Jelena Podgorac

Breech presentation and the cornual-fundal location of the placenta

Aim To investigate the association of cornual-fundal location of the placenta and breech presentation at term delivery. Methods This study was conducted at the Department of Obstetrics and Gynecology, Novi Sad, in 2011. The inclusion criteria were delivery at ≥37 weeks of gestation, singleton gestation, and cornual-fundal location of the placenta determined by ultrasonography at ≥37 weeks of gestation when 3/4 or more of the placenta was in the cornual-fundal region. Results Out of 2750 ultrasound examinations performed, 143 showed cornual-fundal location of the placenta (frequency 5.2%). Eighty six cases had cephalic presentation (60.14%) and 57 (39.86%) had breech presentation. Of the remaining cases with non- cornual-fundal location, 2585 had cephalic presentation and 22 (0.84%) had breech presentation. The difference in the frequency of breech presentation between the cornual-fundal and non-cornual-fundal groups was significant (χ2 = 77.78, P < 0.001). Conclusion Cornual-fundal location of the placenta may be an important clue in resolving the etiology of a number of cases of breech presentation at term delivery.

Early physical and motor development of mouse offspring exposed to valproic acid throughout intrauterine development

Clinical research has identified developmental delay and physical malformations in children prenatally exposed to the antiepileptic drug (AED) valproic acid (VPA). However, the early signs of neurodevelopmental deficits, their evolution during postnatal development and growth, and the dose effects of VPA are not well understood. The present study aimed to examine the influence of maternal exposure to a wide dose range (50, 100, 200 and 400mg/kg/day) of VPA during breeding and gestation on early physical and neuromotor development in mice offspring. Body weight gain, eye opening, the surface righting reflex (SRR) and tail suspension test (TST) were examined in the offspring at postnatal days 5, 10 and 15. We observed that: (1) all tested doses of VPA reduced the body weight of the offspring and the timing of eye opening; (2) offspring exposed to VPA displayed immature forms of righting and required more time to complete the SRR; (3) latency for the first immobilization in the TST is shorter in offspring exposed to higher doses of VPA; however, mice in all groups exposed to VPA exhibited atypical changes in this parameter during the examined period of maturation; (4) irregularities in swinging and curling activities were observed in animals exposed to higher doses of VPA. This study points to delayed somatic development and postponed maturation of the motor system in all of the offspring prenatally exposed to VPA, with stronger effects observed at higher doses. The results implicate that the strategy of continuous monitoring of general health and achievements in motor milestones during the early postnatal development in prenatally VPA-exposed offspring, irrespectively of the dose applied, could help to recognize early developmental irregularities.

Significance of adequate postural control in the appearance of habitual upright bipedal locomotion

Analysis of qualitative indicators of stability of the body during different types of locomotion in primates suggests that bipedal locomotion is not variation of some other type of locomotion. Transition from quadrupedal to bipedal locomotion is accompanied by a qualitative difference in body stability. Because of assuming an upright bipedal posture, the center of mass is lifted, the surface of the base of support is reduced, and the body structure does not provide passive stability in relation to inertial moments of the body around Y-axis. Additional head movements, trunk rotations, forelimb manipulations with objects and surveying the surroundings are necessary for survival, but they increase the degree of freedom of movement and further complicate the task of maintaining balance in the case of a postural change from erect quadrupedal to erect bipedal. This article presents a hypothesis that the transition from quadrupedal to habitual upright bipedal locomotion was caused by qualitative changes in the nervous system that allowed controlling the more demanding type of locomotion. The ability to control a more demanding posture increases possibilities of interactions between the organism and the complex environment and consequently increases the survival rate, breeding possibilities, and chances for occupying a new environmental niche. Existing data show that ability to execute the more demanding type of locomotion was made possible because of changes in the frontal lobe and pyramidal system. Only after the more demanding posture was enabled by changes in the nervous system, could advantages of bipedal over quadrupedal locomotion be utilized, including better scanning of the environment, carrying food and infants, simultaneous upper extremity movements and observation of the environment, limitless manipulation of objects with upper extremities above the individual, and less space for rotating around the Z-axis. The aforementioned advantages of habitual bipedal over quadrupedal locomotion are present in physically complex environments, such as the forest, which is associated with the appearance of habitual bipedal locomotion.

Quantitative and qualitative assessment of the offspring in the Tail suspension test (TST) which mothers were treated with different doses of valproic acid during entire pregnancy

Introduction: Malignant gliomas are highly infiltrative and aggressive primary brain tumors. Achieving gross total resection (GTR) using conventional white light microsurgical technique is a challenge. Five-aminolevulinic acid (5-ALA) can be used as an adjunct for the surgery of adult malignant glioma and improves the rate of gross total resection and patient survival. The use of this method in clinical practice is relatively new in Malaysia. We evaluate the extent of malignant glioma resection under fluorescence-guided resection (FGR) using volumetric MR neuroimaging.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 international normalized ratio (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 on hematoma volume changes. Results: We included 224 consecutive ICH patient. 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 for hematoma volume change, adjusting for baseline hematoma volume and time. Each 1.0 increase in INR was associated with hematoma volume increase by 2.4ml (p = 0.015). Conclusions: We showed that high INR was associated with hematoma growth post ICH. However, the effects of anticoagulation reversal on the attenuation of hematoma growth remain uncertain and require confirmation in future randomized controlled studies. Correspondence to: Bernard Yan, Professor, Melbourne Brain Centre, Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Victoria, Australia, Tel: +61 3 9349 2477, E-mail: bernard.yan@mh.org.au Received: March 20, 2017; Accepted: April 21, 2017; Published: April 24, 2017 Introduction Intracerebral hemorrhage (ICH) is a stroke subtype accounting for approximately 10% – 15% of all strokes [1] and has an annual incidence of approximately 25 per 100,000 [2]. The one month case fatality rate is approximately 40% and rising to 55% in 1 year [2]. The 10-year survival rate is approximately 20% to 25% [3]. The rate of functional independence after ICH at 1 year varies between 12% to 39% [2,4]. Various factors have been shown to influence outcome in ICH, including age, initial hematoma volume, hematoma expansion (HE), neurologic deficit, intraventricular extension, and infratentorial location [5]. HE is a major determinant of early deterioration and death [6], with each milliliter increase in absolute volume is associated with increasing risk of dependence by 7% [7]. In addition, approximately 10 mL increase in hematoma volume over 24 hours was strongly associated with poor outcome [5]. HE has been widely investigated as a therapeutic target in ICH given its modifiable nature [4]. Accordingly, there is interest in determining the risk of HE, and in developing strategies to reduce HE [6]. Oral anticoagulant therapy (OAC) is considered an independent predictor of mortality in patients with intracerebral hemorrhage [8], the incidence of spontaneous intracranial hemorrhage is 7 -10 times higher amongst patients on oral anticoagulation (OAC) compared with those not on anticoagulation. OAC causes 8% – 14% of all ICH [9]. However, the association between hematoma growth and anticoagulation remains unresolved [8,9]. In this study, we aimed to investigate the effects of anticoagulation intensity on hematoma expansion. We hypothesized that ICH cases with higher International normalized ratio (INR) were associated with increased hematoma expansion. Methods Study population The study protocol was approved by the human research ethics committee of the Royal Melbourne Hospital. Written informed consent was not sought as this was a retrospective analysis of data. Yang W (2017) Intracerebral haemorrhage growth is influenced by anticoagulation intensity Volume 1(2): 1-5 Neurol Disord Therap, 2017 doi: 10.15761/NDT.1000107 We confirm that patient records were de-identified prior to analysis. We identified all subjects aged ≥18 years who were hospitalized with ICH between January 1, 2008 and August 1, 2014 at this hospital. The inclusion criteria required 2 CT scans in sequence and that the time period between the first CT to the second CT scan to be less than 72 hours. All cases were extracted from the hospital prospective stroke database. Exclusion criteria were traumatic ICH, hemorrhagic transformation of cerebral infarction, ICH secondary to vascular malformation, aneurysm, vasculitis of the central nervous system, and recent endarterectomy. In addition, we excluded patients with primary intraventricular hemorrhage (IVH), and those with missing INR values or without 2 CT scans. Patient demographics and putative risk factors, including gender, age, hypertension, diabetes mellitus, atrial fibrillation, hypercholesterolemia, ischemic heart disease, previous transient ischemic attack (TIA) or stroke, and pre-admission medications were extracted from the stroke database or by a medical record chart review. Pre-admission modified Rankin Scale (mRS), Glasgow Coma Scale (GCS) at presentation, mRS at discharge, and in-hospital mortality were collected. All presentations were within 7 days of symptom onset, including inter-hospital transfers. The initial baseline brain CT scans, second CT scan and INR values were evaluated. For warfarin-related ICH patients, initial INR values obtained before anticoagulation reversal were used for the analysis. Patients were both dichotomized by warfarin use and stratified by the level of anticoagulation. Neuroimaging analyses All CT scans were reviewed and evaluated in consensus by two experienced stroke neurologists (W.Y, B.Y.) who were blinded to the patients’ clinical status. The ICH volumes were determined from available CT scans. Hematoma Volume of first CT scan (CT 1) and second CT scan (CT 2) were calculated by AxBxC/2 methods. Intraventricular blood was not included in the volume calculation. The hematoma location was categorized into lobar (with or without involvement of subcortical white matter), deep (basal ganglia, thalamus, internal capsule), cerebellum and brainstem. Location was also dichotomized into supraand infratentorial site. One initial shape classification for ICH included three categories: regular, irregular, and separated. Statistical analysis Continuous and categorical were compared using the Mann– Whitney rank-sum test and Fisher exact test as appropriate at baseline. The following factors were considered: age, hypertension, hyperlipidemia, diabetes, and ischemic heart disease. The association between the baseline INR category and hematoma volume change was investigated using median regression analysis. Statistical analyses were performed using Stata/ IC software package, version 12.0 (StataCorp, College Station, TX). All p values are 2-tailed, p <0.05 was considered significant.R 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.