YouTube as a source of patient information on brain aneurysms: a content-quality and audience engagement analysis.

INTRODUCTION: The internet allows patients to access a vast amount of health information. We aimed to evaluate the credibility of YouTube videos that members of the public are accessing on brain aneurysms, and to evaluate what characteristics drive audience engagement. MATERIAL AND METHODS: The first 50 videos for each of the following search terms were taken for analysis: 'brain aneurysm', 'cerebral aneurysm' and 'intracranial aneurysm'. The quality of each video was evaluated by two neurosurgeons and two medical students independently using the Journal of the American Medical Association (JAMA) and the DISCERN instruments. Qualitative and quantitative video data was analysed for quality and audience engagement. Inter-rater agreement was ascertained. RESULTS: Out of a total of 150 videos, 70 met the inclusion criteria. The mean total DISCERN score was 36.5 ± 8.4 (out of 75 points), indicating that the videos were of poor quality. The mean JAMA score was 2.7 ± 0.7 (out of 4 points). Inter-rater agreement between the four raters was excellent (intraclass correlation coefficient 0.90 for DISCERN and 0.93 for JAMA). Most videos were uploaded by hospitals (50%) or educational health channels (30%). Videos had a higher number of average daily views when they included animation (P = 0.0093) and diagrams (P = 0.0422). CONCLUSIONS: YouTube is a poor source of patient information on brain aneurysms. Our quality and audience engagement analysis may help content creators (i.e. hospital staff and physicians) to create more holistic, educational and engaging medical videos concerning brain aneurysms. Physicians could usefully refer their patients to the highest quality videos that we have found.

Influence of variation in the catechol-O-methyltransferase gene on the clinical outcome after lumbar spine surgery for one-level symptomatic disc disease: a report on 176 cases.

BACKGROUND: This study was aimed at the evaluation of the relationship between genetic polymorphisms of catechol-O-methyltransferase (COMT) (rs4680:A > G-Val158Met, rs6269:A > G, rs4633:C > T, rs4818:C > G) and pain sensitivity after lumbar discectomy. METHODS: All patients had one-level symptomatic disc herniation from L3 to S1. The primary data recorded included visual analogue pain scales assessing back and leg pain, Oswestry Disability Questionnaire assessing quality of life and pain intensity, received/filled pre- and postoperatively. Each subject was genotyped for single-nucleotide polymorphism in the COMT gene. Clinical outcome was measured by difference between pre- and postoperative values and those results were analyzed with genetics findings. RESULTS: Pain intensity was associated with the COMT polymorphism. Carriers of rs6269 AA, rs4633 TT, rs4818 CC, and rs4680 AA genotypes were characterized by the lowest preoperative scores related to pain intensity and lower pain intensity at 1 year after the surgery. The rs4633 CC, rs4680 GG genotypes demonstrated significant clinical improvement in VASBACK score at 1 year after the surgery. Patients with COMT haplotype associated with low metabolic activity of enzyme (A_C_C_G) showed better clinical outcome measured by ODI score and VASBACK score 1 year after surgery. We did not observe any significant correlation between leg pain and single-nucleotide polymorphisms in the COMT gene. CONCLUSIONS: The results of our study indicate that polymorphism in the COMT gene may play an important role in the mechanism of pain perception, which may have a potential implication for clinical decision-making in the future.

The TT genotype of methylenetetrahydrofolate reductase 677C>T polymorphism increases the susceptibility to pediatric ischemic stroke: meta-analysis of the 822 cases and 1,552 controls.

The 677C>T polymorphism within methylenetetrahydrofolate reductase (MTHFR) gene is related to an elevated level of homocysteine. Thus it may be considered as a genetic risk factor in ischemic stroke. Apparently studies of this type of polymorphism in childhood stroke have shown conflicting results. We performed meta-analysis of all the data that are available in relation with MTHFR polymorphism and the risk of ischemic stroke in children. We searched PubMed (last search dated December 2010) using "MTHFR polymorphism", "ischemic stroke" "child", "children", "pediatric stroke" as keywords and reference lists of studies and reviews on the topic. Finally, 15 case-control studies corresponded to the inclusion criteria for meta-analysis. These studies involved the total number of 822 children and adolescents after ischemic stroke and 1,552 control subjects. Fixed or random effects models were used depending on the heterogeneity between the studies. The association between ischemic stroke and 677C>T polymorphism within MTHFR gene was observed in three of the studies. The pooled analysis showed that TT genotype of MTHFR gene is more common in stroke patients than in controls (p = 0.0402, odds ratio = 1.57, 95 % confidence interval 1.02-2.41). The Egger's test did not reveal presence of a publication bias. The results based on a sizeable group of cases and controls have proved that the 677C>T polymorphism in MTHFR gene is associated with the development of ischemic stroke in children.

The prevalence of the restless legs Syndrome/Willis-Ekbom disease among teenagers, its clinical characteristics and impact on everyday functioning.

BACKGROUND AND AIMS: The data on the prevalence of the Restless Legs Syndrome/Willis -Ekbom disease (RLS/WED) in the population of teenagers is scarce. The aim of this study was to determine RLS/WED occurrence in adolescents, its diagnostic accuracy, family history, clinical characteristics and impact on everyday functioning. MATERIAL AND METHODS: A group of 2379 pupils (aged 13-18 y.o.) from 6 randomly selected secondary schools in Gdansk, Poland were screened for RLS/WED with the use of a questionnaire. In order to verify the diagnosis and perform additional tests (neurological examination, psychological evaluation, biochemical blood tests, demographic questionnaire, International RLS rating scale/IRLSS, Epworth daytime sleepiness scale). all of the respondents with RLS/WED suspicion and their parents were asked for a consultation by a child neurologist. Both children and parents with RLS/WED diagnosis were tested with actigraphy at home for at least two consecutive nights. RESULTS: Two thousand and ninety seven students (88,15%) filled the questionnaire correctly (1171 girls and 926 boys, 56% and 44%). Sixty four respondents were suspected of having RLS/WED (3,1%), however, 36 of them were diagnosed as RLS/WED-mimics (mainly positional discomfort). Finally, 21 (1%) were diagnosed with definite idiopathic RLS/WED. The average age of symptom onset was 10.96 years. The severity was moderate in the most of the cases (61.9%) and the course of the disease was intermittent in all of them. Family history was positive in 80%. Abnormal actigraphy (PLMS index >5/h) was present in 80%. Blood level of ferritin was low (<50 ng/ml) in 85%. Excessive daytime sleepiness and school problems affected almost half of them. The presence of RLS/WED symptoms was associated with disrupted sleep, behavioral problems (irritability, aggression, hyperactivity), attention deficit and lowered mood. No correlation between RLS/WED and attention deficit hyperactivity disorder (ADHD), nocturnal enuresis or primary headaches was found. Thirty eight percent of the patients sought medical help, but none of them obtained proper diagnosis nor treatment of RLS/WED. CONCLUSIONS: In this study restless legs syndrome affected 1% of Polish teenagers, in the majority of cases was idiopathic and associated with positive family history. It affected sleep and everyday functioning. Neurological consultation is essential to avoid false positive diagnoses of RLS/WED in teenagers.

[Modern approach to WHO grade II glioma classification and treatment--review of the literature]. / Nowe spojrzenie na klasyfikacje i terapie nowotworów glejowych II stopnia zlosliwosci wg WHO--przeglad pismiennictwa.

Although WHO grade II gliomas are slowly growing tumours, they inevitably show local recurrence and progression to higher grade counterparts. Progressive trials become time-consuming and troublesome because of relatively long survival and multimodal therapy. Recent discoveries in molecular pathology have divided patients into subgroups with different prognosis and expected response to therapy. Development did not omit surgical techniques, in particular intraoperative imaging and electrostimulation. The aim of radiotherapy development is preservation of the surroundings of the region of interest. Chemotherapy yields promising results notably with the possibility to choose patients with the best expected response. We present the current state of knowledge regarding these neoplasms.

Factors affecting the health-related quality of life of patients with cervical dystonia and the impact of botulinum toxin type A injections.

The purpose of this study was to analyze the health-related quality of life (HRQL) of patients with cervical dystonia (CD) and the impact of botulinum toxin A (BTX-A) therapy in these patients. The authors recruited 101 patients with CD, all previously treated with BTX-A. Both before and 4 weeks after injection of BTX-A the patients were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS), a Visual Analogue Scale for pain (VAS: 0-100%), the Short Form 36 health survey questionnaire (SF-36), and the Montgomery-Asberg Depression Rating Scale (MADRS). A control group of 84 healthy volunteers was also evaluated. The patients? baseline SF-36 scores were worse in all the domains when compared with those of the controls. Depression was found in 47.5% of the patients. Improvements were noticed 4 weeks after the single BTX-A injections in all the SF-36 domains, and in the VAS, TWSTRS and MADRS scores. The TWSTRS results did not correlate with any of the SF-36 subscores. Stepwise backward regression analysis revealed depression as the main predictor of poor HRQL, as well as female sex, poor financial situation, and living alone. On contrary, longer treatment with BTX-A was associated with better scores. Cervical dystonia has a marked impact on HRQL and treatment with BTX-A injections has a beneficial effect, seen both in objective and in subjective measures. Depression in CD patients is a main predictor of worse HRQL.

[Motor cortex stimulation in the central pain syndrome]. / Stymulacja kory ruchowej w zespole bólu osrodkowego.

We present a case of a 45-year-old male, treated with motor cortex stimulation (MCS). The procedure was performed in order to decrease symptoms of the central pain syndrome (CPS), which developed seven years earlier, after a left-side, cerebellum and brainstem ischemic stroke. The syndrome is defined as pain due to primary damage or dysfunction of the central nervous system. The pain was not sensitive to pharmacological and previous surgical interventions. During four months of follow-up after surgery with the use of MCS, 20% reduction of pain (Visual Analog Scale), withdrawal of narcotic and decrease of non-narcotic medications, ability to introduce rehabilitation and improvement of sleep were observed. No side effects were noticed. The procedure of electrode implantation to motor cortex is a relatively new treatment option in refractory central and neuropathic pain syndromes. The number of described procedures does not exceed 500 worldwide. The presented case is to our knowledge the first procedure of its type in Poland, giving hope to CPS patients, whose symptoms are otherwise difficult to treat.

[The central action of botulinum toxin type A assessed by brain auditory and somatosensory evoked potentials]. / Ocena osrodkowego dzialania toksyny botulinowej typu A w badaniu sluchowych i somatosensorycznych potencjalów wywolanych u chorych z dystonia szyjna.

BACKGROUND AND PURPOSE: Botulinum toxin type A (BTX-A) acts as a neuromuscular blocker in the release of acetylcholine. Nevertheless, some clinical effects and side effects are difficult to explain only due to the peripheral mode of action. The aim of the study was to assess the central effects of BTX-A by measuring the two modalities of evoked potentials (somatosensory and brain-stem auditory). MATERIAL AND METHODS: In 23 patients (13 females, 10 males, mean age of 46, range of 25-71) with idiopathic cervical dystonia (never treated with BTX-A) brainstem auditory evoked responses (BAER) and somatosensory evoked potentials from upper extremities (SEP) were performed before and 4-6 weeks after BTX-A administration. BTX-A (Botox in 14 patients, Dysport in 9 patients) was injected into neck muscles: sternocleidomastoideus, splenius capitis, trapezius and levator scapulae. RESULTS: The authors did not find any statistically significant differences in basic parameters (latency and interlatency of I, III, V in BAER and N9, N13, N20 and P25 responses in SEP) before and after BTX-A administration. CONCLUSIONS: It seems that BTX-A does not have any direct central effect or the methods are not sensitive enough to detect them. Remote (anatomically distant) clinical effects seen by other authors or side effects may be explained by indirect mechanism due to deafferentation of stimuli from muscle spindles after BTX-A injection and thus modifying the central loops of reflexes or due to unpredictable hematogenous spread of BTX-A to distant muscles.

Loss of genetic material within 1p and 19q chromosomal arms in low grade gliomas of central nervous system.

Diffuse gliomas can constitute up to one third of all gliomas diagnosed in neurosurgical centers. Their invasive growth, progression to more malignant lesions, and the lack of standardized management guidelines render a significant clinical problem. The discovery of 1p and 19q chromosomal arms deletion in neoplastic cells will probably influence both more objective diagnosis and more accurate prediction of chemotherapy response. Defining the above mentioned deletion is becoming a standard procedure in Western European countries and in the USA when LGG is diagnosed. As a result an attempt has been made to detect deletion using fluorescence in situ hybridization and to determine its prognostic value. Genetic material from 34 grade II gliomas was examined. Separate 1p and 19q deletions were discovered in 14 and 16 cases respectively. Simultaneous occurrence of both was observed in 12. The frequency of occurrence of simultaneous deletions 1p and 19q varied based on histopathological diagnosis. This disorder was not observed in astrocytomas, in oligoastrocytomas it appeared in 50% cases. The highest incidence of deletion was noted in oligodendrogliomas and amounted to 66.7%, p < 0.005. Median survival in patients with diagnosed 1p and 19q deletion in their neoplastic cells is twice longer in comparison with patients in whom no such deletion was observed (80 months vs. 41 months, p < 0.05). Frontal location of a tumor occurred to be a statistically significant factor unfavorable for prognosis, p < 0.05. In the work presented the fluorescence in situ hybridization was successfully applied to identify deletion 1p/19q. Its incidence depends on the type of diagnosed glioma. Deletions also have prognostic significance in the test group what constitutes the basis for inclusion of determining deletion 1p/19q into diagnostic and treatment algorithm in LGGs.