tibial cut. In the latter, extraarticular osteotomies or combined procedures (osteotomy plus KA) have to be performed.
Another problem that often limits the use of KA is large deformities. It is necessary to distinguish whether they are intra or extra-articular. In the first case, it is possible to decide whether to use the pure KA technique or to restrict the indication at the level of the tibial cut. In the latter, extraarticular osteotomies or combined procedures (osteotomy plus KA) have to be performed.Outdoor tourism and recreational activities strongly depend on actual meteorological conditions. Traditionally, in three studied regions, the peak of tourists’ streams concentrates in summer months. In the present study, we assess suitability of weather conditions for various forms of outdoor tourism in different regions of Serbia, Poland and Ukraine. Additionally, how the location of the station differentiates temporal patterns of weather suitability will be discussed. To analyse the suitability of weather conditions for various forms of outdoor recreation, we have chosen 23 meteorological stations of the national weather networks which represent different tourism areas and destinations. For each weather station, daily data for the period 2000-2017 of air temperature, relative humidity, total cloud cover and wind speed (at 10 m above ground) for 12 UTC as well as the daily maximum and minimum temperature, precipitation totals and snow cover depth were applied. Suitability of climate for outdoor recreation and tourism is assessed by the Weather Suitability Index (WSI) based on Błażejczyk’s bio-thermal weather classification. The results of research show that passive forms of recreation (sun and air bathing) are preferred mostly in months from May till August or September. selleck kinase inhibitor For the active forms of recreation, weather in summer months is very oppressive, especially in the resorts located in the south (Serbia, southern Ukraine). Active forms of recreation are preferred there in autumn, winter and spring months.
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