Clinical presentation of young people (10–24 years old) with brain tumors: results from the international MOBI-Kids study

Journal of Neuro-Oncology - We used data from MOBI-Kids, a 14-country international collaborative case–control study of brain tumors (BTs), to study clinical characteristics of the tumors in...     

Early loading of sandblasted, acid-etched implants in the posterior maxilla and mandible: a 1-year follow-up report from a multicenter 3-year prospective study

PURPOSE: The aim of the present study was to evaluate the concept of an immediate loading protocol in the posterior maxilla and mandible through analysis of implant survival at 1 year. MATERIALS AND METHODS: One year follow-up data of a multicenter study are reported. Eighty-two ITI sandblasted, acid-etched (SLA) implants in 40 patients were loaded between 0 and 11 days after implant placement (mean 4.3 +/- 2.8 days). The restorations consisted of either 2 splinted crowns or a 3-unit fixed prosthesis. All restorations were put into full functional occlusion. Periapical radiographs were evaluated for changes in crestal bone level from baseline to 1 year postloading. Primary stability of the implants was checked initially and before the fitting of the definitive prosthesis. The restorations were evaluated by the practitioners for retention, stability, and esthetics. RESULTS: Three patients' implants were not loaded because of lack of primary stability, and a fourth patient was excluded from the study because of a protocol violation (more than 4 implants were used). All 4 patients were successfully treated outside the protocol. The overall survival rate of the remaining implants at 1 year was 98.8%. The mean bone loss at 1 year was 0.52 +/- 0.98 mm, which is within the reported limits of less than 1 mm (range 0.4 to 1.4 mm) loss in the first year. DISCUSSION AND CONCLUSION: The early results from this study indicate that early and immediate loading of 2 implants in the posterior maxilla and mandible may be suitable in selected patients. On the basis of 1 year of observation, the results appear similar to those achieved with a delayed procedure.     

Serum brain-derived neurotrophic factor (BDNF) levels in attention deficit–hyperactivity disorder (ADHD)

It has been proposed that the neurotrophin brain-derived neurotrophic factor (BDNF) may be involved in attention deficit–hyperactivity disorder (ADHD) etiopathogenesis. Alterations in BDNF serum levels have been observed in childhood/adulthood neurodevelopmental pathologies, but no evidence is available for BDNF serum concentrations in ADHD. The study includes 45 drug-naïve ADHD children and 45 age–sex matched healthy subjects. Concentration of serum BDNF was determined by the ELISA method. BDNF serum levels in patients with ADHD were not different from those of controls (mean ± SD; ADHD: 39.33 ± 10.41 ng/ml; controls: 38.82 ± 8.29 ng/ml, t = ?0.26, p = 0.80). Our findings indicate no alteration of serum BDNF levels in untreated patients with ADHD. A further stratification for cognitive, neuropsychological and psychopathological assessment in a larger sample could be useful to clarify the role of BDNF in the endophenotype characterization of ADHD.     

Using Structural and Diffusion Magnetic Resonance Imaging To Differentiate the Dementias

Dementia is one of the major causes of personal, societal and financial dependence in older people and in today’s ageing society there is a pressing need for early and accurate markers of cognitive decline. There are several subtypes of dementia but the four most common are Alzheimer’s disease, Lewy body dementia, vascular dementia and frontotemporal dementia. These disorders can only be diagnosed at autopsy, and ante-mortem assessments of “probable dementia (e.g. of Alzheimer type)” are traditionally driven by clinical symptoms of cognitive or behavioural deficits. However, owing to the overlapping nature of symptoms and age of onset, a significant proportion of dementia cases remain incorrectly diagnosed. Misdiagnosis can have an extensive impact, both at the level of the individual, who may not be offered the appropriate treatment, and on a wider scale, by influencing the entry of patients into relevant clinical trials. Magnetic resonance imaging (MRI) may help to improve diagnosis by providing non-invasive and detailed disease-specific markers of cognitive decline. MRI-derived measurements of grey and white matter structural integrity are potential surrogate markers of disease progression, and may also provide valuable diagnostic information. This review summarises the latest evidence on the use of structural and diffusion MRI in differentiating between the four major dementia subtypes.     

Clinical evaluation of hyponatremia and hypovolemia in critically ill adult neurologic patients: contribution of the use of cumulative balance of sodium

Purpose

Knowledge of the cumulative balance of sodium (CBS) is important for the diagnosis of salt disorders and water homeostasis and has the potential to predict hypovolemic status in acute neurological patients. However, an extensive application of the use of CBS is still lacking in the intensive care setting, where salt and water homeostasis represents a priority.

Methods

Records of consecutive series of acute neurological patients admitted to a neurointensive care unit over a 6-month period were retrospectively reviewed. CBS was calculated at the admission to the Emergency Department. Discrimination between cerebral salt-wasting syndrome (CSWS) and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was performed on the basis of the classical criteria. Additionally, we used the findings of a negative CBS exceeding 2 mEq/kg for the diagnosis of CSWS. Two independent clinicians who were blinded to the CBS results performed diagnosis of the causes of hyponatremia and estimated the daily volemic status of the patients on the basis of clinical parameters. Logistic regression analysis was used to determine the independent prognostic factors of hypovolemia.

Results

Thirty-five patients were studied for a total of 418 days. Four patients (11.4 %) fitted the criteria of CSWS and three patients (8.5 %) had SIADH. The unavailability of the CBS led to a wrong diagnosis in three of the eight hyponatremic patients (37.5 %). The risk of developing hypovolemia in patients with negative CBS was 7.1 times higher (CI 3.86–13.06; p < 0.001). Multivariate analysis revealed that negative cumulative fluid balance, negative CBS >2 mEq/kg, and CVP ≤5 cmH₂O were independent prognostic factors for hypovolemia.

Conclusions

CBS is likely to be a useful parameter in the diagnosis of CSWS and a surrogate parameter for estimating hypovolemia in acute neurological patients.     

Glycodendrimers as new tools in the search for effective anti-HIV DC-based immunotherapies

Dendritic cells (DC), which play a major role in development of cell-mediated immunity, represent opportunities to develop novel anti-HIV vaccines. Dendrimers have been proposed as new carriers to ameliorate DC antigen loading and in this way, we have determined the potential use of maltose decorated neutrally and positively charged G4 glycodendrimers. Thus, immunostimulatory properties of these glycodendrimers on human DC were evaluated in the context of HIV infection. We have demonstrated that DC treated with glycodendrimers were fully functional with respect to viability, maturation and HIV-derived antigens uptake. Nevertheless, iDC and mDC phenotypes as well as mDC functions such as migration ability and cytokines profile production were changed. Our results showed the potential carrier properties of glycodendrimers to activate the immune system by the way of DC stimulation. This is the first study for exploring the use of maltose-functionalized dendrimers-peptides complexes as a potential DC-based vaccine candidate.From the Clinical EditorIn this paper, maltose-functionalized dendrimer-peptide complexes are demonstrated to activate the immune system by way of dendritic cell (DC) stimulation. DC vaccination using this methodology may be applicable to a variety of conditions, including infections and potentially cancer.     

The accuracy of transcranial Doppler to detect vasospasm in patients with aneurysmal subarachnoid hemorrhage

OBJECTIVES. To examine the accuracy of transcranial Doppler to detect cerebral vasospasm in a patient population with aneurysmal subarachnoid hemorrhage. DESIGN. Prospective blind comparison of transcranial Doppler with cerebral angiography. Diagnostic accuracy of transcranial Doppler was assessed using receiver operating characteristic (ROC) analysis and likelihood ratios. Sensitivity and specificity were calculated using directly measured middle cerebral artery diameter as reference standard. SETTING. Intensive Care Unit of a large university teaching hospital. PATIENTS AND PARTICIPANTS. Twenty-two patients with subarachnoid hemorrhage were included. Patients underwent angiography on admission and after 8 days to diagnose vasospasm and were defined as having clinical vasospasm, angiographic vasospasm, or no vasospasm. MEASUREMENTS AND RESULTS. Sensitivity and specificity were 1.00 and 0.75 for angiographic vasospasm and both equal to 1.00 for clinical vasospasm diagnosis. A transcranial Doppler mean velocity threshold value of 100 cm/s for angiographic vasospasm and 160 cm/s for clinical vasospasm detection were chosen by ROC analysis. CONCLUSIONS. A Transcranial Doppler mean velocity threshold of 160 cm/s, calculated by the ROC analysis, accurately detects clinical vasospasm. A daily transcranial Doppler examination performed by a trained operator should be routinely used to provide early identification of patients at high risk and to orient therapeutic decisions.     

An Experimental Biomimetic Platform for Artificial Olfaction

Artificial olfactory systems have been studied for the last two decades mainly from the point of view of the features of olfactory neuron receptor fields. Other fundamental olfaction properties have only been episodically considered in artificial systems. As a result, current artificial olfactory systems are mostly intended as instruments and are of poor benefit for biologists who may need tools to model and test olfactory models. Herewith, we show how a simple experimental approach can be used to account for several phenomena observed in olfaction.