Corticosteroids in Duchenne muscular dystrophy: Major variations in practice

Introduction: In 2004, a Cochrane Review and AAN practice parameter concluded that prednisone 0.75 mg/kg/day is of short‐term efficacy in Duchenne muscular dystrophy (DMD). Subsequent efforts to standardize care for DMD indicated wide variation in corticosteroid use. Methods: We surveyed physicians who follow patients with DMD, including: (1) clinics in the TREAT‐NMD (Translational Research in Europe—Assessment and Treatment of Neuromuscular Diseases) network (predominantly Europe) and (2) U.S. MDA clinic directors. We also documented the co‐administered corticosteroids in a trial of a putative treatment (ataluren) for DMD. Results: Of 105 Treat‐NMD clinicians, corticosteroids were not used in 10 clinics, and 29 different regimens were used—the most frequent 0.75 mg/kg/day prednisone (61 centers); 10 days on/10 days off (36 centers); 0.9 mg/kg/day deflazacort (32 centers); and 5 mg/kg/day on weekends (10 centers). Similar diversity was identified in MDA clinics and in the ataluren trial. Conclusions: Variability in corticosteroid use suggests uncertainty about risks/benefits of corticosteroid regimens for DMD. Muscle Nerve, 2013     

Prospective randomized trial comparing shock wave lithotripsy and flexible ureterorenoscopy for lower pole stones smaller than 1 cm

In this study, we aimed to compare the success and complications of flexible ureterorenoscopy (F-URS) with its advanced technology and the accomplished method of shock wave lithotripsy (SWL) in the treatment of lower pole stones smaller than 1 cm. One hundred and forty patients were randomized as 70 undergoing SWL (Group 1) and 70 undergoing F-URS (Group 2). Patients were evaluated by plain X-ray and urinary ultrasound 1 week and after 3 months following SWL. The same procedure was done for F-URS patients 1 week after surgery and after 3 months. Success rates were established the day following the procedure and after 3 months. Fragmentation less than 3 mm was considered success. Mean operative time was 44 ± 7.4 min for Group 2 and mean fluoroscopy duration was 51 ± 12 s. In F-URS group, all the patients were stone free after 3 months (100 %). Group 1 had 2.7 ± 0.4 sessions of SWL. Sixty-four patients were stone free in that group after 3 months (91.5 %). The procedure yielded significant success in FURS group, even though patients underwent SWL for 2.7 ± 0.4 sessions and F-URS for 1 session (p < 0.05). With higher success and similar complication rates, fewer sessions per treatment, and advances in technology and experience, we believe F-URS has a potential to be the first treatment option over SWL in the future.     

Ant Colony Optimization Based Feature Selection Method for QEEG Data Classification

Objective

Many applications such as biomedical signals require selecting a subset of the input features in order to represent the whole set of features. A feature selection algorithm has recently been proposed as a new approach for feature subset selection.

Methods

Feature selection process using ant colony optimization (ACO) for 6 channel pre-treatment electroencephalogram (EEG) data from theta and delta frequency bands is combined with back propagation neural network (BPNN) classification method for 147 major depressive disorder (MDD) subjects.

Results

BPNN classified R subjects with 91.83% overall accuracy and 95.55% subjects detection sensitivity. Area under ROC curve (AUC) value after feature selection increased from 0.8531 to 0.911. The features selected by the optimization algorithm were Fp1, Fp2, F7, F8, F3 for theta frequency band and eliminated 7 features from 12 to 5 feature subset.

Conclusion

ACO feature selection algorithm improves the classification accuracy of BPNN. Using other feature selection algorithms or classifiers to compare the performance for each approach is important to underline the validity and versatility of the designed combination.     

Acute Abdominal Aorta Embolism Caused by Rupture of a Cardiac Hydatid Cyst

We report a case of an abdominal aortic embolism due to rupture of a cardiac hydatid cyst. This report emphasizes the diagnostic, preventative, and treatment options for hydatid cyst embolism of abdominal aorta. Echocardiography should be routinely performed in all patients with hydatid disease for possible involvement of the heart. This enables early diagnosis and treatment of cardiac echinococcus before life-threatening complications occur.     

Type 4 median nerve entrapment in a child after elbow dislocation

Case studied Median nerve entrapment is a rare, serious complication of elbow dislocation. We report a Type 4 median nerve entrapment after elbow dislocation in a 10-year-old boy. Radiologically Matev's sign and a new radiological finding—a sclerotic tunnel at the lateral side of the olecranon—were seen.Treatment The patient was treated by excising the damaged segment and reanastomosing the nerve 13 months after the injury.     

Turnover epineural sheath tube in primary repair of peripheral nerves

The epineural repair technique, which is the gold standard of peripheral nerve injuries, is still far from being ideal. The purpose of this study was to investigate the effects of the turnover epineural sheath tube (TEST) when used over the primary nerve repair site to improve nerve regeneration. Twenty-five Wistar rats were divided into three groups and were operated. In the sham control group, the sciatic nerve was dissected from the sciatic notch to its bifurcation and was left intact. In the primary epineural repair group an incision was made on the nerve and it was repaired using six epineural sutures. In the TEST group, after the incision was made the nerve ends were approximated with two epineural sutures. A proximal circular epineural incision was then made to enable the epineurium to be turned and slid over the repair site. Functional recovery was evaluated by walking tract analysis, and the sciatic functional index was calculated. Histomorphometric studies of the sciatic nerves and gastrocnemius muscles were also performed 3 months postoperatively. Three months postoperatively, functional analysis and nerve and muscle histomorphometric studies revealed similar results in the primary repair and TEST groups. There was no significant difference (p > 0.05) between the results of the TEST and the primary nerve repair groups. However, during the microscopic examination, a decrease in both foreign material reaction and an inflammatory response with less fibrosis were observed in the TEST group. The TEST has a nerve-healing property similar to primary epineural repair, with the advantage of a reduced number of sutures, which decreases the fibrosis around the repair site. The TEST is an alternative treatment modality among other techniques, especially for polyfascicular peripheral nerves.