[Neurointensive Care:Managing Intracranial Hypertension and Cerebral Herniation].

In order to optimize neurological outcomes in patients presenting with elevated intracranial pressure, secondary cerebral insults during therapeutic interventions should be prevented and mitigated. Considering the absence of a singular, definitive monitoring parameter, the diverse facets of its pathophysiology-encompassing the Monroe-Kellie doctrine, brain compliance, and cerebral metabolism-should be understood. Multimodality monitoring, which incorporates physiological indicators of intracranial pressure sensors, electroencephalograms, and ultrasound, can be assessed in an integrative manner. These assessments subsequently inform surgical and intensive care strategies, often guided by structured protocols, such as a stepwise approach. This comprehensive paradigm, central to neurocritical care, may significantly enhance the neurological prognosis of patients.

Optical sectioning robotic microscopy for everyone: the structured illumination microscope with the OpenFlexure stages.

We report on the 3D-printed structured illumination microscope (SIM) with optical sectioning capability. Optically sectioned images are obtained by projecting a single-spatial-frequency grid pattern onto the specimen and recording three images with the grid pattern at different spatial phases, and then post-processing with simple mathematics. For the precise actuation of the grid for the structured illumination and the positioning of the sample, stages of the open-sourced, 3D-printable OpenFlexure families, which are capable of highly precise positioning control of tens of nanometers based on the flexure mechanism of the flexible plastics, are utilized. Our system has optical sectioning strength of a few microns, which is equivalent to that achievable with the confocal microscopes. The operation of our system can be automated with the Raspberry Pi and can be remotely operated from a PC via a wireless local area network.

[Surgical Results of Lumbar Degenerative Disease with Foot Drop].

Drop foot is associated with various diseases, such as peripheral nerve disease, lumbar degenerative disease, metabolic disease, and endocrine disease. Among lumbar degenerative diseases, lumbar disc herniation and lumbar canal stenosis are most commonly reported. We report the surgical outcomes of patients with drop foot caused by lumbar degenerative diseases. Between 2008 and 2018, we encountered 24 cases of drop foot in patients who underwent surgery of the lumbar lesion. The mean age was 69.5 years(49-88 years). Fourteen patients were male and ten were female. The mean time interval between the onset of drop foot and surgery was 51.5 days(from 7 days to 1 year). Drop foot, as a clinically significant muscle weakness, was defined at levels of manual muscle test(MMT)3 or lower. Responsible lesions for drop foot were canal stenosis at L4/5 in 8 cases, disc herniation at L4/5 in 10 cases, disc herniation at L5/S1 in 5 cases, and far-out syndrome in 1. One case involved drop foot bilaterally. Muscle weakness improved by surgery at levels of MMT 4 or greater in 16 cases(66.7%). Six cases of complete paresis or tibialis anterior muscle atrophy preoperatively resulted in no improvement;however, neuralgia was relieved in all. Twelve of 15 cases(80%)of lumbar disc herniation and 4 of 10 cases(40%)of lumbar canal stenosis resulted in improvement. Between disc herniation and canal stenosis, the surgical success rate was not statistically different. Age and the time interval between the onset and surgery were also not significant factors of the outcome. Surgical intervention seems to be beneficial even in cases of severe muscle weakness since pain relief can be expected, which leads to improvement in gait.

Mechanical Thrombectomy for Acute Ischemic Stroke Patients Aged 80 Years or Older.

BACKGROUND: There are limited data about the prognostic factors predicting outcomes after mechanical thrombectomy with stent retrievers for the elderly. Here, we evaluated outcomes in elderly patients in a real-world setting. METHODS: Between April 2015 and January 2017, 80 patients with anterior intracranial acute large vessel occlusion, who had lived independently before ictus, were treated with mechanical thrombectomy using a stent retriever at our institute. We compared outcomes between patients ≥80 years old (n = 36) and those <80 years old (n = 44), and assessed prognostic factors for favorable outcomes (modified Rankin Scale score 0-2) at 90 days in all patients. RESULTS: There was no significant difference in baseline National Institutes of Health Stroke Scale score and Alberta Stroke Program Early Computed Tomography Score between the 2 groups. Successful revascularization (modified Thrombolysis in Cerebral Infarction [mTICI] scores 2b/3) (83% versus 93%, P = .286), complete recanalization (mTICI 3) (47% versus 50%, P = .826), and favorable outcomes (42% versus 57%, P = .261) were achieved more often in those <80 years old, but differences did not reach statistical significance. Multivariate regression analysis showed that baseline National Institutes of Health Stroke Scale (P = .013) and mTICI scores of 3 (P = .006) were significant predictive factors, but being ≥80 years old and baseline Alberta Stroke Program Early Computed Tomography Score were not. In those ≥80 years old, mTICI score of 3 was an influential factor for favorable outcome (P = .017). CONCLUSIONS: Being aged 80 years or older was not a significant predictor for outcomes after mechanical thrombectomy, whereas complete recanalization was an influential predictor of outcome in the elderly.

Pitfall of left sided triple-lumen catheter for continuous renal replacement therapy: A case report.

We report a case of vascular injury caused by a multi-lumen catheter for CRRT inserted through left jugular vein. Diagnosis was delayed because CRRT could be continued. Clinicians should be aware of potential vascular complications associated with the wrong placement of multi-lumen catheters even if blood flow continues without difficulty.