Neurological manifestations or disorders associated with the central nervous system are among the most common and important clinical characteristics of antiphospholipid syndrome (APS). Although in the most recently updated (2006) APS classification criteria, the neurological manifestations encompass only transient ischemic attack and stroke, diverse 'non-criteria' neurological disorders or manifestations (i.e., headache, migraine, bipolar disorder, transverse myelitis, dementia, chorea, epileptic seizures, multiple sclerosis, psychosis, cognitive impairment, Tourette's syndrome, parkinsonism, dystonia, transient global amnesia, obsessive compulsive disorder and leukoencephalopathy) have been observed in APS patients. To date, the underlying mechanisms responsible for these abnormal neurological manifestations in APS remain unclear. In vivo experiments and human observational studies indicate the involvement of thrombotic events and/or high titers of antiphospholipid antibodies in the neuro-pathogenic cascade of APS. Although different types of neurologic manifestations in APS patients have successfully been treated with therapies involving anti-thrombotic regimens (i.e., anticoagulants and/or platelet antiaggregants), antineuralgic drugs (i.e., antidepressants, antipsychotics and antiepileptics) and immunosuppressive drugs alone or in combination, evidence-based guidelines for the management of the neurologic manifestations of APS remain unavailable. Therefore, further experimental, clinical and retrospective studies with larger patient cohorts are warranted to elucidate the pathogenic linkage between APS and the central nervous system in addition to randomized controlled trials to facilitate the discovery of appropriate medications for the 'non-criteria' neurologic manifestations of APS.
Matched MeSH terms: Nervous System Diseases/etiology*; Nervous System Diseases/metabolism*
It has been long known that affective disorders as a result of organic brain diseases are not uncommon. Neurological disorders seem to be significant as risk factors for newly diagnosed mania in the elderly. It has been theorized that lesions in the right cerebral hemisphere and limbic structures may produce symptoms suggestive of mania. Even though specific areas of involvement had not been determined, this case discussed below clearly reports a right sided lesion. One of the reasons why not much is known yet about this clinical entity is the rarity of this occurrence. In fact, in one large scale study, only 2 patients out of 700 were identified with mania.
This study aims to determine the most efficacious dose of Botulinum neurotoxin type A (BoNT-A) in reducing sialorrhea in Asian adults with neurological diseases. A prospective, double-blind randomized controlled trial was conducted over 24 weeks. Thirty patients with significant sialorrhea were randomly assigned to receive a BoNT-A (Dysport(®)) injection into the submandibular and the parotid glands bilaterally via an ultrasound guidance. The total dose given per patient was either BoNT-A injection of (i) 50 U; (ii) 100 U; or (iii) 200 U. The primary outcome was the amount of saliva reduction, measured by the differential weight (wet versus dry) of intraoral dental gauze at baseline and at 2, 6, 12, and 24 weeks after injection. The secondary outcome was the subjective report of drooling using the Drooling Frequency and Severity Scale (DFS). Saliva reduction was observed in response to all BoNT-A doses in 17 patients who completed the assessments. Although no statistically significant difference among the doses was found, the measured reduction was greater in groups that received higher doses (100 U and 200 U). The group receiving 200 U of Dysport(®) showed the greatest reduction of saliva until 24 weeks and reported the most significant improvement in the DFS score.
Matched MeSH terms: Nervous System Diseases/drug therapy*
Burkholderia pseudomallei affecting the central nervous system has been extensively reported in the literature. However, combined central nervous system and peripheral nervous system involvement in melioidosis has never been reported. We report a 66-year-old man with diabetes mellitus who was diagnosed to have central nervous system melioidosis and developed acute flaccid quadriplegia. Nerve conduction studies and anti-ganglioside antibodies were consistent with Guillain-Barre syndrome. This case report highlights the importance to recognise the possibility of Guillain Barre syndrome complicating central nervous system melioidosis and stresses the urgency of early consideration of this complication, as early immunomodulatory therapy may hasten neurological recovery.
The segmentation of power lines (PLs) from aerial images is a crucial task for the safe navigation of unmanned aerial vehicles (UAVs) operating at low altitudes. Despite the advances in deep learning-based approaches for PL segmentation, these models are still vulnerable to the class imbalance present in the data. The PLs occupy only a minimal portion (1-5%) of the aerial images as compared to the background region (95-99%). Generally, this class imbalance problem is addressed via the use of PL-specific detectors in conjunction with the popular class balanced cross entropy (BBCE) loss function. However, these PL-specific detectors do not work outside their application areas and a BBCE loss requires hyperparameter tuning for class-wise weights, which is not trivial. Moreover, the BBCE loss results in low dice scores and precision values and thus, fails to achieve an optimal trade-off between dice scores, model accuracy, and precision-recall values. In this work, we propose a generalized focal loss function based on the Matthews correlation coefficient (MCC) or the Phi coefficient to address the class imbalance problem in PL segmentation while utilizing a generic deep segmentation architecture. We evaluate our loss function by improving the vanilla U-Net model with an additional convolutional auxiliary classifier head (ACU-Net) for better learning and faster model convergence. The evaluation of two PL datasets, namely the Mendeley Power Line Dataset and the Power Line Dataset of Urban Scenes (PLDU), where PLs occupy around 1% and 2% of the aerial images area, respectively, reveal that our proposed loss function outperforms the popular BBCE loss by 16% in PL dice scores on both the datasets, 19% in precision and false detection rate (FDR) values for the Mendeley PL dataset and 15% in precision and FDR values for the PLDU with a minor degradation in the accuracy and recall values. Moreover, our proposed ACU-Net outperforms the baseline vanilla U-Net for the characteristic evaluation parameters in the range of 1-10% for both the PL datasets. Thus, our proposed loss function with ACU-Net achieves an optimal trade-off for the characteristic evaluation parameters without any bells and whistles. Our code is available at Github.
A novel mass spectrometry detection technique based on a multi-period and multi- experiment (MRM-EPI-MRM3) with library matching in a single run for fast and rapid screening and identification of amphetamine type stimulants (ATS) related drugs in whole blood, urine and dried blood stain was developed and validated. The ATS-related drugs analyzed in this study include ephedrine, pseudoephedrine, amphetamine, methamphetamine, MDMA (3,4-Methylenedioxymethamphetamine), MDA (3,4-Methylenedioxyamphetamine), MDEA (3,4-Methylenedioxy-N-ethylamphetamine) and phentermine. The relative standard deviation for inter and intraday was less than 15% while recoveries ranged from 80% to 120% for all three matrices, i.e., whole blood, urine and dried blood stain. All compounds gave library matching percentage of more than 85% based on the purity. This method was proven to be simple and robust, and provide high confident results complemented with library matching confirmation.
Matched MeSH terms: Central Nervous System Stimulants
Schizencephaly is a very rare congenital birth defect. It is characterized by a cortical brain malformation that manifests as a grey-matter-lined cleft extending from the ependyma to the pia mater. It is a rare condition, and few cases have been reported in the literature. The exact cause is unknown. Herein, we report a case of an infant presenting with left side hemiparesis. The CT scan of her brain revealed right fronto-temporal and left parieto-temporal open-lip schizencephaly; thus, urgent referral to a pediatric neurologist was made for early intervention.
We report a case of a 65 year old Malay lady with long-standing diabetes mellitus, who presented to our institution with a one month history of worsening neck pain and progressive upper and lower limb weakness. She was stable despite severe hyponatraemia which was initially treated as syndrome of inappropriate anti-diuretic hormone (SIADH). This was consistent with her underlying illness which was concluded as cervical tuberculosis (TB) with spinal cord compression. She underwent decompression and bone grafting. Despite continuous treatment her serum sodium levels remained low. There were no other problems with her adrenals or thyroid. A water loading and hypertonic saline perfusion test was performed and supported the diagnosis of reset osmostat. Her serum sodium remained below the normal range and she was discharged well.
Matched MeSH terms: Tuberculosis, Central Nervous System/surgery*
Primary central nervous system atypical rhabdoid/teratoid tumour (ATRT) is a rare and highly malignant tumour that tends to occur in infancy and early childhood. The majority of tumours (approximately two-third) arise in the posterior fossa. The optimal treatment for ATRT remains unclear. Options of treatment include surgery, radiotherapy, and chemotherapy. Each of their role is still not clearly defined until now. The prognosis of the disease is generally unfavourable. This is a case report of ATRT in an atypical site in a 9-year-old girl.
Matched MeSH terms: Central Nervous System Neoplasms
Functional magnetic resonance imaging (fMRI) makes it possible to detect brain activities in order to elucidate cognitive-states. The complex nature of fMRI data requires under-standing of the analyses applied to produce possible avenues for developing models of cognitive state classification and improving brain activity prediction. While many models of classification task of fMRI data analysis have been developed, in this paper, we present a novel hybrid technique through combining the best attributes of genetic algorithms (GAs) and ensemble decision tree technique that consistently outperforms all other methods which are being used for cognitive-state classification. Specifically, this paper illustrates the combined effort of decision-trees ensemble and GAs for feature selection through an extensive simulation study and discusses the classification performance with respect to fMRI data. We have shown that our proposed method exhibits significant reduction of the number of features with clear edge classification accuracy over ensemble of decision-trees.
Matched MeSH terms: Nervous System Physiological Phenomena
Binary expression systems have revolutionised genetic research by enabling delivery of loss-of-function and gain-of-function transgenes with precise spatial-temporal resolution in vivo. However, at present, each existing platform relies on a defined exogenous transcription activator capable of binding a unique recognition sequence. Consequently, none of these technologies alone can be used to simultaneously target different tissues or cell types in the same organism. Here, we report a modular system based on programmable transcription activator-like effector (TALE) proteins, which enables parallel expression of multiple transgenes in spatially distinct tissues in vivo. Using endogenous enhancers coupled to TALE drivers, we demonstrate multiplexed orthogonal activation of several transgenes carrying cognate variable activating sequences (VAS) in distinct neighbouring cell types of the Drosophila central nervous system. Since the number of combinatorial TALE-VAS pairs is virtually unlimited, this platform provides an experimental framework for highly complex genetic manipulation studies in vivo.
Functional Electrical Stimulation (FES) can be used to revive movement
functions of the human body to a certain degree which was lost due to
occurrences of the nervous system disorders resulting from accidents or
diseases. It can also be employed for gait rehabilitation as well as therapy.
Control systems could be employed to improve on the FES-induced motion,
and the closed-loop was targeted due to its advantages. Based on the papers
reviewed, studies have shown that the linear control schemes are popular for
movement restoration in the lower limb, but mostly for continuous standing
contributing to mainly the stance phase. Therefore, a myriad of limitations
was observed which include: the need for using improved sensors, re-tuning
for every subject, tests conducted using patient with more straightforward
ailments, complexity in implementation and most importantly is the issue of
stability. The swing phase of gait movement and the full walking motion have
more complex dynamics and coupled with the nature of the plant (human with
nervous system disorder and the neuromuscular structure) could render the
linear control method obsolete or unsuitable. Hence, there is a need to
investigate other techniques such as the nonlinear and intelligent control
methods.
Granulomatous amoebic encephalitis due to Acanthamoeba is a chronic disease that almost always results in death. Hematogenous spread is a pre-requisite followed by amoebae invasion of the blood-brain barrier to enter the central nervous system. Given the systemic nature of this infection, a significant latent period of several months before the appearance of clinical manifestations is puzzling. Based on reported cases, here we propose pathogenetic mechanisms that explain the above described latency of the disease.
Sarcoidosis is characterized by formation of inflammatory granulomas affecting all over the body, with pulmonary predilection (1). Neurosarcoidosis is a rare but potentially dangerous manifestation of sarcoidosis. We report a case of disseminated sarcoidosis presenting with a neurological diagnostic dilemma. Worsening mediastinal lymphade- nopathy, together formation of lung and liver nodules making a sarcoidosis diagnosis favourable. Histology from these lesions showed non-caseating granulomatous inflammation. She was treated as a rare case of disseminated sarcoidosis. To date, there is no specific or clear guideline on the management of disseminated sarcoidosis.
Matched MeSH terms: Central Nervous System Diseases
Matched MeSH terms: Nervous System/pathology; Central Nervous System Neoplasms/diagnosis; Central Nervous System Neoplasms/drug therapy*; Central Nervous System Neoplasms/pathology*
Glioblastoma (GBM) is a highly fatal disease with a 5 year survival rate of less than 22%. One of the most effective treatment regimens to date is the use of radiotherapy which induces lethal DNA double-strand breaks to prevent tumour growth. However, recurrence occurs in the majority of patients and is in-part a result of robust radioresistance mechanisms. In this study, we demonstrate that the multifunctional cytokine, interleukin-6 (IL-6), confers a growth advantage in GBM cells but does not have the same effect on normal neural progenitor cells. Further analysis showed IL-6 can promote radioresistance in GBM cells when exposed to ionising radiation. Ablation of the Ataxia-telangiectasia mutated serine/threonine kinase that is recruited and activated by DNA double-strand breaks reverses the effect of radioresistance and re-sensitised GBM to DNA damage thus leading to increase cell death. Our finding suggests targeting the signaling cascade of DNA damage response is a potential therapeutic approach to circumvent IL-6 from promoting radioresistance in GBM.
Matched MeSH terms: Central Nervous System Neoplasms/metabolism; Central Nervous System Neoplasms/radiotherapy*