Variation in neurosurgical management of traumatic brain injury: A survey in 68 centers participating in the CENTER-TBI study

Background Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP). Results The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions. Conclusion Despite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care

The EuroLaD-EEG consortium : towards a global EEG platform for dementia, for seeking to reduce the regional impact of dementia

Background: The value of Electroencephalography (EEG) to unveil pathophysiological signatures in neurodegenerative diseases that cause dementia has been recently highlighted. To grant EEG tools the necessary validity, reliability, and scalability to support the diagnosis of dementia globally, efforts will need to integrate knowledge developed by EEG labs across diverse countries and develop protocols that can be swiftly implemented by such labs to harmonize research and clinical practices. These are the aims of EuroLaD-EEG, a consortium that brings together five Latin American (LAC) and five European countries to develop a harmonised EEG database (Aim 1) that can help improve dementia phenotyping and diagnosis (Aim 2). Methods: EuroLaD-EEG has developed a global EEG database that comprises 1234 EEG recordings from groups of healthy adults (n=1223), patients with mild cognitive impairment (n=199), and with familial and sporadic variants of neurodegenerative diseases (e.g., AD and FTD) (n=501). We have recently published the harmonization pipeline that will allow EuroLaD-EEG meet its Aim 1 (Prado et al., 2022, Int J Psychophysiol, 172, 24–38). We have now developed a multi-feature multimodal approach that combines demographic, neuropsychological, fMRI and EEG data as inputs for a gradient boosting machine-learning classifier. Multicentric data including those from underrepresented samples will enter such a classification algorithm towards our Aim 2. Results: Preliminary results with a subsample from LAC (n=282) revealed high classification (AUC > 0.90 for all the classes) and robustness towards heterogeneity, sociodemographic variability, and missing data. We are now planning to combine data from European and LAC to explore sources of phenotypic variability linked to socio-demographic and cultural factors. Conclusion: By broadening our understanding of dementia phenotypes, risk factors, and affordable diagnostic approaches, and adding new evidence on variability across developed and developing countries, the EEG will contribute unique evidence that will help enhance both dementia phenotyping and diagnostic strategies

Modulation of immune responses by targeting CD169/Siglec-1 with the glycan ligand

A fundamental role in the plant-bacterium interaction for Gram-negative phytopathogenic bacteria is played by membrane constituents, such as proteins, lipopoly- or lipooligosaccharides (LPS, LOS) and Capsule Polysaccharides (CPS). In the frame of the understanding the molecular basis of plant bacterium interaction, the Gram-negative bacterium Agrobacterium vitis was selected in this study. It is a phytopathogenic member of the Rhizobiaceae family and it induces the crown gall disease selectively on grapevines (Vitis vinifera). A. vitis wild type strain F2/5, and its mutant in the quorum sensing gene ΔaviR, were studied. The wild type produces biosurfactants; it is considered a model to study surface motility, and it causes necrosis on grapevine roots and HR (Hypersensitive Response) on tobacco. Conversely, the mutant does not show any surface motility and does not produce any surfactant material; additionally, it induces neither necrosis on grape, nor HR on tobacco. Therefore, the two strains were analyzed to shed some light on the QS regulation of LOS structure and the consequent variation, if any, on HR response. LOS from both strains were isolated and characterized: the two LOS structures maintained several common features and differed for few others. With regards to the common patterns, firstly: the Lipid A region was not phosphorylated at C4 of the non reducing glucosamine but glycosylated by an uronic acid (GalA) unit, secondly: a third Kdo and the rare Dha (3-deoxy-lyxo-2-heptulosaric acid) moiety was present. Importantly, the third Kdo and the Dha residues were substituted by rhamnose in a not stoichiometric fashion, giving four different oligosaccharide species. The proportions among these four species, is the key difference between the LOSs from both the two bacteria. LOS from both strains and Lipid A from wild type A. vitis are now examined for their HR potential in tobacco leaves and grapevine roots