Neuro-Restorative Effect of Nimodipine and Calcitriol in 1-Methyl 4-Phenyl 1,2,3,6 Tetrahydropyridine-Induced Zebrafish Parkinson's Disease Model.

Objective: Parkinson's disease (PD) is one of the most prevalent neurodegenerative diseases, characterized by the loss of dopaminergic neurons in the substantia nigra pars compacta. The treatment of PD aims to alleviate motor symptoms by replacing the reduced endogenous dopamine. Currently, there are no disease-modifying agents for the treatment of PD. Zebrafish (Danio rerio) have emerged as an effective tool for new drug discovery and screening in the age of translational research. The neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) is known to cause a similar loss of dopaminergic neurons in the human midbrain, with corresponding Parkinsonian symptoms. L-type calcium channels (LTCCs) have been implicated in the generation of mitochondrial oxidative stress, which underlies the pathogenesis of Parkinson's disease. Therefore, we investigated the neuro-restorative effect of LTCC inhibition in an MPTP-induced zebrafish PD model and suggested a possible drug candidate that might modify the progression of PD. Methods: All experiments were conducted using a line of transgenic zebrafish, Tg (dat:EGFP), in which green fluorescent protein (GFP) is expressed in dopaminergic neurons. The experimental groups were exposed to 500µã– MPTP from 1 to 3 days post fertilization (dpf). The drug candidates: Levodopa 1m㏖, Nifedipine 10µã–, Nimodipine 3.5 µã–, Diethylstilbestrol 0.3 µã–, Luteolin 100 µã–, Cacitriol 0.25 µã– were exposed from 3 to 5 dpf. Locomotor activity was assessed by automated tracking and dopaminergic neurons were visualized in vivo by confocal microscopy. Results: Levodopa, Nimodipine, Diethylstilbestrol, and Calcitriol had significant positive effects on the restoration of motor behavior, which was damaged by MPTP. Nimodipine and Calcitriol have significant positive effects on the restoration of dopaminergic neurons, which were reduced by MPTP. Through locomotor analysis and dopaminergic neuron quantification, we identified the neuro-restorative effects of Nimodipine and Calcitriol in Zebrafish MPTP-induced PD model. Conclusion: The present study identified the neuro-restorative effects of nimodipine and calcitriol in an MPTP-induced zebrafish model of Parkinson's disease. They restored dopaminergic neurons which were damaged due to the effects of MPTP and normalized the locomotor activity. LTCCs have potential pathological roles in neurodevelopmental and neurodegenerative disorders. Zebrafish are highly amenable to high-throughput drug screening and might, therefore, be a useful tool to work towards the identification of disease-modifying treatment for PD. Further studies including zebrafish genetic models to elucidate the mechanism of action of the disease-modifying candidate by investigating Ca2+ influx and mitochondrial function in dopaminergic neurons, are needed to reveal the pathogenesis of PD and develop disease-modifying treatments for PD.

Cluster-Disjoint Multipath Routing Protocol for Real-Time and Reliable Packet Transmission in Wireless Sensor Networks.

Multipath routing protocol, which is one of the typical schemes to improve end-to-end transmission success ratio in Wireless Sensor Networks (WSNs), exploits two or more paths. However, collisions and interference might occur when each path is adjacent. To prevent this problem, they construct node- or link-disjointed paths. Although the paths could prevent the above-mentioned problem, it still has an issue in the area of time delay. To exploit the disjointed paths, pre-path construction is required. In addition, a lot of time is incurred to recover the whole path when the part of the path is damaged. This phenomenon adversely affects the end-to-end transmission success ratio and transmission time. To alleviate this problem, we propose a cluster-disjoint multipath routing protocol. The proposed scheme divides the whole network into grid clusters of a certain size in the network initialization phase. Each sensor could transmit packets through the pre-constructed cluster structure without the path construction phase. Also, even if any node fails, it could be easily replaced by other nodes within the cluster region. The simulation results show that the proposed scheme has an advantage in terms of transmission delay and end-to-end transmission success ratio compared to existing multipath routing protocols.

Morbidity and Mortality Trends in Preterm Infants of <32 Weeks Gestational Age with Severe Intraventricular Hemorrhage : A 14-Year Single-Center Retrospective Study.

OBJECTIVE: Owing to advances in critical care treatment, the overall survival rate of preterm infants born at a gestational age (GA) <32 weeks has consistently improved. However, the incidence of severe intraventricular hemorrhage (IVH) has persisted, and there are few reports on in-hospital morbidity and mortality. Therefore, the aim of the present study was to investigate trends surrounding in-hospital morbidity and mortality of preterm infants with severe IVH over a 14-year period. METHODS: This single-center retrospective study included 620 infants born at a GA <32 weeks, admitted between January 2007 and December 2020. After applying exclusion criteria, 596 patients were included in this study. Infants were grouped based on the most severe IVH grade documented on brain ultrasonography during their admission, with grades 3 and 4 defined as severe. We compared in-hospital mortality and clinical outcomes of preterm infants with severe IVH for two time periods : 2007-2013 (phase I) and 2014-2020 (phase II). Baseline characteristics of infants who died and survived during hospitalization were analyzed. RESULTS: A total of 54 infants (9.0%) were diagnosed with severe IVH over a 14-year period; overall in-hospital mortality rate was 29.6%. Late in-hospital mortality rate (>7 days after birth) for infants with severe IVH significantly improved over time, decreasing from 39.1% in phase I to 14.3% in phase II (p=0.043). A history of hypotension treated with vasoactive medication within 1 week after birth (adjusted odds ratio, 7.39; p=0.025) was found to be an independent risk factor for mortality. When comparing major morbidities of surviving infants, those in phase II were significantly more likely to have undergone surgery for necrotizing enterocolitis (NEC) (29.2% vs. 0.0%; p=0.027). Additionally, rates of late-onset sepsis (45.8% vs. 14.3%; p=0.049) and central nervous system infection (25.0% vs. 0.0%; p=0.049) were significantly higher in phase II survivors than in phase I survivors. CONCLUSION: In-hospital mortality in preterm infants with severe IVH decreased over the last decade, whereas major neonatal morbidities increased, particularly surgical NEC and sepsis. This study suggests the importance of multidisciplinary specialized medical and surgical neonatal intensive care in preterm infants with severe IVH.

K-Means Clustering-Based Safety System in Large-Scale Industrial Site Using Industrial Wireless Sensor Networks.

A large number of workers and heavy equipment are used in most industrial sizes, and the prevention of safety accidents is one of the most important issues. Therefore, although a number of systems have been proposed to prevent accidents, existing studies assume that workers are gathered in some areas. These assumptions are not suitable for large-scale industrial sites in which workers form as a group and work in a large area. In other words, in a large-scale industrial site, existing schemes are unsuitable for the timely notifying of warnings of threats, and excessive energy is consumed. Therefore, we propose a k-means clustering-based safety system for a large-scale industrial site. In the proposed scheme, workers deployed over a large area are divided into an appropriate number of groups, and threat notification is delivered by a multicasting tree toward each cluster. The notification to workers is delivered through local flooding in each cluster. The simulation results show that the system is able to deliver the notification within a valid time, and it is energy efficient compared to the existing scheme.

Pediatric Minor Traumatic Brain Injury : Growing Skull Fracture, Traumatic Cerebrospinal Fluid Leakage, Concussion.

Traumatic brain injury (TBI) is a major public health issue that causes significant morbidity and mortality in the pediatric population. Pediatric minor TBIs are the most common and are widely underreported because not all patients seek medical attention. The specific management of these patients is distinct from that of adult patients because of the different physiologies in these age groups. This article focuses on minor TBIs, particularly growing skull fractures, traumatic cerebrospinal fluid leakage, and concussion.

Predictive Factors of Surgical Site Infection Following Cranioplasty: A Study Including 3D Printed Implants.

In patients who have undergone decompressive craniectomy (DC), subsequent cranioplasty is required to reconstruct cranial defects. Surgical site infection (SSI) following cranioplasty is a devastating complication that can lead to cranioplasty failure. The aim of the present study, therefore, was to identify predictive factors for SSI following cranioplasty by reviewing procedures performed over a 10-year period. A retrospective analysis was performed for all patients who underwent cranioplasty following DC between 2010 and 2020 at a single institution. The patients were divided into two groups, non-SSI and SSI, in order to identify clinical variables that are significantly correlated with SSI following cranioplasty. Cox proportional hazards regression analyses were then performed to identify predictive factors associated with SSI following cranioplasty. A total of 172 patients who underwent cranioplasty, including 48 who received customized three-dimensional (3D) printed implants, were enrolled in the present study. SSI occurred in 17 patients (9.9%). Statistically significant differences were detected between the non-SSI and SSI groups with respect to presence of fluid collections on CT scans before and after cranioplasty. Presence of fluid collections on computed tomography (CT) scan before (p = 0.0114) and after cranioplasty (p < 0.0000) showed significant association with event-free survival rate for SSI. In a univariate analysis, significant predictors for SSI were fluid collection before (p = 0.0172) and after (p < 0.0001) cranioplasty. In a multivariate analysis, only the presence of fluid collection after cranioplasty was significantly associated with the occurrence of SSI (p < 0.0001). The present study investigated predictive factors that may help identify patients at risk of SSI following cranioplasty and provide guidelines associated with the procedure. Based on the results of the present study, only the presence of fluid collection on CT scan after cranioplasty was significantly associated with the occurrence of SSI. Further investigation with long-term follow-up and large-scale prospective studies are needed to confirm our conclusions.

Energy-Efficient and Reliable Face-Routing Scheme in Wireless Networks.

Face-routing is one of the reliable recovery schemes when geographic routing fails to transmit data packets. Although studies on face-routing can overcome the failure of the data transmission, they lead to much energy consumption due to frequent data transmissions between adjacent nodes for carrying out the rule of face-routing. To avoid the frequent data transmissions, several face-routing schemes have been recently proposed to transmit data packets to the farthest-neighbor node. However, they happen with many data retransmissions because the farthest-neighbor node has a relatively low transmission success ratio. To solve this problem, we propose a new face-routing scheme that determines the most appropriate neighbor node to balance the trade-off between energy efficiency and transmission reliability with two viewpoints. The first viewpoint focuses on how to increase the distance progress of the data delivery in one-hop range to enhance energy efficiency. After that, the second viewpoint focuses on how to increase the success ratio of the data delivery to enhance the transmission reliability. As a result of the simulation, it was confirmed that the proposed method achieves better performance in terms of energy efficiency than existing face-routing research, and it is better than recent face-routing research in terms of reliability and retransmission.

A Hierarchical Routing Graph for Supporting Mobile Devices in Industrial Wireless Sensor Networks.

As many industrial applications require real-time and reliability communication, a variety of routing graph construction schemes were proposed to satisfy the requirements in Industrial Wireless Sensor Networks (IWSNs). Each device transmits packet through a route which is designated based on the graph. However, as existing studies consider a network consists of static devices only, they cannot cope with the network changes by movement of mobile devices considered important in the recent industrial environment. Thus, the communication requirements cannot be guaranteed because the existing path is broken by the varying network topology. The communication failure could cause critical problems such as malfunctioning equipment. The problem is caused repeatedly by continuous movement of mobile devices, even if a new graph is reconstructed for responding the changed topology. To support mobile devices exploited in various industrial environments, we propose a Hierarchical Routing Graph Construction (HRGC). The HRGC is consisted of two phases for hierarchical graph construction: In first phase, a robust graph called skeleton graph consisting only of static devices is constructed. The skeleton graph is not affected by network topology changes and does not suffer from packet loss. In second phase, the mobile devices are grafted into the skeleton graph for seamless communication. Through the grafting process, the routes are established in advance for mobile device to communicate with nearby static devices in anywhere. The simulation results show that the packet delivery ratio is improved when the graph is constructed through the HRGC.

Color Doppler ultrasonography for predicting the patency of anastomosis after superficial temporal to middle cerebral artery bypass surgery.

BACKGROUND: Color Doppler ultrasonography (CDUS) is used to evaluate the surgical success and postoperative hemodynamic changes of patients who receive superficial temporal to middle cerebral artery (STA-MCA) bypass surgery. Previous studies enrolled small populations, and difficulties interpreting the results have limited their use in clinical settings. OBJECTIVE: We attempted to determine the feasibility of using CDUS to evaluate STA hemodynamics and identify the most reliable parameter as a new clinical implication for determining bypass patency. METHOD: Twenty-six patients who underwent STA-MCA bypass surgery were prospectively enrolled. Four times CDUS and two times digital subtraction angiography (DSA) were performed. The CDUS parameters were compensated using the ratio of the operated to the non-operated sides (R1) and compared before and after surgery (R2). The CDUS parameters are then compared with the patency on DSA by statistical analyses. RESULTS: Increased CDUS parameters of the mean flow rate (MFR) and cross-sectional diameter (CSD) showed significant correlations with good patency on DSA. The R2 at 1 month was identified as the most reliable parameter for predicting the patency in both MFR and CSD. Their cutoff values were 1.475 and 1.15, respectively. CONCLUSION: CDUS can be utilized for predicting the patency after STA-MCA bypass surgery; if the postoperative (compensated and compared) CDUS parameters increased by more than 47.5% in the MFR or 15% in the CSD, the patency of the anastomosis on DSA would be good.

An Energy Efficient Sink Location Service for Continuous Objects in Wireless Sensor Networks.

In wireless sensor networks (WSNs), detection and report of continuous object, such as forest fire and toxic gas leakage, is one of the major applications. In large-scale continuous object tracking in WSNs, there might be many source nodes simultaneously, detecting the continuous object. Each nodes reports its data to both a base station and mobile workers in the industry field. For communication between the source nodes and a mobile worker, sink location service is needed to continuously notify the location of the mobile worker. But, as the application has a large number of sources, it causes a waste of energy consumption. To address this issue, in this paper, we propose a two-phase sink location service scheme. In the first phase, the proposed scheme constructs a virtual grid structure for merging the source nodes. Then, the proposed scheme aggregates the merging points from an originated merging point as the second phase. Simulation results show that the proposed scheme is superior to other schemes in terms of energy consumption.

Adaptive Real-Time Routing Protocol for (m,k)-Firm in Industrial Wireless Multimedia Sensor Networks.

Many applications are able to obtain enriched information by employing a wireless multimedia sensor network (WMSN) in industrial environments, which consists of nodes that are capable of processing multimedia data. However, as many aspects of WMSNs still need to be refined, this remains a potential research area. An efficient application needs the ability to capture and store the latest information about an object or event, which requires real-time multimedia data to be delivered to the sink timely. Motivated to achieve this goal, we developed a new adaptive QoS routing protocol based on the (m,k)-firm model. The proposed model processes captured information by employing a multimedia stream in the (m,k)-firm format. In addition, the model includes a new adaptive real-time protocol and traffic handling scheme to transmit event information by selecting the next hop according to the flow status as well as the requirement of the (m,k)-firm model. Different from the previous approach, two level adjustment in routing protocol and traffic management are able to increase the number of successful packets within the deadline as well as path setup schemes along the previous route is able to reduce the packet loss until a new path is established. Our simulation results demonstrate that the proposed schemes are able to improve the stream dynamic success ratio and network lifetime compared to previous work by meeting the requirement of the (m,k)-firm model regardless of the amount of traffic.

Paraspinal muscle changes after single-level posterior lumbar fusion: volumetric analyses and literature review.

BACKGROUND: Posterior lumbar fusion is a widely accepted surgical technique; however, it has been related to the possibility of paraspinal muscle atrophy after surgery. We investigated 1-year postoperative changes in paraspinal muscle volume using a simple formula applicable to magnetic resonance imaging (MRI) or computed tomography (CT) images. METHODS: Patients with degenerative lumbar spinal stenosis who underwent posterior interbody fusion (PLIF) at the L4/5 level in the period from May 2010 to June 2017 were enrolled in this study. Radiologic parameters were measured using MRI or CT images which were taken before surgery and at 1 year after surgery. The volume of the paraspinal muscles was calculated using a simple formula which was derived from the formula for calculating the volume of truncated elliptic cones. RESULTS: A total of 40 patients were included; 24 were analyzed using MRI and 16 were analyzed using CT. The mean age of the patients was 59.6 ± 12.1 years and 32 (80.5%) were female. When comparing the preoperative and 1-year-postoperative images, multifidus muscle (MF) reduction was consistently observed in the MRI and CT groups, right and left (p = 0.003, p < 0.001, p = 0.005 and p < 0.001, respectively). In the erector spinae (ES) group, decrease in muscle volume was observed in the right-sided muscles of the CT group (p < 0.001), but no significant change was observed in the MRI group. The psoas muscle showed no significant change after 1 year. Conversely, regression analysis showed a negative correlation between MF muscle volume loss and age in the MRI group (right and left, p = 0.002 and p = 0.015, respectively), that is, the younger the age, the greater loss of muscle mass. CONCLUSION: After the posterior lumbar fusion, the volume of the MF muscles was markedly decreased, and the degree of decrease was apparent in the MRI. The volume of the ES muscles, which are located relatively laterally, also tended to decrease at 1 year after surgery.

Opportunistic Multipath Routing in Long-Hop Wireless Sensor Networks.

To improve the packet delivery ratio in wireless sensor networks, many approaches such as multipath, opportunistic, and learning-based routing protocols have been proposed. However, the performance of the existing protocols are degraded under long-hop wireless sensor networks because the additional overhead is proportional to the number of hops. To deal with the overhead, we propose an opportunistic multipath routing that forecasts the required number of paths, as well as bifurcation based on opportunistic routing according to the reliability requirement. In the proposed scheme, an intermediate node is able to select a different node for each transmission and to handle path failure adaptively. Through a performance evaluation, we demonstrate that the proposed scheme achieves a higher packet delivery ratio and reduces the energy consumption by at least approximately 33% and up to approximately 65% compared with existing routing protocols, under the condition of an 80% link success ratio in the long-hop sensor network.

Human Induced Pluripotent Stem Cells : Clinical Significance and Applications in Neurologic Diseases.

The generation of human induced pluripotent stem cells (iPSCs) from somatic cells using gene transfer opens new areas for precision medicine with personalized cell therapy and encourages the discovery of essential platforms for targeted drug development. iPSCs retain the genome of the donor, may regenerate indefinitely, and undergo differentiation into virtually any cell type of interest using a range of published protocols. There has been enormous interest among researchers regarding the application of iPSC technology to regenerative medicine and human disease modeling, in particular, modeling of neurologic diseases using patient-specific iPSCs. For instance, Parkinson's disease, Alzheimer's disease, and spinal cord injuries may be treated with iPSC therapy or replacement tissues obtained from iPSCs. In this review, we discuss the work so far on generation and characterization of iPSCs and focus on recent advances in the use of human iPSCs in clinical setting.

Segmental Motion of the Cervical Spine After Total Disc Replacement Using ActivC Versus Discectomy and Fusion Using Stand-alone Cage.

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) has been a widely accepted procedure for the treatment of cervical disc diseases. However, due to several reports regarding postfusion exacerbation of adjacent segments, a motion-preserving prosthesis was developed. In the present retrospective analysis, total disc replacement (TDR) using ActivC (Aesculap AG, Tuttlingen, Germany) was compared with ACDF using a stand-alone cage. METHODS: Among patients diagnosed with cervical disc diseases, those who received either ACDF or TDR at a single level between C3 and C7 from January 2010 to December 2015 were reviewed. Clinical outcomes were assessed using the visual analogue scale for arm and neck pain and the neck disability index. Clinical scales, lateral neutral, and flexion-extension radiographs were taken for all patients preoperatively and 2 months, 6 months, 1 year, and 2 years postoperatively. Global lordosis, C2-C7 Sagittal vertical axis, and T1 slope were measured on lateral neutral radiographs. The segmental range of motion (ROM) of the operated level, cranial adjacent level, and caudal adjacent level were defined as the difference between Cobb angles on flexion-extension lateral radiographs. RESULTS: A total of 53 patients (mean age 48.5 years) were reviewed. Thirty patients were treated with ACDF and the remaining 23 patients received TDR. At the 2-year follow-up, the segmental ROM of operated level was significantly preserved in the TDR group compared with the ACDF group (P = 0.007). Conversely, no significant differences in the ROM at the adjacent segments were observed between the TDR and ACDF groups (P > 0.05). The clinical outcome was excellent in both ACDF and TDR groups and was maintained until the 2-year follow-up. CONCLUSIONS: In the present study, TDR using ActivC showed successful motion preservation at the operated level and equivalent results were observed with ACDF based on clinical and radiologic results.

Posterior circulation involvement and collateral flow pattern in moyamoya disease with the RNF213 polymorphism.

PURPOSE: Moyamoya disease is a chronic cerebrovascular disorder characterized by progressive stenosis of the circle of Willis with a compensatory collateral vessel network. Recent studies have identified the ring finger protein 213 gene (RNF213) as the unique susceptibility gene for moyamoya disease. The purpose of this study was to compare clinical features of moyamoya disease, especially angiographic findings, between patients with and without the RNF213 mutation. METHODS: Blood samples from 35 patients with moyamoya disease were obtained between May 2016 and May 2017. Information on age at the time of diagnosis, sex, and initial symptom were obtained via retrospective chart review. Angiographic records were evaluated. RESULTS: RNF213 variants were detected in the 28 of 35 patients (80%), including all pediatric patients (100%) and 18 of 25 adult patients (72%) in our cohort. Leptomeningeal collateral flow from posterior to anterior circulation was more frequent in the RNF213-negative group than in the RNF213-positive group (100% versus 38.9%; p = 0.020). Posterior cerebral arterial territorial involvement was more frequently observed in RNF213-positive patients than in RNF213-negative patients (50% versus 0%; p = 0.027). CONCLUSIONS: RNF213 may play a significant role in the development of collateral anastomoses.

S100ß, Matrix Metalloproteinase-9, D-dimer, and Heat Shock Protein 70 Are Serologic Biomarkers of Acute Cerebral Infarction in a Mouse Model of Transient MCA Occlusion.

OBJECTIVE: Diagnosing acute cerebral infarction is crucial in determining prognosis of stroke patients. Although many serologic tests for prompt diagnosis are available, the clinical application of serologic tests is currently limited. We investigated whether S100ß, matrix metalloproteinase-9 (MMP-9), D-dimer, and heat shock protein 70 (HSP70) can be used as biomarkers for acute cerebral infarction. METHODS: Focal cerebral ischemia was induced using the modified intraluminal filament technique. Mice were randomly assigned to 30-minute occlusion (n=10), 60-minute occlusion (n=10), or sham (n=5) groups. Four hours later, neurological deficits were evaluated and blood samples were obtained. Infarction volumes were calculated and plasma S100ß, MMP-9, D-dimer, and HSP70 levels were measured using enzyme-linked immunosorbent assay. RESULTS: The average infarction volume was 12.32±2.31 mm3 and 46.9±7.43 mm3 in the 30- and 60-minute groups, respectively. The mean neurological score in the two ischemic groups was 1.6±0.55 and 3.2±0.70, respectively. S100ß, MMP-9, and HSP70 expressions significantly increased after 4 hours of ischemia (p=0.001). Furthermore, S100ß and MMP-9 expressions correlated with infarction volumes (p<0.001) and neurological deficits (p<0.001). There was no significant difference in D-dimer expression between groups (p=0.843). The area under the receiver operating characteristic curve (AUC) showed high sensitivity and specificity for MMP-9, HSP70 (AUC=1), and S100ß (AUC=0.98). CONCLUSION: S100ß, MMP-9, and HSP70 can complement current diagnostic tools to assess cerebral infarction, suggesting their use as potential biomarkers for acute cerebral infarction.

The Potential of Diffusion-Weighted Magnetic Resonance Imaging for Predicting the Outcomes of Chronic Subdural Hematomas.

OBJECTIVE: Diffusion-weighted magnetic resonance imaging (DW-MRI) has proven useful in the study of the natural history of ischemic stroke. However, the potential of DW-MRI for the evaluation of chronic subdural hematoma (CSDH) has not been established. In this study, we investigated DW-MRI findings of CSDH and evaluated the impact of the image findings on postoperative outcomes of CSDH. METHODS: We studied 131 CSDH patients who had undergone single burr hole drainage surgery. The images of the subdural hematomas on preoperative DW-MRI and computed tomography (CT) were divided into three groups based on their signal intensity and density: 1) homogeneous (iso or low) density on CT and homogeneous low signal intensity on DW-MRI; 2) homogeneous (iso or low) density on CT and mixed signal intensity on DW-MRI; and 3) heterogeneous density on CT and mixed signal intensity on DW-MRI. On the basis of postoperative CT, we also divided the patients into 3 groups of surgical outcomes according to residual hematoma and mass effect. RESULTS: Analysis showed statistically significant differences in surgical (A to B: p<0.001, A to C: p<0.001, B to C: p=0.129) and functional (A to B: p=0.039, A to C: p<0.001, B to C: p=0.108) outcomes and treatment failure rates (A to B: p=0.037, A to C: p=0.03, B to C: p=1) between the study groups. In particular, group B and group C showed worse outcomes and higher treatment failure rates than group A. CONCLUSION: CSDH with homogeneous density on CT was characterized by signal intensity on DW-MRI. In CSDH patients, performing DW-MRI as well as CT helps to predict postoperative treatment failure or complications.

Analysis of the Factors Affecting Surgical Site Infection and Bone Flap Resorption after Cranioplasty with Autologous Cryopreserved Bone: The Importance of Temporalis Muscle Preservation.

AIM: To investigate the outcomes and associated complications after delayed cranioplasty using autologous, cryopreserved bone. MATERIAL AND METHODS: This retrospective study included 57 consecutive patients treated with cranioplasty with autologous cryopreserved bone for various conditions causing increased intracranial pressure due to brain swelling. The incidence and risk factor of surgical site infection (SSI) and bone flap resorption were analyzed. RESULTS: The SSI rate was 12.3% and the bone flap resorption rate was 24.0%. There were statistically significant differences in SSI rate in relation to time from craniectomy to cranioplasty (p=0.002) and previous temporalis muscle resection (p=0.021). These factors were also independently associated with surgical site infection (time from craniectomy to cranioplasty: OR 0.901, 95% CI 0.826?0.982, p=0.018; previous temporalis muscle resection: OR 11.607, 95% CI 1.155?116.590, p=0.037). There was also a statistically significant difference in the bone flap resorption rate in relation to previous temporalis muscle resection (p=0.001). This factor was associated with bone flap resorption (OR 11.667, 95% CI 2.276?59.798, p=0.003). CONCLUSION: The risk of these complications particularly increased after previous temporalis muscle resection. Based on this finding, we believe that preservation of the temporalis muscle may help to decrease postoperative complications after autologous cranioplasty.