A case report of Vagus nerve stimulation for intractable hiccups

Introduction: Intractable hiccups frequently result from an underlying pathology and can cause considerable illness in the patients. Initial remedies such as drinking cold water, induction of emesis, carotid sinus massage or Valsalva manoeuvre all seem to work by over stimulating the Vagus nerve. Pharmacotherapy with baclofen, gabapentin and other centrally and peripherally acting agents such as chlorpromazine and metoclopramide are reserved as second line treatment. Medical refractory cases even indulge in unconventional therapies such as hypnosis, massages and acupuncture. Surgical intervention, although undertaken very rarely, predominantly revolves around phrenic nerve crushing, blockade or pacing. A novel surgical strategy is emerging in the form of Vagus nerve stimulator (VNS) placement with three cases cited in literature to date with varying degrees of success. Here the authors report a case of VNS placement for intractable hiccups with partial success, in accordance with SCARE-2018 guidelines. Presentation of the case: An 85-year-old gentleman with a 9-year history of intractable hiccups secondary to pneumonia came to our hospital. The hiccups were symptomatic causing anorexia, insomnia, irritability, depression, exhaustion, muscle wasting and weight loss. The patient underwent countless medical evaluations. All examinations and investigations yielded normal results. The patient underwent aggressive pharmacotherapy, home remedies and unconventional therapies for intractable hiccups but to no avail. He also underwent left phrenic nerve blocking and resection without therapeutic success. The patient presented to our hospital and decision for VNS insertion was taken for compassionate reasons considering patient morbidity. The patient demonstrated significant improvement in his symptoms following VNS insertion. Discussion: A temporary hiccup is an occasional happening experienced by everyone. However, intractable hiccups are associated with significant morbidity and often mortality. Several medical, pharmacological, surgical and novel treatment options are available for intractable hiccups. Conclusion: VNS insertion is a novel surgical option for the treatment of intractable hiccups

Particle Fluxes and Transport Proceses Along the Continental Margins and in Deep Sea Environments.

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Stability, Structure and Scale: Improvements in Multi-modal Vessel Extraction for SEEG Trajectory Planning

Purpose Brain vessels are among the most critical landmarks that need to be assessed for mitigating surgical risks in stereo-electroencephalography (SEEG) implantation. Intracranial haemorrhage is the most common complication associated with implantation, carrying signi cant associated morbidity. SEEG planning is done pre-operatively to identify avascular trajectories for the electrodes. In current practice, neurosurgeons have no assistance in the planning of electrode trajectories. There is great interest in developing computer assisted planning systems that can optimise the safety pro le of electrode trajectories, maximising the distance to critical structures. This paper presents a method that integrates the concepts of scale, neighbourhood structure and feature stability with the aim of improving robustness and accuracy of vessel extraction within a SEEG planning system. Methods The developed method accounts for scale and vicinity of a voxel by formulating the problem within a multi-scale tensor voting framework. Feature stability is achieved through a similarity measure that evaluates the multi-modal consistency in vesselness responses. The proposed measurement allows the combination of multiple images modalities into a single image that is used within the planning system to visualise critical vessels. Results Twelve paired datasets from two image modalities available within the planning system were used for evaluation. The mean Dice similarity coe cient was 0.89 ± 0.04, representing a statistically signi cantly improvement when compared to a semi-automated single human rater, single-modality segmentation protocol used in clinical practice (0.80 ±0.03). Conclusions Multi-modal vessel extraction is superior to semi-automated single-modality segmentation, indicating the possibility of safer SEEG planning, with reduced patient morbidity

Multi-scale spectrally resolved quantitative fluorescence imaging system: Towards neurosurgical guidance in glioma resection

In glioma resection surgery, the detection of tumour is often guided by using intraoperative fluorescence imaging notably with 5-ALA-PpIX, providing fluorescent contrast between normal brain tissue and the gliomas tissue to achieve improved tumour delineation and prolonged patient survival compared with the conventional white-light guided resection. However, the commercially available fluorescence imaging system relies on surgeon’s eyes to visualise and distinguish the fluorescence signals, which unfortunately makes the resection subjective. In this study, we developed a novel multi-scale spectrally-resolved fluorescence imaging system and a computational model for quantification of PpIX concentration. The system consisted of a wide-field spectrally-resolved quantitative imaging device and a fluorescence endomicroscopic imaging system enabling optical biopsy. Ex vivo animal tissue experiments as well as human tumour sample studies demonstrated that the system was capable of specifically detecting the PpIX fluorescent signal and estimate the true concentration of PpIX in brain specimen

Influence of distributary channels on sediment and organic matter supply in event-dominated coastal margins: the Po prodelta as a study case

From November 2008 through May 2009, the Po river (Italy) experienced several floods exceeding 5000 m<sup>3</sup> s<sup>−1</sup>. This long series of events ended with a large flood in early May 2009 (~8000 m<sup>3</sup> s<sup>−1</sup>). An event-response sampling was carried out in the Po prodelta in April–May 2009 to characterize the preservation of this series of floods in the sediment record and to describe the event-supply and deposition of riverborne particulate material during the May 2009 flood. The water sampling was carried out early in the event under conditions of moderate river flow (~5000 m<sup>3</sup> s<sup>−1</sup>) and 24 h later during the peak discharge (~8000 m<sup>3</sup> s<sup>−1</sup>). Sediment cores were collected in the prodelta before and after the peak flood. At each station, profiles of conductivity, transmittance, and fluorescence were acquired. Surface and bottom waters were sampled to collect sediments in suspension. In addition, a few days before the May 2009 event, suspended sediments were collected at Pontelagoscuro gauging station, ~90 km upstream from the coast. Biogeochemical compositions and sedimentological characteristics of suspended and sediment samples were investigated using bulk and biomarker analyses. Furthermore, <sup>7</sup>Be and radiographs were used to analyze the internal stratigraphy of sediment cores. <br><br> During moderate flow, the water column did not show evidence of plume penetration. Stations re-occupied 24 h later exhibited marked physical and biogeochemical changes during the peak flood. However, the concentration of terrestrially-derived material in surface waters was still less than expected. These results suggested that, since material enters the Adriatic as buoyancy-driven flow with a reduced transport capacity, settling and flocculation processes result in trapping a significant fraction of land-derived material in shallow sediments and/or within distributary channels. <br><br> Although numerous discharge peaks occurred from November 2008 through April 2009 (4000–6000 m<sup>3</sup> s<sup>−1</sup>), sediment cores collected in late April 2009 showed lack of event-strata preservation and reduced <sup>7</sup>Be penetrations. This suggested that only a small fraction of the sediment supply during ordinary events reaches the deepest region of the prodelta (12–20 m water depth). As a result, these event-strata have a thickness not sufficient to be preserved in the sediment record because of post-depositional processes that destroy the flood signal. <br><br> Stations in the northern and central prodelta were re-occupied after the peak of the May 2009 flood. Based on <sup>7</sup>Be and radiographs, we estimated event layers of 17 and 6 cm thickness, respectively. Selective trapping of coarse material occurred in the central prodelta likely because of the geomorphologic setting of the central outlet characterized by an estuary-like mouth. Despite these settling processes, lignin-based parameters indicated that the composition of the terrigenous OC was fairly homogenous throughout the network of channels and between size-fractions

A small slug from a tropical greenhouse reveals a new rathouisiid lineage with triaulic tritrematic genitalia (Gastropoda: Systellommatophora)

A small slug found in the tropical greenhouse of the Science Museum (MUSE) of Trento (Italy) turned out to be a species of the little-known systellommatophoran family Rathouisiidae. We undertook detailed comparative anatomical and molecular studies using specimens of the MUSE slug, Rathouisia sinensis, and sequences of other systellommatophoran species deposited in GenBank to conduct a systematic and phylogenetic assessment. Analysis of the genitalia of the MUSE slug and R. sinensis revealed an unusual triaulic tritrematic structure: two separate female ducts – one for egg release (oviduct), the other for intake of allosperm (vagina) – and a separate male duct for autosperm release. Analysis of the nucleotide sequences of several mitochondrial (COI, 16S rDNA) and nuclear (18S rDNA, ITS2 flanked by 5.8S and 28S rDNA fragments, H3) gene fragments supported assignation of the MUSE slug to Rathouisiidae, but also its distinction from the other rathouisiid genera Atopos, Granulilimax, Rathouisia and an undescribed genus from the Ryukyu Islands (Japan). Therefore, we decided to describe the MUSE slug as a new species in a new genus: Barkeriella museensis gen. et sp. nov. The species is certainly an alien introduced into the tropical greenhouse of MUSE, but its origin is unknown and calls for further investigation. © 2022 The Linnean Society of London

Doublecortin-expressing cell types in temporal lobe epilepsy

Doublecortin (DCX) is widely regarded as a marker of immature and migrating neurons during development. While DCX expression persists in adults, particularly in the temporal lobe and neurogenic regions, it is unknown how seizures influence its expression. The aim of the present study was to explore the distribution and characteristics of DCX-expressing cells in surgical and postmortem samples from 40 adult and paediatric patients, with epilepsy and with or without hippocampal sclerosis (HS), compared to post mortem controls. The hippocampus (pes and body), parahippocampal gyrus, amygdala, temporal pole and temporal cortex were examined with DCX immunohistochemistry using four commercially-available DCX antibodies, labelled cells were quantified in different regions of interest as well as their co-expression with cell type specific markers (CD68, Iba1, GFAP, GFAP∂, nestin, SOX2, CD34, OLIG2, PDGFRβ, NeuN) and cell cycle marker (MCM2). Histological findings were compared with clinical data, as well as gene expression data obtained from the temporal cortex of 83 temporal lobe epilepsy cases with HS. DCX immunohistochemistry identified immature (Nestin-/NeuN-) neurons in layer II of the temporal neocortex in patients with and without epilepsy. Their number declined significantly with age but was not associated with the presence of hippocampal sclerosis, seizure semiology or memory dysfunction. DCX+ cells were prominent in the paralaminar nuclei and periamygdalar cortex and these declined with age but were not significantly associated with epilepsy history. DCX expressing cells with ramified processes were prominent in all regions, particularly in the hippocampal subgranular zone, where significantly increased numbers were observed in epilepsy samples compared to controls. DCX ramified cells co-expressed Iba1, CD68 and PDGFRβ, and less frequently MCM2, OLIG2 and SOX2, but no co-localization was observed with CD34, nestin or GFAP/GFAP ∂. Gene expression data from neocortical samples in patients with TLE and HS supported ongoing DCX expression in adults. We conclude that DCX identifies a range of morphological cell types in temporal lobe epilepsy, including immature populations, glial and microglial cell types. Their clinical relevance and biological function requires further study but we show some evidence for alteration with age and in epilepsy

Breast cancer and communication: Monocentric experience of a self-assessment questionnaire

Background: The communication of the diagnosis of breast cancer induces to the patient a strong psychological trauma. Radiologists are at the forefront of communicating, either for a biopsy or the probable diagnosis of malignancy. This is a complex task, which requires the knowledge and application of correct “communicative models”, among which the SPIKES protocol rep-resents a fundamental reference. Design and methods: 110 patients, with a history of breast cancer, filled out a questionnaire consisting of six questions: five aimed at defining communication compliance with the SPIKES protocol, the sixth, consisting of six feelings, aimed at the knowledge of the next emotional state. Results: Regarding compliance with various “strategic points” of the SPIKES protocol, questionnaires show that 70% of patients reported no omissions, while the remaining 30% reported omissions relatively to perception (56%), emotions (23%), setting (13%), knowledge (6%) and invitation (2%). The results showed the existence of a correlation between the final emotional state and the correct application of the SPIKES protocol; in fact, patients who reacted with a positive final emotional state-reported greater adherence to the strategic points of the SPIKES protocol. Conclusions: In healthcare, knowing the communicative compliance of a team in giving “bad news” is fundamental, especially in breast cancer. The SPIKES protocol is recognized by the Literature as a fundamental reference able to affect “positively” the emotional state of patients. The proposed questionnaire is a valid tool to identify the weak points of communication and related criticalities, to improve clinical practice

Automated computation and analysis of accuracy metrics in stereoencephalography

Background: Implantation accuracy of electrodes during neurosurgical interventions is necessary to ensure safety and efficacy. Typically, metrics are computed by visual inspection which is tedious, prone to inter-/intra-observer variation, and difficult to replicate across sites. New Method: We propose an automated approach for computing implantation metrics and investigate potential sources of error. We focus on accuracy metrics commonly reported in the literature to validate our approach against metrics computed manually including entry point (EP) and target point (TP) localisation errors and angle differences between planned and implanted trajectories in 15 patients with a total of 158 stereoelectroencephalography (SEEG) electrodes. We evaluate the effect of line-of-best-fit approaches, EP definition and lateral versus Euclidean distance on metrics to provide recommendations for reporting implantation accuracy metrics. Results: We found no bias between manual and automated approaches for calculating accuracy metrics with limits of agreement of ±1 mm and ±1°. Automated metrics are robust to sources of errors including registration and electrode bending. We observe the highest error in EP deviations of μ = 0.25 mm when the post-implantation CT is used to define the point of entry. Comparison with Existing Method(s): We found no reports of automated approaches for quality assessment of SEEG electrode implantation. Neither the choice of metrics nor the possible errors that could occur have been investigated previously. Conclusions: Our automated approach is useful to avoid human errors, unintentional bias and variation that may be introduced when manually computing metrics. Our work is relevant and timely to facilitate comparisons of studies reporting implantation accuracy