Endovascular coiling versus surgical clipping in the treatment of ruptured anterior communicating artery aneurysm in Cairo University Hospitals

AbstractIntroductionAneurysmal Subarachnoid Hemorrhage (SAH) remains a devastating and often fatal form of stroke. The aneurysm is targeted for obliteration to prevent re-bleeding and to manage the possible complications from the event. Endovascular coiling has emerged as a less invasive alternative to conventional surgical clipping to treat aneurysms.Patients and methodsThis study was done prospectively in the Cairo University (Kasr El-Eini) hospitals to evaluate the outcome of both modalities used in the treatment of ruptured anterior communicating artery (Acom) aneurysm. 30 patients with Hunt and Hess grade I, II or III. were classified into two groups of microsurgical clipping (Endoscopic assistance used in five cases) and endovascular coiling.ResultsMortality rate was higher in the clipping group (26.7%) compared to the coiling group while recurrence rate was high in the coiling group (26.7%). Complications including hydrocephalus, hemiparesis and failed procedures occurred in (6.7%).ConclusionWe concluded that coiling is better for treating cases of ruptured Acom aneurysms being less invasive and achieving a favorable outcome compared to surgery. While Endoscope-Assisted Microsurgical Clipping (EAM) gives better control during clipping provided that a well-trained, competent and experienced neurosurgeon is available

SYNDROME DE LA FENTE MEDIANE A PROPOS D’UN CAS

The median cleft syndrome is a complex facial dysmorphism. it may be associated with other malformations incompatible to life. Prenatal diagnosis is of major interest to prepare parents and to accept the child's disability. Through an observation collected in pediatric ophthalmology department, we present the characteristics of this disease. This is an infant of 5 months, the sole of his family,from a non-consanguineous marriage and consults for a facial dysmorphism. The ophthalmology test note a cyst dermoid bilateral interest blade, the conjunctiva, 2 / 3 of the cornea uncomfortable viewing eyes. The CT cranio-orbital showed a hypoplastic orbits with cerebral atrophy. The heart-ultrasound showed a perished ventricular , restrictive intercomminication. The caryotype study was normal. The ophthalmological treatement consisted to a surgical cure of both dermoid cysts. We discuss the clinical et paraclinical, etiopathogenic aspects of the slots medians and we stress the importance of antenatal diagnosis of this condition.Le syndrome de la fente médiane est une dysmorphie faciale complexe pouvant rentrer dans un cadre polymalformatif incompatible avec la vie. Le diagnostic anténatal revêt un intérêt majeur pour préparer les parents et l’entourage à l’accueil de l’enfant et son handicap. À travers une observation colligée au service d’ophtalmologie pédiatrique, nous présentons les caractéristiques de cette affection. Il s’agit d’un nourrisson de 5 mois unique de sa famille, issu d’un mariage non consanguin et consultant pour une dysmorphie faciale. L’examen ophtalmologique a noté un kyste dermoïde bilatérale intéressant le limbe, la conjonctive, les 2/3 de la cornée gênant la visualisation des yeux. Le bilan malformatif a montré à la TDM cranio-orbitaire une hypoplasie des orbites avec atrophie cérébrale. L’écho-coeur a montré une communication inter ventriculaire péri membraneuse restrictive. L’étude du caryotype était normale. La prise en charge ophtalmologique a consisté en une cure chirurgicale des deux kystes dermoïdes. Nous discutons les aspects cliniques, para cliniques, étiopathogéniques des fentes médianes et nous insistons sur l’importance du diagnostic anténatale de cette affection

Manifestations ophtalmologiques du lupus chez l’enfant

Le lupus  à début pédiatrique est une maladie souvent sévère, dont la morbidité à long terme est importante. Ses manifestations ophtalmologiques sont variées et peuvent être révélatrices.  Elles sont  représentées par les nodules cotonneux avec ou sans hémorragies intra rétiniennes. Les auteurs rapportent l'observation d'un enfant  ayant un lupus érythémateux disséminé qui a présenté une vascularite  rétinienne

Can Bcl-XL expression predict the radio sensitivity of Bilharzial-related squamous bladder carcinoma? a prospective comparative study

<p>Abstract</p> <p>Background</p> <p>Local pelvic recurrence after radical cystectomy for muscle invasive bilharzial related squamous cell carcinoma accounts for 75% of treatment failures even in organ confined tumors. Despite the proven value of lymphadenectomy, up to 60% of patients undergoing cystectomy do not have it. These factors are in favor of adjuvant radiotherapy reevaluation. objectives: to evaluate the effect of adjuvant radiotherapy on disease free survival in muscle invasive bilharzial related squamous cell carcinoma of the urinary bladder and to test the predictability of radio-sensitivity using the anti apoptotic protein Bcl-XL.</p> <p>Methods</p> <p>The study prospectively included 71 patients, (47 males, 24 females) with muscle invasive bilharzial related squamous cell carcinoma of the bladder (Stage pT2a-T3N0-N3M0) who underwent radical cystectomy in Assiut university hospitals between January 2005 and December 2006. Thirty eight patients received adjuvant radiotherapy to the pelvis in the dose of 50Gy/25 fractions/5 weeks (Group 1), while 33 patients did not receive adjuvant radiotherapy (group 2). Immunohistochemical characterization for bcl-xL expression was done. Follow up was done every 3 months for 12 to 36 months with a mean of 16 ± 10 months. All data were analyzed using SPSS version 16. Three years cumulative disease free survival was calculated and adjusted to Bcl-XL expression and side effects of the treatment were recorded.</p> <p>Results</p> <p>The disease free cumulative survival was 48% for group 1 and 29% for group 2 (log rank p value 0.03). The multivariate predictors of tumor recurrence were the positive Bcl-XL expression (odd ratio 41.1, 95% CI 8.4 - 102.3, p < 0.0001) and radiotherapy (odd ratio 0.19, 95% CI 0.05 - 0.78, p < 0.02). With Cox regression, the only independent multivariate predictor of radio-sensitivity was the Bcl-XL expression with odd ratio 4.6 and a p value < 0.0001. All patients tolerated the treatment with no life threatening or late complications during the period of follow up.</p> <p>Conclusions</p> <p>Adjuvant radiotherapy for muscle invasive bilharzial related squamous cell carcinoma of the urinary bladder has potential effectiveness and minor side effects. Moreover, Bcl-XL expression is a valuable tool for predicting those who might not respond to this adjuvant treatment.</p

Human bocavirus (HBoV) in children with respiratory tract infection by enzyme linked immunosorbent assay (ELISA) and qualitative polymerase chain reaction (PCR)

<p>Abstract</p> <p>Background</p> <p>Human bocavirus (HBoV) is a recently discovered parvovirus associated with mild to severe lower respiratory tract infections in children, the aim of the work was determination of human bocavirus in nasopharyngeal aspirate (NPA) of infants by qualitative PCR and determination of acute human bocavirus infection by estimation of immunoglobulin M (IgM) antibodies in serum by enzyme linked immunosorbent assay.</p> <p>Results</p> <p>Twenty two (22%) out of the 100 NPA specimens of the patients with respiratory manifestations were positive for HBoV by qualitative PCR, while ELISA revealed positive HBoV IgM antibodies in 18 (18%) patients who were also positive by PCR. Non of the controls were positive by both techniques. The correlation study between ELISA and PCR revealed high significant association, (p < 0.001, X²= 36 and agreement = 96%). Also PCR detected 4 (18.1%) NPA samples as HBoV positive cases among the patients that were not identified by ELISA. This could be due to high sensitivity and efficacy of PCR. ELISA being less sensitive than RT-PCR, sensitivity was (81.8% vs 100%), the efficacy was 97.7% in ELISA versus 99.7% for RT-PCR.</p> <p>Conclusion</p> <p>HBoV infections could be diagnosed in NPA of children by conventional PCR as a rapid and sensitive technique. While ELISA was a reliable serologic analysis for diagnosis of acute HBoV infection by estimation IgM antibodies in serum.</p

The Cognitive Role of the Globus Pallidus interna; Insights from Disease States.

The motor symptoms of both Parkinson's disease and focal dystonia arise from dysfunction of the basal ganglia, and are improved by pallidotomy or deep brain stimulation of the Globus Pallidus interna (GPi). However, Parkinson's disease is associated with a greater degree of basal ganglia-dependent learning impairment than dystonia. We attempt to understand this observation in terms of a comparison of the electrophysiology of the output of the basal ganglia between the two conditions. We use the natural experiment offered by Deep Brain Stimulation to compare GPi local field potential responses in subjects with Parkinson's disease compared to subjects with dystonia performing a forced-choice decision-making task with sensory feedback. In dystonic subjects, we found that auditory feedback was associated with the presence of high gamma oscillations nestled on a negative deflection, morphologically similar to sharp wave ripple complexes described in human rhinal cortex. These were not present in Parkinson's disease subjects. The temporal properties of the high gamma burst were modified by incorrect trial performance compared to correct trial performance. Both groups exhibited a robust low frequency response to 'incorrect' trial performance in dominant GPi but not non-dominant GPi at theta frequency. Our results suggest that cellular processes associated with striatum-dependent memory function may be selectively impaired in Parkinson's disease even if dopaminergic drugs are administered, but that error detection mechanisms are preserved

Dipolar cortico-muscular electrical stimulation: a novel method that enhances motor function in both - normal and spinal cord injured mice

<p>Abstract</p> <p>Background</p> <p>Electrical stimulation of the central and peripheral nervous systems is a common tool that is used to improve functional recovery after neuronal injury.</p> <p>Methods</p> <p>Here we described a new configuration of electrical stimulation as it was tested in anesthetized control and spinal cord injury (SCI) mice. Constant voltage output was delivered through two electrodes. While the negative voltage output (ranging from -1.8 to -2.6 V) was delivered to the muscle via transverse wire electrodes (diameter, 500 μm) located at opposite ends of the muscle, the positive output (ranging from + 2.4 to +3.2 V) was delivered to the primary motor cortex (M1) (electrode tip, 100 μm). The configuration was named dipolar cortico-muscular stimulation (dCMS) and consisted of 100 pulses (1 ms pulse duration, 1 Hz frequency).</p> <p>Results</p> <p>In SCI animals, after dCMS, cortically-elicited muscle contraction improved markedly at the contralateral (456%) and ipsilateral (457%) gastrocnemius muscles. The improvement persisted for the duration of the experiment (60 min). The enhancement of cortically-elicited muscle contraction was accompanied by the reduction of M1 maximal threshold and the potentiation of spinal motoneuronal evoked responses at the contralateral (313%) and ipsilateral (292%) sides of the spinal cord. Moreover, spontaneous activity recorded from single spinal motoneurons was substantially increased contralaterally (121%) and ipsilaterally (54%). Interestingly, spinal motoneuronal responses and muscle twitches evoked by the test stimulation of non-treated M1 (received no dCMS) were significantly enhanced as well. Similar results obtained from normal animals albeit the changes were relatively smaller.</p> <p>Conclusion</p> <p>These findings demonstrated that dCMS could improve functionality of corticomotoneuronal pathway and thus it may have therapeutic potential.</p

A consensus statement on detection of hippocampal sharp wave ripples and differentiation from other fast oscillations

Decades of rodent research have established the role of hippocampal sharp wave ripples (SPW-Rs) in consolidating and guiding experience. More recently, intracranial recordings in humans have suggested their role in episodic and semantic memory. Yet, common standards for recording, detection, and reporting do not exist. Here, we outline the methodological challenges involved in detecting ripple events and offer practical recommendations to improve separation from other high-frequency oscillations. We argue that shared experimental, detection, and reporting standards will provide a solid foundation for future translational discovery.This work was funded by K23NS104252 (A.A.L.) R01 MH117777 (E.B., J.W.R.) Whitehall Foundation (KH) 5F31NS120783-02 (Z.L.) 1U19NS104590 (A.L.) R01NS106611-02 (J.S., M.K.) MTEC-20-06-MOM013 (J.S., M.K.) 1U19NS107609-01 (I.S., J.L.) 1U19NS104590 (A.L., J.S.F., I.S.) 1U19NS107609 (E.A.B., J.W.R., J.J.L., I.S.) La Caixa LCF/PR/HR21/52410030 (A.N.O., L.dl.P) European Research Council Consolidator Grant 101001121 (B.P.S.) U.S.-Israel BSF grant 2017015 (RM)U01-NS113198 (J.J.) NSF CAREER IOS-1844935 (M.vdM.) 1R01NS121764-01 (B.L.M.) R01 MH122391 (G.B.) 30MH126483 (J.A.G.) Fondation pour la Recherche Médicale EQU202103012768 (M.Z.) 1R16-NS131108-01 (L.L.)

The Role of Mislocalized Phototransduction in Photoreceptor Cell Death of Retinitis Pigmentosa

Most of inherited retinal diseases such as retinitis pigmentosa (RP) cause photoreceptor cell death resulting in blindness. RP is a large family of diseases in which the photoreceptor cell death can be caused by a number of pathways. Among them, light exposure has been reported to induce photoreceptor cell death. However, the detailed mechanism by which photoreceptor cell death is caused by light exposure is unclear. In this study, we have shown that even a mild light exposure can induce ectopic phototransduction and result in the acceleration of rod photoreceptor cell death in some vertebrate models. In ovl, a zebrafish model of outer segment deficiency, photoreceptor cell death is associated with light exposure. The ovl larvae show ectopic accumulation of rhodopsin and knockdown of ectopic rhodopsin and transducin rescue rod photoreceptor cell death. However, knockdown of phosphodiesterase, the enzyme that mediates the next step of phototransduction, does not. So, ectopic phototransduction activated by light exposure, which leads to rod photoreceptor cell death, is through the action of transducin. Furthermore, we have demonstrated that forced activation of adenylyl cyclase in the inner segment leads to rod photoreceptor cell death. For further confirmation, we have also generated a transgenic fish which possesses a human rhodopsin mutation, Q344X. This fish and rd10 model mice show photoreceptor cell death caused by adenylyl cyclase. In short, our study indicates that in some RP, adenylyl cyclase is involved in photoreceptor cell death pathway; its inhibition is potentially a logical approach for a novel RP therapy

Inhibition decorrelates visual feature representations in the inner retina

The retina extracts visual features for transmission to the brain. Different types of bipolar cell split the photoreceptor input into parallel channels and provide the excitatory drive for downstream visual circuits. Mouse bipolar cell types have been described at great anatomical and genetic detail, but a similarly deep understanding of their functional diversity is lacking. Here, by imaging light-driven glutamate release from more than 13,000 bipolar cell axon terminals in the intact retina, we show that bipolar cell functional diversity is generated by the interplay of dendritic excitatory inputs and axonal inhibitory inputs. The resulting centre and surround components of bipolar cell receptive fields interact to decorrelate bipolar cell output in the spatial and temporal domains. Our findings highlight the importance of inhibitory circuits in generating functionally diverse excitatory pathways and suggest that decorrelation of parallel visual pathways begins as early as the second synapse of the mouse visual system