BACKGROUNDObstructive sleep apnea syndrome (OSAS) is a disease with increasing prevalence, which is mainly characterized by increased cardiopulmonary mortality and morbidity. It is well-known that OSAS patients have increased prevalence of cardiovascular diseases including coronary heart disease, heart failure, and arrhythmias. The aim of this study was to evaluate the presence of prolonged and fragmented QRS complexes, which have previously been associated with cardiovascular mortality, in OSAS patients.

METHODSOur study included 51 patients (mean age 41.6 ± 10.1 years) who were recently diagnosed with OSAS (apnea-hypopnea index [AHI] ≥5 events/h) and never received therapy. The control group consisted of 34 volunteers (mean age 43.1 ± 11.6 years) in whom OSAS was excluded (AHI <5 events/h). The longest QRS complexes was measured in the 12-lead electrocardiogram (ECG) and the presence of fragmentation in QRS complexes was investigated.

RESULTSFragmented QRS frequency was significantly higher in patients with OSAS (n = 31 [61%] vs. n = 12 [35%], P = 0.021). QRS and QTc durations were also significantly longer in OSAS patients than controls (99.8 ± 13.9 ms vs. 84.7 ± 14.3 ms, P < 0.001; 411.4 ± 26.9 ms vs. 390.1 ± 32.2 ms, P = 0.001, respectively). Analysis of the patient and controls groups combined revealed a weak-moderate correlation between AHI and QRS duration (r = 0.292, P = 0.070). OSAS group had no correlation between AHI and QRS duration (r = -0.231, P = 0.203).

CONCLUSIONSIn our study fragmented QRS frequency and QRS duration were found to increase in OSAS patients. Both parameters are related with increased cardiovascular mortality. Considering the prognostic importance of ECG parameters, it may be reasonable to recommend more detailed evaluation of OSAS patients with fragmented or prolonged QRS complexes with respect to presence of cardiovascular diseases.

Adult ; Case-Control Studies ; Echoencephalography ; Electrocardiography ; Female ; Humans ; Male ; Polysomnography ; Sleep Apnea, Obstructive ; physiopathology

Intraventricular hemorrhage (IVH) remains an important cause of morbidity and mortality in Very Low Birth Weight (VLBW) infants. Since 2004, Indomethacin, which is effective in preventing IVH, has been removed from the Philippine market. Ketorolac is a nonselective cyclooxygenase inhibitor which is structurally-related and of equal potency to Indomethacin.
OBJECTIVE: This study aims to determine if prophylactic ketorolac compared to placebo will decrease IVH and its associated morbidities among preterm neonates.
METHODS: We conducted a double-blind, randomized, placebo-controlled trial among neonates born in a tertiary government university hospital. Newborns with gestational age ?32 weeks and birth weight RESULTS: A total of 134 infants were included in this study. There was no difference in the proportion of infants who developed IVH between the ketorolac and placebo groups (46% vs. 45%). The mean serum creatinine levels were significantly higher in the ketorolac group (1.15 ± 0.69 vs 0.79 ±0.38; p=0.002). The rates of death, sepsis, necrotizing enterocolitis, bleeding, platelet counts of <50,000/mm3, mean urine output and the lengths of hospital stay were similar in the two groups.
CONCLUSION: Prophylactic intravenous ketorolac was ineffective in preventing IVH among preterm infants. Ketorolac cannot be recommended for the prevention of IVH.

Human ; Infant Newborn ; Birth Weight ; Cerebral Hemorrhage ; Creatinine ; Cyclooxygenase Inhibitors ; Echoencephalography ; Gestational Age ; Philippines ; Platelet Count ; Sepsis

OBJECTIVETo study the insular development of small for gestational age (SGA) infants.

METHODSThe insular area and circle were measured by cerebral ultrasonography in 92 SGA infants. The results were compared with those from 109 appropriate for gestational age (AGA) infants.

RESULTSThe insular area and circle were positively correlated with the birth weight and gestational age in SGA infants. The insular area in SGA infants with a gestational age of either >37 weeks (451 +/- 92 mm2 vs 516 +/- 116 mm2; p<0.01) or < or = 34 weeks (248 +/- 78 mm2 vs 314 +/- 80 mm2; p<0.01) was significantly less than that in the AGA infants. The insular circle in SGA infants with a gestational age of >37 weeks was also significantly less than that in the AGA infants (92 +/- 11 mm vs 97 +/- 11 mm; p<0.05).

CONCLUSIONSThe insular development of SGA infants seems to be immature. The insular development may be assessed based on the insular area and circle measured by cerebral ultrasonography.

Birth Weight ; Cerebral Cortex ; embryology ; Echoencephalography ; Female ; Gestational Age ; Humans ; Infant, Newborn ; Infant, Small for Gestational Age ; Male

OBJECTIVESponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association, more than 10 large-scale hospitals participated in the near two-year multicenter investigation for Brain Injuries in Premature Infants in China. The present study presents the follow-up results of 147 premature infants with brain injuries from 6 Third Class A Level hospitals.

METHODSAll premature infants with intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) diagnosed in the early neonatal period in the 6 hospitals were followed-up between January 2005 and August 2006. Based on the synthetic results of physical development, examination of nervous system, intelligence tests and cranial ultrasound, the premature infants with brain injuries were classified as normal development, marginal development and retarded development.

RESULTSOne hundred and forty-seven premature infants with brain injuries from the 6 hospitals consisted of 141 cases of IVH and 36 cases of PVL (30 cases having IVH and PVL). Based on the synthetic follow-up results, 51.4% of premature infants with brain injuries were generally assessed as normal development, 38.4% as marginal development and 10.7% as retarded development. Among them, delayed growth in head circumference, height and weight was 13.4%; the occurrence frequency of cerebral paralysis (CP) was 7.1% in PVL grade I, 28.6% in PVL grade II and 100% in PVL grade III; 12.7% showed retarded development of intelligence; and 30% presented post-injurious changes on cranial sonography.

CONCLUSIONSThe data of the multicenter follow-up can basically reflect the short-term prognosis of premature infants with brain injuries in major big cities of China. About 10% of them have retarded physical, motor-and mental developments. The long-term regular follow-up study is expected for more premature infants with brain injuries, and behavioral sequelae of brain injuries which may occur in peri-school age and adolescence should be paid particularly close attention.

Cerebral Hemorrhage ; complications ; physiopathology ; Cerebral Palsy ; etiology ; Echoencephalography ; Follow-Up Studies ; Humans ; Infant, Newborn ; Infant, Premature ; Intelligence ; Leukomalacia, Periventricular ; complications ; physiopathology

OBJECTIVETo understand the relationship of the grading of periventricular echodensities (PVE) with the morbidity and the occurrence time of periventricular white matter cystic lesions in preterm infants.

METHODSA retrospective, single-centre cohort study of 120 preterm infants with PVE diagnosed by ultrasonography between February 2005 and May 2008 was performed. The infants had a median gestational age of 32 weeks and a median birth weight of 2 230 g.

RESULTSFifty-two infants (43%) were diagnosed as having PVE I, 42 infants (35%) having PVE II, and 26 infants (22%) having PVE III. The grading of PVE was closely related to birth weight, but not with gestational age. The total morbidity of periventricular white matter cystic lesions was 24% (29/120). The morbidity of the cystic lesions in PVE III patients (65%) was significantly higher than that in PVE II patients (21%) (<0.01). The PVE III patients developed the cystic lesions earlier than the PVE II patients.

CONCLUSIONSThe grading of PVE is closely related to the morbidity and the occurrence time of periventricular white matter cystic lesions in preterm infants.

Cerebral Ventricles ; diagnostic imaging ; Cysts ; diagnostic imaging ; Echoencephalography ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; Leukomalacia, Periventricular ; diagnostic imaging ; epidemiology ; Male ; Retrospective Studies

BACKGROUNDFew studies have addressed whether abnormalities in the lenticular nucleus (LN) are characteristic transcranial sonography (TCS) echo features in patients with primary dystonia. This study aimed to explore alterations in the basal ganglia in different forms of primary focal dystonia.

METHODScross-sectional observational study was performed between December 2013 and December 2014 in 80 patients with different forms of primary focal dystonia and 55 neurologically normal control subjects. TCS was performed in patients and control subjects. Multiple comparisons of multiple rates were used to compare LN hyperechogenicity ratios between control and patient groups.

RESULTSThirteen individuals were excluded due to poor temporal bone windows, and two subjects were excluded due to disagreement in evaluation by sonologists. Totally, 70 patients (cervical dystonia, n = 30; blepharospasm, n = 30; oromandibular dystonia, n = 10) and 50 normal controls were included in the final analysis. LN hyperechogenicity was observed in 51% (36/70) of patients with primary focal dystonia, compared with 12% (6/50) of controls (P < 0.001). Substantia nigra hyperechogenicity did not differ between the two groups. LN hyperechogenicity was observed in 73% (22/30) of patients with cervical dystonia, a greater prevalence than in patients with blepharospasm (33%, 10/30, P = 0.002) and oromandibular dystonia (40%, 4/10, P = 0.126). LN hyperechogenicity was more frequently observed in patients with cervical dystonia compared with controls (73% vs. 12%, P < 0.001); however, no significant difference was detected in patients with blepharospasm (33% vs. 12%, P = 0.021) or oromandibular dystonia (40% vs. 12%, P = 0.088).

CONCLUSIONSLN hyperechogenicity is more frequently observed in patients with primary focal dystonia than in controls. It does not appear to be a characteristic TCS echo feature in patients with blepharospasm or oromandibular dystonia.

Adult ; Aged ; Blepharospasm ; diagnostic imaging ; Corpus Striatum ; diagnostic imaging ; Cross-Sectional Studies ; Dystonic Disorders ; diagnostic imaging ; Echoencephalography ; Female ; Humans ; Male ; Middle Aged

BACKGROUNDIntraoperative ultrasound (IOUS) has been increasingly used as a guiding tool during neurosurgical procedures. In this study, we aimed to evaluate the potential application of intraoperative ultrasound assisted surgery in the resection of small, deep-seated, or ill-defined lesions.

METHODSEighty-six consecutive patients with small, deep-seated, or ill-defined intracerebral lesions were studied prospectively. An improved intraoperative imaging technique and surgical setup were practiced during the surgery. IOUS was performed in three orthogonal imaging planes (horizontal, coronal and sagittal).

RESULTSHistopathological diagnoses of these 86 cases included cavernomas, metastases, hemangioblastomas, gliomas, and radiation necrosis. Forty-seven of the 86 lesions (54.7%) were small and deep-seated, 34/86 (39.5%) were ill-defined, and 5/86 (5.8%) were small, deep-seated, and ill-defined. Sonograms in the horizontal plane were obtained in all 86 cases. Sonograms in the sagittal plane and in the coronal plane were obtained only in 52 cases and in 46 cases, respectively, due to technical limitation. In 13 cases, sonograms in all three orthogonal planes were available. All lesions were successfully identified and localized by IOUS. Total resection was performed in 67 lesions (77.9%) and partial resection was performed in 19 lesions (22.1%).

CONCLUSIONSWe propose IOUS to be performed in three orthogonal planes when surgery is planned for small, deep-seated, or ill-defined brain lesions. By applying this simple, improved technique, surgeons can perform resection of these lesions precisely.

Adolescent ; Adult ; Aged ; Brain ; pathology ; surgery ; Child ; Echoencephalography ; Female ; Humans ; Intraoperative Period ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neurosurgical Procedures ; methods ; Prospective Studies ; Young Adult

OBJECTIVETo study changes of serum S100B protein level in preterm infants with brain damage and its role.

METHODSForty-seven preterm infants were classified into 3 groups based on the results of brain ultrasound and MRI: brain white matter damage (WMD; n=13), brain but not white matter damage (non-WMD; n=14) and control (no brain damage; n=20). Blood samples were collected within 24 hrs, 72 hrs and 7 days after birth. S100B protein level was measured using ELISA.

RESULTSSerum levels of S100B in the WMD and non-WMD groups were significantly higher than in the control group within 24 hours, 72 hours and 7 days after birth (P<0.05). More increased serum S100B levels were observed in the WMD group compared with the non-WMD group (P<0.05).

CONCLUSIONSSerum S100B protein level increases in preterm infants with brain damage within 7 days after birth, suggesting that it may be used as an early sensitive marker for the diagnosis of brain damage, especially WMD.

Brain ; pathology ; Echoencephalography ; Female ; Humans ; Infant, Newborn ; Infant, Premature ; blood ; Magnetic Resonance Imaging ; Male ; Nerve Growth Factors ; blood ; S100 Calcium Binding Protein beta Subunit ; S100 Proteins ; blood

Brain ; pathology ; Cerebrovascular Circulation ; Echoencephalography ; Humans ; Infant, Newborn ; Infant, Premature ; Leukomalacia, Periventricular ; diagnosis ; pathology ; physiopathology ; Magnetic Resonance Imaging ; Necrosis ; Spectroscopy, Near-Infrared ; Tomography, X-Ray Computed

BackgroundCompared with full-term infants, very preterm infants are more vulnerable to injury and long-term disability and are at high risk of death. The predictive value of ultrasound and imaging on the neurodevelopment is one of the hot topics. This study aimed to investigate the relationship between cranial ultrasound (cUS) variables and neurodevelopmental outcomes of very preterm infants.

MethodsTotally 129 very preterm infants (gestational age ≤28 weeks) in neonatal intensive care unit of Hunan Children's Hospital between January 2012 and November 2014 were included in this retrospective study. Serial cUS (weekly before discharge and monthly after discharge) was performed on the infants until 6 months or older. Magnetic resonance imaging (MRI) was performed on the infants at approximately the term-equivalent age. The mental developmental index (MDI) and psychomotor developmental index (PDI) were followed up until the infants were 24 months or older. The relationship between brain injury and MDI/PDI scores was analyzed.

ResultsThe consistency rate between cUS and MRI was 88%. At the first cUS, germinal matrix hemorrhage (GMH) Grades 3 and 4, hospitalization duration, and weight are significantly correlated with MDI/PDI and prognosis (MDI: odds ratio [OR] = 8.415, 0.982, and 0.042, P = 0.016, 0.000, and 0.004; PDI: OR = 7.149, 0.978, and 0.012, P = 0.025, 0.000, and 0.000, respectively). At the last cUS, gestational age, extensive cystic periventricular leukomalacia (c-PVL), and moderate and severe hydrocephaly are significantly correlated with MDI (OR = 0.292, 60.220, and 170.375, P = 0.004, 0.003, and 0.000, respectively). Extensive c-PVL and moderate and severe hydrocephaly are significantly correlated with PDI (OR = 76.861 and 116.746, P = 0.003 and 0.000, respectively).

ConclusionsVery premature infants with GMH Grades 3 and 4, short hospitalization duration, and low weight have low survival rates and poorly developed brain nerves. Cerebral palsy can result from severe cerebral hemorrhage, moderate and severe hydrocephaly, and extensive c-PVL. The sustained, inhomogeneous echogenicity of white matter may suggest subtle brain injury.

Brain ; diagnostic imaging ; Brain Injuries ; diagnostic imaging ; Cerebral Hemorrhage ; diagnostic imaging ; Echoencephalography ; Female ; Gestational Age ; Humans ; Hydrocephalus ; diagnostic imaging ; Infant, Premature ; Infant, Premature, Diseases ; diagnostic imaging ; Magnetic Resonance Imaging ; Pregnancy ; Retrospective Studies