Selection of Fermentation Supernatant from Probiotic Strains Exhibiting Intestinal Epithelial Barrier Protective Ability and Evaluation of Their Effects on Colitis Mouse and Weaned Piglet Models.

The intestinal epithelial barrier can prevent the invasion of pathogenic microorganisms and food antigens to maintain a consistent intestinal homeostasis. However, an imbalance in this barrier can result in various diseases, such as inflammatory bowel disease, malnutrition, and metabolic disease. Thus, the aim of this study was to select probiotic strains with epithelial barrier-enhancing ability in cell-based model and further investigate them for their improving effects on colitis mouse and weaned piglet models. The results showed that selected specific cell-free fermentation supernatants (CFSs) from Ligilactobacillus salivarius P1, Lactobacillus gasseri P12, and Limosilactobacillus reuteri G7 promoted intestinal epithelial cell growth and proliferation, strengthening the intestinal barrier in an intestinal epithelial cell line Caco-2 model. Further, the administration of CFSs of L. salivarius P1, L. gasseri P12, and L. reuteri G7 were found to ameliorate DSS-induced colitis in mice. Additionally, spray-dried powders of CFS from the three strains were examined in a weaned piglet model, only CFS powder of L. reuteri G7 could ameliorate the feed/gain ratio and serum levels of D-lactate and endotoxin. In conclusion, a new potential probiotic strain, L. reuteri G7, was selected and showed ameliorating effects in both colitis mouse and weaned piglet models.

Rathke's cleft cyst classification and outcomes after endoscopic endonasal approach.

BACKGROUND: Rathke's cleft cyst is rare, with variable characteristics and no unified categorization system. This study aimed to evaluate long-term outcomes, based on different categorizations, of symptomatic Rathke's cleft cysts treated with endoscopic endonasal approach. METHODS: This retrospective study of 38 patients with symptomatic Rathke's cleft cyst treated with endoscopic endonasal approach from 2006/06-2021/08 recorded pre- and post-operative clinical presentation, endocrine and visual tests, radiological findings, and resection status. Rathke's cleft cysts were categorized by both cyst consistency and radiological features and clinical characteristics were analyzed. RESULTS: The most common pre-operative symptoms were visual field deficit (65.8%) and hypopituitarism (39.5 %). Visual field deficit improved in 84% of affected patients, and hyperprolactinemia improved in 80% of affected patients. Pre-operative hypothyroidism and hypogonadism were associated with radiological type 3 cysts, while headache was more common in type B and C. Type 3 cysts were also associated post-operative hypogonadism and hypothyroidism. Permanent Diabetes insipidus was found in 3 patients (7.9%). Cyst height was a significant factor related to pre-operative visual field deficit and post-operative Diabetes insipidus. Residual cysts were found in 11 cases (30.6%) and 9 patients experienced regrowth/recurrence. Residual cysts were a significant factor in regrowth/recurrence. Recurrence rate and post-operative complications were not correlated with different subtypes. CONCLUSIONS: Endoscopic endonasal approach for removal of Rathke's cleft cyst is a safe and effective intervention. It leads to significant improvement in visual field deficit and recovery of hyperprolactinemia. Although the incidence of post-operative Diabetes insipidus is high, it is usually temporary. Although different categorizations are not correlated to recurrence rate, they could help predict the status of hormone deficit.

Using a continuous electrocardiographic patch with heart rhythm analysis in the subacute stage of aneurysmal subarachnoid hemorrhage: The feasibility verification.

OBJECTIVE: Continuous cardiac monitoring on patients with aneurysmal subarachnoid hemorrhage (aSAH) is difficult out of intensive care unit (ICU) in the subacute stage. Therefore, we verified the feasibility of a novel electrocardiography (ECG) patch device to record long-term heart rhythm. METHODS: The ECG patches were applied on aSAH patients during their stay in general ward. Any types of significant arrythmia were identified, and heart rate variability (HRV) measures were calculated in time and frequency domains. We analyzed the correlation between heart rhythm with Hunt and Hess scale and modified Fisher scale as well as the occurrence of secondary complications. RESULTS: Twenty-six patients used the devices on median day 6 after aSAH onset, with put on and take down time average as 137 s and 45 s, respectively. Mean record time was 221.7 h, and no adverse event presented within the period. Hunt and Hess II/III subgroup had higher percentage of HRV high frequency band than IV/V subgroup (9.1 % vs 3.5 %, p = 0.043), whereas ultra low frequency band presented more in the later subgroup (50.4 % vs 61.4 %, p = 0.035). The very low frequency percentage significantly decreased (p = 0.025) at an average of 3 days prior to the occurrence of secondary complications compared to the days without complications. CONCLUSION: For aSAH patients in general ward during subacute stage, the ECG patch is a safe and feasible tool. The correlation of long-term heart rhythm with prognosis is worthy to be investigated on larger sample size using this device in the future.

Spinal cord injury and spinal fracture in patients with ankylosing spondylitis.

BACKGROUND: Spinal cord injury (SCI) and spinal fracture are major complications in patients with ankylosing spondylitis (AS) who sustain spinal trauma. The purpose of this study was to investigate the incidence, predictors, and sequelae of spinal trauma in patients with AS. METHODS: This retrospective study included patients with AS who were admitted for spinal trauma between January 1, 2006, and June 30, 2016. The study compared clinical outcomes of patients between group 1: SCI alone, group 2: spinal fracture alone (no SCI), and group 3: both SCI and spinal fracture. RESULTS: Of the 6285 patients with AS admitted during the retrospective study period, only 105 suffered from spinal trauma and were enrolled in the study. Case number in group 1, 2, and 3 was 11(10.48%), 45(42.85%), and 49(46.67%), respectively. Among the patients with spinal fractures, 52.1% had SCI. Bamboo spine was significantly more prevalent in the fracture group than in the nonfracture group (78.7% vs. 36.4%; P = 0.006). Patients with SCI had more instances of subluxation or dislocation (48.3% vs. 8.9%; P < 0.001) and more cases of spinal epidural hematoma (SEH; 21.7% vs. 2.2%; P = 0.003) than patients without SCI. The rate of delayed diagnosis for spinal fracture was 31.4%, with one-third of patients developing delayed SCI. Among the patients with incomplete SCI, 58.3% achieved neurological improvement after treatment (P = 0.004). CONCLUSIONS: Patients with AS and bamboo spine at radiograph had a higher rate of spinal fracture, which may be an important factor in SCI in patients with AS. Spinal fractures involving the C3-C7 region, subluxation or dislocation, severe spinal fracture, and SEH were found to be predictive of SCI, and SCI in patients with AS resulted in higher mortality and complication rates.

Predictive Value of Swab Cultures for Cryopreserved Flaps During Delayed Cranioplasties.

OBJECTIVE: To assess the predictive value of swab cultures of cryopreserved skull flaps during cranioplasties for surgical site infections (SSIs). METHODS: A retrospective review was conducted of consecutive patients who underwent delayed cranioplasties with cryopreserved autografts between 2009 and 2017. The results of cultures obtained from swabs and infected surgical sites were assessed. The accuracy, sensitivity, and specificity of swab cultures for SSIs were evaluated. RESULTS: The study included 422 patients categorized into two groups, swab and nonswab, depending on whether swab cultures were implemented during cranioplasties. The overall infection rate was 7.58%. No difference was seen in infection rates between groups. There were 18 false-positive and no true-positive swab culture results. All bacteria between swab cultures and SSI cultures were discordant. Meanwhile, there were 19 false-negative swab cultures. The results showed high specificity but low sensitivity for swab cultures to predict SSI occurrence and the pathogens. CONCLUSIONS: Owing to low accuracy and sensitivity, swab cultures of cryopreserved autografts should not be routinely performed during delayed cranioplasties.

Ticagrelor versus clopidogrel in stent-assisted coil embolization of unruptured intracranial aneurysms.

BACKGROUND: Dual antiplatelet therapy is widely used for stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs) to prevent thromboembolic events (TEs). Compared to clopidogrel associated with aspirin, knowledge of the safety and efficacy of ticagrelor is lacking in large studies to date. METHODS: A retrospective cohort study was conducted from January 2016 to December 2018 with at least one year of follow-up in a single institution and systemic review. RESULTS: Altogether, 153 patients with UIA receiving SACE were separated into two groups: 113 patients receiving clopidogrel plus aspirin and 40 patients receiving ticagrelor plus aspirin. Acute in-stent thrombotic events were noted in two patients in the clopidogrel group (1.77%) and none in the ticagrelor group (0%). Additionally, one patient (0.88%) in the clopidogrel group had an early ischemic stroke (<3 months). Delayed ischemic stroke was noted in 6 patients (5.31%) in the clopidogrel group and 3 patients (7.50%) in the ticagrelor group. There were no major hemorrhagic events in either group. The two groups showed no significant differences with regard to ischemic stroke or hemorrhagic stroke. CONCLUSION: Compared to the clopidogrel based regimen, ticagrelor can also reduce TEs without increasing bleeding tendency for SACE of UIAs. Ticagrelor combined with low-dose aspirin is a safe and effective alternative option for SACE.

The surgical strategy for multilevel massive ossification of the posterior longitudinal ligaments.

Purpose: Creating enough decompression, favorable outcome, less complication, and maintain adequate lordosis and stability in the patients with cervical myelopathy due to multilevel massive ossification of the posterior longitudinal ligament (OPLL) still poses a challenge for surgeons. The aim of our study is to retrospectively evaluate our patients and try to seek a better surgical strategy. Methods: Between 2015 and 2019, 55 consecutive patients with multilevel massive OPLL underwent surgical treatment. Among these, 40 patients were treated with cervical laminectomy and then anterior decompression, fusion, and fixation (ADF), which was defined as group 1, and 15 patients were treated with cervical laminectomy and fixation simultaneously, which was defined as group 2. The patient's radiographic characteristics and postoperative outcomes were evaluated. Results: Better postoperative cervical sagittal lordosis and less long-term axial pain was achieved in group 1 (p < 0.001), though the functional outcome had no significant difference. In the multivariable analysis, anterior fixation accounts for independent factors for better cervical sagittal alignment (p < 0.001). No complications directly associated with cervical laminectomy were observed. Conclusion: In patients with cervical multilevel massive OPLL, laminectomy at compression level and then ADF depended on the severity and range of compression, but corpectomy of not more than two vertebral bodies is suggested, except K-line (+) and long-segment massive OPLL majorly involving the C2 and posterior laminectomy above and below the OPLL-affected levels with posterior fixation simultaneously.

Verification of the critical-care pain observation tool in conscious patients with hemiparesis or cognitive dysfunction.

PURPOSE: Altered cognition or hemiparesis can occur in neurocritical but conscious patients, and recognizing pain is challenging. This study aimed to test the reliability and validity of the Critical-Care Pain Observation Tool (CPOT) in this specific group. MATERIALS AND METHODS: This prospective study included ventilated, conscious patients who had certain neurologic deficits. CPOT scores were assessed before and after nociceptive (turning the patient) and non-nociceptive (measuring body temperature) procedures. The patients' self-reported pain was also recorded using a numerical rating scale (NRS). RESULTS: Sixty-three patients were enrolled. The intraclass correlation coefficient was r = 0.975-1.000 (p < 0.001) for turning the patient. Discriminant validation indicated that CPOT scores were significantly higher after turning the patient compared with measuring body temperature (p = 0.025). CPOT scores were positively correlated with NRS when turning the patient (r = 0.724, p < 0.001). After turning, the mean increase in CPOT score was lower in the patients with hemiparesis than in those without hemiparesis (p = 0.079), however it was significantly higher in the patients with cognitive dysfunction compared to those without cognitive dysfunction (p = 0.022). CONCLUSIONS: The CPOT is an appropriate instrument to assess pain in conscious patients, particularly those with cognitive dysfunction. The influence of hemiparesis on the CPOT is noteworthy.

Incidence and Factors Associated with Postoperative Delayed Hyponatremia after Transsphenoidal Pituitary Surgery: A Meta-Analysis and Systematic Review.

INTRODUCTION: Postoperative delayed hyponatremia is a complication associated with transsphenoidal pituitary surgery. Due to a wide spectrum of symptoms, the reported incidence and predictors of postoperative delayed hyponatremia vary among studies, and this deserves to be reviewed systematically. METHODS: PubMed, EMBASE, and CENTRAL databases were searched until September 1, 2020. Studies were included when (1) the event number of delayed hyponatremia after transsphenoidal pituitary surgery was reported, or (2) the associated factors of such complication were evaluated. RESULTS: A total of 27 studies were included for meta-analysis. The pooled incidence of overall and symptomatic delayed hyponatremia was 10.5% (95% confidence interval (CI) = 7.4-14.7%) and 5.0% (95% CI = 3.6-6.9%), respectively. No overt variations of the pooled estimates were observed upon subgroups stratified by endoscopic and microscopic procedure, publication year, and patients' age. In addition, 44.3% (95% CI = 29.6-60.2%) of unplanned hospital readmissions within 30 days were caused by delayed hyponatremia. Among the predictors evaluated, older age was the only significant factor associated with increased delayed hyponatremia (odds ratio = 1.16, 95% CI = 1.04-1.29, P = 0.006). CONCLUSION: This meta-analysis and systematic review evaluated the incidence of postoperative delayed hyponatremia and found it as a major cause of unplanned readmissions after transsphenoidal pituitary surgery. Older patients are more prone to such complications and should be carefully followed. The retrospective nature and heterogeneity among the included studies and the small number of studies used for risk factor evaluation might weaken the corresponding results. Future prospective clinical studies are required to compensate for these limitations.

Effectiveness of dose-escalated topiramate monotherapy and add-on therapy in neurosurgery-related epilepsy: A prospective study.

BACKGROUND: Lesional and symptomatic causes of epilepsy are the most common neurological disorders of the brain. Topiramate effectively controls newly diagnosed epilepsy and refractory focal seizures, but high-dose topiramate does not improve seizure control. This study aimed to evaluate the clinical efficacy and safety of dose-escalated topiramate as first-line monotherapy and add-on therapy in patients with neurosurgery-related epilepsy. MATERIAL AND METHODS: A total of 55 neurosurgical patients with epilepsy were divided into monotherapy and add-on therapy groups and both groups received topiramate via the dose-escalation method. The primary efficacy outcomes were seizure-free rate and seizure response rate. Adverse events and seizure frequency were recorded. RESULTS: The seizure response rate in the first month of monotherapy was significantly better than that of add-on therapy (89% vs 65%, P < .05), but no significant differences were found in seizure response rates between the 2 groups after 2 months of treatment. Both monotherapy and add-on therapy were effective in controlling seizures, with mean seizure frequency of 0.725 vs 0.536 and seizure-free rate of 88% vs 78.6%. Both treatments showed good improvement of seizure frequency in patients without tumor. The efficacy of monotherapy was better than that of add-on therapy (80% vs 29.2%) in patients with body mass index (BMI) ≤24. However, add-on therapy was better than monotherapy (76.7% vs 21.4%) in patients with BMI > 24. Dizziness (25.5%) and headache (16.4%) were the most common adverse events. No severe adverse event such as cognitive impairment was observed. CONCLUSIONS: Dose-escalated topiramate monotherapy and add-on therapy demonstrate good efficacy and safety, with fewer adverse events in seizure control in neurosurgical patients.

Occipitocervical fusion complicated with cerebellar abscess: a case report.

BACKGROUND: Occipitocervical (OC) fusion is indicated for OC instability and other conditions. Surgical complications include infection, malunion, and instrument failure. CASE PRESENTATION: We described a patient who underwent OC fusion and subsequently developed complication of cerebellar abscess and obstructive hydrocephalus. A 63-year-old male patient had been suffering from long-term neck pain and limb numbness and weakness. Cervical spine examination revealed tight stenosis at C1 level and instability in the C1-C2 joints. A C1 laminectomy with OC fusion was performed, and the patient was discharged. Unfortunately, a few days later, he went to the emergency department and complained of persistent dizziness, vomiting, and unsteady gait. Computed tomography (CT) and magnetic resonance imaging (MRI) images revealed a suspicious cerebellar abscess formation and hydrocephalus. Furthermore, CT images indicated that the left screw was loose, and the diameter of the right screw hole was much larger than the size of the screw. Besides, inappropriate length of the screw penetrated the occipital bone and may cause the disruption of dura mater. The patient underwent external ventricular drainage first, followed by abscess drainage and C1-C2 fixation a few days later. He was discharged without any further neurological deficits or infectious problems. The patient recovered with intact consciousness, full muscle strength, and improved numbness throughout the extremities, with a Nurick grade of 1. A follow-up magnetic resonance imaging at 3 months after surgery revealed near total resolution of the abscess. Inform consent was obtained from this patient. CONCLUSIONS: Carefully conducting the procedure using the most tailored approach is essential to successful surgery, but this rare complication should always be kept in mind.

Long-Term Complications of Cranioplasty Using Stored Autologous Bone Graft, Three-Dimensional Polymethyl Methacrylate, or Titanium Mesh After Decompressive Craniectomy: A Single-Center Experience After 596 Procedures.

OBJECTIVE: Cranioplasty is a technically simple procedure intended to repair defects of the skull to provide protection after craniectomy, improve functional outcomes, and restore cosmesis. Several materials have been used for the restoration of skull defects, including autologous bone grafts (AGs), polymethyl methacrylate (PMMA) flaps, and titanium mesh (T-mesh). However, the long-term results of cranioplasty after use of these materials are controversial. METHODS: Medical records of 596 patients who underwent cranioplasty at our medical center between 2009 and 2015 with at least 2.5 years of follow-up were retrospectively reviewed. Patients were classified into 3 groups according to the materials used: AG, three-dimensional PMMA, and T-mesh. Demographic and clinical characteristics and postoperative complications were analyzed. RESULTS: Cranioplasty with AG had the highest bone flap depression rate (4.9%; P = 0.02) and was associated with a 26% long-term bone flap resorption. Younger age was a risk factor for bone flap resorption. T-mesh had a higher risk of postoperative skin erosion and bone exposure (17%; P = 0.004). Patients with diabetes, previous craniotomy, or hydrocephalus showed a higher risk of postoperative skin erosion. PMMA was associated with the highest rate of postoperative infection (14.4% <3 months, 28.1% >3 months; P < 0.05), and previous craniotomy may increase the infection risk after cranioplasty with PMMA. CONCLUSIONS: Complications after cranioplasty are high, and the various types of cranioplasty materials used are associated with different complications. Surgeons need to be aware of these potential complications and should choose the appropriate material for each individual patient.

A Novel Protocol to Reduce Early Seizures After Cranioplasty: A Single-Center Experience.

BACKGROUND: Cranioplasty is a relatively simple and straightforward intervention; however, it is associated with a high incidence of postoperative seizures. Postcranioplasty seizures, especially early seizures, are common and associated with poor outcomes and longer hospital stays. Protocols for preventing and managing early seizures have not been well established. METHODS: The medical records of 595 patients who underwent cranioplasty were retrospectively reviewed. Of these patients, 259 had preexisting seizures and 336 had no seizures before cranioplasty. Prophylactic antiepileptic drugs (AEDs) were administered to patients who had no seizures before cranioplasty for 1 week, whereas an advanced AED regimen was administered to patients with preexisting seizures. Subsequently, clinical characteristics, occurrence of recurrent seizures, early seizures, and postoperative complications were analyzed. RESULTS: Our previous study showed positive results for prophylaxis in new-onset early seizures. In the patients with preexisting seizures, 46.7% of the patients (121/259) experienced recurrent seizures after cranioplasty and 17.4% of the patients (45/259) experienced early recurrent seizures within 1 week of their operation. In the group who received the advanced AEDs, early recurrent seizures were significantly reduced to 8.7% compared with the regular group (20.5%; P = 0.027). Younger age and preoperative hydrocephalus engendered a higher risk of recurrent seizures. The number of previous craniotomies was observed to have a trend of increasing early recurrent seizures. CONCLUSIONS: Cranioplasty is associated with a high incidence of postoperative seizures. Our management protocol for postcranioplasty seizures includes seizure prophylaxis and advanced use of AEDs, which can reduce the occurrence of early seizures.

Effects of porcine brain hydrolysate on impairment of cognitive learning ability in amyloid ß(1-40) -infused rats.

This study assessed whether administering porcine brain hydrolysate (PBH) ameliorates the impairment of spatial cognition learning ability in amyloid ß (Aß)-infused rats. PBH was prepared using organic solvents (i.e., acetone and ethanol). Enzyme hydrolysates were derived from these PBH and the sequence of the Aß peptide for infusion was selected. The results indicated the PBH, in particular EP (porcine brain extract with ethanol and protease N), demonstrated the potentials to reduce damage of neurodegenerative disorders in vitro and in vivo. The principal findings of this study indicate that PBH has prolyl endopeptidase inhibitory activity in vitro. Moreover, administering EP to Aß(1-40)-infused rats significantly improves their performance on reference, spatial performance, and working memory tests during water maze tasks; concurrent proportional decreases are also observed in malondialdehyde levels, acetylcholinesterase (AChE) activity, and Aß accumulation levels in brain tissues. The PBH was suggested to ameliorate learning deficits associated with Alzheimer's disease by inhibition of lipid peroxidation in the brain of Aß infused rat.

Postcranioplasty seizures following decompressive craniectomy and seizure prophylaxis: a retrospective analysis at a single institution.

OBJECTIVE: Cranioplasty is a relatively simple and less invasive intervention, but it is associated with a high incidence of postoperative seizures. The incidence of, and the risk factors for, such seizures and the effect of prophylactic antiepileptic drugs (AEDs) have not been well studied. The authors' aim was to evaluate the risk factors that predispose patients to postcranioplasty seizures and to examine the role of seizure prophylaxis in cranioplasty. METHODS: The records of patients who had undergone cranioplasty at the authors' medical center between 2009 and 2014 with at last 2 years of follow-up were retrospectively reviewed. Demographic and clinical characteristics, the occurrence of postoperative seizures, and postoperative complications were analyzed. RESULTS: Among the 583 patients eligible for inclusion in the study, 247 had preexisting seizures or used AEDs before the cranioplasty and 336 had no seizures prior to cranioplasty. Of these 336 patients, 89 (26.5%) had new-onset seizures following cranioplasty. Prophylactic AEDs were administered to 56 patients for 1 week after cranioplasty. No early seizures occurred in these patients, and this finding was statistically significant (p = 0.012). Liver cirrhosis, intraoperative blood loss, and shunt-dependent hydrocephalus were risk factors for postcranioplasty seizures in the multivariable analysis. CONCLUSIONS: Cranioplasty is associated with a high incidence of postoperative seizures. The prophylactic use of AEDs can reduce the occurrence of early seizures.

Probable pathogenesis, diagnosis, and management of untreated arteriovenous malformation with cyst formation: case report and literature review.

Arteriovenous malformations (AVMs) usually manifest as headaches, seizures, focal neurological signs, and spontaneous intracerebral or subarachnoid hemorrhages. An untreated AVM with associated cyst formation is extremely rare, and the probable pathogenesis is unclear. We propose and discuss the possible pathogenesis of this condition and its diagnosis and management. A 26-year-old male presented with a generalized tonic-clonic seizure. Computed tomography showed a cystic lesion in the left frontal lobe and magnetic resonance imaging revealed a complex composition within the lesion, without a flow-voiding signal. Therefore, the initial diagnosis was oligodendroglioma and surgical treatment was performed. However, intraoperatively, engorged reddish nodule-like vessels with a cystic capsule and intra-cyst brown and sticky fluid were found. The nodule-like vessels and cystic capsule were resected completely. The patient's postoperative course was uneventful, with an excellent neurological outcome and no further seizures. Pathological examination of the surgical specimen revealed the typical microscopic appearance of an AVM, with numerous thin-walled vascular channels and deposits of hemosiderin in fibrous tissue. In conclusion, an untreated AVM with associated cyst formation is extremely rare, and the mechanism of formation is unclear. We propose a probable pathogenesis. Preoperative diagnosis, intraoperative management, and postoperative follow-up are equally crucial in dealing with this extremely rare condition. Cystic tumors associated with arteriovenous malformations (AVMs) are uncommon and are usually a complication of stereotactic radiosurgery (Ilyas et al. in J Neurosurg. https://doi.org/10.3171/2016.12.JNS162478 , 2017) or form after a hemorrhage (Daniels et al. in Radiology 133:393-394, 1979). Untreated AVMs with large cysts or cystic tumors are rare, with only five cases reported in the literature (Table 1). Here, we present a case of an untreated AVM associated with cystic formation, or a cystic tumor, in the left frontal lobe.

Changes in the axial orientation of the zygapophyseal joint in the subaxial cervical spine from childhood to middle-age, and the biomechanical implications of these changes.

The objective of this study was to investigate the effect of age on facet orientation (FO) of the cervical spine during development, maturation, and degeneration. Computed tomography (CT) data of the cervical spine of 131 subjects without pathology of the cervical spine were analyzed. Subjects were categorized as: pediatric (n=36, 8-16years old), young adult (n=33, 18-24years old), and middle-age (n=62, 40-59years old). Serial CT scans were reconstructed by image processing. The FO in the axial plane was measured bilaterally at each vertebral level from C3/4 to C6/7. Differences in FO were analyzed between the 3 groups. The degree of external rotation of FO significantly decreased at C3/4 and C4/5 with increasing in age, and maximum external rotation was observed at C5/6. The external rotation at C6/7 increased from pediatric to young adulthood, but decreased from young adults to middle-aged adults. The dominant external rotation was seen in C4/5 and C5/6 in the pediatric age group, C5/6 and C6/7 in young adults, and C4/5 and C5/6 in middle-aged adults. These results lead us to conclude that FO in the axial plane exhibits significant differences with age. The degree of external rotation with respect to FO at each vertebral level is comparable to changes in cervical spinal dynamics with age. Hence, FO in the axial plane is a biomechanical parameter that can be used to assess changes in the cervical spinal during maturation and degeneration.

Effects of animal liver and bile extracts on biochemical values of rat ethanol-induced fatty liver.

The purposes of this study were to assess the improvement of fatty liver induced by ethanol with animal liver and bile extracts. This research aimed to increase the economic values of animal liver and bile extracts and used these to reduce damage of ethanol-induced fatty liver. Extracts came from animal liver and bile, including pig bile powder, pig liver extract, a mixture of pig bile powder and pig liver extract, chicken bile powder, chicken liver extract, and a mixture of chicken bile powder and chicken liver extract, and these were fed to Long-Evans rats. The results showed that rats fed ethanol for long terms could increase values of aspartate transaminase, cholesterol, γ-glutamy-transferase and alkaline phosphatase. Pig bile powder could decrease the values of aspartate transaminase, cholesterol and γ-glutamy-transferase. The significances also decreased on aspartate transaminase, γ-glutamy-transferase and aspartate transaminase, which were carried out with the pig liver extract treatment. These results suggest pig bile and liver extracts have high potential to improve rats' ethanol-induced fatty liver with serum biochemical parameters.

The association between use of dietary supplements and headache or migraine complaints.

PURPOSE: To examine the prevalence of headache or migraine complaints and the use of dietary supplements, and to determine their correlation according to sex. METHODS: This population-based cross-sectional study used data from a 2005 National Health Interview Survey of 15,414 participants (age 18-65 years) in Taiwan. Prevalence of headache or migraine complaints was accessed by a single question on their occurrence during the previous 3 months. Dietary supplement use was evaluated by another single question. Data were stratified by sex and analyzed using independent t-test, chi-square test, and multivariate logistic regression. RESULTS: The prevalence of headache or migraine complaints was 17.2% in males and 32.4% in females. The percentage of women taking supplements was 31.8%, which was much higher than the 15.5% of men. In male supplement users, use of isoflavones had a significantly higher odds ratio (OR) of headache or migraine complaint compared with those of male without use of isoflavones (adjusted OR = 3.86, 95% confidence interval [CI] = 1.68-8.85). In females, vitamin B complex, vitamin C, and green algae supplement use had higher likelihoods of headache or migraine complaint in comparison to those of female without use of supplements (adjusted OR = 1.28, 1.21, and 1.43; 95% CI = 1.05-1.57, 1.03-1.42, and 1.07-1.90, respectively). CONCLUSIONS: This population-based study confirmed sex-specific associations between headache or migraine complaints and the use of dietary supplements, warranting further investigation of the underlying causes.

Predictors of shunt-dependent chronic hydrocephalus after aneurysmal subarachnoid haemorrhage.

INTRODUCTION: Chronic hydrocephalus is a common complication that can occur after aneurysmal subarachnoid haemorrhage (SAH). The purpose of this study was to investigate clinical risk factors that could predict the occurrence of shunt-dependent chronic hydrocephalus after aneurysmal SAH. METHODS: Eighty-eight consecutive patients who underwent either surgery or transarterial endovascular embolization as a treatment for cerebral aneurysm within 72 h -after experiencing SAH from March 2005 to July 2006 were studied retrospectively to assess the risk factors that might predict shunt-dependent chronic hydrocephalus. Clinical and demographic factors were examined, including age, sex, initial admission mean arterial blood pressure (MABP), blood sugar level at admission, fever frequency, initial external ventricular drainage (EVD), Fisher grade, Hunt and Hess grade, intraventricular haemorrhage (IVH) and treatment methods to define predictors of shunt-dependent hydrocephalus. The length of hospital stay and modified Rankin scale recorded 6 months after SAH were also evaluated; these parameters were compared between the shunt-dependent and non-shunt-dependent groups. RESULTS: Of the 88 patients, 22 (25%) underwent shunt placement to treat their chronic hydrocephalus. The average length of hospital stay was 33.9 days for the shunt-treated group and 14 days for the non-shunt-treated group. The non-shunt-treated group scored an average of 1.05 on the modified Rankin scale compared with 2.77 for the shunt-treated group. A univariate analysis revealed that several admission variables were associated with long-term shunt-dependent hydrocephalus: (1) increased age (p = 0.023); (2) initial admission MABP (p = 0.027); (3) a high Fisher grade (p = 0.031); (4) a poor admission Hunt and Hess grade (p = 0.030); (5) the presence of IVH (p = 0.029), and (6) initial EVD (p < 0.0001). The factor most commonly associated with shunt-dependent hydrocephalus over the course of hospital days was fever frequency (p < 0.0001). CONCLUSIONS: Chronic hydrocephalus after aneurysmal SAH has a multifactorial aetiology. Understanding the risk factors that predict the occurrence of chronic hydrocephalus may help neurosurgeons to expedite permanent cerebrospinal fluid diversion, which could decrease both the cost and length of hospital stay and prevent further complications.