Intracranial Parasitic Fetus in a Living Infant: A Case Study with Surgical Intervention and Prognosis Analysis.

BACKGROUND Fetus in fetu (FIF), or parasitic fetus, is a rare malformation that typically occurs in the retroperitoneum, but can be found in other unusual locations, such as the skull, sacrum, and mouth. The presence of a spine is necessary for diagnosis. CASE REPORT Intracranial FIFs were retrospectively studied. Abnormalities were detected in the fetal head during a 33-week prenatal examination; however, MRI could not provide more information, due to space occupation. A baby girl was born via cesarean delivery at 37 weeks, with a large head circumference. She had delays in motor skills and speech development, only able to say "mom". There was a large mass in the cerebral hemisphere, with a 13-cm maximum diameter, smooth boundary, and internal bone structure visible on head CT scan. Both ventricles and third ventricle had hydrops, with a fetal shape at a continuous level, along with apparent compression near the cerebral parenchyma. After performing preoperative examinations, laboratory tests, and surgical planning, craniotomy was performed on the FIF, under general anesthesia. Following complete mass resection, mouth, eye, arm, and hand shapes could be observed. The patient was unconscious after surgery and had seizures that were difficult to control. She died 12 days after surgery. Teratomas can be distinguished based on anatomy and imaging. Surgical resection is the only curative treatment and its prognosis is poor. CONCLUSIONS Intracranial FIF cases are rare and require early diagnosis and surgical treatment. Differentiating between FIF and teratoma is crucial, and monitoring alpha-fetoprotein levels after surgery can help detect recurrence.

Meta-analysis of the relationship between ocular and peripheral serum IL-17A and diabetic retinopathy.

Purpose: A systematic evaluation and Meta-analysis were performed to determine the relationship between IL-17A levels in ocular aqueous and peripheral venous serum samples and diabetic retinopathy (DR). Methods: PubMed, Embase, Web of Science, and CNKI databases were searched from the time of library construction to 2023-09-20.The results were combined using a random-effects model, sensitivity analyses were performed to determine whether the arithmetic was stable and reliable, and subgroup analyses were used to look for possible sources of heterogeneity. Results: A total of 7 case-control studies were included. The level of IL-17A was higher in the Nonproliferative DR(NPDR) group than in the Non-DR(NDR) group [SMD=2.07,95%CI(0.45,3.68),P=0.01], and the level of IL-17A in the proliferating DR(PDR) group was higher than that of the NDR group [SMD=4.66,95%CI(1.23,8.08),P<0.00001]. IL-17A levels in peripheral serum and atrial fluid were significantly higher in NPDR and PDR patients than in non-DR patients in subgroup analyses, and detection of peripheral serum IL-17A concentrations could help to assess the risk of progression from NPDR to PDR. Sensitivity analyses suggested that the results of the random-effects arithmetic were stable and reliable. Subgroup analyses based on assay method and sample source showed that the choice of these factors would largely influence the relationship between IL-17A levels and DR. Conclusion: Elevated peripheral serum and ocular aqueous humor IL-17A levels in diabetic patients are associated with the risk of DR, IL-17A may serve as a potential predictor or therapeutic target for DR, and IL-17A may be an important predictor of inflammation for the progression of NPDR to PDR. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42024532900.

Evaluation of brain function in adult patent ductus arteriosus surgery: A multimodal monitoring approach.

Adult patent ductus arteriosus (PDA) repair surgery often involves hypothermic cardiopulmonary bypass (CPB) and is associated with postoperative neurological complications. Our study evaluates brain function during PDA surgery using regional cerebral oxygen saturation (rSO2) and bispectral index (BIS) monitoring to mitigate these complications. Patients were categorized into moderate (26-31 â„ƒ) and mild (32-35 â„ƒ) hypothermia groups. Findings indicate a positive correlation between PDA diameter and pulmonary artery systolic blood pressure, and a strong correlation between delirium and average rSO2-AUC. The mild hypothermia group had longer extubation and hospitalization times. During CPB, rSO2 levels fluctuated significantly, and EEG analysis revealed changes in brain wave patterns. One case of nerve injury in the mild hypothermia group showed incomplete recovery after a year. Our results advocate for moderate hypothermia during CPB in adult PDA repair, suggesting that combined rSO2 and BIS monitoring can reduce neurological complications post-surgery.

EEG Changes during Propofol Anesthesia Induction in Vegetative State Patients Undergoing Spinal Cord Stimulation Implantation Surgery.

OBJECTIVE: To compare the EEG changes in vegetative state (VS) patients and non-craniotomy, non-vegetative state (NVS) patients during general anesthesia with low-dose propofol and to find whether it affects the arousal rate of VS patients. METHODS: Seven vegetative state patients (VS group: five with traumatic brain injury, two with ischemic-hypoxic VS) and five non-craniotomy, non-vegetative state patients (NVS group) treated in the Department of Neurosurgery, Peking University International Hospital from January to May 2022 were selected. All patients were induced with 0.5 mg/kg propofol, and the Bispectral Index (BIS) changes within 5 min after administration were observed. Raw EEG signals and perioperative EEG signals were collected and analyzed using EEGLAB in the MATLAB software environment, time-frequency spectrums were calculated, and EEG changes were analyzed using power spectrums. RESULTS: There was no significant difference in the general data before surgery between the two groups (p > 0.05); the BIS reduction in the VS group was significantly greater than that in the NVS group at 1 min, 2 min, 3 min, 4 min, and 5 min after 0.5 mg/kg propofol induction (p < 0.05). Time-frequency spectrum analysis showed the following: prominent α band energy around 10 Hz and decreased high-frequency energy in the NVS group, decreased high-frequency energy and main energy concentrated below 10 Hz in traumatic brain injury VS patients, higher energy in the 10-20 Hz band in ischemic-hypoxic VS patients. The power spectrum showed that the brain electrical energy of the NVS group was weakened R5 min after anesthesia induction compared with 5 min before induction, mainly concentrated in the small wave peak after 10 Hz, i.e., the α band peak; the energy of traumatic brain injury VS patients was weakened after anesthesia induction, but no α band peak appeared; and in ischemic-hypoxic VS patients, there was no significant change in low-frequency energy after anesthesia induction, high-frequency energy was significantly weakened, and a clear α band peak appeared slightly after 10 Hz. Three months after the operation, follow-up visits were made to the VS group patients who had undergone SCS surgery. One patient with traumatic brain injury VS was diagnosed with MCS-, one patient with ischemic-hypoxic VS had increased their CRS-R score by 1 point, and the remaining five patients had no change in their CRS scores. CONCLUSIONS: Low doses of propofol cause great differences in the EEG of different types of VS patients, which may be the unique response of damaged nerve cell residual function to propofol, and these weak responses may also be the basis of brain recovery.

Effect of cerebral oxygen saturation monitoring in patients undergoing superficial temporal anterior-middle cerebral artery anastomosis for ischemic Moyamoya disease: a prospective cohort study.

Objective: Regional cerebral oxygen saturation (rSO2) is linked with blood pressure. This study evaluated the influence of perioperative rSO2 monitoring on the prognosis of ischemic Moyamoya disease (MMD) patients undergoing anastomosis surgery. Methods: In this prospective cohort, patients with unilateral ischemic MMD of Suzuki stage ≥3 were included. The decision of rSO2 was made by the clinician and the patient. The rSO2 group maintained intraoperative rSO2 levels through the modulation of blood pressure, inhaled oxygen concentration, carbon dioxide in arterial blood, and red blood cell transfusion. The non-rSO2 group used conventional anesthesia practices. Perioperative mean arterial pressure (MAP), rSO2 values, neurological complications, and postoperative results were assessed. Results: A total of 75 eligible patients were categorized into a rSO2 monitoring group (n = 30) and a non-rSO2 monitoring group (n = 45). For the rSO2 group, the preoperative rSO2 was significantly lower on the affected side (P < 0.05). After anastomosis, this value notably increased (P = 0.01). A moderate relationship was observed between perioperative rSO2 and MAP before, during, and after surgery, with correlation coefficients (r) of 0.536, 0.502, and 0.592 (P < 0.05). Post-surgery MAP levels differed between the groups, with the rSO2 group showing decreased levels compared to pre-surgery and the non-rOS2 group displaying elevated levels. Notably, the rSO2 group reported shorter hospitalizations and decreased neurological complications. Patients with a hypertension history found postoperative MAP influencing hospital stay duration. Conclusion: Perioperative rSO2 surveillance enhanced cerebral perfusion and minimized postoperative complications in ischemic MMD patients. Thus, rSO2 monitoring is advocated for MMD patients undergoing vascular anastomosis.

Evaluation of Brain Source Localization Methods Based on Test-Retest Reliability With Multiple Session EEG Data.

OBJECTIVE: Various EEG source localization methods have been proposed for functional brain research. The evaluation and comparison of these methods are usually based on simulated data but not real EEG data, as the ground truth of source localization is unknown. In this study, we aim to evaluate source localization methods quantitatively under the real situation. METHODS: We examined the test-retest reliability of the source signals reconstructed from a public six-session EEG data of 16 subjects performing face recognition tasks by five mainstream methods, including weighted minimum norm estimation (WMN), dynamical Statistical Parametric Mapping (dSPM), Standardized LOw Resolution brain Electromagnetic TomogrAphy (sLORETA), dipole modeling and linearly constrained minimum variance (LCMV) beamformers. All methods were evaluated in terms of peak localization reliability and amplitude reliability of source signals. RESULTS: In the two brain regions responsible for static face recognition, all methods have promising peak localization reliability, with WMN showing the smallest peak dipole distance between session pairs. The spatial stability of source localization in the familiar face condition is better than those in the unfamiliar face and the scrambled face conditions in the face recognition areas in the right hemisphere. In addition, the test-retest reliability of source amplitude by all methods is good to excellent under the familiar face condition. CONCLUSION: Stable and reliable results for source localization can be obtained in the presence of evident EEG effects. Due to different levels of a priori knowledge, different source localization methods have different applicable scenarios. SIGNIFICANCE: These findings provide new evidence for the validity of source localization analysis and a new perspective for the evaluation of source localization methods on real EEG data.

Twin Growth Discordance and Risk of Postpartum Hemorrhage: A Retrospective Cohort Study.

Background: In recent years, the incidence of postpartum hemorrhage has increased globally. Multiple pregnancies and cesarean sections are well-known risk factors for postpartum hemorrhage. No studies have evaluated the associations between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section. This study aimed to identify the relationship between fetal growth anomalies and postpartum hemorrhage in women with twin pregnancies undergoing cesarean section. Methods: This retrospective single-center study included 3,180 women with twin pregnancies at a tertiary hospital between August 2013 and July 2020. Singleton reference charts were used to assess fetal growth restriction at birth. Discordant growth was defined as an intertwin birth weight difference of ≥20%. Logistic regression analyses were used to evaluate the association between fetal growth anomalies and postpartum hemorrhage. Additionally, sensitivity analysis of abnormal placenta and stratification by twin chorionicity were conducted. Results: The overall incidence of postpartum hemorrhage was 4.3%. Twin growth discordance, especially with fetal growth restriction, was associated with an increased risk of postpartum hemorrhage (adjusted odds ratio [AOR] = 1.62, 95% confidence interval [CI], 1.05-2.51, P = 0.031; AOR = 1.71; 95% CI, 1.08-2.70, P = 0.022; AOR = 1.98, 95% CI, 1.21-3.25, P = 0.006, respectively). After stratification, this relationship persisted in dichorionic twins (OR = 1.71, 95% CI, 1.04-2.82, P = 0.036; OR = 1.90, 95% CI, 1.13-3.21, P = 0.016; OR = 2.48, 95% CI, 1.41-4.38, P = 0.002, respectively). However, no significant association was observed in monochorionic twin pregnancies. Conclusion: Growth discordance, especially complicated by fetal growth restriction, was associated with an increased risk of postpartum hemorrhage in women with twin pregnancies undergoing cesarean section, and was more evident in patients with dichorionic twins.

Evaluating coagulation status with thromboelastography in a woman with antiphospholipid syndrome and sepsis: a case report.

This study presents the case of a pregnant woman with antiphospholipid syndrome (APS) who developed septic shock after labor induction. Prolonged coagulation times suggested a hypocoagulable state and contraindication to anticoagulation. Thromboelastography (TEG) similarly indicated hypocoagulation. To exclude the impact of lupus anticoagulant on the coagulation assays, a mixing test of prolonged activated partial thromboplastin times was conducted. The mixing test confirmed that prolongation of coagulation times in vitro was affected by antiphospholipid antibodies (aPL), such as lupus anticoagulant. The patient was administered human immunoglobulin and low-molecular weight heparin to neutralize antibodies and for anticoagulation, respectively. The patient's coagulation state significantly improved. Based on these findings, anesthesiologists and obstetricians should be aware that TEG might not be a reliable method of correcting coagulation parameters in patients with sepsis in the presence of aPL. If necessary, a mixing test can be performed to correctly define a patient's coagulation status.

Detection and Monitoring of Thermal Lesions Induced by Microwave Ablation Using Ultrasound Imaging and Convolutional Neural Networks.

Microwave ablation (MWA) for cancer treatment is frequently monitored by ultrasound (US) B-mode imaging in the clinic, which often fails due to the low intrinsic contrast between the thermal lesion and normal tissue. Deep learning, especially convolutional neural network (CNN), has shown significant improvements in medical image analysis. Here, we propose and evaluate an US imaging based on a CNN architecture for the detection and monitoring of thermal lesions induced by MWA in porcine livers. Unlike dealing with images in many visual object recognition tasks, US radiofrequency (RF) data backscattered from the ablated region were utilized to capture features related to the thermal lesion. The dataset comprised of 1640 US RF envelope data matrices and their corresponding gross-pathology images, and were utilized for training and testing. After envelope detection, US B-mode, segmentation results based on CNN (SICNN), and modified CNN (SIm-CNN) for US data were simultaneously reconstructed to reveal the suitability for monitoring of MWA. The SICNN and SIm-CNN outperformed B-mode images for the detection and monitoring of MWA-induced thermal lesions. The values of the area under the receiver operating characteristic curve were 0.8728 and 0.8948 for the SICNN and Sim-CNN, respectively, which were both higher than the value of 0.6904 for B-mode images. Ablated regions that were assessed using SIm-CNN showed a good correlation (J 0.8845, r 0.8739, and E 0.410) to gross-pathology images. This study was the first to illustrate that SIm-CNN has the potential to detect and monitor thermal lesions, and may be utilized as an alternative modality for image-guided MWA treatments.

Cholestatic pregnancy is associated with reduced VCAM1 expression in vascular endothelial cell of placenta.

OBJECTIVE: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific disease which is closely correlated with abnormal placental vascular formation and deficient vascular maturation. This study intends to explore the role of VCAM-1 in the vascular formation in the placenta of ICP. METHODS: Patients with ICP or healthy puerperant were respectively used as ICP group and control group. The umbilical vein endothelial cell Eahy926 was selected as in vitro cell model. Immunohistochemistry and western blot were used for analysis of protein expression. MRNA expression was assayed by real time-PCR and the cell viability was detected by the MTT method. Cell proliferation and cell apoptosis were probed by the flow cytometer. Luciferase report assay was used for the interaction analysis between the microRNA and the 3'UTR of gene VCAM-1. RESULTS: Immunohistochemistry indicated that the expression of VCAM-1 was reduced in the ICP group compared to that in control group. The cell culture and cell behavior assays indicated that the TCA (Taurocholic acid) could reduce the expression of gene VCAM-1 and inhibit the cell proliferation and enhance the cell apoptosis. In order to probe its reduction mechanism, the potential microRNAs were detected and gene VCAM-1 was confirmed to be the target of miR-590-3p by western blot and luciferase report assays. CONCLUSIONS: The expression pattern of gene VCAM-1 was suppressed by TCA through miR-590-3p, which participated in the regulation of cell growth, cell proliferation and cell apoptosis.