Delayed-onset seizures after subthalamic nucleus deep brain stimulation surgery for Parkinson's disease.

BACKGROUND: Delayed-onset seizures after deep brain stimulation (DBS) surgery were seldom reported. This study summarized the clinical characteristics of delayed-onset seizures after subthalamic nucleus (STN) DBS surgery for Parkinson's disease (PD) and analyzed risk factors. METHODS: A single-center retrospective study containing consecutive STN-DBS PD patients from 2006 to 2021 was performed. Seizures occurred during the DBS surgery or within one month after DBS surgery were identified based on routine clinical records. Patients with postoperative magnetic resonance imaging (MRI) were included to further analyze the risk factors for postoperative seizures with univariate and multivariate statistical methods. RESULTS: 341 consecutive PD patients treated with bilateral STN-DBS surgery wereidentified, and five patients experienced seizures after DBS surgery with an incidence of 1.47 %. All seizures of the five cases were characterized as delayed onset with average 12 days post-operatively. All seizures presented as generalized tonic-clonic seizures and didn't recur after the first onset. In those seizures cases, peri-electrode edema was found in both hemispheres without hemorrhage and infarction. The average diameter of peri-electrode edema of patients with seizures was larger than those without seizures (3.15 ± 1.00 cm vs 1.57 ± 1.02 cm, p = 0.005). Multivariate risk factor analysis indicated that seizures were only associated with the diameter of peri-electrode edema (OR 4.144, 95 % CI 1.269-13.530, p = 0.019). CONCLUSIONS: Delayed-onset seizures after STN-DBS surgery in PD patients were uncommon with an incidence of 1.47 % in this study. The seizures were transient and self-limiting, with no developing into chronic epilepsy. Peri-electrode edema was a risk factor for delayed-onset seizures after DBS surgery. Patients with an average peri-electrode edema diameter > 2.70 cm had a higher risk to develop seizures.

Influence of the Emitter Shape on the Field-of-View in Atom Probe Tomography.

Atom probe tomography (APT) is a unique analytical technique that offers three-dimensional elemental mapping with a spatial resolution down to the sub-nanometer. When APT is applied on complex heterogenous systems and/or under certain experimental conditions, that is, laser illumination, the specimen shape can deviate from an ideal hemisphere. Insufficient consideration of this aspect can introduce artifacts in the reconstructed dataset, ultimately degrading its spatial accuracy. So far, there has been limited investigation into the detailed evolution of emitter shape and its impact on the field-of-view (FOV). In this study, we numerically and experimentally investigated the FOV for asymmetric emitters and its evolution throughout the analysis depth. Our analysis revealed that, for asymmetric emitters, the ions evaporated from the topmost region of the specimen (summit) project approximately to the detector center. Furthermore, we demonstrated the implications of this finding on the FOV location for asymmetric emitters. Based on our findings, the location of the center of the FOV can deviate from the specimen central axis with an evolution depending on the evolution of the emitter shape. This study highlights the importance of accounting for the specimen shape when developing advanced data reconstruction schemes to enhance spatial resolution and accuracy.

Postoperative use of steroids for peri-electrode edema after deep brain stimulation surgery: A retrospective cohort study.

BACKGROUND: To review the incidence and extent of peri-electrode edema after DBS and to clarify the effect of postoperative use of steroids on the peri-electrode edema. METHODS: This retrospective cohort study included 250 patients who underwent bilateral subthalamic nucleus (STN) DBS surgery with intact MRI within 1 month after DBS surgery. Patients were divided into steroid and non-steroid groups, based on postoperative steroids use. The occurrence and extent of peri-electrode edema were compared between the two groups, and other associated factors were analyzed using univariate and multivariate methods. RESULTS: Peri-electrode edema >1 cm3 in at least one hemisphere was reported in 215 (86.00%) patients. The mean volume of peri-electrode edema observed in the steroid group was significantly smaller than in the non-steroid group (8.09 ± 8.47 cm3 vs 17.10 ± 16.90 cm3 , p < 0.001). In the steroid group, 104 (32.91%) of the 316 implanted electrodes present with edema less than 1 cm3 , whereas in the non-steroid group, only 27 (14.67%) of the 184 implanted electrodes present with edema less than 1 cm3 (p < 0.001). Multivariate analysis indicated that lesser peri-electrode edema was significantly associated with postoperative steroids use and general anesthesia. CONCLUSIONS: Peri-electrode edema is common after DBS surgery, and postoperative steroids use reduces the occurrence and extent of peri-electrode edema.

Optimal vaccination strategies for COVID-19 in population migration between two regions scenario.

Population movements had a significant impact on the spread of COVID-19, and vaccination is considered the most effective means for humans to face viral infections. This study identifies the optimal control strategy for COVID-19 prevention and control, and explores the impact of short-term and long-term migration on the optimal proportion of vaccine allocation between two regions. We proposed to establish the SIR (Susceptible-Infectious-Recovered) model and determine the stability by calculating the disease free equilibrium and Jacobi matrix of the model. We then established the vaccine optimization model, solved the optimal vaccine distribution strategy by gradient descent method and explored the impact of short-term and long-term migration on the optimal vaccine allocation ratio. The stability analysis revealed that the virus could not be eliminated only by reducing the migration rates and infection rates. we introduced the vaccine methods and obtained the optimal vaccine allocation ratio in Shenzhen and Hong Kong as p1:p2=0.000341: 0.001739, and the daily vaccination rate we need to impose in each region as p1:p2=0.00068:0.001901. The presence or absence of short-term migration had no greater impact on the distribution of the vaccine, whereas Rv with long-term migration had a greater effect than no migration. We found that migration rates could not eliminate the outbreak in both regions and that adopting an effective vaccine distribution strategy could be more effective in eliminating the outbreak. And for different allocation scenarios with limited vaccine supply, we obtained the optimal allocation most favorable to control the epidemic.

The efficacy and safety of asleep and awake subthalamic deep brain stimulation for Parkinson's disease patients: A 1-year follow-up.

Introduction: Traditional DBS is usually conducted under local anesthesia (LA) which is intolerable to some patients, DBS under general anesthesia (GA) was opted to extended surgical indication. This study aimed to compare the efficacy and safety of bilateral subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease (PD) under asleep and awake anesthesia state in 1-year postoperative follow-up. Methods: Twenty-one PD patients were assigned to asleep group and 25 patients to awake group. Patients received bilateral STN-DBS under different anesthesia state. The PD participants were interviewed and assessed preoperatively and at 1-year postoperative follow-up. Results: At 1-year follow-up, compared surgical coordinate in two groups, the left-side Y of asleep group showed more posterior than awake group (Y was-2.39 ± 0.23 in asleep group, -1.46 ± 0.22 in awake group, p = 0.007). Compared with preoperative OFF MED state, MDS-UPDRS III scores in OFF MED/OFF STIM state remained unchanged, while in OFF MED/ON STIM state were significantly improved in awake and asleep groups, yet without significant difference. Compared with preoperative ON MED state, MDS-UPDRS III scores in ON MED/OFF STIM, and ON MED/ON STIM state remained unchanged in both groups. In non-motor outcomes, PSQI, HAMD, and HAMA score significantly improved in asleep group compared to awake group at 1-year follow-up (PSQI, HAMD, and HAMA score in 1-year follow-up were 9.81 ± 4.43; 10.00 ± 5.80; 5.71 ± 4.75 in awake group, 6.64 ± 4.14; 5.32 ± 3.78; 3.76 ± 3.87 in asleep group, p = 0.009; 0.008; 0.015, respectively), while there was no significant difference in PDQ-39, NMSS, ESS, PDSS score, and cognitive function. Anesthesia methods was significantly associated with improvement of HAMA and HAMD score (p = 0.029; 0.002, respectively). No difference in LEDD, stimulation parameters and adverse events was observed between two groups. Discussion: Asleep STN-DBS may be considered a good alternative method for PD patients. It is largely consistent with awake STN-DBS in motor symptoms and safety. Yet, it showed higher improvement in terms of mood and sleep compared to awake group at 1-year follow-up.

Exploring epidemic voluntary vaccinating behavior based on information-driven decisions and benefit-cost analysis.

A complex dynamic interplay exists between epidemic transmission and vaccination, which is significantly influenced by human behavioral responses. We construct a research framework combining both the function modeling of the cumulative global COVID-19 information and limited individuals' information processing capacity employing the Gompertz model for growing processes. Meanwhile, we built a function representing the decision to get vaccinated following benefit-cost analysis considered the choices made by people in each scenario have an influence from altruism, free-riding and immunity escaping capacity. Through the mean-field calculation analysis and using a fourth-order Runge-Kutta method with constant step size, we obtain plots from numerical simulations. We found that only when the total number of infectious individuals proves sufficient to reach and exceed a certain level will the individuals face a better trade-off in determining whether to get vaccinated against the diseases based on that information. Besides, authoritative media have a higher decisive influence and efforts should be focused on extending the duration of vaccine protection, which is beneficial to inhibit the outbreaks of epidemics. Our work elucidates that reducing the negative payoff brought about by the free-riding behavior for individuals or improving the positive payoff from the altruistic motivation helps to control the disease in cultures that value social benefits, vaccination willingness is generally stronger. We also note that at a high risk of infection, the decision of vaccination is highly correlated with global epidemic information concerning COVID-19 infection, while at times of lower risk, it depends on the game theoretic vaccine strategy. The findings demonstrate that improving health literacy, ensuring open and transparent information on vaccine safety and efficacy as a public health priority can be an effective strategy for mitigating inequalities in health education, as well as alleviating the phenomenon that immunity escaping abilities is more likely to panic by populations with high levels of education. In addition, prosocial nudges are great ways to bridge these immunity gaps that can contribute to implementing government public health control measures, creating a positive feedback loop.

The Effect of Surgical Positioning on Pneumocephalus in Subthalamic Nucleus Deep Brain Stimulation Surgery for Parkinson Disease.

OBJECTIVES: This research analyzed the effect of surgical positioning on postoperative pneumocephalus and assessed additional potential risk factors of pneumocephalus in subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson disease (PD). MATERIALS AND METHODS: In this study, 255 consecutive patients with PD who received bilateral STN DBS under general anesthesia were retrospectively included. Of these, 180 patients underwent surgery with their heads in an elevated position, and 75 patients underwent surgery in a supine position. The postoperative pneumocephalus volume was compared between the two groups. Other potential risk factors for pneumocephalus also were analyzed. RESULTS: The mean pneumocephalus volume for the group with elevated-head positioning (16.76 ± 15.23 cm3) was greater than for the supine group (3.25 ± 8.78 cm3) (p < 0.001). Multivariable analysis indicated that the pneumocephalus volume was related to surgical positioning, lateral trajectory angle, intraoperative mean arterial pressure (MAP), microelectrode recording (MER) passage number, brain atrophy degree, and the anterior trajectory angle. No correlation was found between pneumocephalus and age, sex, duration of PD, surgery length, or intracranial volume. In the subgroup analysis, the pneumocephalus volume exhibited a negative correlation with intraoperative MAP (r = -0.210, p = 0.005) and positive correlations with degree of brain atrophy (r = 0.242, p = 0.001) and MER passage number (r = 0.184, p = 0.014) in the elevated-head group. Specifically, an MER passage number > 3 was a significant risk factor for pneumocephalus in the elevated-head group. A positive correlation was observed between the pneumocephalus volume and the lateral trajectory angle in both groups (elevated-head positioning, r = 0.153, p = 0.041; supine positioning, r = 0.546, p < 0.001). CONCLUSIONS: In patients with PD who were anesthetized and receiving STN DBS, supine positioning reduced pneumocephalus volume compared with patients with PD receiving STN DBS with their heads elevated. The pneumocephalus volume was negatively correlated with intraoperative MAP and positively correlated with the degree of brain atrophy, the lateral trajectory angle, and the MER passage number.

Nomogram for Prediction of Postoperative Delirium after Deep Brain Stimulation of Subthalamic Nucleus in Parkinson's Disease under General Anesthesia.

Introduction: Postoperative delirium can increase cognitive impairment and mortality in patients with Parkinson's disease. The purpose of this study was to develop and internally validate a clinical prediction model of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson's disease under general anesthesia. Methods: We conducted a retrospective observational cohort study on the data of 240 patients with Parkinson's disease who underwent deep brain stimulation of the subthalamic nucleus under general anesthesia. Demographic characteristics, clinical evaluation, imaging data, laboratory data, and surgical anesthesia information were collected. Multivariate logistic regression was used to develop the prediction model for postoperative delirium. Results: A total of 159 patients were included in the cohort, of which 38 (23.90%) had postoperative delirium. Smoking (OR 4.51, 95% CI 1.56-13.02, p < 0.01) was the most important risk factor; other independent predictors were orthostatic hypotension (OR 3.42, 95% CI 0.90-13.06, p=0.07), inhibitors of type-B monoamine oxidase (OR 3.07, 95% CI 1.17-8.04, p=0.02), preoperative MRI with silent brain ischemia or infarction (OR 2.36, 95% CI 0.90-6.14, p=0.08), Hamilton anxiety scale score (OR 2.12, 95% CI 1.28-3.50, p < 0.01), and apolipoprotein E level in plasma (OR 1.48, 95% CI 0.95-2.29, p=0.08). The area under the receiver operating characteristic curve (AUC) was 0.76 (95% CI 0.66-0.86). A nomogram was established and showed good calibration and clinical predictive capacity. After bootstrap for internal verification, the AUC was 0.74 (95% CI 0.66-0.83). Conclusion: This study provides evidence for the independent inducing factors of delirium after deep brain stimulation of the subthalamic nucleus in Parkinson's disease under general anesthesia. By predicting the development of delirium, our model may identify high-risk groups that can benefit from early or preventive intervention.

Risk Factors for Hiccups after Deep Brain Stimulation of Subthalamic Nucleus for Parkinson's Disease.

Background: After deep brain stimulation (DBS), hiccups as a complication may lead to extreme fatigue, sleep deprivation, or affected prognosis. Currently, the causes and risk factors of postoperative hiccups are unclear. In this study, we investigated the risk factors for hiccups after DBS of the subthalamic nucleus (STN) for Parkinson's disease (PD) under general anesthesia. Methods: We retrospectively included patients who underwent STN DBS in the study, and collected data of demographic characteristics, clinical evaluations, and medications. According to the occurrence of hiccups within seven days after operation, the patients were divided into a hiccups group and non-hiccups group. The potentially involved risk factors for postoperative hiccups were statistically analyzed by logistic regression analysis. Results: A total of 191 patients were included in the study, of which 34 (17.80%) had postoperative transient persistent hiccups. Binary univariate logistic regression analysis showed that male, higher body mass index (BMI), smoker, Hoehn and Yahr stage (off), preoperative use of amantadine, hypnotic, Hamilton anxiety scale and Hamilton depression scale scores, and postoperative limited noninfectious peri-electrode edema in deep white matter were suspected risk factors for postoperative hiccups (p < 0.1). In binary multivariate logistic regression analysis, male (compared to female, OR 14.00; 95% CI, 1.74−112.43), postoperative limited noninfectious peri-electrode edema in deep white matter (OR, 7.63; 95% CI, 1.37−42.37), preoperative use of amantadine (OR, 3.64; 95% CI, 1.08−12.28), and higher BMI (OR, 3.50; 95% CI, 1.46−8.36) were independent risk factors for postoperative hiccups. Conclusions: This study is the first report about the risk factors of hiccups after STN DBS under general anesthesia for PD patients. The study suggests that male, higher BMI, preoperative use of amantadine, and postoperative limited noninfectious peri-electrode edema in deep white matter are independent risk factors for postoperative hiccups of STN-DBS for PD patients. Most hiccups after STN-DBS for PD patients were transient and self-limiting.

Assessing Vaccination Prioritization Strategies for COVID-19 in South Africa Based on Age-Specific Compartment Model.

The vaccines are considered to be important for the prevention and control of coronavirus disease 2019 (COVID-19). However, considering the limited vaccine supply within an extended period of time in many countries where COVID-19 vaccine booster shot are taken and new vaccines are developed to suppress the mutation of virus, designing an effective vaccination strategy is extremely important to reduce the number of deaths and infections. Then, the simulations were implemented to study the relative reduction in morbidity and mortality of vaccine allocation strategies by using the proposed model and actual South Africa's epidemiological data. Our results indicated that in light of South Africa's demographics, vaccinating older age groups (>60 years) largely reduced the cumulative deaths and the "0-20 first" strategy was the most effective way to reduce confirmed cases. In addition, "21-30 first" and "31-40 first" strategies have also had a positive effect. Partial vaccination resulted in lower numbers of infections and deaths under different control measures compared with full vaccination in low-income countries. In addition, we analyzed the sensitivity of daily testing volume and infection rate, which are critical to optimize vaccine allocation. However, comprehensive reduction in infections was mainly affected by the vaccine proportion of the target age group. An increase in the proportion of vaccines given priority to "0-20" groups always had a favorable effect, and the prioritizing vaccine allocation among the "60+" age group with 60% of the total amount of vaccine consistently resulted in the greatest reduction in deaths. Meanwhile, we observed a significant distinction in the effect of COVID-19 vaccine allocation policies under varying priority strategies on relative reductions in the effective reproduction number. Our results could help evaluate to control measures performance and the improvement of vaccine allocation strategy for COVID-19 epidemic.

Pre-operative breathing training based on video learning reduces emergence delirium in preschool children: A randomized clinical trial.

STUDY OBJECTIVE: Emergence delirium is a common complication in preschool children after general anesthesia and may result in undesirable complications. This study aimed to determine whether breathing training after watching an informative video during the pre-operative visit could reduce the incidence of emergence delirium in preschool children after otorhinolaryngologic surgery under general anesthesia. DESIGN: A single-center, double-blinded, randomized controlled trial. SETTING: Perioperative care. PATIENTS: A total of 170 children undergoing otorhinolaryngologic surgery, aged 3-7 years, ASA physical status I or II were involved. INTERVENTIONS: Patients were randomized to receive breathing training during the pre-operative visit (Training group) or to receive pre-operative visit only (Control group) the day before surgery. MEASUREMENTS: Emergence delirium was measured by the Pediatric Anesthesia Emergence Delirium score during the anesthesia recovery time. Data regarding extubation time and post-anesthesia care unit stay time were collected. MAIN RESULTS: Children who received breathing training during the pre-operative visit had a significantly lower incidence of emergence delirium than those who only underwent the pre-operative visit (10.4% vs. 35.1%, P < 0.001). The awakening time score and the maximum score in the post-anesthesia care unit were significantly lower in the training group compared with the control group [4.4 ± 3.4 vs. 6.9 ± 4.2, P < 0.001 and 5.0 (5.0) vs 7.0 (7.0), P = 0.001, respectively]. We found no differences in the extubation time and post-anesthesia care unit stay time between groups. CONCLUSIONS: We concluded that breathing training based on video learning during the pre-operative visit in preschool children undergoing otorhinolaryngologic surgery could significantly decrease the incidence of emergence delirium. TRIAL REGISTRATION: Chinese Clinical Trial Registry (Reference number: ChiCTR1900026162); registered on September 24, 2019.

New approaches suggest term and preterm human fetal membranes may have distinct biomechanical properties.

Preterm prelabour rupture of membranes is the leading cause of preterm birth and its associated infant mortality and morbidity. However, its underlying mechanism remains unknown. We utilized two novel biomechanical assessment techniques, ball indentation and Optical Coherence Elastography (OCE), to compare the mechanical properties and behaviours of term (≥ 37 weeks) and preterm (33-36 weeks) human fetal membranes from ruptured and non-ruptured regions. We defined the expression levels of collagen, sulfated glycosaminoglycans (sGAG), matrix metalloproteinase (MMP-9, MMP-13), fibronectin, and interleukin-1ß (IL-1ß) within membranes by biochemical analysis, immunohistochemical staining and Western blotting, both with and without simulated fetal movement forces on membrane rupture with a new loading system. Preterm membranes showed greater heterogeneity in mechanical properties/behaviours between ruptured and non-ruptured regions compared with their term counterparts (displacement rate: 36% vs. 15%; modulus: 125% vs. 34%; thickness: 93% vs. 30%; collagen content: 98% vs. 29%; sGAG: 85% vs 25%). Furthermore, simulated fetal movement forces triggered higher MMP-9, MMP-13 and IL-1ß expression in preterm than term membranes, while nifedipine attenuated the observed increases in expression. In conclusion, the distinct biomechanical profiles of term and preterm membranes and the abnormal biochemical expression and activation by external forces in preterm membranes may provide insights into mechanisms of preterm rupture of membranes.

Analyzing COVID-19 Vaccination Behavior Using an SEIRM/V Epidemic Model With Awareness Decay.

Information awareness about COVID-19 spread through multiple channels can stimulate individuals to vaccinate to protect themselves and reduce the infection rate. However, the awareness individuals may lose competency over time due to the decreasing quality of the information and fading of awareness. This paper introduces awareness programs, which can not only change people from unaware to aware state, but also from aware to unaware state. Then an SEIRM/V mathematical model is derived to study the influence of awareness programs on individual vaccination behavior. We evaluate the dynamical evolution of the system model and perform the numerical simulation, and examine the effects of awareness transformation based on the COVID-19 vaccination case in China. The results show that awareness spread through various information sources is positively associated with epidemic containment while awareness fading negatively correlates with vaccination coverage.

Analyzing the COVID-19 vaccination behavior based on epidemic model with awareness-information.

BACKGROUND: The widespread use of effective COVID-19 vaccines could prevent substantial morbidity and mortality. Individual decision behavior about whether or not to be vaccinated plays an important role in achieving adequate vaccination coverage and herd immunity. METHODS: This research proposes a new susceptible-vaccinated-exposed-infected-recovered with awareness-information (SEIR/V-AI) model to study the interaction between vaccination and information dissemination. Information creation rate and information sensitivity are introduced to understand the individual decision behavior of COVID-19 vaccination. We then analyze the dynamical evolution of the system and validate the analysis by numerical simulation. RESULTS: The decision behavior of COVID-19 vaccination in China and the United States are analyzed. The results showed the coefficient of information creation and the information sensitivity affect vaccination behavior of individuals. CONCLUSIONS: The information-driven vaccination is an effective way to curb the COVID-19 spreading. Besides, to solve vaccine hesitancy and free-ride, the government needs to disseminate accurate information about vaccines safety to alleviate public concerns, and provide the widespread public educational campaigns and communication to guide individuals to act in group interests rather than self-interest and reduce the temptation to free-riding, which often results from individuals who are inadequately informed about vaccines and thus blindly imitate free-riding behavior.

A Bottom-Up Volume Reconstruction Method for Atom Probe Tomography.

This paper describes a reconstruction method for atom probe tomography based on a bottom-up approach accounting for (i) the final tip morphology (which is frequently induced by inhomogeneous evaporation probabilities across the tip surface due to laser absorption, heat diffusion effects, and inhomogeneous material properties), (ii) the limited (and changing) field of view, and (iii) the detector efficiency. The reconstruction starts from the final tip morphology and reverses the evaporation sequence through the pseudo-deposition of defined small reconstruction volumes, which are then stacked together to create the full three-dimensional (3D) tip. The subdivision in small reconstruction volumes allows the scheme to account for the changing tip shape and field of view as evaporation proceeds. Atoms within the same small reconstruction volume are reconstructed at once by placing atoms back onto their possible lattice sites through a trajectory-matching process involving simulated and experimental hit maps. As the ejected ion trajectories are simulated using detailed electrostatic modeling inside the chamber, no simplifications have been imposed on the shape of the trajectories, projection laws, or tip surface. We demonstrate the superior performance of our approach over the conventional reconstruction method (Bas) for an asymmetrical tip shape.

Characteristics of Electroencephalogram in the Prefrontal Cortex during Deep Brain Stimulation of Subthalamic Nucleus in Parkinson's Disease under Propofol General Anesthesia.

BACKGROUND: Monitoring the depth of anesthesia by electroencephalogram (EEG) based on the prefrontal cortex is an important means to achieve accurate regulation of anesthesia for subthalamic nucleus (STN) deep brain stimulation (DBS) under general anesthesia in patients with Parkinson's disease (PD). However, no previous study has conducted an in-depth investigation into this monitoring data. Here, we aimed to analyze the characteristics of prefrontal cortex EEG during DBS with propofol general anesthesia in patients with PD and determine the reference range of parameters derived from the depth of anesthesia monitoring. Additionally, we attempted to explore whether the use of benzodiazepines in the 3 days during hospitalization before surgery impacted the interpretation of the EEG parameters. MATERIALS AND METHODS: We included the data of 43 patients with PD who received STN DBS treatment and SedLine monitoring during the entire course of general anesthesia with propofol in a single center. Eighteen patients (41.86%) took benzodiazepines during hospitalization. We divided the anesthesia process into three stages: awake state before anesthesia, propofol anesthesia state, and shallow anesthesia state during microelectrode recording (MER). We analyzed the power spectral density (PSD) and derived parameters of the patients' prefrontal EEG, including the patient state index (PSI), spectral edge frequency (SEF) of the left and right sides, and the suppression ratio. The baseline characteristics, preoperative medication, preoperative frontal lobe image characteristics, preoperative motor and non-motor evaluation, intraoperative vital signs, internal environment and anesthetic information, and postoperative complications are listed. We also compared the groups according to whether they took benzodiazepines before surgery during hospitalization. RESULTS: The average PSI of the awake state, propofol anesthesia state, and MER state were 89.86 ± 6.89, 48.68 ± 12.65, and 62.46 ± 13.08, respectively. The preoperative administration of benzodiazepines did not significantly affect the PSI or SEF, but did reduce the total time of suppression, maximum suppression ratio, and the PSD of beta and gamma during MER. Regarding the occurrence of postoperative delirium and mini-mental state examination (MMSE) scores, there was no significant difference between the two groups (chi-square test, p = 0.48; Mann-Whitney U test, p = 0.30). CONCLUSION: For the first time, we demonstrate the reference range of the derived parameters of the depth of anesthesia monitoring and the characteristics of the prefrontal EEG of patients with PD in the awake state, propofol anesthesia state, and shallow anesthesia during MER. Taking benzodiazepines in the 3 days during hospitalization before surgery reduces suppression and the PSD of beta and gamma during MER, but does not significantly affect the observation of anesthesiologists on the depth of anesthesia, nor affect the postoperative delirium and MMSE scores.

Subthalamic Nucleus Deep Brain Stimulation Treats Parkinson's Disease Patients with Cardiovascular Disease Comorbidity: A Retrospective Study of a Single Center Experience.

Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective method for treating Parkinson's disease (PD). However, safety of STN-DBS treating PD patients with cardiovascular disease (CVD) comorbidity is rarely focused and reported. The aim of this study is to investigate the efficacy and safety of STN-DBS treating PD patients with CVD comorbidity. Methods: We retrospectively included PD patients with CVD comorbidity who underwent STN-DBS under general anesthesia in our center from January 2019 to January 2021. Patient's PD symptoms and cardiopulmonary function were evaluated by a multi-disciplinary team (MDT) before surgery. Post-operative clinical outcome and complications were collected until 1-year follow-up. Results: A total of 38 patients (26 men/12 women) of mean body mass index (BMI) 24.36 ± 3.11 kg/m2, with different CVD comorbidity were finally speculated in the study. These CVD include mainly hypertension, coronary artery disease, thoracic aortic aneurysm, heart valve replacement, pacemaker implantation, atrial fibrillation, patent foramen ovale, and so on. The mean systolic blood pressure (SBP) of 38 patients at admission day, pre-operation day, and discharge day timepoint was 135.63 ± 18.08 mmHg, 137.66 ± 12.26 mmHg, and 126.87 ± 13.36 mmHg, respectively. This showed that blood pressure was controlled well under stable and normal state. The indicators of myocardial infarction Troponin T (Tn T-T) levels at pre-operation, 1 day and 7 days after operation timepoint were 0.014 ± 0.011 ng/mL, 0.015 ± 0.011 ng/mL, and 0.014 ± 0.008 ng/mL, showing no significant fluctuation (F = 0.038, p = 0.962). STN-DBS improved PD patients' UPDRS III scores by 51.38% (t = 12.33, p < 0.0001) at 1-year follow-up compared with pre-operative baseline. A total of 11 adverse events were recorded until 1-year follow-up. No obvious cardiovascular complications such as intracranial hematoma or clot-related events occurred within 1 year after surgery except 1 case of hematuria. Conclusions: STN-DBS under general anesthesia is safe and effective for treating PD patients with CVD comorbidity. Our clinical experience and protocol of the MDT offers comprehensive perioperative evaluation for DBS surgery and mitigates bleeding and cardiovascular-associated events in PD patients with CVD comorbidity.

Characterisation of Collagen Re-Modelling in Localised Prostate Cancer Using Second-Generation Harmonic Imaging and Transrectal Ultrasound Shear Wave Elastography.

Prostate cancer has a poor prognosis and high mortality rate due to metastases. Extracellular matrix (ECM) re-modelling and stroma composition have been linked to cancer progression, including key components of cell migration, tumour metastasis, and tissue modulus. Moreover, collagens are one of the most significant components of the extracellular matrix and have been ascribed to many aspects of neoplastic transformation. This study characterises collagen re-modelling around localised prostate cancer using the second harmonic generation of collagen (SHG), genotyping and ultrasound shear wave elastography (USWE) measured modulus in men with clinically localised prostate cancer. Tempo-sequence assay for gene expression of COL1A1 and COL3A1 was used to confirm the expression of collagen. Second-harmonic generation imaging and genotyping of ECM around prostate cancer showed changes in content, orientation, and type of collagen according to Gleason grades (cancer aggressivity), and this correlated with the tissue modulus measured by USWE in kilopascals. Furthermore, there were clear differences between collagen orientation and type around normal and cancer tissues.

Optimized Propofol Anesthesia Increases Power of Subthalamic Neuronal Activity in Patients with Parkinson's Disease Undergoing Deep Brain Stimulation.

INTRODUCTION: Propofol is a general anesthetic option for deep brain stimulation (DBS) of the subthalamic nucleus (STN) of patients with Parkinson's disease (PD). However, its effects on STN activity and neuropsychological outcomes are controversial. The optimal propofol anesthesia for asleep DBS is unknown. This study investigated the safety and effectiveness of an optimized propofol anesthesia regimen in asleep DBS. METHODS: This retrospective study enrolled 68 PD patients undergoing bilateral STN-DBS surgery. All patients received local scalp anesthesia, with (asleep group, n = 35) or without (awake group, n = 33) propofol-remifentanil general anesthesia by target-controlled infusion under electroencephalogram monitoring. The primary outcome was subthalamic neuronal spiking characterization during microelectrode recording. The secondary outcomes were clinical outcomes including motor, cognition, mind, sleep, and quality of life at 6 months. RESULTS: Significantly increased delta and theta power were obtained under propofol anesthesia (awake vs. asleep group, mean ± standard deviation; delta: 31.97 ± 9.87 vs. 39.77 ± 10.56, p < 0.01; theta: 21.09 ± 5.55 vs. 24.82 ± 6.63, p = 0.01). After excluding the influence of confounding factors of age and preoperative motor scores, there was a statistically significant influence on the delta, theta, and alpha power of STN neuronal activity under different anesthesia regimens (delta: ß = 2.64, p < 0.01; theta: ß = 2.11, p < 0.01; alpha: ß = 1.42, p = 0.01). There were no differences in modified burst index, firing rate, tract numbers of microelectrode recording, and other clinical outcomes between the two groups. CONCLUSION: Optimized propofol anesthesia enhanced the delta, theta, and alpha power in STN compared with the awake technique and likely contributed to target recognition under propofol anesthesia. These results demonstrate that propofol is suitable, but needs to be optimized, for asleep STN-DBS. TRIAL REGISTRATION: Chinese Clinical Trial Registry Identification number: ChiCTR2100045942. Registered 29 April 2021-Retrospectively registered.

Quantitative measurement of mechanical properties in wound healing processes in a corneal stroma model by using vibrational optical coherence elastography (OCE).

Corneal wound healing, caused by frequent traumatic injury to the cornea and increasing numbers of refractive surgeries, has become a vital clinical problem. In the cornea, wound healing is an extremely complicated process. However, little is known about how the biomechanical changes in wound healing response of the cornea. Collagen-based hydrogels incorporating corneal cells are suitable for replicating a three-dimensional (3D) equivalent of the cornea in-vitro. In this study, the mechanical properties of corneal stroma models were quantitatively monitored by a vibrational optical coherence elastography (OCE) system during continuous culture periods. Specifically, human corneal keratocytes were seeded at 5 × 105 cells/mL in the hydrogels with a collagen concentration of 3.0 mg/mL. The elastic modulus of the unwounded constructs increased from 2.950 ± 0.2 kPa to 11.0 ± 1.4 kPa, and the maximum thickness decreased from 1.034 ± 0.1 mm to 0.464 ± 0.09 mm during a 15-day culture period. Furthermore, a traumatic wound in the construct was introduced with a size of 500 µm. The elastic modulus of the neo-tissue in the wound area increased from 1.488 ± 0.4 kPa to 6.639 ± 0.3 kPa over 13 days. This study demonstrates that the vibrational OCE system is capable of quantitative monitoring the changes in mechanical properties of a corneal stroma wound model during continuous culture periods and improves our understanding on corneal wound healing processes.