Recent advances in diagnostic approaches for sub-arachnoid hemorrhage

Sub-arachnoid hemorrhage (SAH) has been easily one of the most debilitating neurosurgical entities as far as stroke related case mortality and morbidity rates are concerned. To date, it has case fatality rates ranging from 32-67%. Advances in the diagnostic accuracy of the available imaging methods have contributed significantly in reducing morbidity associated with this deadly disease. We currently have computed tomography angiography (CTA), magnetic resonance angiography (MRA) and the digital subtraction angiography (DSA) including three dimensional DSA as the mainstay diagnostic techniques. The non-invasive angiography in the form of CTA and MRA has evolved in the last decade as rapid, easily available, and economical means of diagnosing the cause of SAH. The role of three dimensional computed tomography angiography (3D-CTA) in management of aneurysms has been fairly acknowledged in the past. There have been numerous articles in the literature regarding its potential threat to the conventional "gold standard" DSA. The most recent addition has been the introduction of the fourth dimension to the established 3D-CT angiography (4D-CTA). At many centers, DSA is still treated as the first choice of investigation. Although, CT angiography still has some limitations, it can provide an unmatched multi-directional view of the aneurysmal morphology and its surroundings including relations with the skull base and blood vessels. We study the recent advances in the diagnostic approaches to SAH with special emphasis on 3D-CTA and 4D-CTA as the upcoming technologies.     

Improvement of image quality of time-domain diffuse optical tomography with l sparsity regularization

An l(p) (0 < p ≤ 1) sparsity regularization is applied to time-domain diffuse optical tomography with a gradient-based nonlinear optimization scheme to improve the spatial resolution and the robustness to noise. The expression of the l(p) sparsity regularization is reformulated as a differentiable function of a parameter to avoid the difficulty in calculating its gradient in the optimization process. The regularization parameter is selected by the L-curve method. Numerical experiments show that the l(p) sparsity regularization improves the spatial resolution and recovers the difference in the absorption coefficients between two targets, although a target with a small absorption coefficient may disappear due to the strong effect of the l(p) sparsity regularization when the value of p is too small. The l(p) sparsity regularization with small p values strongly localizes the target, and the reconstructed region of the target becomes smaller as the value of p decreases. A phantom experiment validates the numerical simulations.     

Relevance of the processed blood volume per granulocyte and monocyte apheresis session to its clinical efficacy in patients with ulcerative colitis

Granulocyte/monocyte adsorption (GMA) has been introduced as an adjunct intervention for active ulcerative colitis (UC) patients. The processed blood volume (PV) per GMA session is an important factor for its efficacy because depletion of elevated/activated myeloid leukocytes is its main action. Hitherto, this aspect of GMA has been largely ignored. Thirty-three patients were enrolled for remission induction therapy with five weekly GMA sessions at a standard PV of 1800 mL, regardless of patients' bodyweight (BW). The patients were divided into three groups: high (H)BW (≥ 65 kg, n = 11), 50 kg ≤ medium (M)BW < 65 kg (n = 12), and low (L)BW (≤ 50 kg, n = 10). UC clinical activity index (CAI) was according to Lichtiger, and the clinical efficacies were evaluated at both one week post 3(rd) GMA (Week 4) and one week post 5(th) GMA (Week 6). The average BW was 70.9 ± 6.2 kg in HBW, 55.8 ± 4.5 kg in MBW, and 46.8 ± 1.2 kg in LBW, indicating the mean PV/BW in the three groups being 25.6 ± 2.12, 32.5 ± 2.50, and 38.7 ± 1.0 (mL/kg, P < 0.05), respectively. The LBW group consisted of female patients only. Significant improvements of CAI were seen before treatment at either Week 4 or Week 6 in all groups. A significantly higher remission rate was achieved in the LBW (80.0%) vs. MBW (33.3%) or HBW (27.3%) at Week 6 (P < 0.03). According to this GMA evaluation, the lower-limit of optimum PV/kg should be higher than 38.7 mL/kg for its potential clinical efficacy to be significantly greater than the routine GMA method. Additional BW-oriented GMA studies in larger and gender controlled cohorts of patients should strengthen our findings.     

Depressive Symptoms and Past Lifestyle Among Japanese Elderly People

In order to develop an effective preventive intervention for depression, this cross-sectional study aimed to analyze the relationship between past lifestyle, social activity, and depressive symptoms among community-dwelling elderly people in Japan (n = 887). The Geriatric Depression Scale was used for assessing depressive symptoms. The lifestyle of middle-aged people was assessed using a recall report. The prevalence of depressive symptoms among the subjects was 12.9%. Logistic regression analyses showed that physical exercise, daily intake of well-balanced meals and milk products, and the presence of hobbies were related to the absence of depressive symptoms among both men and women. Among men, avoidance of excess salt and fat was related to the absence of depressive symptoms, while among women, moderate alcohol consumption and good relationships with neighbors were related. Physical exercise, dietary education, and promotion of social activities among middle-aged people were recommended for prevention of depressive symptoms.     

Children with attention deficit/hyperactivity disorder and pervasive developmental disorder:attention and response inhibition in the kiddie continuous performance test

Continuous Performance Test (CPT) is widely used to assess the attention function and response inhibition in both children and adults. This study attempts to examine the performances of boys with attention deficit/hyperactivity disorder (AD/HD) and pervasive developmental disorder (PDD) with and without comorbid AD/HD using a CPT. Among the various versions of the CPT available, we used the Kiddie CPT (K-CPT) modified for younger children. The K-CPT was administered to children with AD/HD (n=22), those with PDD (n=19), and typically developing children (n=41) from 7 to 12 years of age. All children were drug free at the time of examination. The performances were examined in 6 measures:total number of omission errors (OE), total number of commission errors (CE), mean hit reaction time (HRT), hit reaction time standard error (HRTSE), perceptual sensitivity (d'), and response style (beta). Significantly lower scores in d' and a tendency to more errors in CE were found in the AD/HD group compared with the control group. Significantly lower scores in d' and significantly more errors in CE were also found in the PDD group with AD/HD symptoms compared with the control group. Moreover the AD/HD group showed significantly more errors in OE and higher scores in HRTSE compared with the control group. There were no significant group differences between the PDD group without AD/HD symptoms and the control group on all measures. Less favorable scores in AD/HD suggest inadequate selective attention, sustained attention and/or response inhibition. Results of the PDD group with comorbid AD/HD may reflect a basis of AD/HD impairment. Our findings may provide an understanding of neuropsychological characteristics underlying developmental disorders.