The authors present a rare case of an infarction complication 15 days following acute intraventricular bleeding due to moyamoya disease. Before the infarction occurred, perfusion CT imaging disclosed early but reversible ischemic injury on the day of hemorrhage. Dehydration and hypotension are both possibly contributing factors of progressive injury from reversible ischemia due to infarction. Although the patient underwent successful bypass surgery, 1 month after the ictus the neurobehavior evaluation still showed marked executive dysfunction. The authors address that, in hemorrhagic-type moyamoya disease, early perfusion CT scanning is not only a powerful tool to identify the high-risk group of patients who could experience subacute infarction, but also alarms neurosurgeons to eliminate any predisposing factors when it shows reversible ischemic injuries.
The Frontal Assessment Battery (FAB) is commonly used to evaluate executive functions. Although psychometric properties have been examined in Western studies, data on the FAB in Eastern societies are limited. This study thus aims to examine psychometric properties of the Taiwanese FAB (TFAB). A total of 301 healthy participants were recruited. All participants were evaluated with the TFAB. Thirty participants were retested 3 months after the 1st examination for test–retest reliability. The Verbal Fluency Test was used for criterion-related validity. Although the TFAB had an unacceptable Cronbach's alpha, its test–retest reliability was good. The criterion validity was also good, while the factor analysis revealed that the TFAB may be represented as a 2-factor or 3-factor structure. The TFAB score was significantly associated with age and education level. This study comprehensively re-examined the psychometric properties of the TFAB for Chinese-speaking people, and it merited more validations for the TFAB with clinical samples in the future.
Summary. The relationship of inhibitory quotient (IQ) with the virologic response to specific inhibitors of human hepatitis C virus (HCV) and the best method to correct for serum protein binding in calculating IQ have not been addressed. A common method is to determine a fold shift by comparing the EC 50 values determined in cell culture in the absence and presence of human serum (fold shift in EC 50 ), but this method has a number of disadvantages. In the present study, the fold shifts in drug concentrations between 100% human plasma (HP) and cell culture medium (CCM) were directly measured using a modified comparative equilibrium dialysis (CED) assay for three HCV protease inhibitors (PIs) and for a novel HCV inhibitor GS‐9132. The fold shift values in drug concentration between the HP and CCM (CED ratio) were ∼1 for SCH‐503034, VX‐950 and GS‐9132 and 13 for BILN‐2061. These values were ∼3–10‐fold lower than the fold shift values calculated from the EC 50 assay for all inhibitors except BILN‐2061. Using the CED values, a consistent pharmacokinetic and pharmacodynamic relationship was observed for the four HCV inhibitors analysed. Specifically, an approximate 1 log 10 reduction in HCV RNA was achieved with an IQ close to 1, while 2–3 and greater log 10 reductions in HCV RNA were achieved with IQ values of 3–5 and greater, respectively. Thus, use of CED to define IQ provides a predictive and quantitative approach for the assessment of the in vivo potency of HCV PIs and GS‐9132. This method provides a framework for the evaluation of other classes of drugs that are bound by serum proteins but require the presence of serum for in vitro evaluation.
Hippocampal avoidance whole-brain radiotherapy (HA-WBRT) shows potential for neurocognitive preservation. This study aimed to evaluate whether HA-WBRT or conformal WBRT (C-WBRT) is better for preserving neurocognitive function.This single-blinded randomized phase II trial enrolled patients with brain metastases and randomly assigned them to receive HA-WBRT or C-WBRT. Primary endpoint is decline of the Hopkins Verbal Learning Test-Revised (HVLT-R) delayed recall at 4 months after treatment. Neurocognitive function tests were analyzed with a mixed effect model. Brain progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method.From March 2015 to December 2018, seventy patients were randomized to yield a total cohort of 65 evaluable patients (33 in the HA-WBRT arm and 32 in the C-WBRT arm) with a median follow-up of 12.4 months. No differences in baseline neurocognitive function existed between the 2 arms. The mean change of HVLT-R delayed recall at 4 months was -8.8% in the HA-WBRT arm and +3.8% in the C-WBRT arm (P = 0.31). At 6 months, patients receiving HA-WBRT showed favorable perpetuation of HVLT-R total recall (mean difference = 2.60, P = 0.079) and significantly better preservation of the HVLT-R recognition-discrimination index (mean difference = 1.78, P = 0.019) and memory score (mean difference = 4.38, P = 0.020) compared with patients undergoing C-WBRT. There were no differences in Trail Making Test Part A or Part B or the Controlled Oral Word Association test between the 2 arms at any time point. There were no differences in brain PFS or OS between arms as well.Patients receiving HA-WBRT without memantine showed better preservation in memory at 6-month follow-up, but not in verbal fluency or executive function.
Abstract Objective Patients who experience a mild traumatic brain injury (MTBI) may have a headache condition preceding injury, develop a post-traumatic headache after injury, or experience headache neither before nor after injury. This study examined whether MTBI patients with no headache, pre-existing headache, and post-traumatic headache differed in acute-to-subacute outcomes. Method Patients with MTBI were recruited from an outpatient neurosurgery clinic in Taipei, Taiwan after emergency department referral (N = 291; 40.2% men; M = 37.9 ± 13.9 years-old; Mdn = 7 days-since-injury, range = 0–21), completing neuropsychological tests of attention, memory, and verbal fluency and questionnaires evaluating depression, anxiety, and post-concussion symptoms. Participants with no headache (reported neither pre- or post-injury), pre-existing headache (reported pre-injury headache, of whom some reported worsened post-injury headache), and post-traumatic headache (denied pre-injury headache, reported post-injury headache) were compared using non-parametric ANCOVA, controlling for gender and days-since-injury. Results Neuropsychological test performances did not differ between headache groups. Participants with pre-injury headache and post-traumatic headache had greater change in self-reported physical (F = 25.52, p < 0.011, η2 = 0.15) and cognitive symptoms (F = 3.74, p = 0.025, η2 = 0.03) than participants with no headache. Participants with pre-injury headache reported worse post-injury anxiety symptoms than participants with post-traumatic headache (F = 12.02, p < 0.011, η2 = 0.08). Conclusion(s) Participants with pre-injury and post-traumatic headache did not differ in outcome within 21 days of injury but had worse self-reported physical and cognitive symptoms than participants with no headache. Most participants with pre-injury headache experienced worsened headache following MTBI (53.7%). Future research is needed to assess whether more specific headache subtypes are differentially associated with MTBI outcome.
In managing patients with brain metastasis in the disciplines of neuro-oncology, neurosurgery, and radiation oncology, intracranial control and care. Of note, the controversies and problems associated with delayed radiation-related cognitive dysfunction cannot be ignored, particularly in patients who have undergone whole-brain radiation therapy (WBRT). Concerning neurocognitive consequences related to cranial irradiation, previous studies have shown that impaired hippocampal neurogenesis may be responsible for such cognitive impacts resulting from the delivery of WBRT. Therefore, it has been hypothesized that conformal hippocampal sparing during the course of WBRT (HS-WBRT) would contribute to meaningful preservation with regard to neurocognitive functions (NCFs).
Objective: Presurgical psychological screening (PPS) is a procedure for mitigating possible unfavorable outcomes after spinal surgery. Although the effectiveness of PPS on degenerative spinal diseases has been investigated in Western studies, a potential cultural influence on PPS is still unknown. This study thus aims to explore the experiences of Taiwanese people before spinal surgery and tries to establish culture-specific components of PPS in Taiwan. Participants and Methods: A total of five participants aged from 44–69 with degenerative spinal diseases were eligible in this study. All participants visited a neurosurgical outpatient clinic for potential surgical treatment, and each participant underwent an one-hour semi-structured interview before surgery. The demographical information, medical history, psychological status (e.g., personality traits and emotional disturbances) and considerations to make a surgical decision, were recorded and further analyzed following the rule of grounded theory. Results: Four major components with 21 sub-components were reported when deciding to receive a surgical treatment for their spinal diseases, including disease-related considerations, medical information, self-concept and interpersonal relations. In terms of disease-related aspects, patients concerned about etiology, symptomatology, impacts, coping strategies and rehabilitation methods. As for medical information, patients paid more attention on medical compliance, the relationship with medical system, attitude for treatment, expectation to surgical outcomes, medical decisions and medical information. As for the self-concept, patients considered more on the impacts of disease on self-concept, strategies of emotional regulations and personality traits. In terms of interpersonal relations, patients reported more on the supportive resources, patterns of interpersonal activities and impacts of interpersonal relations on medical decisions. Additionally, other specific factors, such as past negative experiences (e.g., chronic insomnia, experiences of psychological counseling), litigation, physical punishment in childhood and social roles, were also reported. Conclusions: Like previous findings, our results supported that the interpersonal relations and doctor-patient relationship in PPS were important considerations before surgery, while we further evidenced that influences of family members on medical decision is determinant and unique in this culture.
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