Idiopathic normal pressure hydrocephalus (iNPH) is one of the very few treatable types of dementia. Shunt therapy has been shown to be effective in improving symptoms. However, the long-term results ...of cerebrospinal fluid diversion are variable. The aim of this retrospective study was to investigate long-term outcomes of patients with idiopathic normal pressure hydrocephalus treated with ventriculoperitoneal shunt by using programmable valves.
Symptoms before treatment were recorded. Clinical symptoms and outcome after ventriculoperitoneal shunt were assessed based on changes in gait, urinary incontinence, and cognitive dysfunction at yearly follow-up spanning at least 10 years.
Among 50 patients treated, 5 had died at the time of the evaluation. Median age was 71 years, and mean follow-up time of the surviving patients was 120.2 ± 2.3 years. Overall, there was a significant and lasting improvement among all symptoms compared with the baseline (P < 0.05). Gait showed better and sustained improvement compared with the baseline (P < 0.05). Cognitive impairment and urinary incontinence improved in the early follow-up (P < 0.05) followed by declines in long-term follow-up. Ten patients (20%) required surgical revisions for shunt malfunction. Change in valve pressure was performed in 20 patients (40%). Overall, 93.3% revisions resulted in clinical improvement.
Surgical treatment for idiopathic normal pressure hydrocephalus by ventriculoperitoneal shunt is a safe modality that improves symptoms in most patients, including in the long-term. Strict follow-up is necessary for early diagnosis of shunt malfunction or need for valve adjustment.
Spinal cord injury (SCI) is a debilitating neurologic condition with tremendous socioeconomic impact on affected individuals and the health care system. The treatment of SCI principally includes ...surgical treatment and marginal pharmacologic and rehabilitation therapies targeting secondary events with minor clinical improvements. This unsuccessful result mainly reflects the complexity of SCI pathophysiology and the diverse biochemical and physiologic changes that occur in the injured spinal cord. Once the nervous system is injured, cascades of cellular and molecular events are triggered at varying times. Although the cascade of tissue reactions and cell injury develops over a period of days or weeks, the most extensive cell death in SCI occurs within hours of trauma. This situation suggests that early intervention is likely to be the most promising approach to rescue the cord from further and irreversible cell damage. Over the past decades, a wealth of research has been conducted in preclinical and clinical studies with the hope to find new therapeutic strategies. Researchers have identified several targets for the development of potential therapeutic interventions (e.g., neuroprotection, replacement of cells lost, removal of inhibitory molecules, regeneration, and rehabilitation strategies to induce neuroplasticity). Most of these treatments have passed preclinical and initial clinical evaluations but have failed to be strongly conclusive in the clinical setting. This narrative review provides an update of the many therapeutic interventions after SCI, with an emphasis on the underlying pathophysiologic mechanisms.
Personalized medicine is a new paradigm of healthcare in which interventions are based on individual patient characteristics rather than on “one-size-fits-all” guidelines. As epidemiological datasets ...continue to burgeon in size and complexity, powerful methods such as statistical machine learning and artificial intelligence (AI) become necessary to interpret and develop prognostic models from underlying data. Through such analysis, machine learning can be used to facilitate personalized medicine via its precise predictions. Additionally, other AI tools, such as natural language processing and computer vision, can play an instrumental part in personalizing the care provided to patients with spine disease. In the present report, we discuss the current strides made in incorporating AI into research on spine disease, especially traumatic spinal cord injury and degenerative spine disease. We describe studies using AI to build accurate prognostic models, extract important information from medical reports via natural language processing, and evaluate functional status in a granular manner using computer vision. Through a case illustration, we have demonstrated how these breakthroughs can facilitate an increased role for more personalized medicine and, thus, change the landscape of spine care.
The history of superconductivity in MgB2 has been short, but intense. Ten years after its discovery, the two-gap mechanism of superconductivity in MgB2 has been mastered to a considerable extent ...while developing its superconducting properties in wires that meet the technical and economic requirements of industrial applications. The hope for dry superconductivity (i.e., without any liquid cryogen) using this simple and low-cost material has been recently fulfilled, with current commercial availability of MgB2-based dry MRI machines. We expect that scientific progress in understanding and developing MgB2 conductors will continue, strengthening the base for further deployment of MgB2 in applications. This article presents the main scientific and technical highlights of MgB2, describing its two-gap superconductivity, progress in improving its superconducting properties, the advances toward making MgB2 a fully recognized practical superconductor, and its prospects for ongoing and upcoming applications.
Objective: Symptomatic lumbar spinal stenosis (LSS) unresponsive to conservative therapy is commonly treated by surgical decompression. In this study, we compared clinical outcomes after ...decompressive surgery for LSS in patients implanted with interarticular spacers along with microdecompression (MD) with those receiving only MD.
Methods: A retrospective study was analyzed 40 patients (Group A) affected by LSS treated by MD and implant of interarticular spacers comparing the outcome with a homogeneous group of 40 patients with LSS treated with MD alone (Group B). Clinical outcome was evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, as well as Macnab's criteria.
Results: At 1-year follow-up, ODI improved in both groups with statistically significant differences as compared to baseline and both Groups (P < 0.05). Statistically significant differences were observed at 3-year follow-up (P < 0.05), without further variation at 5-year follow-up. At 1-year follow-up, VAS for back and leg pain scores was significantly better than that of Group B (P < 0.05). At 3-year follow-up, back and leg pain scores were no longer significantly improved (P > 0.01), resulting almost the same at 5-year follow-up. A comparison of functional outcomes between the groups showed significant improvements in Group A as compared to Group B (P < 0.05). The reoperation rate was 10% in Group A and 30% in Group B. In implanted patients, successful fusion was obtained in 90% of the cases.
Conclusions: Interarticular spacers showed significant and clinically meaningful improvements in pain and disability, even in a long follow-up.
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