Microbiome composition comparison in oral and atherosclerotic plaque from patients with and without periodontitis.

There is no conclusive evidence regarding a causal relationship between periodontitis and atherosclerosis. In this study, we examined the microbiome in the oral cavity and atheromatous plaques from atherosclerosis patients with or without periodontitis to investigate the role of oral bacteria in the formation of atheromatous plaques. We chose four patients with and without periodontitis, who had undergone carotid endarterectomy. Bacterial samples were extracted from the tongue surface, from periodontal pocket (during the oral examination), and from the atheromatous plaques (APs). We investigated the general and oral conditions from each patient and performed next-generation sequencing (NGS) analysis for all bacterial samples. There were no significant differences between both groups concerning general conditions. However, the microbiome patterns of the gingival pocket showed differences depending on the absence or presence of periodontitis, while those of the tongue surface were relatively similar. The microbiome pattern of the atheromatous plaques was entirely different from that on the tongue surface and gingival pocket, and oral bacteria were seldom detected. However, the microbiome pattern in atheromatous plaques was different in the presence or absence of periodontitis. These results suggested that oral bacteria did not affect the formation of atheromatous plaques directly.

Excellent Outcomes of Large-Volume Epidural Blood Patch Using an Intravenous Catheter in 15 Consecutive Cases with Cerebrospinal Fluid Leak.

OBJECTIVE: The effects of large-volume epidural blood patch (EBP) remain unclear in patients with cerebrospinal fluid (CSF) leak. We report excellent outcomes from 15 consecutive CSF leak cases that underwent a large-volume EBP using an intravenous catheter from a single lumbar entry point, together with outcomes from 4 patients who underwent direct surgical closure or drip-and-rest therapy during the same period. METHODS: Nineteen patients with idiopathic CSF leaks were enrolled in this study since November 2011 (12 women; mean age, 43.3 ± 14.0 years). Patient demographic data, radiologic findings, symptoms, administrated therapies, complications, and clinical courses were investigated retrospectively. RESULTS: Different types of headache were observed, including typical orthostatic headache alone (n = 10), orthostatic headache with chronic subdural hematoma (CSDH) (n = 3), and posture-unrelated headache accompanied with CSDH (n = 6). Regarding treatments, in 1 case, direct surgical closure was performed. In 15 cases, large-volume EBPs were performed, and the volume of injected blood was 44.8 ± 21.6 mL. The other 3 cases were treated by simple drip infusion regardless of the drainage for CSDH. Out of 9 cases with accompanied CSDH, recurrence of subdural hematoma was completely prevented by the application of an EBP after drainage in 5 cases and without drainage in 3 cases, and by simple intravenous drip-and-rest therapy after drainage in 1 case. Among 10 patients suffering from typical orthostatic headache alone, symptoms disappeared completely in 7 cases and were relieved in 3 cases. CONCLUSIONS: We demonstrate here a perfect control of spinal CSF leaks with the administration of a large-volume EBP through an intravenous catheter.

Seizures after intracerebral hemorrhage; risk factor, recurrence, efficacy of antiepileptic drug.

OBJECTIVE: This study aimed to determine the risk factors for recurrent post stroke seizure (PSS) and the efficacy of anti-epileptic drugs (AED) in patients having intracerebral hemorrhage (ICH) with initial seizure. METHODS/SUBJECTS: A total of 1920 consecutive patients with ICH from 2004 to 2012 were investigated retrospectively. The relationships among the baseline clinical and radiological data, administration of AED, and incidence of initial and recurrent PSS were evaluated using multiple logistic regression analysis. RESULTS: Seizures occurred in 127 (6.6%) of the 1920 patients, displaying statistically significant relationships with cortical involvement of a cerebral lesion (P<0.001), non-hypertensive ICH (P<0.001), younger age (P<0.001), and severe neurological deficits (P<0.001). Early (4.3%) and late seizure (2.3%) had no significant relationship with the development of recurrent PSS. Larger volume of hematoma was the only independent factor associated with recurrence of PSS (OR 1.03; 95% CI 1.00-1.05; P=0.027). A Kaplan Meier survival analysis revealed that AED treatment had a poor association with recurrence of PSS (P=0.750). CONCLUSIONS: Larger volume of hematoma was predictive of recurrence of PSS. AED therapy had poor association with preventing the recurrence of PSS.

[The Clinical Features of Cerebrospinal Fluid Leaks--Based on Our Experiences].

Cerebrospinal fluid (CSF) leak, which usually occurs idiopathically or traumatically as a rare situation, is a rare disease that causes orthostatic headache or idiopathic chronic subdural hematoma (CSDH). We report our therapeutic experience of consecutive 20 cases for this disease, and review the current status and problems. Consecutive 20 patients (11 women; age 44.7±12.1 years) between April, 2006 and March, 2014, who were diagnosed by MRI and/or CT myelography (CTM), were evaluated retrospectively about clinical features. The main symptoms were as follows: orthostatic headache only; 10 cases, orthostatic headache with CSDH; 6, and none-orthostatic headache accompanied with CSDH; 4. As a treatment, direct surgeries were performed in 2 cases. Epidural blood patch (EBP) was applied in 14 cases (direct surgery was performed finally in the early one case), and widespread EBP with a single lumbar entry point utilizing an intravenous catheter was performed especially in the latest 9 cases. Another 5 cases were treated simply with the administration of a drip infusion regardless of the drainage for CSDH. Of 10 cases suffering from headache only, the headache disappeared completely or it was relieved in 9 cases. Of 10 cases accompanied with CSDH, recurrence of hematoma was prevented in all cases with a drip infusion after the drainage in one case and EBP after the drainage in another 9 cases. It was certified that we could diagnose CSF leak correctly with MRI and/or CTM and control this disorder almost completely with widespread EBP utilizing an intravenous catheter.

[Clinical and radiological studies of seizure in chronic subdural hematoma--case control study].

We studied the mechanism underlying seizure induction in patients with chronic subdural hematoma. In our study population of 1,009 patients with chronic subdural hematoma, 26 (2.6%) had seizure-related complications. Six of them had already been diagnosed with epilepsy (4 patients) or suspected of having secondary epilepsy (2 patients) after experiencing traffic accidents or cerebral bleeding. Twenty patients (seizure group) had been tentatively diagnosed as having hematoma-induced convulsion. Of the remaining 989 patients without convulsion, 40 randomly sampled patients were included in the non-seizure group by matching with clinical terms. Intergroup comparisons showed that patients with dementia were more common in the seizure group than in the non-seizure group; however, no intergroup differences were observed for other clinical parameters. Radiological examinations showed that bilateral hematomas were relatively more common and sulcal hyperintensity on FLAIR MR images was significantly more frequent in the seizure group than in the non-seizure group. Interestingly, many patients presenting with sulcal hyperintensity exhibited mixed-density hematomas on CT images. These findings suggest the mechanism by which hematoma content infiltrates into the brain parenchyma and the subsequent induction of convulsions by the stimulatory component.

Ultrasonographic quantification of spinal cord and dural pulsations during cervical laminoplasty in patients with compressive myelopathy.

PURPOSE: Pulsatile movements of the dura mater have been interpreted as a sign that the cord is free within the subarachnoid space, with no extrinsic compression. However, the association between restoration of pulsation and adequate decompression of the spinal cord has not been established. The present study investigated the relationship between the extent of spinal cord decompression and spinal cord and dural pulsations based on quantitative analysis of intraoperative ultrasonography (US). METHODS: Eighty-five consecutive patients (55 males, 30 females; mean age, 64 ± 13 years) who underwent cervical double-door laminoplasty to relieve compressive myelopathy were enrolled. Spinal cord decompression status was classified as: Type 1 (non-contact), the subarachnoid space was retained on the ventral side of the cord, Type 2 (contact and apart), the cord showed both contact with and separation from the anterior element of the cervical spine, or Type 3 (contact), the cord showed continuous contact with the anterior element of the cervical spine. Spinal cord and dura mater dynamics were quantitatively analyzed using automatic video-tracking software. Furthermore, the intensity of spinal and dural pulsation was compared with the recovery of motor function at 1 year after surgery as measured by increase in the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). RESULTS: Spinal cord pulsation amplitude ranged from 0.01 to 0.84 mm (mean 0.30 ± 0.16 mm) and dural pulsation amplitude ranged from 0.01 to 0.38 mm (mean 0.14 ± 0.08 mm). Average spinal cord pulsation amplitude in Type 2 patients was significantly larger than that in the other groups, whereas, average dural pulsation amplitudes were similar for all three groups. There was a significant correlation between spinal cord and dural pulsation amplitudes in Type 1 patients, but not in Type 2 or Type 3 patients. Type 3 patients showed a particularly poor correlation between spinal cord and dural pulsations. Spinal cord pulsation amplitude was moderately correlated with the recovery of motor function evaluated by JOACMEQ. CONCLUSION: The present results suggest that restoration of dural pulsation is not an adequate indicator of sufficient decompression of the spinal cord following a surgical procedure.

Intraarterial colforsin may improve the outcome of patients with aneurysmal subarachnoid hemorrhage: a retrospective study.

OBJECTIVE: Papaverine hydrochloride (PPV) has been widely used for pharmacologic angioplasty to dilate spastic vessels after aneurysmal subarachnoid hemorrhage (SAH). Colforsin daropate hydrochloride (CDH) has also recently been reported to be useful for reversal of cerebral vasospasm (CV). In this study, we compared the impacts of intraarterial PPV and CDH on the outcomes of SAH patients. METHODS: A consecutive series of SAH patients were retrospectively analyzed. Ninety-eight and 133 patients were included in the study during 1998-1999 (group A) and 2003-2005 (group B), respectively. PPV or CDH was the only agent used for pharmacologic angioplasty in groups A and B, respectively. Good outcome was defined as a modified Rankin scale score ≤ 2 at discharge. RESULTS: The percentages of patients without CV who had good outcomes were similar in groups A (78%) and B (81%, P = 0.91). However, the percentage of patients with CV with a good outcome was significantly higher in group B (66%) than in group A (34%, P = 0.032). Logistic regression revealed that age ≤ 65 years (P = 0.0001), World Federation of Neurological Surgeons (WFNS) grade ≤ 2 (P < 0.0001), CV (P = 0.0001), and group B (P = 0.0069) were independent causative factors for good outcome in the overall patient population. Age ≤ 65 (P = 0.0002) and WFNS grade ≤ 2 (P < 0.0001) were independent causative factors for good outcome in patients without CV, whereas only group B (P = 0.0089) was an independent factor for good outcome in patients with CV. CONCLUSION: CDH appears to be associated with a better outcome in patients with SAH.

A novel extraction method of fetal electrocardiogram from the composite abdominal signal.

In contrast to the ultrasonic measurement of fetal heart motion, the fetal electrocardiogram (ECG) provides clinically significant information concerning the electrophysiological state of a fetus. In this paper, a novel method for extracting the fetal ECG from abdominal composite signals is proposed. This method consists of the cancellation of the mother's ECG and blind source separation with the reference signal (BSSR). The cancellation of the mother's ECG component was performed by subtracting the linear combination of mutually orthogonal projections of the heart vector. The BSSR is a fixed-point algorithm, the Lagrange function of which includes the higher order cross-correlation between the extracted signal and the reference signal as the cost term rather than a constraint. This realizes the convexity of the Lagrange function in a simple form, which guarantees the convergence of the algorithm. By practical application, the proposed method has been shown to be able to extract the P and T waves in addition to the R wave. The reliability and accuracy of the proposed method was confirmed by comparing the extracted signals with the directly recorded ECG at the second stage of labor. The gestational age-dependency of the physiological parameters of the extracted fetal ECG also coincided well with that of the magnetocardiogram, which proves the clinical applicability of the proposed method.