7^th Global Neurologists Annual Meeting on Neurology and Neuro Surgery August 22-24, 2016 Vienna, Austria

Biography:

Haris Huseinagić is the head of Department of radiology and nuclear medicine in University Clinical Center Tuzla Tuzla, Bosnia and Herzegovina

Abstract:

Endovascular treatment of giant basilar artery aneurysm is a complex procedure that requires the work of an experienced team and a range of materials and techniques available. Treatment of a giant aneurysm of the basilar artery in the body which includes the initial parts of both arteriae cerebelaris posterior was a special kind of technical challenges and use techniques Waffle cone. Technically it was not possible to implement the classic waffle cone technique, and made modifications to the horizontal stenting in the right artery cerebelaris posterior, and above it are set Koil, and the aneurysm successfully closed with rear patent cerebellar artery. Technical correctly written procedure with good outcome for the patient left the question of objective verification of results. Using Voronoi diagrams and indirect visualization of the 3D models of aneurysms with the analysis of the dynamics of flow (flow dynamics), an objective verification of results. Results of verification coincide with the real results to the patient. The new method of analysis of endovascular treatment has proven to be an effective model verification results

Biography:

Mirza Moranjkic is a renowned neurosurgeon of Clinical Center Tuzla Tuzla, Bosnia and Herzegovina

Abstract:

Introduction: Fusiform and some wide-neck aneurysms remained unaddressed by both reconstructive surgical and endovascular techniques until the introduction of dedicated intracranial self-expandable stent.

Aim: The aim of the current study was to review a single center experience with stent-assited aneurysm coilling.

Results: Approximately 200 endovascular procedures were performed in our department for various cerebrovascular conditions over the course of some 30 months. Of those, there were over 100 aneurysm patients, and over 50 patients were treated with stent-assisted coilling. We encountered 2 technical complications (one stent migration, and one stent dislodgment). No thromboembolic complications were noted, and none of those technical complications proved to be clinically relevant.

Conclusion: Stent-assisted aneurysm coiling is a safe and highly effective endovascular technique that provides us with means to treat aneurysms previously deemed untreatable by endovascular means.

Biography:

Biljana Milatović has completed her postgraduate Specialist academic studies in Radiology with the paper entitled “The Comparison of Digital Subtraction Angiography and Multi slice CT Angiography in the Evaluation of Intracranial Aneurysms“ and completed her PhD in neuroradiology with paper entitled as “ Predictive factors for haemorrhage in arteriovenous malformations by digital subtraction angiography and MDCT angiography of the brain”. In 2006 and 2007 she worked as a general practitioner at the Institute for the Medical Protection of Mother and Child, at the Radiology department. She started working as a general practitioner at Radiology – Neurosurgery department (Interventional Neuroradiology, MSCT neuroradiology imaging and MRI imaging) in October 2007. She has worked at the Emergency and Trauma Center since September 1st, 2009 (Diagnostic emergency neuroradiology, Ultrasound diagnostics and x-ray diagnostics). Dr. Biljana Milatović is currently working at the Clinical center of Serbia as a neuroradiologist in Center for Radiology and Magnetic resonance Imaging since February 1st, 2008. She is a member of the European Association of Radiologists since 2008.

Abstract:

Patients with brain arteriovenous malformation (AVM) have a certain risk to bleed, and the goal of this study is to examine the effect of radiological and clinical predictive characteristics of AVM hemorrhage using multidetector CT angiography (MDCT).

Material: this is a series of 57 patients with a mean age of 35.46 years, who were diagnosed at the Institute for Radiology and MRI, while the same were hospitalized at the Clinic of Neurosurgery, Clinical Center of Serbia in the period from January 2008 to March 2016. For all patients, the diagnosis was made using MDCT angiography. Two groups of patients were observed. The first group includes patients who were not initially presented by hemorrhage, while the second group was initially presented by hemorrhage. Both groups were treated with medical therapy, or a combination of medical therapy with embolization / surgery / radiotherapy.

Results: Deep venous drainage (p <0.05), the combined arterial supply from different basins (p <0.05) with a length> 60mm, venous dilation present in the drainage vein (p <0.01) and the angle of casting supply arteries in the nidus (p <0.01), carry a risk of repeated bleeding. In the group of patients who had initial hemorrhage a mean value of the sized corner casting was 130o, while the group that did not had initially bleeding mean value of the size of the measured angle was 103.81 with a standard deviation of 17.21 (p <0.01).

Conclusion: arterio-venous malformations with the deep venous drainage from the carotid and VB basin, the length of the feeding arteries> 60mm, angle of casting feeding arteries in the nidus ≥ 130 ° and dilatation and / or venous aneurysm drainage vessel are predictive model for clinical presenting by hemorrhage.

Key Words: AVM of the brain, bleeding, morphological parameters

Biography:

Abstract:

Acute ischemic stroke is a medical emergency and accounts for a worldwide mortality of 6.2 million lives each year. There has been a revolution of sorts in the endovascular management of acute ischemic stroke in the past two years. Our hospital experience in acute ischemic strokes presenting in the window period has evolved with a view to better the management outcomes of such cases. Based on intra-hospital logistics imaging in these cases has evolved from MRI & MRA to NCCT & CTA and more recently to CT based collateral scoring. The endovascular management similary has seen the use of various stentreivers and more recently the use of thromboaspiration using the ADAPT technique utilising the Penumbra system. The paper shall also cover the current evidence in the endovascular management of Acute ischmic stroke.

Biography:

Abstract:

Aortic arch plaque (AAP) is associated with stroke and is a potential embolic source. Amarenco reported an increase of recurrent stroke in patients with complex (AAP) plaques >4mm thickness compared to simple plaques. Plaque heterogeneity and mobility play a role. We developed a noninvasive method to image AAP with B-mode sonography through the supraclavicular fossa to determine whether AAP is an etiology of stroke. B-mode correlation with transesophageal echocardiography (TEE) in 37 patients showed 93.75% sensitivity, 80.95% specifiticy, 78.95% positive predictive value and 94.40% negative predictive value. In 500 consecutive patients referred for carotid duplex, the arch was visualized completely in 468, partially in 27 and not visualized in 15. Complex plaques were seen in 40 symptomatic patients and 64 asymptomatic patients, simple plaques in 131 symptomatic patients and 260 asymptomatic patients, difference not significant. Excluding patients with ipsilateral carotid stenosis and atrial fibrillation, complex plaques were seen in 24 symptomatic patients and 31 asymptomatic patients, simple plaques in 90 symptomatic patients and 188 asymptomatic patients, p = 0.075. Among patients with complex plaques, 19 heterogeneous plaques were symptomatic and 15 asymptomatic, 21 patients with homogeneous plaques were symptomatic and 46 asymptomatic p=0.037. One hundred sequential studies in 89 patients over 18 months were performed to measure a change >0.5mm. For 46 simple plaques, 77% had no growth, 10% regressed and 13% progressed. For 27 complex plaques 48% had no growth, 38% regressed and 14% progressed. Intimal thickness of AAP in 504 patients correlated linearly with presence of coronary artery disease r=0.97, p<0.001 (0-1mm 16%, 1-2mm 38%, 2-3mm 56%, 3-4mm 58%, 4-5mm 79%, 5-6mm 89%)

Conclusions: Aortic arch plaques are relatively stable. High risk aortic arch plaques are associated with heterogeneous morphology. Complex AAP are associated with generalized atherosclerosis including coronary artery disease. Sequential noninvasive imaging of AAP can have value in future studies of therapy to prevent stroke from AAP. The proposed mechanism of embolism from carotid and aortic arch plaque is plaque rupture. Ultrasound videos of carotid and aortic arch plaque rupture in acute stroke patients will be shown.

Biography:

Khaled Magdy is a fourth year medical student, has successfully participated in the course Experimental laboratory Animals "basic information & Advanced Practical Training Workshop" During the period 7th to 11th September 2014 in Medical Experimental Reserach center, Faculty of Medicine, Mansoura University. To fullfill his passion toward neuroscience he attended two conferences in neuroscience in the Mansoura University Faculty of Medicine.

Abstract:

Objective: the present study aimed to investigate the role of Cx43 and Hsp70 in PTZ induced seizures and the effects of ferulic acid on in rat model of PTZ-induced epilepsy. Methods: twenty four Sprague dawely rats were subdivided into 4 equal groups, a) normal group (normal rats), b) PTZ group: rats received PTZ at a dose of 50 mg/kg i.p. on alternate day till the animal became fully kindled, c) FA before group, rats received FA at a dose of 40 mg/kg daily via gastric gavage with PTZ on alternate day d)FA after group, rats FA at a dose of 40 mg/kg daily via gastric gavage from 6th dose of PTZ. The parameters measured were the Racine score, seizure duration and latency to develop kindling, immunohistopathological study for Cx43 and Hsp70 expression in hippocampus and hippocampal lipid peroxidation studies. Results: In this study, PTZ caused significant increase in oxidative stress marker (MDA), Cx43 expression and Hsp70 expression in hippocamal region with significant reduction in antioxidants GSH and CAT in hippocampal region. FA pretreatment significantly reduced the seizure severity and duration kindling in PTZ treated rats and exhibited a marked prolongation in the latencies to seizures. Also, FA pretreatment caused significant improvement in markers of oxidative stress, Cx43 expression and Hsp70 expression in hippocampal region. Although FA post-treatment caused significant improvement in seizure behavior and oxidative stress and HSP70, it did not cause any significant change in Cx43 compared to PTZ group. Conclusions: These findings may provide insights into the understanding of the mechanism of FA as an anti-kindling agent and could offer a useful support to the basic antiepileptic therapy in preventing the development of PTZ induced seizures, suggesting its potential for therapeutic applications in temporal lobe epilepsy.

Biography:

Dr. Gammoh has completed his PhD in Pharmacological Sciences at the age of 29 years from the University of Pavia-Italy. Currently, he is an assistant professor of pharmacology and therapeutics at the American University of Madaba. He has several publications in psychopharmacology and mental health among refugees.

Abstract:

Fibromyalgia is a chronic disorder characterized by chronic widespread pain, that could be accompanied by fatigue and sleep disturbances with higher prevalence in females. Psychological factors contribute largely to fibromyalgia. The American College of Rheumatology recommends the use of centrally acting drugs such as pregabalin and duloxetine to effectively alleviate the symptoms. Female war refugees represent a fragile population that is highly prone to psychological distress and possibly fibromyalgia. Therefore, the current study had three objectives: 1) To study fibromyalgia prevalence,2) To study fibromyalgia treatment trends and their concordance with the guidelines and 3) To study if there is a correlation between fibromyalgia severity and insomnia among female Syrian refugees residing in Jordan. A cross-sectional study design was performed, data from 384 Syrian female were analyzed from four medical centers in Jordan. The Fibromyalgia Impact Questionnaire (FIQ) was used to study fibromyalgia prevalence and symptoms severity, structured questions were designed to explore fibromyalgia pharmacotherapeutic trend, and the Insomnia Severity Index (ISI) was used to screen insomnia. The prevalence of severe fibromyalgia was about (30%), an alarming pharmacotherapeutic inconstancy with the ACR guidelines was evident and a significant correlation between fibromyalgia and insomnia was reported. This is the first article that sheds light on fibromyalgia prevalence, its current therapy and its correlation with insomnia in refugees’ settings. The early screening and raising awareness of fibromyalgia diagnosis and treatments are highly recommended among health care professionals in order to improve the quality of life and the wellbeing of this fragile population.

Biography:

Yun Zhou is Assistant Professor at the Russell H. Morgan Department of Radiology and Radiological Science, and Guest Professor of Peking University First Hospital. He obtained his M.S. in Biomathematics and Ph.D. in Biomedical Physics from University of California at Los Angeles.

Abstract:

  Brain PET is a well-established quantitative functional imaging technique to measure physiological and biochemical process. As recent advances in hybrid imaging technology, such as PET-CT and PET-MRI, for whole-body PET imaging, there are urgent needs to develop and validate technologies for quantitative whole-body PET from data acquisition to quantification. The fundamentals of quantitative PET developed in last three decades which include kinetic modeling approach and parametric imaging algorithms will be briefly reviewed. Recent developments in quantitative PET imaging on dopamine and serotonin receptors and transporters will be highlighted. Tremendous efforts have been made to extend quantitative brain or organ-specific PET to dynamic whole-body PET in last few years. We investigated the feasibility of quantitative dynamic whole-body PET via multi-bed multi-pass technology. Optimization in data acquisition and quantification were studied by both computer simulation and an ongoing multi-center multi-tracer dynamic whole-body PET project. The potentials and challenges in quantitative whole-body PET in clinical diagnosis, monitoring disease progression, responses to treatments or psychological/ pharmacological stimulations will be discussed with our promising results. 

Biography:

Abstract:

Functional Magnetic Resonance Imaging (fMRI) is a technique that takes advantage of the diferences in magnetic susceptibility between oxyhemoglobin and deoxyhemoglobin. Once the goal of neurosurgery is to maximize patient safety and to minimize residual tumor, fMRI may be an alternative, non-invasive and reproducible tool for assessing potential risk of dysfunction resulting from brain ressection near eloquente cortex. Tumoral mass effects can distort normal cortical anatomy losing anatomical landmarks. So fMRI studies with specific –tasks combines structural with physiological information and provides data helping in localizing cortex controlling language, motor, sensory, hearing and visual pathways , according to tumor region. In addition, many studies confirm the large individual variability in cortical localization of language and fmri data may aid in the determination of language laterality and localization of Wernicke’s and Broca’s areas in cases of temporo-parietal lesions. Althout fmri can show cortical signals, imaging the White matter bundle may be just as crucial. Therefore Diffusion Tensor imaging complements fMRI examinations and provides the surgeon with fiber-tracking information. In summary, fMRI data can alter a neurosurgical approach to a tumor, indicates eloquent cortex in distorted areas, guide surgical resections or even emphasize too high risk in total tumor resection in other cases. Clinical cases showing such fMRI applications and a literature review about clinical outcomes is presented.

Biography:

Abstract:

The comprehension of the inner mechanism of low back pain is hard and often the conventional diagnostic approach can’t reveal the exact cause of the disease. The functional radiologic study of the spine is not so precise, and only bone structures are directly seen. More complex conventional radiologic functional studies like myelography and stereo-radiology are invasive or obsolete and difficult to obtain; in any case the informations obtained are quite always “indirect”, since anatomical structures as discs, roots and ligaments are not visible. In last 20 years, a possible “in vivo” bio-mechanic approach in the study of the spine has been proposed with the use of devices like the Axial Loader and the Dynawell able to produce a variable axial load on the spine during CT or MR examinations on conventional diagnostic units. This allows to directly image all the anatomical structures in a precise way during a work. This lecture reviews the personal experience in the study mainly on the lumbar spine with the Axial Loader (AL) both in CT and in MR. The Axial Loader device is described together with the CT and MR acquisitions. The disc, intersomatic and articular facet changes obtained during the examinations are described with a breakdown of the classification of findings as Elementary Dynamic Modifications (EDMs) or Complex Dynamic Modifications (CDMs). From this data derived a possible functional model of the lumbar spine. A particular look will be given to the post-surgical functional evaluation of the lumbar spine. Early data from AL studies of pediatric isthmian lysis with MR will be presented. Finally a comparison with data from studies with MR units that allows real orthostatic spine studies will be attempted.

Biography:

Abstract:

Purpose: It has been shown that using variable window width and center level settings facilitates the detection of ischemic brain parenchyma in unenhanced cerebral CT (CCT) by accentuating the contrast between normal and edematous tissue. The aim of this study was to apply color-coded volume rendering to CCT datasets and assess the clinical value of the resulting volume-rendered CCT images in the detection of early infarction signs.

Method and Materials: Ethics committee at our institute approved this study. The calculated sample size was 80 patients. Unenhanced CCT datasets of 80 consecutive patients with clinical suspicion of acute stroke were retrospectively evaluated. Utilizing commercially available software, CCT images were reconstructed and a specific color was assigned to each voxel corresponding to its HU value. Two resident doctors, after completion of their neuroradiological training, evaluated source and volume-rendered CCT images. The reference standard was MRI with DWI that proved or ruled out an acute infarction. The diagnostic confidence in the presence of acute brain ischemia was scored by using a 5-point ordinal scale (1, definitely present and 5, definitely absent) and assessed with ROC analysis.

Results: All volume-rendered CCT images were of good and diagnostic image quality. On DWI, 57 hyperacute cerebral infarction foci in 43 patients were identified. Volume-rendered CCT images allowed better performance than gray-scale CT images (Az, 0.84 and 0.61, respectively) in detecting early signs of infarction. Mean sensitivity, specificity and accuracy were 79%, 86% and 81%, respectively for volume-rendered images and 53%, 86% and 59%, respectively for source images. Interobserver agreement was substantial for volume-rendered and moderate for gray-scale CT images.

Conclusion: Particularly for radiologists in training, color-coded volume-rendered CCT images may facilitate the visualization of ischemic brain parenchyma and augment its diagnostic confidence in the detection of acute stroke

Biography:

Abstract:

NCCT states a first-line diagnostic procedure for the emergency assessment of acute stroke. Although the NCCT is highly specific in differentiation of intracerebral hemorrhage from ischemia, it has a poor sensitivity in evaluation of acute ischemic stroke. Hence, computer-aided diagnosis is able to improve the performance. In 2013 we introduced a computational method for detection and localization of visible infarcts in NCCT. Herein, we aimed to evaluate and extend our method to localize a non-visible hyperacute ischemia by means of Stroke Imaging Marker (SIM). Based on the SIM and its components: ratio of percentile differences in subranges of HU distribution (P-ratio), ratio of voxels count in ranges of brain CT intensity (N-ratio), median HU attenuation value (MAV); the infarct localization was performed in 140 early and follow-up scans of 70 patients. The infarct was not visible to a radiologist or to an experienced stroke neuroradiologist in any of the early scans. The infarcted hemisphere detection rate and sensitivity of infarct localization were measured by comparing the detected region in the initial scan, with the gold standard set in respective follow-up examination. The best performance of the algorithm was found for the P-ratio including 7 percentile subranges within the range of 35th- 75th percentile. The modified SIM provided 76% ischemic hemisphere detection rate and 54% sensitivity in spatial localization of hyperacute ischemia (68% among properly detected sides). The improved SIM is a dedicated and potentially useful tool for hyperacute non-visible brain infarcts detection in NCCT and may contribute to decision to triage.

Biography:

Abstract:

Both psychoanalysis and medical models, the two theoretical empires of psychological empires of mental disorders, suffer from serious theoretical and empirical difficulties (see Rofé, 2000, 2010; Rofé & Rofé, 2013, 2015). In an attempt to resolve the theoretical confusion in this field, a new theory was proposed termed, Psycho-Bizarreness: An intuitive Rational-Choice Theory of Madness. Basically, this theory claims that when individuals are confronted with intolerable levels of current stress, they are likely to choose a mad behavior when other options, such as suicide, drug abuse, and antisocial behaviors, are unavailable or too costly. The major benefit of madness is repression, which the new theory defines in line with Freud’s (1915, p. 147) original suggestion, as distraction. The distractive effect of the mad behaviors is so strong that it blocks the accessibility of stress-related thoughts. Hence, while Freud claimed that repression causes madness, according to Psycho-Bizarreness Theory (PBT), madness results in repression. Accordingly, the choice of a specific mad behavior is determined by the same principles used in consumer decision-making when purchasing a specific economic product. Lack of awareness of the Knowledge of Self-Involvement (KSI) is induced through sophisticated information processing that causes the forgetting of KSI and enables the development of a self-deceptive belief. As already demonstrated, PBT can integrate all studies pertaining to the development and treatment of neuroses and psychos into one theoretical framework (see Rofé, 2000, 2010; Rofé & Rofé, 2013, 2015).

Biography:

Abstract:

Endoscopy and cross-sectional imaging are considered indispensible for evaluation of larynx and oral cavity.USG is undoubtedly a powerful investigative tool in head and neck pathologies. Larynx and tongue are no exception. But, when compared to cross-sectional imaging where USG does stand is the question raised and answered in this paper. It is important to follow a systematic USG technique to evaluate the larynx and the tongue. USG has accuracy of 71.4% while CT had 92.8% accuracy in assessing cancer of hypopharynx. USG has accuracy of 61%, while MRI has accuracy of 91% in assessing tongue cancer. Post cricoid extension and small PFS growth are not appreciable on USG in cases of larynx cancers, where as small intrinsic tongue muscle growths and alveolar involvement were not seen on USG in cases of tongue malignancy.USG can easily visualize vocal cord movements, pre-epiglottic space lesions and sub-mandibular duct involvement, which are relatively difficult to appreciate on cross-sectional imaging. Even though small tumors are difficult to visualize, USG can play a significant role in assessment of the tumor extension inside and outside the organ. Especially when cross-sectional imaging is unavailable, unaffordable, contraindicated and in post treatment follow up cases.

Biography:

Abstract:

Introduction: Febrile seizures (FS) are always a relevant topic; thermoregulation and febrile responses, complex processes, are important aspects of the unsolved puzzle.

Methods: Here, FS are explored from comparative “evolutionary pressure” data-sets for insights/contributing factors to age dependent vulnerability and for potential MRI data acquisition for evidence-based medicine.

Results/Discussion: Thermoregulatory responses’ evolutionary quest is for maximal performance at optimal temperature, experimentally shown for insects’/viruses’ population growth, not performance. Relying on external heat sources, ectotherms’ narrow range of performance thermal sensitivities is explained by natural selection, not thermodynamics; endotherms’, birds’/mammals’, thermally constrained set-points evolved promoting heat loss, not enhancing performance. Mammalian brains’ selective brain cooling (SBC) is a special evolutionary case within the thermal core because hyperthermia, causing febrile seizures, limits performance; SBC separates brain temperature (T) regulation independently from the body to keep Tbrain < Ttrunk, p<0.01.

Species-specific SBC mechanisms during hyperthermia promote reversing normal blood flow, from brain->skin to skin->brain, to cool/maintain constant cerebral metabolism. A 4-part venous pathway connects extracranial diploic/emissary veins with intracranial meningeal veins/sinuses; the richly vascularized/complex human diploe has an age dependent developmental pattern, fully established, age 5, large variations at each age. Primate emissary veins respond immediately to hyperthermia; their parietal/mastoid/condyloid/ post-glenoid foramina prominence shifts in an evolutionary pattern: Tarsius 0%,0%,0%,100%; Lemurs 0%,74.4%,0%,99%; orangutan 3%,81.6%, 1%,2%; chimpanzee 8.7%,14%,16.5%,0%; human 60.5%,68%,77%,0.6%. Furthermore, intrinsic brain geometry plays an important evolutionary role in thermoregulatory patterns/heat distribution. Notably, perinatal discontinuity of ontological size/ shape changes in chimps/humans at 4-6 months, p<0.0044, produces topographical changes in vascular system; an expanded human frontoparietal volume, now globular, with highest concentration of diploic/emissary veins, richly anastomosed/reticulated, affects heat dissipation. Brain surface:volume ratio values for chimps’/humans’ heat loading, 1.59 vs 0.91, respectively, confirms globular shape decreases thermic values in heat transfer.

Conclusion: In light of evolution, human ontological variations from MRI measurements may offer an option to FS’ unsolved puzzle for evidence-based medicine.

Biography:

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Biography:

Abstract:

Introduction: Burkholderia pseudomallei is a gram negative environmental bacterium found in soil and surface water which causes melioidosis, commonly reported to occur in south-east Asia and northern Australia. It is being increasingly reported in India and transmission is through inhalation, inoculation and ingestion. Two clinical forms are recognised – acute septicemic form and the chronic granulomatous form. Both these forms are recognised to affect the neuraxis and the adjacent soft tissues and bone. Involvement of these structures is rare but of importance due to the significant mortality and morbidity associated with cranio-spinal infection

Methods: 14 culture proven cases with involvement of the cranio-spinal structures were retrospectively identified between Jan 2008 and May 2016 via search of the hospital’s electronic database Involvement of the cranio-spinal structures included multiple parenchymal abscesses(5) which usually occurred in contiguity with skull osteomyelitis. Parenchymal and leptomeningeal disease was secondary to septicaemia. Pachymeningeal disease was found to be secondary to sino-nasal involvement and otomastoid infections(5). Acute myelitis (1) and spondylodiscitis (3) were the other forms seen Parenchymal involvement ranged from cerebritis, early and mature parenchymal abscess formation. Patients with fewer abscesses which were amenable to surgical evacuation had a favourable outcome compared to those who had multiple small, widespread abscesses Chronic pachymeningeal disease was invariably associated with sino-nasal, otomastoid infections or a skull osteomyelitis. Multiple cranial neuropathies were recorded in those with pachymeningitis. Local inoculation or inhalation is presumed to be the route of infection One patient who presented with longitudinally extensive transverse myelitis had received immunosuppression prior to admission and this exacerbated the progression of disease 2 patients with parenchymal abscesses and the one with myelitis succumbed to their illness

Conclusion: CNS manifestations of Burkholderia in the form of pachymeningeal disease and myelitis must be suspected in the appropriate clinical scenario as alternative imaging and clinical differentials entail therapy with immunosuppression which are detrimental

Biography:

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Biography:

Abstract:

The dyskinetic subtype of cerebral palsy is difficult to manage, and there is no established gold standard for treating the condition. External rotation of the shoulder(s) is often managed non-surgicallynonsurgically using injections of botulinum toxin A into the external rotator muscles. I present a novel surgical technique designed to for manage external rotation when botulinum toxin A treatment is not sufficient or possible. Six patients with dyskinetic cerebral palsy underwent denervation of the infraspinatus muscle and release of the posterior part of the deltoid muscle. Postoperative questionnaires were given to the patients/caregivers, and video recordings were made both pre- and postoperatively. Preoperative and postoperative Assisting Hand Assessment was possible in only 1 case. Five patients were very satisfied with their outcome. Four patients’ video recordings showed improvement in of their condition. One patient developed postoperative complications.The results indicate that denervation of the infraspinatus muscle and posterior deltoid release can be an option for patients with dyskinetic cerebral palsy to manage external rotation of the shoulder when other treatment alternatives are insufficient.

Biography:

Abstract:

Purpose: Because unusual entrance of vertebral artery into the cervical transverse foramen (UE-V2S) is relatively common anomaly in clinical field, therefore spine surgeon always have one’s eye to understand its anatomical characteristics and clinical implications. The aim of this study is to assess the above task with a very large number of UE-V2S anomaly cases.

Methods: Retrospectively, the authors analyzed 2207 three-dimensional head and neck computed tomographic angiograms (CTA) without a specific vascular abnormalities. After confirming the unusual entrance of the vertebral artery (VA) into the transverse foramen (TF), we measured its vertebral artery diameter (VAD), transverse foramen area (TFA) and pedicle width (PW) from C3 to C7, bilaterally. The shortest horizontal distance from the vertical line in the medial margin of the TF to VA (D-TFVA) were measured in extra-osseous region to estimate the exact location of extra-osseous VA, excepting C7 level.

Results: The unusual V2 entrance was observed in 11.4 % (252 patients) of all 2207 consecutive patients and 6.5 % (268 courses) of all 4414 courses. The prevalence of unilateral UE-V2S level was followed as below: E5 > E4 > E7> E3 and prevalence of bilateral UE-V2S were ordered as below: E5 (bilateral) was most prominent and E4 (right) / E5 (left) and E4 (bilateral) was followed. Generally, the VAD of the anomaly side was statistically smaller than the normal contra-lateral side, which can induce small value of TFA in all sub-axial level. Although UE-V2S can assure larger PW dimension in below adjacent level of UE-V2S, the difference value of PW between anomaly and normal side was not much in it, or insignificant in some types of UE-V2S (E4-Right and E7-both). The least value of D-TFVA was -3.8 mm in this study, which means that we should take a care not to pass exceeding 3.8mm medial to the vertical line of medial wall of TF during dissection in anterior cervical approach.

Conclusions: For avoiding unexpected VA injury or improving efficiency of cervical operation, spine surgeon should know the possible presence of UE-V2S in a routine cervical operation and understand its clinical characteristics in advance.

Keywords: Cervical spine, Vertebral artery, V2 segment, Anomalous course, CT angiography

Biography:

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Object: Frame-based image-guided system is the most widely used for stereotactic brain biopsy. Recently frameless stereotactic biopsy techniques have become utilized. We evaluated the application usefulness of skull-mounted frameless image-guided stereotactic brain biopsy system.

Methods: We reviewed consecutive 10 patients using skull-mounted frameless image-guided stereotactic brain biopsy system compared to patients using conventional frame-based system. We evaluated the usability and the advantage of both systems.

Results: To set up frameless system needed less invasive procedure and shortened surgical time in comparison to frame-based system. In many cases frame-based system required the drilling of the external table and the diploe of calvaria to insert the biopsy needle away from the skull. Consequently large skin incision were made. On the other hand there is a limit of insertion angle in the frameless system. In one case flame-less system could not be used due to this limitation.

Conclusion: With regard to less invasiveness and shortening of the surgical time, skull-mounted frameless image-guided stereotactic brain biopsy system may represent more efficient means of biopsy though there is a limitation of biopsy needle insertion angle.

Biography:

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Background: Dehydration is associated with poor outcome after acute ischemic stroke. However, the relationship between hydration therapy during acute ischemic stroke and clinical outcome remains unclear. Our study aimed to determine whether providing hydration therapy to patients with a blood urea nitrogen/creatinine (BUN/Cr) ratio ≥15 improves their clinical outcome.

Methods: A non-blinded, phase II single arm prospective study of patients with acute ischemic stroke and BUN/Cr ratio ≥15 was conducted from January 2011 to December 2013, with historical controls from November 2007 to June 2010. The hydration group received intravenous bolus (300–500 mL) saline followed by maintenance saline infusion (40–80 mL/h for the first 72 h), while the control group received maintenance saline infusion (40–60 mL/h for the first 24 h and 0–60 mL/h for 24–72 h). The study endpoint was the proportion of patients with favorable outcome, defined as modified Rankin scale (mRS) ≤ 2 at 3 months post stroke.

Results: Overall, 237 patients were enrolled (hydration group, n = 134; control group, n = 103). The median volume of infused saline from day 1 to day 3 was significantly larger (P < 0.001) and the rate of favorable outcome at 3 months post stroke was significantly higher (P =0.016) in the hydration group. Dividing acute ischemic stroke into lacunar and non-lacunar subtypes, the difference was significant only in the lacunar stroke subtype (P=0.020). Conclusion: Thus, providing saline hydration therapy to patients with acute ischemic stroke based on BUN/Cr ratio can significantly increase the rate of favorable clinical outcome with functional independence at 3 months post stroke.

Biography:

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Background: Brain tumors can present to the emergency department for many causes. It is unusual for those patients to need emergency tumor resection surgery. One of the exceptions is patients with markedly increased ICP secondary to the tumor mass.

Objective: To define an international guideline for the indications of urgent surgical resection of brain tumors according to inclusion criteria.

Methods: A prospective analysis for twenty patients who undergone urgent brain tumor resection surgery at Neurosurgery Teaching Hospital –Baghdad-Iraq was conducted from October 2014 to February 2016. The variables assessed for each case is gender, age, GCS score (pre and post-op.), functional deficit (pre and post-op.), Brain CT-scan criteria for each tumor, medical therapy trial in hours and the histopathological data.

Results: Analysis for the 20 urgently operated cases is done. According to this analysis the female gender is 55%, the mean age is 43 year (SD 16.056), the mean pre-op GCS score is 9, 19 brain tumors is supratentorial and 1 brain tumor is infratentorial, For supratentorial tumors 11 tumors is in the right hemisphere, the tumors are 55% intra-axial, 45% extra-axial, the lobes affected are temporal (11 patient) then parietal (5 patient), others (3 patients), hemorrhagic tumor is found in 20%, the minimum midline shift in brain CT scan is 1 cm (mean 1.79 cm), the mean tumor size is 5.5 cm in maximum diameter, medical therapy is tried for a minimum of 2 hours (mean 3.50 hours), the histopathological data as follows meningioma (9 patients), glioma (6 patients 4 of those are glioblastoma multiforme), metastasis (5 patients), post-op GCS score is 15 (except 1 case GCS score 14), the paired test for pre and post-op GCS score shows strongly significant improvement (P value > 0.01), ), the paired test for pre and post-op functional deterioration shows strongly significant improvement (P value > 0.01).

Conclusion: From the study result we suggest the following inclusion criteria as indication guideline for urgent brain tumor resection surgery. The selected patient for surgery must fulfill all the following criteria: (1) Acute neurological deterioration [life-threatening decrease in GCS or functional deterioration (motor or visual function)]. (2) Significant midline shift in Brain CT-scan ( < 1cm). (3) The response to medical therapy trial to decrease ICP is either unexpected or failed. (4) The tumor mass is the main cause of deterioration: (A) Strong indication: tumor size maximum diameter > 4 cm or tumors that involve or compress the temporal lobe. (B) Relative Indication: hemorrhagic tumors.

Abbreviations: GCS= Glascow Coma scale, CT=Computerized Tomography.

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Abstract:

Background: Despite the signs of involvement of autonomic nervous system (ANS) in the pathomechanism of migraine, the significance of dysfunction was not fully explained. One of the parameters serving to establish a balance of both ANS parts is relation of low frequency (LF) to high frequency (HF) spectrum of heart rate variability (HRV), LF/HF ratio. HF reflects parasympathetic activity, whereas LF both sympathetic and parasympathetic activity as well as respiratory rhythm.

Aims: The aims of the study was to establish LF and HF ratio in children with migraine with aura, during rest as well as during passive tilting and also during active standing. Prospective research, approved by Bioethical Commission of Jagiellonian University, KBET/188/B/2011.

Material and methods: The examination was performed in 86 children with migraine during a headache-free period and in 32 children without headaches and syncope, constituting an age-matched control group. HRV was evaluated during rest, during a 10- min 70 degrees head-up passive tilting and during 3-min active standing test, using Task Force Monitor 3030i/3040i. Results: In 47 children with migraine with aura head-up tilt test was negative for syncope. Postural orthostatic tachycardia syndrome (POTS) was diagnosed in 4/24 children with migraine with sensory aura, as well as in 1/39 children with migraine without aura. In 2/39 children with migraine without aura and in 2 controls head-up tilt-induced syncope occurred. Results of LF/HF ratio did not differ between groups with migraine with aura and controls, but they were significantly higher in group of 24 children with migraine with sensory aura during passive tilting. Active standing did not reveal differences of LF/HF ratio between any groups.

Conclusions: Predominance of sympathetic nervous system activity during passive head-up tilt test, as well as more common POTS in patients with migraine with sensory aura as compared with children with migraine with visual aura and healthy volunteers indicate differential autonomic reactivity. False positive result of passive tilting in healthy children may suggest a higher risk of syncope. In spite of poor orthostatic tolerance reported by patients with migraine, active standing did not reveal differences between migraine patients and healthy volunteers

Biography:

Abstract:

In our previous study on mindfulness-based stress reduction, we found an entrainment of electronic activities of brain and heart. In this study, we aimed to further identify the specific brain region which plays an important role in modulating heart beat. Sixteen participants with experience in chanting Amitofo Buddha were recruited in this emotion-related study. Fearful/neutral pictures from international affective pictures system were shown in a block-designed functional MRI (fMRI) study. Participants were asked to (1) chant Amitofo Buddha or (2) chant Santa Claus, or (3) remain silent when viewing the pictures. Physiological data like heart beat, skin conductance etc. were also recorded. FMRI data were analyzed by SPM8 and physiological data were analyzed by EEGlab. The results showed that responds of brain regions to fearful pictures were most intensive in bilateral fusiform gyri, left inferior parietal lobe, and the frontal lobe, among these regions only the activities in the fusiform gyri were significantly correlated with the heart rate. Moreover, such significant correlation only exists under condition (2) & (3), but not under condition (1) stated above. We also note that significant difference of heart beat between viewing fearful and viewing neutral pictures was found only under conditions (2) & (3). In conclusion, this analysis suggests that chanting Amitofo can reduce the emotional response to fearful events, and the correlation of fusiform brain activity and heart beat is most significant than other brain regions. This gives credit that central nervous system can interact with peripheral autonomic nerve system in emotional events.

Biography:

Abstract:

Research is a corner stone for the development of medicine. Good Medical practice is not only based on evidence, skills, knowledge and technology but also on good values and ethics in medical practice and medical research(i.e. value-based medicine). Value Based medicine is concerning about patient’s rights, Patient’s family rights, researcher’s rights and animal rights among other related subjects to ensure the best and safest ethical approach to every step in medical practice and research and to enhance the best benefit for the patients. Many scholars and philosophers recently studied the medical ethics (Bioethics) as solid science to highlight the ethics of medical practice and research and suggest the different and necessary ethical codes either on medical practice or in medical research.

The main pillars of good neurosurgical and neurology practice are based on 1, knowledge, 2. Skills and 3. Technology all these three basic elements should be integrated for the interest of the patient in a clear vision to provide that patients with state of art treatment and to create strategy to achieve this aim and draw plans in order to obtain and maintain such uncompromised goal. The vision and strategy and the medical practice should be performed within a rigid frame of values and ethics. Therefore, it is quite important to include medical ethics as one of the main subjects of different CME and training programs. The trainees should be encouraged to know about the ethics as science and art.

Medical ethics may be come under this chapter and it is based on such main ethical principles:

1.Autonomy; regarding the right of patients to choose methods of the management of their medical problem or to refuse it- (Voluntas aegroti suprema lex.).

2.Beneficence; To determine that the physician or surgeon must consider patient’s benefit as his solo goal for his relationship with patient - (Salus aegroti suprema lex.).

3.Non-maleficence: clearly means “first, do no harm” (primum non nocere).

4.Justice: concerns the application of justice , fairness and equality by all means to every patient. Every patient has the right to receive the best possible and avoidable medical care.

5.Dignity: it goes in both ways ; patient and his treating medical staff should be treated by respect and their dignity is preserved always.

6.Truthfulness and honesty: the relationship between a patient and his treating physician or surgeon should be based on honest and truthfulness.

Biography:

Abstract:

Background: Patients with chronic pain have mostly additional psychiatric diseases especially depression. The aim of this study is to determine a relation between depression and back aches.

Methods: We conducted a study between January 2015 and November 2015 at Shifa International Hospital, Islamabad that included 165 adult patient’s ≥20 years of both genders having back pain. Visual Analogue Scale (VAS) and Beck Depression Inventory (BDI) scores were calculated.

Results: 112/165(67.8%) females were more prone to backache with depression than males 53/165 (32.2%).Younger age group had more backache complains associated depression as compared to older groups i.e. 21-35 years had 47/67(70.1%) and 36-50 years had 50/71(70.4%) depression. On visual analogue scale 19/165 (11.5%) patients had mild, 111/165(67.2%) patients had moderate and 36/165(21.8%) patients had severe back pains. Beck depression inventory scores showed 21/165(12.1%) normal, 23/165 (13.9%) mild, 165(3%) borderline, 43/165(26%) moderate, 41/165(24.8%) severe, 32/165(19.3%) extreme depression as depicted in table 3. There was statistically significant correlation between severity of backache and severity of depression (P <0.003).

Conclusion: Depression is major co morbidity in patients with backache and should be recognized early to get an optimal response to treatment.

Key Words: Backache, Depression

Abbreviations: VAS=Visual Analogue Scale, BDI= Beck Depression Inventory

Biography:

Sima gul Ghasemi, 25 years and she is studying medicine in Mashhad University of Medical Sciences, Iran. She has published 3 papers in neuropharmacology specially in Dementia. She is member of Pharmacological Research Center of Medicinal Plants, Neurogenic Inflammation and neurocognitive Research Center, School of Medicine,Mashhad University of Medical Sciences.

Abstract:

Alzheimer’s disease (AD) as the most common form of dementia is an age-related neurodegenerative disease.It is characterized by a progressive loss of memory and decline of comprehensive cognition. Hypnotic, analgesic, anticonvulsant, and antioxidant effects of Rosa damascena have been reported. This study, investigated the effect of R. damascena hydroalcoholic extract on memory performance in a scopolamine-induced memory impairment model.

The rats were divided into control group received saline; scopolamine.treatment groups were daily treated by 50 and 250 mg/ kg of R. damascena extract and were finally injected by scopolamine before each trial in Morris water maze. The brains were removed for biochemical measurements.Time latency and path length in the scopolamine group were higher than control (P < 0.01 to<0.001). Both treatment groups showed shorter traveled distance and time latency compared with scopolamine group. Time spent in target quadrant by scopolamine group was lower than control, while Sco + Ext 250 group spent longer time in target quadrant than scopolamine group .MDA concentrations in hippocampal and cortical tissues of scopolamine group were higher, while thiol concentrations were lower than control ones. Treatment by both doses of the extract decreased the MDA concentration, while increased the thiol concentration.The results showed that the hydroalcoholic extract of R. damascena prevents scopolamine-induced memory deficits. This finding suggests that memory improvement may be in part due to the antioxidant effects.

Keywords: Memory, Morris water maze, Rosa damascena, Oxidative damage, Scopolamine

Biography:

Abstract:

Although antiepileptic therapy implies constant daily medication there is a lack of the animal model that examines consequences of continuous usage of VPA during gestation on the offspring development, with the accent on VPA doses that do not induce physical anomalies of progeny. Our study was aimed to elucidate consequences of continuous maternal exposure to VPA (50, 100, 200 and 400 mg/kg/day) on early physical and neuromotor development of the offspring (postnatal days (PND) 5-15, NMRI mice). It is well known the remarkable similarities between human and rodent motor development, i.e. immaturity at birth and rostro-caudal gradient of motor maturation. The offspring was tested in the tail suspension test (TST) at PND 5, 10 and 15. The quantitative and qualitative evaluation of the animals’ behavior in the TST was assessed. The latency to the first immobilization in TST was measured and the maturational profile was assessed in all VPA-exposed groups. Our findings showed for the first time that there are symptomatic similarities in early postnatal development between the offspring continuously exposed to different doses of VPA during intrauterine development, i.e. delayed somatic development was accompanied with postponed rostrocaudal gradient of motor system maturation and affected muscle tone. Long-lasting functional consequences of prenatal exposure to VPA are of importance, but early motor development should not be neglected since it is could be an indication of difficulties in later psychomotor activities. Subsequent assessment is important to discriminate between subjects with motor disorders and those that develop slowly but typically.

Biography:

Abstract:

Stroke is a major complication of coronary artery bypass surgery (CABG), ranging from 1.3% to 4.5%, with a higher rate in diabetic patients of up to 5.2%. This detracts from the overall superiority of CABG over percutaneous coronary intervention (PCI) in patients with multiple complex coronary lesions. In the Syntax Trial, the overall rate of stroke was 2.2% for CABG and 0.6% for PCI, with 9 of 33 strokes occurring within 30 days of the procedure for CABG and 2/20 for PCI, with no difference in delayed stroke after thirty days. However, 3 of the 9 perioperative strokes occurred prior to the bypass surgery and were included in the intention to treat analysis. In the FREEDOM Trial with a population confined to diabetic patients, the incidence of stroke was 5.2% for CABG and 2.4% for PCI, with 16/37 CABG strokes within 30 days and 3/22 PCI strokes within thirty days, but no difference in delayed stroke after thirty days. The only pre-procedural risk factors significantly associated with perioperative stroke were history of arrhythmia 8/59 13.6% p<0.05 and warfarin use at baseline 8 (13.6%) p<0.05. These results suggest that perioperative stroke during CABG is related to withdrawal of antithrombotic therapy for stroke prophylaxis. This may provide an opportunity for prevention of stroke during coronary bypass surgery.

Biography:

Abstract:

Subjective: We describe our surgical strategy for craniopharyngioma using hybrid surgery of microscope and neuroendoscope.

Materials and methods: Ninety one patients with cranipahrynigoma were treated our Hospital (38 patients operated by only microscope from 1974 to 2000, 53 patients operated by hybrid surgery using microscope and endoscope from 2011 to 2012). We analyzed recurrence rate of only microscopic surgery (1974-2000) vs. hybrid surgery.

Result: Samii’s grade of 91 patients was as follows; Grade I-1, II-16, III-37, IV-31, V-6. Expedient surgical approaches were 40 pterional/subfrontal, 30 interhemispheric, 16 transshenoidal approaches, so on. Eight (21%) in 38 patients were recognized tumor recurrence from 1974 to 2000 by only microscopic surgery. On the other hand, 5 (9.4%) in 53 patients recognized tumor recurrence from 2001 to 2012 operated by hybrid surgery using microscope and neuroendoscope. Advantage of hybrid surgery is as follows; wide and clear view, fit to deep-seated tumors, ordinary instruments can use, microscopic surgical education to junior Neurosurgeon can do, and residual tumor of dead space for example under optic chiasm by hybrid surgery. On the other hand, disadvantage of this surgery is as follows; 2D, special practice is needed, narrow space, adhesion, ossified tumor, or vascular tumor.

Biography:

Abstract:

Recently, we proposed and theoretically substantiated the hypothesis, which offers new approaches to treating neurodegenerative diseases of the retina and brain (Zueva, 2015). For the first time, we suggested that the impact of visual environmental cues of complex spatiotemporal structure on a person throughout his life is necessary for normal development and aging of the brain and visual system. The theory sets the link between the complexity of neural connections, nonlinear dynamics of physiological processes in the brain and the nonlinear characteristics of sensory cues. The loss in the complexity of neural networks in the retina and the brain develops in such socially relevant neurodegenerative diseases as glaucoma, diabetic retinopathy, Alzheimer’s disease, Parkinson’s disease, etc. The necessity of maintaining and strengthening of mental abilities in extreme situations and normal aging is a separate social and medical problem. The idea is to improve the scheme of neural circuits and brain’s function in normal and neurodegenerative diseases by nonlinear visual and other sensory stimuli with complex temporal structure through the reactivation of the brain plasticity. We can expect that the development of innovative non-drug technologies of impact on brain plasticity and definition of ways to manage this process will contribute to a more efficient recovery of neuronal contacts, cognitive functions, and overall functionality in patients with neurodegenerative disorders and amblyopia. The creation of devices for nonlinear sensory stimulation and the detection of mechanisms of its impact on the brain are crucial for therapeutic strategies, which can underlay of future breakthrough technologies.

Biography:

Abstract:

The method of neuronal activity topography (NAT) is a complex and harmonic theory by fourier transform. However, it seems to be very far away from understanding and interpreting all images on NAT, because NAT consists of 210 submarkers referring to 10 frequency components ranging from 4 to 20 Hz. Furthermore, there are some limitations for using the 210-dimensional NAT spaces for clinical application, 1) EEG at rest have been implicated in some functions of a Default Mode Network (DMN), not Central-Executive Network (CEN), 2) frequency range for NAT include low frequency range (θ, α, β band), not high frequency range (γ band), 3) reliability of NAT depends on the quality of the EEG databases of central nervous system (CNS) diseases.

Recently, to visualize 210-dimensional NAT spaces at a glance, we develop a visualization application called a NAT print, which is similar to fingerprint. This E-poster showed that we could classified two geometrical and symmetrical patterns in the 52 normal subjects comprised 28 men and 24 women aging 71.9 ± 5.9 years, group 1 (dominant alpha and beta rhythm in occipital-temporal regions), or group 2 (dominant frontal midline theta rhythm in frontal regions). The sensitivity-versus-specificity characteristics were assessed with NAT and were compared between the two groups, showing that separation of the group 1 and group 2 was made with a sensitivity of 78%, as well as a false-positive rate of 22%. In future, we would like to elucidate a relationship between geometric diversity on NAT print and several CNS disorders.

Biography:

Abstract:

Sulcus arteria vertebralis is the groove that is located on first cervical vertebra (atlas) where vertebral artery passes over the posterior arch of atlas to reach the foramen magnum. An abnormal bridge between the posterior part of the superior articular process and posterolateral part of the posterior arch of the atlas is a common variation detected by radiographies of the patients. This bony bridge is called as ponticulus posticus or a variant of Kimmerle’s anomaly. Its prevalance has been reported to be between 5.14-37.83%. This common variation may be a possible cause of the ischemia in posterior circulation and headache. This study aimed to determine and analyse the existence of ponticulus posticus and correlate the dimensions of the vertebral artery with its prevalance with a retrospective analysis of 600 CT angiographies (1mm sections) of Department of Radiology, University Hospital of Hacettepe. We have detected a complete ponticulus posticus in 12.10% of the patients and 27.38% of them were bilateral. Right and left sided post-sulcus arterial dimensions were found to be lesser then the pre-sulcus dimensions with the incomplet ponticulus posticus existence. Variations of the sulcus arterial vertebralis is a commonly studied variation among different nations. This study will be a preliminary analysis for the clinical problems like headache, vascular diseases and surgical interventions of atlas.

Biography:

Abstract:

Fibromyalgia is a chronic disorder characterized by chronic widespread pain, that could be accompanied by fatigue and sleep disturbances with higher prevalence in females. Psychological factors contribute largely to fibromyalgia. The American College of Rheumatology recommends the use of centrally acting drugs such as pregabalin and duloxetine to effectively alleviate the symptoms. Female war refugees represent a fragile population that is highly prone to psychological distress and possibly fibromyalgia. Therefore, the current study had three objectives: 1) To study fibromyalgia prevalence,2) To study fibromyalgia treatment trends and their concordance with the guidelines and 3) To study if there is a correlation between fibromyalgia severity and insomnia among female Syrian refugees residing in Jordan. A cross-sectional study design was performed, data from 384 Syrian female were analyzed from four medical centers in Jordan. The Fibromyalgia Impact Questionnaire (FIQ) was used to study fibromyalgia prevalence and symptoms severity, structured questions were designed to explore fibromyalgia pharmacotherapeutic trend, and the Insomnia Severity Index (ISI) was used to screen insomnia. The prevalence of severe fibromyalgia was about (30%), an alarming pharmacotherapeutic inconstancy with the ACR guidelines was evident and a significant correlation between fibromyalgia and insomnia was reported. This is the first article that sheds light on fibromyalgia prevalence, its current therapy and its correlation with insomnia in refugees’ settings. The early screening and raising awareness of fibromyalgia diagnosis and treatments are highly recommended among health care professionals in order to improve the quality of life and the wellbeing of this fragile population

Biography:

Abstract:

Introduction: Neuro-oncology is the study of brain and spinal cord neoplasms, many of which are life threatening. Brain imaging relying almost exclusively on MRI has been impressive in detecting early abnormalities in the brain, tumor types and grade. However, extremely small neoplasms (at early stages) are very difficult to detect. In addition to this, interpretation of disease response and progression in comparison to actual effects of tumor treatment has been quite poor. In order to address this problem, we have developed a computational method for differentiating normal brain tissues from abnormalities.

Results: A wolfram Mathematica program is developed according to Eqn(2) with which experimentally determined T1,T2 could be used for obtaining My maps. The GUI is shown in Fig.1 while the results for several brain tissues are shown in Fig.2.

Conclusion: The computer program was able to show contrasts between normal/abnormal brain tissues when the sizes are just few microns. This is particularly important in not only tumor diagnosis but also monitoring of patient response after treatment. Another advantage of this study is that diagnosis/treatment monitoring could be done without risking health deterioration due constant administration of chemotherapeutic drugs; ie, the simulation could be run as many times as required until best treatment plans are decided based on the results.

Biography:

Sarah Crawford received the Master’s Degree in Biochemistry from Princeton University in 1982 and a Ph.D. Degree from the Department of Biochemistry and Biophysics, Columbia University College of Physicians and Surgeons in 1987. I have been affiliated with Southern Connecticut State University for over 20 years, currently Full Professor in the Department of Biology where I teach Genetics and Medical Genetics, and direct a research laboratory in cancer biology. In 2013 I was awarded a patent by the US Patent Office for a novel cancer treatment for the brain cancer, glioblastoma.

Abstract:

The Quantitative Threshold Exposure (QTE) hypothesis is a multifactorial threshold model that accounts for the cumulative effects of risk factor exposure in both the causation of autism spectrum disorder (ASD) and its dramatic increase over the past 30 years. The QTE hypothesis proposes that ASD is triggered by the cumulative effects of high-level exposure to endogenous and environmental factors that act as antigens to impair normal immune system (IS) and associated central nervous system (CNS) functions during critical developmental stages. The quantitative threshold parameters that comprise a cumulative risk for the development of ASD are identified by the assessment of documented epidemiological factors that, in sum, determine the likelihood that ASD will occur as a result of their effects on critically integrated IS and CNS pathways active during prenatal, neo-natal and early childhood brain maturation. The model proposes an explanation for the relationship between critical developmental stages of brain/immune system development in conjunction with the quantitative effects of genetic and environmental risk factors that may interface with these critical developmental windows. This model may be useful even when the individual contributions of specific risk factors cannot be quantified, as it proposes that the combined quantitative level of exposure to risk factors for ASD rather than exposure to any one risk factor per se defines threshold occurrence rates.

Biography:

Czeslawa Kowal completed her PhD in the Institute of Organic Chemistry of the Polish Academy of Sciences, Warsaw, Poland, and her postdoctoral training in molecularbiology and in immunology at Columbia University and at the Albert Einstein College of Medicine New York. She has published 45 peer reviewed papers and book chaptersin reputed journals. She is a member of the American Association of Immunologists.

Abstract:

 Lupus is an autoimmune disease affecting primarily women in child bearing age. It is a multiorgan involvement disease, with frequent central nervous system (CNS) manifestation, most particularly, cognitive impairment. Lupus is characterized by the production of antinuclear autoantibodies and in particular, anti-dsDNA antibodies. We have created an animal model of CNS lupus in which autoantibodies cross-reactive with dsDNA and with the NMDA receptor (NMDAR) lead to an enhanced NMDAR activation and, at higher concentration to neuronal death when present in the brain parenchyma. We have shown that this requires breaching of the blood brain barrier. We have further demonstrated in the mouse model that the impact of these antibodies on neurons was concentration dependent and that at higher concentration, these antibodies promote neuronal excitotoxicity through enhanced mitochondrial permeability transition. In the model spatial recognition deficits are caused by the presence of these antibodies in the hippocampus. Structural analysis revealed a substantial reduction in dendritic processes and spines accompanied by a significant expansion of a place field size of surviving CA1 pyramidal. We and others have shown that the presence of these antibodies in the cerebrospinal fluid of lupus patients correlates with diffuse manifestations of CNS lupus. Recent studies of lupus patients harboring dsDNA and NMDAR reactive antibodies demonstrate an association with an impairment in spatial memory. This observation is in striking similarity to the mouse model.

Biography:

António Pais de Lacerda was graduated in medicine at the Medical School of the University of Lisbon (Portugal), and he has a master's degree in Medical Education. His current position is as intensive care consultant in an Intensive Care Unit (Hospital de Santa Maria); He is Assistant Professor of the Disciplines of "Introduction to Medicine", "Electrocardiography" and "Intensive Care Medicine". His main interests are on “pre- and post-graduate medical education ", "Medicine in the movies", "Sepsis" and "HIV / AIDS medicine." He has about 80 published papers, and two books on AIDS.

Abstract:

Human immunodeficiency virus (HIV) infection has been associated to premature atherosclerosis. Carotid intima-media thickness (CIMT) and pulsatility index (PI) accessed by carotid duplex ultrasonography (CDU) and transcranial Doppler (TCD), may be useful markers. Carotid and Cerebral circulation were evaluated by CDU and TCD in forty HIV-infected Caucasian men (mean age 49,4±5,9 years). CD4+ T-cell current and nadir counts, current and zenith viral load and duration of antiretroviral therapy (ART) were registered and cardiovascular risk scores were assessed. Multivariate regression analysis and Pearson's correlation coefficient were used. All men received ART and presented mean CD4+ count of 817±369 cells/mm3, (mean nadir: 242,8 ±158,2 cells/mm3), 95% had non-detectable viral load (mean zenith: 381.416±858.881 copies/mm3), 35% of men had history of high blood pressure, 35% dyslipidaemia, 7,5% diabetes, 80% tobacco consumption. Mean Framingham Risk Score was 8,5±6,6%; 35% presented low risk by SCORE, 55% moderate risk and 7,5% high risk. Mean ASCVD score was 7±4% at 10 years and 49±12% lifetime. 67.5% men had increased CIMT (mean 0,92±0,13mm), but none presented increased PI. No correlation was found between duration of infection, ART or cardiovascular risk scores with CDU or TCD data. However, a significantly positive association between a CD4+ nadir count <400 cells/mm3 and an increase of 0,12 in PI, was confirmed by regression analysis where CD4 categories showed significant effect over PI (p=.04). In this series, HIV infection showed an association with premature cerebral atherosclerosis, even at low cardiovascular risk scores. PI may be an early marker of atherosclerosis in HIV-infected people with CD4+ nadir <400 cells/mm3.

Biography:

Zhengqin Zhai has completed her Bachelor’s degree from Shandong University and now has been working for her Master’s degree in Peking Union Medical College.

Abstract:

Autonomic dysfunction, characterized by sympathetic activation and vagal withdrawal, contributes to the occurrence of ventricular arrhythmias after myocardial infarction. Here, we hypothesize that a novel pathway nerve stimulation - median nerve stimulation inhibit the occurrence of ventricular arrhythmias after myocardial infarction in rabbits. Two weeks after the ligation of mthe left coronary artery, 11 surviving New Zealand rabbits were randomized to median nerve stimulated (MI-MNS, n = 5) group and sham-stimulated (MI-SS, n = 6) group. Using an implantable electrical stimulator, we stimulated the bilateral median nerve for 2 weeks with the frequency of 5 HZ, width of 200ms, cycle of 10s on and 30s off, and the intensity of electrical stimulation was adjusted to the threshold of not resulting in the tremble of upper limbs. A holter was implanted to record the types and frequencies of arrhythmias. The treated rabbits had significantly lower percentage of ventricular arrhythmias (3.67% ± 1.73% vs. 6.69% ± 2.50%, p < 0.001) and lower norepinephrine (NE) level in blood (7.88 ± 2.34 pg/ml vs. 17.57 pg/ml± 11.72pg/ml, p = 0.01) than the untreated rabbits. Median nerve modulation markedly decreased the incidence of ventricular arrhythmias after myocardial infarction in rabbits through reducing the NE level in blood.

Biography:

Giovanni Antioco Putzu is working as professor in Neurology and Clinical Neurophysiology in Casa di Cura Sant’Elena, Italy. He has published more than 15 papers inreputed journals and has been serving as an editorial board member of repute.

Abstract:

We demonstrated, by the means of double immunochemistry technique, that TNF-alpha was localized in both axons and Schwann Cells, leading to demyelination and axonal in the peripheral nerve of patients with Guillain-Barré Syndrome (GBS, Putzu G.A. et al, J. Neurol. Sci, 2000). The pivotal role of pro-inflammatory cytokines such as IL-1Beta in GBS was also investigated. We present an original immunochemistry study with a panel of antibodies directed against TNF-alpha, INF-gamma, IL-1Beta, CD68, CD11, CD3 and C5b9 in the peripheral nerve of seventy-five patients affected by vasculitis. Sixty patients (27 males and 23 females, mean age 63 years) were classified as systemic vasculitic neuropathy (SVN) where as 15 patients (7 males and 8 females, mean age 52 years) had non systemic vasculitic neuropathy (NSVN). Results suggested a prevalent Th1 immune response in both SVN e NSVN. The presence of great amounts of TNF alpha and IL-1Beta into the vasculature determines a pro-coagulant effect with thrombosis of the vasa nervorum and hypoxia of the nervous fascicules. TNF-alpha was localized in axons as well, suggesting that it may be responsible for an axonal degeneration per se. Peripheral nerves of SNV e NSVN were immunoreactive to INF-gamma antibodies. This finding indirectly confirms the presence in the vasculature of IL-28A, a powerful pro-inflammatory cytokines. CD11, an antibody reacting with leucocytes and ICAM (Intercellular Adhesion Molecule) was also detected in the peripheral nerve of SVN and NSVN. Immunoreactivity to CD68 (macrophage antigen) and C5b9 (activated complement fraction) were also easily detected. In conclusion, immune response in SVN and NSVN is of Th 1 type (cellular). The role of TNF-alpha and cytokines is crucial in vascular thrombosis. Axonal degeneration may be the consequence of both hypoxia and direct toxic effect of TNF-alpha on axons. Moreover, pattern of immune response is not specific in SVN and NSVN

Biography:

Weimin Yang has completed his PhD from Sichuan University and visiter scholor studies from Melbourne University. He is the professor in Dept. of Neurology, First Affiliated Hospital of Zhengzhou University, master tutor, innovative talents of Henan Province Health Sciences and Technology. His research work mainly related to clinical features of Chinese stroke patients, stroke register, dementia, and systematic reviews of therapies from China. He has published more than 25 papers in reputed journals.

Abstract:

Background: Intracerebral hemorrhage (ICH) is a significant contributor to global health-related morbidity and mortality. Due to improved recognition and treatment of atrial fibrillation by antithrombotics, there is an increase in proportion of ICH caused by warfarin and novel oral anticoagulants. However, the relationship between anticoagulation intensity and hematoma expansion remains unclear. We aimed to investigate the effects of INR on hematoma expansion post ICH.

Methods: We conducted a retrospective study of all patients hospitalized for ICH at a single institution from January 1, 2008 and August 1, 2014. Hematoma volumes on initial CT scans and repeat CT scans were analyzed by the AxBxC/2 method. Univariate analysis was used to compare baseline characteristics and median regression analysis was performed to estimate the effects of INR and hematoma volume changes.

Results: We included 224 consecutive ICH patients. Median age (IQR) was 68.5 years (17.0), 60.3% were male, median presentation Glasgow Coma Scale (GCS) (IQR) was 14.0 (4.0), median volume (IQR) of the first CT was 11.7ml (25.6), median INR (IQR) was 1.1 (0.2). We showed that INR and time lapsed between first CT and second CT were independent risk factors to hematoma volume change, adjusting for baseline hematoma volume and time. For each 1.0 increase in INR was associated with hematoma volume increased by 2.4ml (p = 0.015).

Conclusions: We showed that high INR was associated with hematoma growth post ICH. However, the effects of reversal anticoagulation.

Biography:

Lenka Maruscakova, MD. was graduaded in General Medicine at the School of Medicine, Comenius University Bratislava, Slovakia. She does her postgradual studies at Institute of Immunology School of Medicine, Comenius University Bratislava, Slovakia. Her PhD. thesis is devoted to the inflammatory markers in brain tumors. Her scientific work is multidisciplionary approach connecting field of immunology, oncology and neurology.

Abstract:

Immune cells and molecules in tumor microenvironment are crucial in tumorigenesis. Inflammation is known as one of hallmarks of cancer and is considered as an protumorigenic factor. Glioma tumor microenvironment glioma still needs deeper insight into its immunological characteristics. Both local and systemic chronic low grade inflammatory response are operative for correlation with gliomas grading and their prognosis. Complex network of immune signals and pathways is in intricate background of most of cancer hallmarks. This concept is an intersection of three huge research fields: immunology, oncology and neurology. Cancer immunology has a perspective in complex approach to diagnosis of gliomas. There is an appealing importance of establishing immune molecules in gliomas. TREM-1 (Triggering receptor expressed on myelocytes) is an inflammation amplifier, hovewer its role in glioma remains still unclear. The aim of our study is to establish the expression of TREM-1 in glioma tissues and to correlate it with staging, grading and other laboratory parameters. Establishing of TREM-1 expression could have a promissing role in pathophysiology of gliomas. Our preliminary results show densely infiltrating TREM-1+ immune cells in tumor tissue. At signal pathways level, inflammation is interconnect with molecules related to hypoxia. Cross-talk of inflammation and hypoxia becomes more obvious in glioma as well. Consideration of relations dynamics is also necessary. But, deep understanding of their signal network in glioma tumorigenesis 

Biography:

Zhengqin Zhai has completed her Bachelor’s degree from Shandong University and now has been working for her Master’s degree in Peking Union Medical College.

Abstract:

Autonomic dysfunction, characterized by sympathetic activation and vagal withdrawal, contributes to the occurrence of ventricular arrhythmias after myocardial infarction. Here, we hypothesize that a novel pathway nerve stimulation - median nerve stimulation inhibit the occurrence of ventricular arrhythmias after myocardial infarction in rabbits. Two weeks after the ligation of mthe left coronary artery, 11 surviving New Zealand rabbits were randomized to median nerve stimulated (MI-MNS, n = 5) group and sham-stimulated (MI-SS, n = 6) group. Using an implantable electrical stimulator, we stimulated the bilateral median nerve for 2 weeks with the frequency of 5 HZ, width of 200ms, cycle of 10s on and 30s off, and the intensity of electrical stimulation was adjusted to the threshold of not resulting in the tremble of upper limbs. A holter was implanted to record the types and frequencies of arrhythmias. The treated rabbits had significantly lower percentage of ventricular arrhythmias (3.67% ± 1.73% vs. 6.69% ± 2.50%, p < 0.001) and lower norepinephrine (NE) level in blood (7.88 ± 2.34 pg/ml vs. 17.57 pg/ml± 11.72pg/ml, p = 0.01) than the untreated rabbits. Median nerve modulation markedly decreased the incidence of ventricular arrhythmias after myocardial infarction in rabbits through reducing the NE level in blood.

Biography:

Teena Shetty is a Fulbright scholar who received her medical degree and bachelor’s degree with honours from Brown University and her master of philosophy degree in medicine from the University of Cambridge. Her residency was completed at Weill Cornell Medical College, New York-Presbyterian Hospital. Dr. Shetty received her fellowship training in neuromuscular diseases at Harvard Medical School, Brigham and Women’s Hospital and in neuromuscular diseases and intraoperative monitoring at Hospital for Special Surgery. Dr. Teena Shetty is now a neurologist at Hospital for Special Surgery and is triple board-certified in neurology, neuromuscular medicine, and electro diagnostic medicine. Her research interests include concussion, post-operative neuropathies, muscle diseases, and intraoperative monitoring, and she has authored more than 30 publications on these topics.

Abstract:

Historically, routine types of neurological imaging for mTBI include CT and Conventional MRI, both of which are usually normal in mild TBI (mTBI). Newer MRI methods may demonstrate more abnormalities following mTBI than just CT or Conventiona MRI alone (Brody et al 2015). These include, but are not limited to, SWI, DTI, rs-fMRI, ASL and Volumetry. Susceptibility Weighted Imaging (SWI) uses contrast to highlight differences between tissues that can show changes in blood products in the brain. Diffusion Tensor Imaging (DTI) can detect brain abnormalities in white matter through its sensitivity to microstructural axonal injury. Resting State Functional MRI (rs-fMRI) measures changes in blood perfusion to determine if pathways of communication within the brain  have been disrupted. ASL (arterial spin labelling) uses spatially selective inversion of inflowing arterial blood as a method to label blood flow and measure perfusion. Lastly, volumetric MRI measures the volume and structure of regions in the brain and can detect changes in the volume of gray matter that may result from mTBI. These specific types of imaging can be incorporated into research in order to learn more about concussions, their diagnosis, and their prognosis. This is the case for the GE-NFL Study on Advanced MRI Applications for mild TBI. By utilizing a research pack for neurological imaging that includes SWI, DTI, Volumetric T1, ASL, and rs-fMRI, researchers have been able to detect abnormalities, including white matter lesions, in the brains of several patients who have suffered from mTBI. Overall, neuroimaging is evolving such that white matter abnormalities, changes in gray matter volume, and blood perfusion in the brains of mTBI patients may be visualized. However, these scans cannot be used conclusively and these techniques are limited to research tools at this time. Therefore, continued study is necessary to further validate these software techniques

Biography:

Dr. Jesse Weinberger has completed his MD at the age of 23 years from The Johns Hopkins University School of Medicine, Neurology Residency at The Mount Sinai Hospital and Postdoctoral studies at the University of Pennsylvania School of Medicine. He is a Professor of Neurology and Director of the Neurovascular Laboratory at the Icahn School of Medicine at Mount Sinai. He has published more than 130 papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

Aortic arch plaque (AAP) is associated with stroke and is a potential embolic source. Amarenco reported an increase of recurrent stroke in patients with complex (AAP) plaques >4mm thickness compared to simple plaques. Plaque heterogeneity and mobility play a role. We developed a noninvasive method to image AAP with B-mode sonography through the supraclavicular fossa to determine whether AAP is an etiology of stroke. B-mode correlation with transesophageal echocardiography (TEE) in 37 patients showed 93.75% sensitivity, 80.95% specifiticy, 78.95% positive predictive value and 94.40% negative predictive value. In 500 consecutive patients referred for carotid duplex, the arch was visualized completely in 468, partially in 27 and not visualized in 15. Complex plaques were seen in 40 symptomatic patients and 64 asymptomatic patients, simple plaques in 131 symptomatic patients and 260 asymptomatic patients, difference not significant. Excluding patients with ipsilateral carotid stenosis and atrial fibrillation, complex plaques were seen in 24 symptomatic patients and 31 asymptomatic patients, simple plaques in 90 symptomatic patients and 188 asymptomatic patients, p = 0.075. Among patients with complex plaques, 19 heterogeneous plaques were symptomatic and 15 asymptomatic, 21 patients with homogeneous plaques were symptomatic and 46 asymptomatic p=0.037. One hundred sequential studies in 89 patients over 18 months were performed to measure a change >0.5mm. For 46 simple plaques, 77% had no growth, 10% regressed and 13% progressed. For 27 complex plaques 48% had no growth, 38% regressed and 14% progressed. Intimal thickness of AAP in 504 patients correlated linearly with presence of coronary artery disease r=0.97, p<0.001 (0-1mm 16%, 1-2mm 38%, 2-3mm 56%, 3-4mm 58%, 4-5mm 79%, 5-6mm 89%). CONCLUSIONS: Aortic arch plaques are relatively stable. High risk aortic arch plaques are associated with heterogeneous morphology. Complex AAP are associated with generalized atherosclerosis including coronary artery disease. Sequential noninvasive imaging of AAP can have value in future studies of therapy to prevent stroke from AAP. The proposed mechanism of embolism from carotid and aortic arch plaque is plaque rupture. Ultrasound videos of carotid and aortic arch plaque rupture in acute stroke patients will be shown.

Biography:

Michael Chopp is Vice Chairman, Department of Neurology, Scientific Director , Neurosciences Institute, Zoltan J. Kovacs Chair in Neuroscience Research at Henry Ford Hospital, Detroit Michigan, and a Distinguished Professor of Physics at Oakland University, Rochester Michigan. He has published widely (>650 peer reviewed publications) in the area of neurorestorative and neuroprotective therapies for stroke, traumatic brain injury and neurodegenerative diseases. He has also served on many NIH study sections, and as a consultant to the pharmaceutical industry. He is the recipient of major awards and recognition for his research, including the 2015 Willis Lecture from the American Heart Association, 2012 Lecture of Excellence at the World Stroke Organization and the Abraham White Distinguished Science Award from George Washington University.

Abstract:

The ability to regulate and modulate intercellular communication may provide the basis for the treatment of neurological injury, neurodegenerative diseases and stroke. Exosomes are small (30-100 nm) endosomal generated particles consisting of a complex lipid membrane and contain proteins, RNAs,mRNAs and microRNAs (miRNAs). Nearly all cells generate exosomes, and these small lipid containers are ubiquitous in biological systems and provide an intercellular communications network which regulate cellular function. Exosomes mediate intercellular communication by transferring proteins, lipids, and genomic materials including mRNAs and miRNAs between source and target cells In this presentation, I will describe our work on the treatment of stroke, traumatic brain injury and diabetic peripheral neuropathy with exosomes, with a focus on the transfer of microRNA (miR) content within the exosomes to recipient cells. miRs are 20-25 nucleotide non coding RNA which regulate gene translation . They act as major molecular switches and are post transcriptional regulators of protein production and simultaneously impact multiple molecular pathways and signaling within cells. We have found that cell-based therapies promote neurological recovery and promote neurovascular remodeling by transferring exosomes to recipient cells. Thus, we have harvested exosomes by means of ultracentrifugation of biochemical methods from a variety of cells, and directly employed these exosomes by intravenous administration for stroke ,TBI and peripheral neuropathy to promote neurological recovery. Exosome treatment was highly effective in promoting neurovascular remodeling and enhancing neurological recovery after stroke, TBI, and peripheral neuropathy. Our studies demonstrate that exosomes may provide effective therapy for the treatment of neurological diseases and injury.

Biography:

Abstract:

Neurodegenerative diseases (NDs) such as Alzheimer’s disease [1,2] and Parkinson disease [3] are among the big challenges facing the researches and the clinical professionals. NDs have complex mechanism including pathways that are yet to be elucidated. Each of these diseases is often studiesseparately and investigated towards explaining the mechanisms and finding potential therapies of one disease. Changing such approach might be a way to improve the data we obtain. Indeed, many common features exist between the NDs. Therefore, focusing on such common features and mechanisms will allow us to extrapolate the obtained results and explain a pathway involved in more than one neurodegenerative disease and thus find out potential therapies for more than on neurodegenerative disease. Such methodologies still require further elucidation of the common features linking the divers’ neurodegenerative disease and whether they are such links are the results of common underlying pathways or only similar symptoms or phenotypes. These needs collaborations between experts in different fields including the concerned NDs and always study each neurodegenerative disease within the context of the common features shared between more than a neurodegenerative disease and complete the data by cell culture studies results [4], pharmacology [5-10] and toxicology [11,12] to reach the final goal which is identify efficient therapies. Such approaches will optimize the efforts aiming to understand the NDs and treat them by reducing the research cost, efforts and time. For building an animal model of a neurodegenerative disease such as Alzheimer’s disease [13] expressing a specific feature will contribute to study all the NDs that include that specific feature within its pathogenesis. Importantly, this concept is further strengthened by several facts such as the physiology of the brain that constitutes of a network within which the neurotransmitters are in continuous interactions [14] and the common molecular basics [15] related to the G protein coupled receptors [16] that are of a great importance in both neurophysiology [17] and pharmacotherapy [18-20]. In addition, other non-degenerative diseases share also similar mechanisms or pathways with some NDs which means that the range of extrapolation of the common features shared by some neurodegenerative disease might also include some non-NDs.

Biography:

Sylvain Lanthier trained in optometry, medicine, ophthalmology and neurology at University of Montreal. During his neurovascular fellowship, he studied unusual causes of stroke at the University of Toronto and clinical epidemiology and biostatistics at McMaster University. He is Associate Professor of Medicine, Department of Neurosciences at the University of Montreal and Stroke Neurologist at the Centre hospitalier de l’Université de Montréal. Dr. Lanthier published more than 40 research articles and book chapters on cerebrovascular disease. His main research interests are stroke in the young and CNS vasculitis. He is the lead-PI of the INTERSPACE.

Abstract:

Primary angiitis of the CNS (PACNS) is an idiopathic, single-organ vasculitis of small and medium-sized vessels. Diagnosis of PACNS is a real challenge because it is rarer than several other potential mimicking conditions. Clinical presentation are variable, including persistent headaches, cognitive decline, multifocal deficits and seizures. Brain lesions on MRI and inflammation of the cerebrospinal fluid are common findings, whereas angiographic changes may be documented mainly when medium-sized arteries are affected. None of these manifestations are specific for PACNS. CNS biopsy can prove the diagnosis when small arteries are involved, but this procedure is invasive and associated with potential false-negative results due to skipped lesions. Complementarily, gadolinium-enhancement of medium-sized arteries can be documented by high-resolution MRI. Treatment of PACNS is also challenging, aiming at minimizing the risks of treatment failure and recurrent vasculitis due to insufficient immunosuppression while avoiding adverse effects of potent immunosuppressant agents. Other single-organ vasculitides of the CNS comprise the amyloid-beta-related angiitis (ABRA) and the inflammatory form of cerebral amyloid angiopathy (iCAA). The nosological limits of PACNS, ABRA and iCAA remain misunderstood. The INTERnational Study on Primary Angiitis of the CEntral nervous system (INTERSPACE) is an international, multi-center, prospective, currently ongoing, cohort study. INTERSPACE was designed to describe clinical manifestations, investigation results, diagnostic processes, misdiagnoses, treatments and outcomes of clinically-suspected or biopsy-proven PACNS. Its primary objective is to identify predictors of death or dependence after 1 year of clinical follow-up. To join INTERSPACE, study investigators are invited to contact the Coordination Centre: sylanthier@gmail.com.

Biography:

Dr. Marcelo Kauffman is the Head of the Neurogenetics Clinic and Laboratory at the JM Ramos Mejia Hospital, in Buenos Aires, Argentina. He obtained his MD, MSc and PhD degrees from the University of Buenos Aires and from the University Pablo de Olavide in Spain. He completed his Residency in Neurology at the JM Ramos Mejia Hospital in Buenos Aires. He is a researcher at the Argentine’s National Science Council (CONICET) and Assistant Professor of Neurology at the University of Buenos Aires, School of Medicine. His clinical and research interests include the diagnosis, management and treatment of neurogenetic disorders. He has received many clinical and scientific awards and authored more than 40 peer-review papers, mainly in the field of neurogenetic diseases

Abstract:

As a whole neurogenetic diseases are a common group of neurological disorders. However, the recognition and molecular diagnosis of these disorders is not always straightforward. Besides, there is a paucity of information regarding the diagnostic yield that specialized neurogenetic clinics could obtain. We performed a prospective, observational, analytical study of the patients seen in a neurogenetic clinic at a tertiary medical centre to assess the diagnostic yield of a comprehensive diagnostic evaluation that included a personalized clinical assessment along with traditional and next-generation sequencing diagnostic tests. We included a cohort of 424 patients from May 2008 to July 2015. For sub-group analysis we selected a sample of patients whose main complaint was the presence of progressive ataxia, to whom we applied a systematic molecular diagnostic algorithm. Overall, a diagnostic mutation was identified in 28% of our cohort. However, if we only considered those patients where a molecular test could be performed, the success rate rises to 45%. We obtained diagnostic yields of 23•5 and 57•5% in the global group of ataxic patients and in the subset of ataxic patients with a positive family history, respectively. Thus, about a third of patients evaluated in a neurogenetic clinic could be successfully diagnosed.

Biography:

Dr. Manconi is the Head of the Service at the Sleep and Epilepsy Centre of the Neurocenter of Southern Switzerland, Lugano, Switzerland. Mauro Manconi earned his medical degree (1997) at the University of Bologna (Italy) with honour, discussing a thesis on Central Alveolar Hypoventilation. He completed his specialization in Neurology (2002) at the University of Ferrara (Italy) with honour, discussing a thesis on Restless Syndrome and Pregnancy. He defended his PhD in Sleep Medicine (2005) at the University of Bologna (Italy) with honour on REM Behaviour Disorder. For 10 years he served as clinical researcher at the Sleep Lab of Scientific Institute of San Raffaele, Milan (Italy). Dr. Manconi served for 1 year as Visiting Professor at the Circadian Rodent Lab of the Wisconsin Medical College, Milwaukee (WI, USA), where he obtained the “Excellent in Sleep Research Award 2006 for his innovative and leading research activity in developing a pharmacogenetic rodent model for Restless Legs Syndrome. He is currently involved in clinical and basic research in sleep field, with particular interest in sleep related motor disorders. He has written over 100 publications and 1 book and is member of various International Sleep Societies.

Abstract:

Restless leg syndrome (RLS) is an often under diagnosed sleep-related sensorimotor disorder which affects up to 10% of adult general population, characterized by uncomfortable sensations in the legs, which begins or worsens during rest, improves or disappears with movement, and occurs or worsens in the evening or at night. RLS is often associated to insomnia and reduced quality of life. In more than 80% of patients, the polysomnography unmasks periodic leg movements (PLM) during sleep, which are repetitive leg jerks characterized by a triple flexion movement of the lower limbs, usually associated to electroencephalographic arousals and to an increasing of the heart rate, which can contribute to sleep disruption. The idiopathic one is the most common form of RLS and can be inherited as an autosomal dominant trait. Recently, two large genome-wide scan studies recognized three genomic regions encoding the intronic variants of the genes MEIS 1, BTBD9 and MAP2K5. Even though the pathogenesis of the RLS is still unknown, there are several pieces of evidence that address to a possible dysfunction of the descending dopaminergic neurons from the hypothalamic A11 region to the intermediolateral and dorsal spinal gray matter. RLS worsens with antidopaminergic treatment, can be induced by hyposideremia (iron is the coenzyme of the tyrosine-hydroxylase, the limiting enzyme in the dopamine synthesis), may be associated with Parkinson diseases, and shows a circadian trend of the symptoms and PLM distribution which is inversely related to the levels of blood and cerebro-spinal fluid dopamine. As well as in reward and cognitive processes, dopamine is also strongly implicated in regulation of locomotor activity and movement in general. Mainly, the dopaminergic hypothesis in RLS is supported by the fact that both RLS and PLM respond dramatically to dopamine-agonists medication, even at very low dosages and since the first night of administration.

Biography:

Abstract:

Neuromyelitis optica (NMO) is an inflammatory CNS syndrome distinct from multiple sclerosis (MS) that is associated with serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG). It became known as Devic disease following a seminal 1894 report. Prior NMO diagnostic criteria required optic nerve and spinal cord involvement but more restricted or more extensive CNS involvement may occur. The International Panel for NMO Diagnosis (IPND) was convened to develop revised diagnostic criteria using systematic literature reviews and electronic surveys to facilitate consensus. The core clinical characteristics required for patients with NMOSD withAQP4-IgG include clinical syndromes or MRI findings related to optic nerve, spinal cord, area postrema, other brainstem, diencephalic, or cerebral presentations. The consensus definition of NMOSD unifies traditional NMO and modern NMOSD definitions. The International Panel for NMO Diagnosis (IPND) was convened to develop revised diagnostic criteria using systematic literature reviews and electronic surveys to facilitate consensus. The IPND criteria are expected to facilitate more comprehensive and comparable epidemiologic studies by supplying a uniform case definition and a glossary of defined terms. We will be reviewing advances in this field .

Biography:

Yun Zhou is Assistant Professor at the Russell H. Morgan Department of Radiology and Radiological Science, and Guest Professor of Peking University First Hospital. He obtained his M.S. in Biomathematics and Ph.D. in Biomedical Physics from University of California at Los Angeles.

Abstract:

Brain PET is a well-established quantitative functional imaging technique to measure physiological and biochemical process. As recent advances in hybrid imaging technology, such as PET-CT and PET-MRI, for whole-body PET imaging, there are urgent needs to develop and validate technologies for quantitative whole-body PET from data acquisition to quantification. The fundamentals of quantitative PET developed in last three decades which include kinetic modeling approach and parametric imaging algorithms will be briefly reviewed. Recent developments in quantitative PET imaging on dopamine and serotonin receptors and transporters will be highlighted. Tremendous efforts have been made to extend quantitative brain or organ-specific PET to dynamic whole-body PET in last few years. We investigated the feasibility of quantitative dynamic whole-body PET via multi-bed multi-pass technology. Optimization in data acquisition and quantification were studied by both computer simulation and an ongoing multi-center multi-tracer dynamic whole-body PET project. The potentials and challenges in quantitative whole-body PET in clinical diagnosis, monitoring disease progression, responses to treatments or psychological/ pharmacological stimulations will be discussed with our promising results.

Biography:

Jianhua Zhang has completed his M.S. in 2004 and M.D. studies in 2012 from Peking University, majoring in Radiology and Nuclear Medicine. He joined the faculty of nuclear medicine at Peking University First Hospital.in 2004 and now is the associate professor. He has published more than 20 papers in journals and 20 chapters in proceedings and medical textbooks. The research interests of Dr. Zhang include application of positron emission tomography (PET) in studies of tumors, especially the lymphoma, and quantitve analysis. He has been involved in teaching of more than 30 residents.

Abstract:

Richter’s transformation (RT, Richter’s syndrome) was first described by Maurice Richter as the development of an aggressive large-cell lymphoma in the setting of underlying small lymphocytic lymphoma /chronic lymphocytic leukemia (SLL/CLL). We try to investigate the role of in detection of RT of SLL/CLL. Twelve patients with SLL/CLL underwent 18F-FDG PET/CT between Jul 2010 and Nov 2015 were retrospectively analyzed. FDG avid lesions with a maximum standardized uptake value (SUVmax) of greater than 5 were considered highly suggestive of RT. The diagnosis of RT was based on the histopathological examination. All patients (8 males and 4 females) had the history of SLL/CLL ranged from 2 years to 11 years. Four patients underwent RT to diffuse large B-cell lymphoma, PET/CT detected sites of increased FDG uptake with SUVmax ＞5 in 3 patients(3/4, 75%), 1 patient has false-negative PET/CT findings. No patient had false-positive PET/CT findings and PET/CT correctly excluded RT in the other 8 patients. The overall sensitivity, specificity and accuracy of PET/CT for RT of SLL/CLL were 75%, 100% and 91.6%, respectively. According to the preliminary data, 18F-FDG PET/CT has high accuracy for detection of RT of SLL/CLL. PET/CT can exclude the diagnosis of RT with a high degree of confidence in patients with SLL/CLL. 

Biography:

Rong Fu Wang has completed his MD at the age of 27 years from Fujian Medical University in 1982, postdoctoral studies from Paris V University School of Medicine in 1993 and his PhD at the age of 40 years from Toulous IIl University in 1995. He is the director of Department of Nuclear Medicine, Peking University Health Science Center. The research interests of Dr. Wang include experimental study and clinical application of molecular and clinical nuclear medicine. He has published more than 400 papers in reputed journals and has been serving as many editorial board member of reputed journals at home and abroad. He has published 3 monographs, and has got 3 patents of invention and 3 provincial and ministerial Awards.

Abstract:

18F-FDG uptake rate constant Ki is a most interested and commonly used parameter for absolute quantification of 18F-FDG PET/CT. Ki is usually estimated by fitting a kinetic model with plasma input function (PIF) to the measured dynamic PET data. The need for arterial blood sampling to measure PIF (mPIF) is a main barrier to estimate Ki for clinical 18F-FDG PET. Two existing noninvasive PIF estimation methods, image derived PIF and simultaneous fitting method with kinetic model and parametric PIF, require image data to be acquired continuously and immediately post tracer injection. The objective of the study is to validate and optimize a generalized population-based PIF estimation method for noninvasive quantification of dynamic 18F-FDG PET for sparsely sampled PIF. Eight 60-min 27-frame monkey dynamic 18F-FDG PET studies were collected from a Philips Gemini GXL PET/CT with 3D data acquisition mode. Total 34 arterial blood samples were taken during PET scan as: 22 samples for the first 4 min, and followed by sampling at 5, 6, 8, 10, 12, 15, 20, 25, 30, 40, 50 and 60 min. Time activity curves (TACs) of 7 cerebral regions of interests (ROIs) were generated from each study. A generalized population-based approach to recover full kinetics of the PIF from sparsely sampled blood data is proposed. The estimated PIF (ePIF) from the incomplete PIF sampling data was determined by interpolation and extrapolation using scale-calibrated population mean of normalized PIFs. The optimal blood sampling scheme with given sample size m was determined by maximizing coefficient coefficients of Ki estimates between the Kis from measured PIF (mPIF) and estimated PIF (ePIF). The leave-two-out cross validation was performed. The linear correlations between the Ki estimates from the ePIF (with optimal sampling scheme) and those from the mPIF were: Ki(ePIF; 1 sample at 40 min) = 1.015Ki(mPIF) -0.000, R2 = 0.974; Ki(ePIF; 2 samples at 25 and 50 min) = 1.029Ki(mPIF) - 0.000, R2 = 0.985; Ki(ePIF; 3 samples at 8, 20, and 50 min) = 1.039Ki(mPIF) - 0.001, R2= 0.993; and Ki(ePIF; 4 samples at 8,12, 25, 40, and 55 min) = 1.02Ki(mPIF)-0.000, R2=0.997. The correlations of R2 from leave-2-out validation study were 0.978±0.007, 0.990±0.006, and 0.996±0.003 (mean ±SD) for 1, 2, and 3 samples of optimal sampling scheme, respectively. The generalized population-based PIF estimation method is a reliable method to estimate PIFs from incomplete blood sampling data for quantification of dynamic 18F-FDG PET using the Gjedde-Patlak plot. 

Biography:

Zhoulei Li has completed her PhD in 2013 from Ludwig-Maximilians-University of Munich and postdoctoral studies from technical university Munich. She has published more than 10 papers in reputed journals. She is a research leader, managing a pharmaceutical project from Helmholtz Center Munich. Before that, She was a postdoc researcher, managed the clinical research lab at nuclear medicine of technical university Munich, supervised research staff and graduate students. She has extensive hands on experience on molecular imaging. Her research focuses on monitoring progress of cancer therapy and developing biomarker for cancer therapy.

Abstract:

The prognosis of relapsed or refractory aggressive lymphoma is poor. The huge variety of currently evolving targeted treatment approaches would benefit from tools for early prediction of response or resistance. Molecular imaging is recently recognized as a tool that can improve every facet of cancer care. PET images biochemical or physiologic phenomena in comparison with computed tomography (CT) or magnetic resonance imaging (MRI), which show anatomic details. PET imaging would predict areas of abnormal metabolic behaviour of cancers in vivo, and the addition of CT imaging underlines the site of malignancy. More accurate andprecise interpretation of cancer lesions can therefore be performed by PET/CT imaging than PET or CT imaging alone. We used various lymphoma cell lines (ALCL, DLBCL, MCL, Myc-induced murine lymphoma etc.) to evaluate therapeutic effect of different anti-cancer drugs in vitro by molecular biological and biochemical methods. Micro-FDG- and/or FLT-positron emission tomography (PET) or PET/CT imaging studies were carried out with the suitable xenograft or transgenic mouse models to assess early treatment response to anti-cancer therapy in vivo. Interestingly, we detected a significant reduction of FLT-uptake in ALCL bearing animals using targeted drug therapy compared with baseline as early as 2 days after initiation of targeted therapy. Immunostaining showed a decrease in Ki-67 and an increase in cleaved caspase-3 staining. Additionally, the detection of therapeutic response of other aggressive cancer was proved to be highly correlated with other in vito and in vivo data, suggests that PET/CT is a suitable method for detection of therapeutic respons on cancer. 

Biography:

Tang graduated from University of South China and received her master’s degree in plastic and reconstruction surgery form Peking Union Medical College. She finished her surgical residency training and became a breast surgery specialist in 2011. After that, she has been working as a postdoctoral fellow at Surgical Oncology of Massachusetts General Hospital.She has published peer reviewed journal papers. Her interests include oncoplastic breast procedures, breast cancer shaved cavity margins, nipple sparing mastectomy, and novel breast imaging methods

Abstract:

Intraoperative specimen imaging is commonly performed to confirm complete excision breast lesions, but has false positive and false negative rates that lead to incorrect specimen assessment in 21-44% of cases.Micro-CT provides non-invasive, highly quantitative imaging in small specimens within a few minutes. We explored the use of micro-CT for intraoperative assessment of a variety of breast specimens. Excised breast specimens, including lumpectomy specimens, shaved cavity margins(SCM), mastectomy specimens and axillary lymph nodes, were evaluated with a table top micro-CT scanner, Skyscan 1173 (Skyscan, Belgium), with a 40-130kV,8W X-ray source. Scanning for 7 minutes and reconstruction for another 7 minutes provided desired resolution in breast specimens. In lumpectomy specimens, micro-CT could clearly visualize orienting sutures and see the location of tumour masses and associated calcifications relative to specimen margins. In separately excised cavity margin specimens, micro-CT visualized tumour masses and calcifications that indicated the need for additional tissue excision. Micro-CT provided detailed images of axillary lymph nodes and their vessels’ 3D structure. 103 SCM from 26 lumpectomies were scanned and compared with histopathology results. Margin status by micro-CT was concordant with histopathology in 86/103 (83%) SCM. Micro-CT had 73% sensitivity, 85% specificity, 46% positive predictive value, and 95% negative predictive value of SCM. 5/26(19%) case required a re-excision based on the final margin status, micro-CT could identify 3 out of these 5 cases intra operatively.  Micro-CT is a potentially useful tool for assessment of breast cancer specimens, allowing real-time analysis of breast lumpectomy specimens or cavity shaved margins.

Biography:

Jianhua Zhang has completed his M.S. in 2004 and M.D. studies in 2012 from Peking University, majoring in Radiology and Nuclear Medicine. He joined the faculty of nuclear medicine at Peking University First Hospital.in 2004 and now is the associate professor. He has published more than 20 papers in journals and 20 chapters in proceedings and medical textbooks. The research interests of Dr. Zhang include application of positron emission tomography (PET) in studies of tumors, especially the lymphoma, and quantitve analysis. He has been involved in teaching of more than 30 residents.

Abstract:

18F-FDG PET/CT imaging has become a crucial component of oncological management for a wide variety of malignancies and is routinely used in staging, restaging and treatment response assessment tasks. Compared to qualitative method and semi-quantitative method, quantitative method is more accurate and can overcome the limitations of the routine methods, but it is more complicated on the management of many cancer patients. As for the quantitative method, plasma input function and FDG influx rate constant (Ki) are indispensable. An emphasis in the present work is to develop non-invasive plasma input function estimation techniques in order to facilitate clinical acceptance. Image derived input function method will be studied and validated in the novel context of whole body dynamically-acquired images to facilitate parametric imaging. The present work is expected to significantly enhance the capability of dynamic whole body FDG PET/CT imaging to quantify the kinetics of FDG, and in turn, has the long-term potential to significantly enhance diagnostic, prognostic and treatment response monitoring capabilities of the FDG PET imaging modality and to fundamentally alter routine clinical practice.

Biography:

Ernesto A Salegio completed his PhD at the age of 32 from Flinders University of South Australia and then moved to San Francisco California in 2009, where he conducted his postdoctoral studies at the University of California San Francisco (UCSF) School of Medicine, Department of Neurological surgery. Since then he has been appointed as a principal investigator/research faculty at UCSF. He has published 24 published peer-reviewed publications including a book chapter on gene therapy and MRI protocols, and one on neuroinflammation following CNS trauma.

Abstract:

Local, targeting of anatomical regions within the central nervous system (CNS) is challenging, but can be facilitated by the implementation of image-guided technology and neuronavigational platforms. For this reason, my work focuses on the implementation of image-guided tools (CT-MRI) to accurately deliver drugs focally into the CNS parenchyma, while minimizing untoward side effects to peripheral organs. Together with industry collaborators, I have developed novel neurosurgical, neuronavigational, image-guided components to improve drug delivery protocols that are safe and clinically relevant. During my postdoctoral work, as part of translational pre-clinical/safety studies, I specialized in local and systemic delivery of gene therapy products into the CNS in large animal species, demonstrating surprising levels of therapeutic effectiveness. This type of delivery employed a simple neurosurgical approach coupled with magnetic resonance image (MRI)-guided technology to successfully administer gene therapy products into the brain and spinal cord parenchyma. Recently, in collaboration with the Department of Radiology at UCSF, I have developed a minimally invasive protocol that uses computed tomography (CT) and MRI fusion to target the spinal cord via an inter-laminar percutaneous trajectory. These projects have gain considerable interest within the clinical and research community as a conduit to deliver treatments, advance technology and strengthen multi-departmental collaborations.

Biography:

Abstract:

The perception and integration of external stimuli lead to a constant, lifelong adaptation of the central nervous system. Functional adaptations lead to anatomic changes of gross brain morphology. Behavioural measurements reveal correlations between performance and changes in brain structure. Young, healthy musicians state an ideal group to study the principles of neuronal plasticity in vivo. With the complex process of integrating auditive, visual and sensory stimuli to form fine tuned movement patterns making music is a highly demanding, multimodal network task. Due to the bimanual dexterity the heterogenous age of commencement of musical training and the possibility of standardized measurements of motor performance via midi keyboards, pianists have been in the focus of research. We collected behavioural data, scale playing measurements of temporal precision and T1, DTI and Resting State 3T MRI Scans of 36 high-level pianists and an age matched control group. Voxel-based morphometry was used to analyze gray-matter differences at whole-brain level. Pianists compared to non-musicians showed significant volumetric effects in multiple cortical and subcortical structures. A higher gray matter (GM) volume was shown in the left superior temporal and bilateral lingual gyri, as well as in striatal areas as the bilateral putamen, hippocampus and amygdala and the right thalamus. Lower GM volume was shown in the supramarginal, superior temporal and postcentral gyri of the right hemisphere. Behaviourally, early-onset pianists showed higher temporal precision in their piano performance than late-onset pianists, especially in the left hand. Furthermore, early-onset of piano playing was associated with smaller GM volume in the right putamen and better piano performance, mainly in the left hand. For the first time the link between onset of musical practice, behavioural performance, and putaminal gray matter structure could be shown in a single large dataset of healthy young pianists. These results reveal a complex pattern of plastic effects showing increased GM volume in networks involved in reinforcement learning, while decrease of gray matter volume in networks related to sensorimotor control, auditory processing and score-reading.

Biography:

Abstract:

Advances in resuscitation and critical care management have resulted in the survival of many patients despite severe brain damage. These patients may remain in coma or in vegetative state. The probability of recovery of conscious function is dependent on the extent of structural brain damage, which is difficult to assess by clinical, laboratory or functional tests. Positron emission tomography (PET) of 18F-fluordeoxyglucose (FDG) can be used to investigate metabolic and functional impairment of the brain. In acute vegetative state (AVS, duration < 1 month), overall glucose utilization was significantly reduced in comparison with age-matched controls. In a few cases with locked-in syndrome, cortical metabolism was in the normal range. 11C-Flumazenil (FMZ) measures the density of benzodiazepine receptors (BZRs) and thereby furnishes an estimate of neuronal integrity. PET with this tracer demonstrated a considerable reduction in BZRs in cortical areas, but indicated that the cerebellum was spared from neuronal loss. The comparison of FDG- and FMZ-PET findings in AVS demonstrates that alterations of cerebral glucose consumption do not represent mere functional inactivation, but also irreversible structural damage. In some cases with minimally conscious state, auditory stimuli with emotional valence induced more brain activation (investigated by H215O-PET) than meaningless noise; such studies can be used to detect residual cortical function. To improve prognostication of chances for recovery, a combination of functional activation studies and assessment of the extent of neuronal damage might be the optimal procedure and should be tested in larger cohorts of patients with comatose states of different severity.

Biography:

Abstract:

Objectives: Ventriculoperitoneal shunt (VPS) is the mainstay in the treatment of hydrocephalus. But carries a significant risk of malfunctioning. This study aims to compare the outcomes of laparoscopic (LVPS) versus Open (OVPS) VPS-placement and reviews the literature from 1993 – 2012. Methods: Between 2003 and 2012, 232 patients underwent first time VPS placement at BIDMC. Of those, 155 were laparoscopically guided and 77 were done conventionally. We analyzed independent variables (age, gender, medical history, clinical presentation, indication for surgery and surgical technique) and dependent variables (operative time, postoperative complications, length of stay in the hospital, and occurrence of shunt failure). Results: Mean operative time was 43.7 minutes (18.0 – 102.0) in the laparoscopic group versus 63.0 minutes (30.0 – 151.0) in the open group, (P < 0.05). Length of stay was similar, 5 days in the laparoscopic and in the open group, (P = 0.945). The incidence of shunt failure during the entire follow up period was not statistically different between the two groups, occurring in 14.1% in the laparoscopic group and 16.9% in the open group, (P = 0.601). Kaplan-Meier analysis demonstrated no difference in shunt survival between the two groups (P = 0.868), with functionality in 85% at 6-months and 78.5% at 1-year. Conclusion: According to our results, laparoscopic VPS-placement works as well as open VPS placement. Although laparoscopy is not routinely indicated, we suggest a prospective study to assess its value as an alternative technique especially in obese patients and patients with previous abdominal operations.

Biography:

Graduated from the Medical School in 1977. Started Trained and qualified as neurosurgeon from Karolinska Institute, Stockholm, Sweden and Shinshu University, Matsumoto, Japan. Fellowship , Pittsburgh University Pittsburgh , USA. Joined Neurosurgery of Neurosurgery, KFU (Dammam University) since 1987, Professor of neurosurgery since 1994. Visiting professor, departments of Neurosurgery, Virginia University, Charlottesville, USA and Shinshu University, Matsumoto, Japan. Parallel career , member of The committee of ethics, World Federation for Neurosurgical societies for 8 years, from 1992 to 2000, and shared in writing the “Good Practice: A Guide for Neurosurgeons. Acta Neurochir (Wien), 1999;141: 791-799”. Co- Chairman of the Ethics Committee, world Association of Disasters and emergency medicine. Wrote with Dr. Mark Bernstein a new book “Neurosurgical ethics in practice- value based medicine “which published by springer in August 2014. Presented more than 50 lectures and workshops about medical ethics and introduced the concept “ Value Based Medicine since 2010”. He published nearly 100 scientific papers and wrote 6 chapters in different books and presented over 500 talks in Scientific meetings in 57 countries and one book. Obtained 5 patents and filed other 2 patents. Designed 5 neurosurgical instruments. He described and named special neurological and neurosurgical condition in children which was published in Journal of Neurosurgery

Abstract:

Research is a corner stone for the development of medicine. Good Medical practice is not only based on evidence, skills, knowledge and technology but also on good values and ethics in medical practice and medical research(i.e. value-based medicine). Value Based medicine is concerning about patient’s rights, Patient’s family rights, researcher’s rights and animal rights among other related subjects to ensure the best and safest ethical approach to every step in medical practice and research and to enhance the best benefit for the patients. Many scholars and philosophers recently studied the medical ethics (Bioethics) as solid science to highlight the ethics of medical practice and research and suggest the different and necessary ethical codes either on medical practice or in medical research. The main pillars of good neurosurgical and neurology practice are based on 1, knowledge, 2. Skills and 3. Technology all these three basic elements should be integrated for the interest of the patient in a clear vision to provide that patients with state of art treatment and to create strategy to achieve this aim and draw plans in order to obtain and maintain such uncompromised goal. The vision and strategy and the medical practice should be performed within a rigid frame of values and ethics. Therefore, it is quite important to include medical ethics as one of the main subjects of different CME and training programs. The trainees should be encouraged to know about the ethics as science and art. Medical ethics may be come under this chapter and it is based on such main ethical principles; 1. Autonomy; regarding the right of patients to choose methods of the management of their medical problem or to refuse it- (Voluntas aegroti suprema lex.). 2. Beneficence; To determine that the physician or surgeon must consider patient’s benefit as his solo goal for his relationship with patient - (Salus aegroti suprema lex.). 3. Non-maleficence: clearly means "first, do no harm" (primum non nocere). 4. Justice: concerns the application of justice , fairness and equality by all means to every patient. Every patient has the right to receive the best possible and avoidable medical care. 5. Dignity: it goes in both ways ; patient and his treating medical staff should be treated by respect and their dignity is preserved always. 6. Truthfulness and honesty: the relationship between a patient and his treating physician or surgeon should be based on honest and truthfulness.