Motor skills, cognitive impairment, and quality of life in normal pressure hydrocephalus: early effects of shunt placement.

BACKGROUND: Traditionally, clinical findings of normal pressure hydrocephalus are mainly characterized by the Hakim triad. The aim of this study is to evaluate the performance of patients suffering from idiopathic normal pressure hydrocephalus (iNPH) in a more holistic manner regarding motor skills, cognitive impairment, and quality of life. METHODS: In total, 30 individuals diagnosed with iNPH as well as a reference group with another 30 individuals were included. The iNPH patients and the reference group were age, educational, and morbidity matched. A standardized test battery for psychomotor skills, gait, neuropsychological abilities as well as questionnaires for quality of life was applied. The iNPH group was tested prior to surgery, at 6 weeks, and 3 months postoperatively. The reference group was tested once. RESULTS: Patients showed a significant improved performance in various items of the test battery during the first 3 months postoperatively. This included neuropsychological evaluation, motor skills including gait and upper motor function as well as the quality of life of the patients. Compared to reference individuals, neuropsychological aspects and quality of life of iNPH patients improved in some parts nearly to normal values. CONCLUSION: Our findings underline that shunt surgery does not only improve the symptoms in iNPH patients but also ameliorates the quality of life to a great extent close to those of age and comorbidity matched reference individuals. This data enables an optimized counseling of iNPH patients regarding the expectable outcome after shunt surgery especially regarding cognitive performance, motor skills as well as life quality.

Pyramid approach for the reduction of parallax-related artefacts in optical recordings of moving translucent volumes.

Functional optical imaging (OI) of intrinsic signals (like blood oxygenation coupled reflection changes) and of extrinsic properties of voltage sensitive probes (like voltage-sensitive dyes (VSD)) forms a group of invasive neuroimaging techniques, that possess up to date the highest temporal and spatial resolution on a meso- to macroscopic scale. There are different sources that contribute to the OI signal of which many are noise. In our previous works, we have used dense optical flow for the reduction of movement artefacts. The translucent surface of the cortex allows contributions from multiple depths. Due to the depth offield (DOF) effect, we get an implicit relation of depth and 2D frequency components. In this work, we introduce registration on the levels of a Laplacian pyramid to remove movement artefacts which have different motion components in different spatial frequency bands. This aims to resolve artefacts that remain after normal registration and are caused e.g. by parallax motion, dead pixels or dust on the sensor and other high frequent, moving particles on the cortex surface without the compromise of using high smoothness weights.

Motion invariant contrast enhancement of optical imaging data in the gradient domain.

Functional optical imaging (OI) of intrinsic signals (like blood oxygenation coupled reflection changes) and of extrinsic properties of voltage sensitive probes (like voltage-sensitive dyes (VSD)) forms a group of neuroimaging techniques that possess up to date highest temporal and spatial resolution on a meso-to macroscopic scale. An inherent problem of OI is a very low signal to noise ratio (SNR), which restricts the recordings to be completely motionless and requires detailed knowledge of the properties of the different noise sources. In our experiments we performed a durectomy and did not use an imaging chamber to allow us future joint electroencephalography-optical imaging (EEG-OI) measures, which resulted in movement artifacts. With the goal of motion compensation in OI recordings and magnification of signal changes, we present a novel processing pipeline, which is based on optic flow guided denoising and gradient domain tone mapping for spatiotemporal contrast enhancement.

Compensation of pulsation artifacts during optical imaging with and without cranial chamber.

Functional Optical Imaging (OI) through the opened skull forms a group of Neuroimaging techniques characterized by a high temporal and spatial resolution on a meso-to macroscopic scale. State of the art OI experiments are generally difficult to execute, with a very timely surgical preparation preceding the experiment, that requires a skilled surgeon to mount a sealed imaging chamber onto the skull. The chamber reduces brain pulsation artifacts and swelling of the brain through movement restriction. In this work, we present preliminary results of a novel approach that does not rely on the usage of an imaging chamber with the goal to facilitate heavily the surgical animal preparation and to allow straightforward joint Electroencephalography - Optical Imaging recordings in the future. We carried out experiments to compare the movement restricting properties of the imaging chamber with the movement in a recording of an unconstrained and periodically irrigated brain. We used high-level image processing techniques to reduce brain pulsation artifacts and did a quantitative movement analysis of the recordings. Our results suggest that while recordings with imaging chamber show less sagittal movement, both with and without imaging chamber comprise the same lateral movements.

Multidrug donor preconditioning protects steatotic liver grafts against ischemia-reperfusion injury.

BACKGROUND: Graft dysfunction of steatotic livers (SL) still remains a major challenge in liver transplantation. Different mechanisms are thought to be involved in the impaired tolerance of SL to ischemia-reperfusion injury. Thus, different pharmacologic strategies may need to be combined to effectively protect SL and to reduce graft dysfunction after transplantation. Therefore, we analyzed the effectiveness of a multidrug donor preconditioning (MDDP) procedure to protect SL from cold ischemia-reperfusion injury. METHODS: Liver steatosis was induced by a high-carbohydrate, fat-free diet. A total of 24 Sprague-Dawley rats were divided into 3 groups (n = 8 each), including a control group with nonsteatotic livers (Con), a vehicle-treated SL group (SL-Con), and a SL group undergoing MDDP (SL-MDDP), including pentoxyphylline, glycine, deferoxamine, N-acetylcysteine, erythropoietin, melatonin, and simvastatin. MDDP was applied before liver perfusion with 4°C histidine-tryptophan-ketoglutarate (HTK) solution and organ harvest. After 24 hours of cold storage in HTK, postischemic reperfusion was performed in an isolated liver reperfusion model using 37°C Krebs-Henseleit bicarbonate buffer. RESULTS: After 60 minutes of reperfusion, SL showed a significant reduction of bile flow as well as a marked increase of liver enzyme levels and apoptotic cell death compared with Con. This was associated with an increased malondialdehyde formation, interleukin-1 production, and leukocytic tissue infiltration. MDDP completely abolished the inflammatory response and was capable of significantly reducing parenchymal dysfunction and injury. CONCLUSIONS: MDDP decreases SL injury after cold storage and reperfusion. The concept of MDDP as a simple and safe preoperative regime, thus may be of interest in clinical use, expanding the donor pool from marginal donors.

Split-liver procedure and inflammatory response: improvement by pharmacological preconditioning.

BACKGROUND: Final outcome of split-liver (SL) transplantation is impaired due to an increased rate of vascular complications and primary non-function. Herein, we hypothesized that an in situ split-liver procedure induces an inflammatory response and a deterioration of graft quality. We further studied whether graft quality can be improved by pharmacologic preconditioning. MATERIAL AND METHODS: SL-procedure was performed in rats. One group (SL-HPP; n = 8) was pretreated according to a defined protocol [Homburg preconditioning protocol (HPP)], including pentoxyphylline, glycine, deferoxamine, N-acetylcysteine, erythropoietin, melatonin, and simvastatin. A second SL group (SL-Con; n = 8) received NaCl. Untreated non-SL served as controls (Sham; n = 8). Cytokines release, leukocyte invasion, endothelial activation and liver morphology were studied directly after liver harvest and after 8 h cold storage. Lung tissue was studied to determine remote injury. RESULTS: The SL-procedure induced an increase of TNF-α concentration, intercellular-adhesion-molecule 1 (ICAM-1) expression, leukocytic-tissue infiltration and vacuolization. This was associated with an increased number of apoptotic hepatocytes. HPP reduced TNF-α release, ICAM-1 expression, the number of infiltrated leukocytes, as well as hepatocellular vacuolization and apoptosis. In lung tissue, the SL-procedure caused an increased IL-1 and IL-6 concentration and leukocyte infiltration. CONCLUSIONS: HPP was capable of abrogating cytokine-mediated leukocytic response. Pharmacologic preconditioning of liver donors prevents the SL procedure-mediated inflammatory response, resulting in an improved graft quality.