Management of an acute intracranial emergency in pregnancy

We report a case of a mid-20s primigravida at 37 weeks' gestation who presented with severe headache and acute neurological deterioration. The CT brain scan showed hydrocephalus caused by a colloid cyst in the third ventricle. The patient underwent emergency placement of an external ventricular drain for decompression of acute hydrocephalus. Four hours later, labour commenced spontaneously, and in view of her neurological status, a decision was taken to perform a caesarean section under general anaesthetics. Four days postpartum, the patient underwent an endoscopic removal of the cyst. Intracranial emergencies during pregnancy are rare and challenging to manage. The mortality rate can be significant. Diagnostic and surgical intervention should not be delayed because of pregnancy. An individualised treatment approach is required with multidisciplinary input. The collaborative efforts of our multidisciplinary team resulted in prompt diagnosis and surgical treatment in this case that resulted in both a healthy mother and child.</p

A unified approach for the solution of the Fokker-Planck equation

This paper explores the use of a discrete singular convolution algorithm as a unified approach for numerical integration of the Fokker-Planck equation. The unified features of the discrete singular convolution algorithm are discussed. It is demonstrated that different implementations of the present algorithm, such as global, local, Galerkin, collocation, and finite difference, can be deduced from a single starting point. Three benchmark stochastic systems, the repulsive Wong process, the Black-Scholes equation and a genuine nonlinear model, are employed to illustrate the robustness and to test accuracy of the present approach for the solution of the Fokker-Planck equation via a time-dependent method. An additional example, the incompressible Euler equation, is used to further validate the present approach for more difficult problems. Numerical results indicate that the present unified approach is robust and accurate for solving the Fokker-Planck equation.Comment: 19 page

Investigating the role of the fusiform face area and occipital face area using multifocal transcranial direct current stimulation.

The functional role of the occipital face area (OFA) and the fusiform face area (FFA) in face recognition is inconclusive to date. While some research has shown that the OFA and FFA are involved in early (i.e., featural processing) and late (i.e., holistic processing) stages of face recognition respectively, other research suggests that both regions are involved in both early and late stages of face recognition. Thus, the current study aims to further examine the role of the OFA and the FFA using multifocal transcranial direct current stimulation (tDCS). In Experiment 1, we used computer-generated faces. Thirty-five participants completed whole face and facial features (i.e., eyes, nose, mouth) recognition tasks after OFA and FFA stimulation in a within-subject design. No difference was found in recognition performance after either OFA or FFA stimulation. In Experiment 2 with 60 participants, we used real faces, provided stimulation following a between-subjects design and included a sham control group. Results showed that FFA stimulation led to enhanced efficiency of facial features recognition. Additionally, no effect of OFA stimulation was found for either facial feature or whole face recognition. These results suggest the involvement of FFA in the recognition of facial features

Fluvial organic carbon fluxes from oil palm plantations on tropical peatland

Intact tropical peatlands are dense long-term stores of carbon. However, the future security of these ecosystems is at risk from land conversion and extensive peatland drainage. This can enhance peat oxidation and convert long-term carbon sinks into significant carbon sources. In Southeast Asia, the largest land use on peatland is for oil palm plantation agriculture. Here, we present the first annual estimate of exported fluvial organic carbon in the drainage waters of four peatland oil palm plantation areas in Sarawak, Malaysia. Total organic carbon (TOC) fluxes from the plantation second- and third-order drains were dominated (91 %) by dissolved organic carbon (DOC) and ranged from 34.4 ± 9.7 C m−2 yr−1 to 57.7 %, 16.3 g C m−2 yr−1 (± 95 % confidence interval). These fluxes represent a single-year survey which was strongly influenced by an El Ninõ event and therefore lower discharge than usual was observed. The magnitude of the flux was found to be influenced by water table depth, with higher TOC fluxes observed from more deeply drained sites. Radiocarbon dating on the DOC component indicated the presence of old (pre-1950s) carbon in all samples collected, with DOC at the most deeply drained site having a mean age of 735 years. Overall, our estimates suggest fluvial TOC contributes ∼ 5 % of total carbon losses from oil palm plantations on peat. Maintenance of high and stable water tables in oil palm plantations appears to be key to minimising TOC losses. This reinforces the importance of considering all carbon loss pathways, rather than just CO2 emissions from the peat surface, in studies of tropical peatland land conversion

Quantitative model for inferring dynamic regulation of the tumour suppressor gene p53

Background: The availability of various "omics" datasets creates a prospect of performing the study of genome-wide genetic regulatory networks. However, one of the major challenges of using mathematical models to infer genetic regulation from microarray datasets is the lack of information for protein concentrations and activities. Most of the previous researches were based on an assumption that the mRNA levels of a gene are consistent with its protein activities, though it is not always the case. Therefore, a more sophisticated modelling framework together with the corresponding inference methods is needed to accurately estimate genetic regulation from "omics" datasets. Results: This work developed a novel approach, which is based on a nonlinear mathematical model, to infer genetic regulation from microarray gene expression data. By using the p53 network as a test system, we used the nonlinear model to estimate the activities of transcription factor (TF) p53 from the expression levels of its target genes, and to identify the activation/inhibition status of p53 to its target genes. The predicted top 317 putative p53 target genes were supported by DNA sequence analysis. A comparison between our prediction and the other published predictions of p53 targets suggests that most of putative p53 targets may share a common depleted or enriched sequence signal on their upstream non-coding region. Conclusions: The proposed quantitative model can not only be used to infer the regulatory relationship between TF and its down-stream genes, but also be applied to estimate the protein activities of TF from the expression levels of its target genes

Neurosurgical and Perioperative Management of Chronic Subdural Hematoma

Objective:Surgery and specifically burr hole craniostomy is the most common first choice treatment of patients with Chronic Subdural Hematoma (CSDH). However, several aspects of neurosurgical and peri-operative management are still a subject of research, such as how to treat bilateral CSDH and the anesthetic approach. We aim to investigate the effect of the surgical approach to bilateral CSDH and the effect of anesthesia modality on outcome of CSDH patients. Methods:We retrospectively included surgically treated CSDH patients between 2005 and 2019 in three hospitals in the Netherlands. The effect of the surgical approach to bilateral CSDH (unilateral vs. bilateral decompression) and anesthesia modality (general vs. local anesthesia) on outcome (complications, recurrence, and length of hospital stay over 4 days) was studied with logistic regression adjusting for potentially confounding radiological and clinical characteristics. Results:Data of 1,029 consecutive patients were analyzed, mean age was 73.5 years (+/- 11) and 75% of patients were male. Bilateral CSDH is independently associated with an increased risk of recurrence within 3 months in logistic regression analysis (aOR 1.7, 95% CI: 1.1-2.5) but recurrence rate did not differ between primary bilateral or unilateral decompression of bilateral CSDH. (15 vs. 17%,p= 0.775). Logistic regression analysis showed that general anesthesia was independently associated with an increased risk of complications (aOR 1.8, 95% CI: 1.0-3.3) and with a length of hospital admission of over 4 days (aOR 8.4, 95% CI: 5.6-12.4). Conclusions:Bilateral CSDH is independently associated with higher recurrence rates. As recurrence rates in bilateral CSDH are similar for different surgical approaches, the optimal choice for primary bilateral decompression of bilateral CSDH could vary per patient. General anesthesia for surgical treatment of CSDH is associated with higher complication rates and longer hospital admission