Cerebrospinal fluid viral load and biomarkers of neuronal and glial cells in Ramsay Hunt syndrome

Reactivation of varicella zoster virus (VZV) can manifest with facial palsy diagnosed as Ramsay Hunt Syndrome (RHS) or Ramsay Hunt Syndrome zoster sine herpete (RHS‐ZSH). These syndromes are associated with poor prognosis despite treatment with antivirals and corticosteroids. Concentrations of biomarkers such as neurofilament protein (NFL), S‐100β protein and glial fibrillary acidic protein (GFAp) have previously been measured in cerebrospinal fluid (CSF) to assess neuronal damage and glial pathology. We employed immunochemical methods to measure concentrations of NFL, S‐100β protein and GFAp in CSF from patients with RHS (n = 15) and RHS‐ZSH (n = 13) diagnosed by detection of VZV DNA in the CSF by quantitative PCR, and compared with a control group (n = 52). The biomarker concentrations were correlated with CSF viral load and outcome measured by House‐Brackmann score. NFL and GFAp concentrations were increased compared with controls (P = 0.008 and P = 0.04), while S‐100β levels were decreased. This pattern was more pronounced in patients with RHS compared to the patients with RHS‐ZSH (NS and P = 0.028). The amount of viral DNA in CSF correlated with increased GFAp (P = 0.003) and NFL (P = 0.006). No correlations were found between biomarker concentrations and patient outcome. Patients with facial palsy caused by VZV had biochemical signs of neuronal damage and astrogliosis. High amounts of viral DNA may be associated with the degree of damage on neuronal and astroglial cells. Prospective studies are warranted to elucidate the association of elevated biomarkers in the CSF and outcome assessed by more sensitive tests.     

Identification of risk factors for 30-day postoperative complications in patients undergoing primary ventral hernia repair: a prospective cohort study of 2,374 patients

Background

Primary ventral hernia is a common condition. Surgical repair is associated with complications, but no clear predictive risk factors have been identified. The European Hernia Society classification offers a structured framework to describe hernias and to analyze postoperative complications. Given this structured nature, the European Hernia Society classification might prove useful for preoperative patient or treatment classification. The objective of this study was to investigate the European Hernia Society classification as a predictor for complications within 30 days after primary ventral hernia surgery.

Acute diverticulitis in renal transplant patients: should we treat them differently?

Background

Current guidelines suggest that transplant patients with acute diverticulitis should be managed aggressively with early operative intervention to reduce morbidity and mortality. This study compared the treatment choices and clinical outcomes between renal transplant patients and immunocompetent patients with acute diverticulitis.

Automated extraction,labelling and analysis of the coronary vasculature from arteriograms

For clinical decision-making and documentation purposes we have developed techniques to extract, label and analyze the coronary vasculature from arteriograms in an automated, quantitative manner. Advanced image processing techniques were applied to extract and analyze the vasculatures from non-subtracted arteriograms while artificial intelligence techniques were employed to assign anatomical labels. Lumen diameters of 11 phantom vessels were assessed with an accuracy of 0.27±0.19 mm (d _true = 0.45 + 0.92d _measured ; r> 0.99) and 0.21±0.15 mm (d _true =0.42+0.91d _measured ; r> 0.99), from cine and digital images, respectively. We collected a total of 15 routinely acquired cine-arteriograms showing 74 vessel segments with 18 stenoses (severity larger than 30% assessed quantitatively), and 53 digital arteriograms showing 236 vessel segments with 69 stenoses. From the cine arteriograms we extracted 64 (86%) of the vessel segments without manual correction and 196 (83%) from the digital arteriograms. Repeated analysis (3 times) of the arteriograms by the same operator resulted in a standard deviation of the mean segment diameters (precision) of 0.064 mm for the cine-images and 0.020 mm for the digital images, while the standard deviations in the measurement of the minimal luminal diameter of the observed stenoses were 0.020 mm and 0.019 mm, respectively. The LAD artery, the septal and diagonal branches were correctly identified automatically in 86% of the segments. From these evaluations we conclude that our automated approach provides reliable tools for the assessment of multi-vessel disease, both in an offand on-line environment.