Subarachnoid Space Measurements in Apparently Healthy Fetuses Using MR Imaging.

BACKGROUND AND PURPOSE: The fetal subarachnoid space size serves as an indicator of normal brain development. The subarachnoid space is commonly measured by an ultrasound examination. Introduction of MR imaging for fetal brain evaluation enables standardization of MR imaging-driven subarachnoid space parameters for a more accurate evaluation. This study aimed to determine the normal range of MR imaging-derived subarachnoid space size in fetuses according to gestational age. MATERIALS AND METHODS: A cross-sectional study based on a retrospective assessment of randomly selected brain MR images of apparently healthy fetuses performed between 2012 and 2020 at a large tertiary medical center was performed. Demographic data were collected from the mothers' medical records. Subarachnoid space size was measured at 10 reference points using the axial and coronal planes. Only MR imaging scans obtained between weeks 28 and 37 of pregnancy were included. Scans with low-quality images, multiple pregnancy, and cases with intracranial pathologic findings were excluded. RESULTS: Overall, 214 apparently healthy fetuses were included (mean maternal age, 31.2 [SD, 5.4] years). Good interobserver and intraobserver agreement was observed (intraclass correlation coefficient > 0.75 for all except 1 parameter). For each gestational week, the 3rd, 15th, 50th, 85th, and 97th percentiles of each subarachnoid space measurement were described. CONCLUSIONS: MR imaging-derived subarachnoid space values at a specific gestational age provide reproducible measurements, probably due to the high resolution of MR imaging and adherence to the true radiologic planes. Normal values for brain MR imaging could provide valuable reference information for assessing brain development, thus being an important tool in the decision-making process of both clinicians and parents.

The role of tissue expansion in the treatment of atypical facial clefting.

Tissue expansion can be a valuable tool in the reconstruction of soft-tissue defects in craniofacial clefts. To our knowledge, there have been no reports in the literature of the use of tissue expanders to help solve this problem. We report the case of a child with an atypical Tessier no. 3 craniofacial cleft who had a forehead tissue expander placed, inflated, and thus used to provide sufficient local facial skin for repair of the soft-tissue defect.

[Primary cilia in cells of the epidermis and dermis]. / Primär-Zilien in Zellen der Epidermis und Dermis.

Primary cilia were detected in keratinocytes, melanocytes, pericytes, fibroblasts, histiocytes, endothelial cells, nevus cells and cells of Kaposi's disease. Their significance is not clear.

Distributed reacceleration of cosmic rays.

We develop a model in which cosmic rays, in addition to their initial acceleration by a strong shock, are continuously reaccelerated (e.g., by weak shocks) while propagating through the galaxy. The equations describing this acceleration scheme are solved analytically (approximating ionization losses by a cutoff) and numerically. Solutions for the spectra of primary and secondary cosmic rays are given in a closed analytic form, and they allow a rapid search in parameter space for viable propagation models with distributed reacceleration included. The observed boron-to-carbon ratio can be reproduced by the reacceleration theory over a range of escape parameters, some of them quite different from the standard "leaky box" model. It is also shown that even a very modest amount of reacceleration by strong shocks causes the boron-to carbon ratio to level off at sufficiently high energies, and this effect may be observed in the CRNE data. Several other curiosities in the data may be explained naturally if a modest amount of distributed reacceleration is invoked, including (a) the apparent truncation at low energy in the otherwise exponential pathlength distribution associated with the leaky box model, (b) the sub-iron isotopic anomalies and other effects noted by Silberberg et al., and (c) the discrepancy between the reported 10Be lifetime and the lifetime of cosmic rays in the dense strata of the galactic disk.

Prediction of walking function in stroke patients with initial lower extremity paralysis: the Copenhagen Stroke Study.

OBJECTIVES: The majority of stroke patients with initial leg paralysis do not regain independent walking. We characterize the minority who, despite initial leg paralysis, regained independent walking. DESIGN: Consecutive and community based. SETTING: A stroke unit receiving all stroke patients from a well-defined community. PATIENTS: A total of 859 acute stroke patients; 157 (15%) initially had leg paralysis. MAIN OUTCOME MEASURES: Scandinavian Stroke Scale (SSS) and Barthel index (BI) on admission and weekly during rehabilitation. Univariate and multivariate statistics were considered. RESULTS: Of the 157 patients with initial leg paralysis, 84 (60%) died; 73 (40%) survived. Fifteen (21%) survivors regained walking function (the walking group), and 58 (79%) did not (the nonwalking group). The BI on admission was the only factor of significant predictive value (p < .03). Mean admission BI was 50 in the walking group versus 3 in the nonwalking group (p < .001). Age, gender, lesion size, total SSS score, and comorbidity had no predictive value. Within the first week, the walking group gained 3.2 points in the SSS subscore for leg strength versus 0.5 points in the nonwalking group (p < .02). CONCLUSION: Only 10% of stroke patients with initial leg paralysis regained independent walking. In these patients, BI on admission was high and leg strength improved quickly in the first week.

Ipsilateral pushing in stroke: incidence, relation to neuropsychological symptoms, and impact on rehabilitation. The Copenhagen Stroke Study.

OBJECTIVES: A "pusher syndrome" encompassing postural imbalance and hemineglect is believed to aggravate the prognosis of stroke patients. Our aim was to determine the incidence, associated neuropsychological symptoms, and the consequences for rehabilitation of ipsilateral pushing. DESIGN: Consecutive and community-based. SETTING: A stroke unit receiving all acute stroke patients from a well-defined catchment area. All stages of rehabilitation were complete within the unit. PATIENTS: 647 acute stroke patients admitted during a 1-year period. Excluded were 320 patients who did not receive physiotherapy because they did not have pareses of the leg, had a fast remission, or died. MAIN OUTCOME MEASURES: Gain in activities of daily living (ADL) function (Barthel Index), time course of functional remission, and discharge rate to nursing home. The independent impact of ipsilateral pushing was analyzed with multiple linear and logistic regression analyses. RESULTS: Ipsilateral pushing was found in 10% of the included patients. No significant differences were found in the incidence of hemineglect and anosognosia between patients with and without ipsilateral pushing. No association with side of stroke lesion was found. Ipsilateral pushing had no independent influence on gain in ADL function or discharge rate to nursing home, but patients with ipsilateral pushing used 3.6 weeks (p < .0001) more to reach the same final outcome level than did patients without ipsilateral pushing. CONCLUSIONS: The existence of a "pusher syndrome" was not confirmed. Ipsilateral pushing did not affect functional outcome, but slowed the process of recovery considerably.