Non-invasive assessment of ICP in children: advances in ultrasound-based techniques

The assessment of intracranial pressure (ICP) in children with neurological disease remains a cornerstone in their routine management. The quest for a reliable, reproducible and radiation-free non-invasive technique for assessing ICP in children remains somewhat of a holy grail for neurosurgery. This work assesses some of the recent advances in ultrasound-based techniques, addressing both novel processes and modifications aimed at improving the accuracy of existing techniques.acceptedVersio

Identitat-Anlage durch Warter und Aussehen

The identity of a person is his most important aspect. It has a big impact on the way someone sees himself, and how other people recognize him. Without a unique identity, a person has no characteristic character. In their lives, everyone creates an identity. However, identity becomes most important when one is a foreigner or visits a foreign country. Because of this, many aspects of society and everyday life could be very different, and if one lacks what he knows, he can find solace in his identity. However, if a person\u27s identity is not certain, they may feel lost afterwards. Therefore one can say that identity is not only important for a person to feel happy, but also that the identity of a person is very complex. One should understand identity, because with this understanding more security in the life comes

Nonextensive thermodynamic functions in the Schr\"odinger-Gibbs ensemble

Schr\"odinger suggested that thermodynamical functions cannot be based on the gratuitous allegation that quantum-mechanical levels (typically the orthogonal eigenstates of the Hamiltonian operator) are the only allowed states for a quantum system [E. Schr\"odinger, Statistical Thermodynamics (Courier Dover, Mineola, 1967)]. Different authors have interpreted this statement by introducing density distributions on the space of quantum pure states with weights obtained as functions of the expectation value of the Hamiltonian of the system. In this work we focus on one of the best known of these distributions, and we prove that, when considered in composite quantum systems, it defines partition functions that do not factorize as products of partition functions of the noninteracting subsystems, even in the thermodynamical regime. This implies that it is not possible to define extensive thermodynamical magnitudes such as the free energy, the internal energy or the thermodynamic entropy by using these models. Therefore, we conclude that this distribution inspired by Schr\"odinger's idea can not be used to construct an appropriate quantum equilibrium thermodynamics.Comment: 32 pages, revtex 4.1 preprint style, 5 figures. Published version with several changes with respect to v2 in text and reference

A possible cyclotron resonance scattering feature near 0.7 keV in X1822-371

We analyse all available X-ray observations of X1822-371 made with XMM-Newton, Chandra, Suzaku and INTEGRAL satellites. The observations were not simultaneous. The Suzaku and INTEGRAL broad band energy coverage allows us to constrain the spectral shape of the continuum emission well. We use the model already proposed for this source, consisting of a Comptonised component absorbed by interstellar matter and partially absorbed by local neutral matter, and we added a Gaussian feature in absorption at $\sim 0.7$ keV. This addition significantly improves the fit and flattens the residuals between 0.6 and 0.8 keV. We interpret the Gaussian feature in absorption as a cyclotron resonant scattering feature (CRSF) produced close to the neutron star surface and derive the magnetic field strength at the surface of the neutron star, $(8.8 \pm 0.3) \times 10^{10}$ G for a radius of 10 km. We derive the pulse period in the EPIC-pn data to be 0.5928850(6) s and estimate that the spin period derivative of X1822-371 is $(-2.55 \pm 0.03) \times 10^{-12}$ s/s using all available pulse period measurements. Assuming that the intrinsic luminosity of X1822-371is at the Eddington limit and using the values of spin period and spin period derivative of the source, we constrain the neutron star and companion star masses. We find the neutron star and the companion star masses to be $1.69 \pm 0.13$ M$_{\odot}$ and $0.46 \pm 0.02$ M$_{\odot}$, respectively, for a neutron star radius of 10 km.In a self-consistent scenario in which X1822-371 is spinning-up and accretes at the Eddington limit, we estimate that the magnetic field of the neutron star is $(8.8 \pm 0.3) \times 10^{10}$ G for a neutron star radius of 10 km. If our interpretation is correct, the Gaussian absorption feature near 0.7 keV is the very first detection of a CRSF below 1 keV in a LMXB. (abridged)Comment: 14 pages, 12 figures, accepted for publication in A&

Transcranial Doppler Monitoring of Intracranial Pressure Plateau Waves

$\textbf{BACKGROUND}$: Transcranial Doppler (TCD) has been used to estimate ICP noninvasively (nICP); however, its accuracy varies depending on different types of intracranial hypertension. Given the high specificity of TCD to detect cerebrovascular events, this study aimed to compare four TCD-based nICP methods during plateau waves of ICP. $\textbf{METHODS}$: A total of 36 plateau waves were identified in 27 patients (traumatic brain injury) with TCD, ICP, and ABP simultaneous recordings. The nICP methods were based on: (1) interaction between flow velocity (FV) and ABP using a "black-box" mathematical model (\textit{nICP_BB}); (2) diastolic FV (\textit{nICP_FV}$_{d}$); (3) critical closing pressure (\textit{nICP_CrCP}), and (4) pulsatility index (\textit{nICP_PI}). Analyses focused on relative changes in time domain between ICP and noninvasive estimators during plateau waves and the magnitude of changes ($\textit{∆}$ between baseline and plateau) in real ICP and its estimators. A ROC analysis for an ICP threshold of 35 mmHg was performed. $\textbf{RESULTS}$: In time domain, \textit{nICP_PI, nICP_BB,} and \textit{nICP_CrCP} presented similar correlations: 0.80 ± 0.24, 0.78 ± 0.15, and 0.78 ± 0.30, respectively. \textit{nICP_FV}$_{d}$ presented a weaker correlation (R = 0.62 ± 0.46). Correlations between ∆ICP and ∆nICP were better represented by \textit{nICP_CrCP} and BB, R = 0.48, 0.44 (p < 0.05), respectively. \textit{nICP_FV}$_{d}$ and $\textit{PI}$ presented nonsignificant $\textit{∆}$ correlations. ROC analysis showed moderate to good areas under the curve for all methods: \textit{nICP_BB}, 0.82; \textit{nICP_FV}$_{d}$, 0.77; \textit{nICP_CrCP}, 0.79; and \textit{nICP_PI}, 0.81. $\textbf{CONCLUSIONS}$: Changes of ICP in time domain during plateau waves were replicated by nICP methods with strong correlations. In addition, the methods presented high performance for detection of intracranial hypertension. However, absolute accuracy for noninvasive ICP assessment using TCD is still low and requires further improvement