CIMIL-CRC: A clinically-informed multiple instance learning framework for patient-level colorectal cancer molecular subtypes classification from H&E stained images.

Background And Objective: Treatment approaches for colorectal cancer (CRC) are highly dependent on the molecular subtype, as immunotherapy has shown efficacy in cases with microsatellite instability (MSI) but is ineffective for the microsatellite stable (MSS) subtype. There is promising potential in utilizing deep neural networks (DNNs) to automate the differentiation of CRC subtypes by analyzing hematoxylin and eosin (H&E) stained whole-slide images (WSIs). Due to the extensive size of WSIs, multiple instance learning (MIL) techniques are typically explored.

Challenging Cases in Cerebrovascular Disease.

Disorders involving the vascular system of the brain are numerous and sundry. Atherosclerotic thromboembolism of large vessels and lacunar infarctions of small vessel disease are well known. Brain infarction due to cardioembolism is common as well, and even more so when diligently sought.

Obstructive and central sleep apnoea in a patient with medically intractable epilepsy.

A woman in her 30s with medically intractable epilepsy and Lennox-Gastaut Syndrome on multiple antiseizure medications and with a deep brain stimulator presented to the epilepsy monitoring unit with increased seizure frequency. She was noted to have periods of apparent apnoea time linked to bursts of epileptiform activity on continuous video EEG monitoring. Once the clinical seizures were controlled, she was discharged to the sleep laboratory.

International Recommendations for the Management of Adults Treated With Ketogenic Diet Therapies.

Objective: To evaluate current clinical practices and evidence-based literature to establish preliminary recommendations for the management of adults using ketogenic diet therapies (KDTs).

Methods: A 12-topic survey was distributed to international experts on KDTs in adults consisting of neurologists and dietitians at medical institutions providing KDTs to adults with epilepsy and other neurologic disorders. Panel survey responses were tabulated by the authors to determine the common and disparate practices between institutions and to compare these practices in adults with KDT recommendations in children and the medical literature.

Modified ketogenic diets in adults with refractory epilepsy: Efficacious improvements in seizure frequency, seizure severity, and quality of life.

Objective: This study evaluates the efficacy of a modified ketogenic diet (MKD) on seizure frequency, severity, and quality of life (QOL), as well as potential complications of MKD therapy among adults with drug-resistant epilepsy (DRE).

Methods: Changes in seizure frequency, severity, QOL, and side effects were retrospectively examined among adults, ≥17 years of age, with DRE (≥2 antiepileptic drugs [AEDs]), after 3 months of MKD therapy. Attention was paid to medication or vagus nerve stimulator (VNS) changes as well to evaluate potential confounders.

Do certain subpopulations of adults with drug-resistant epilepsy respond better to modified ketogenic diet treatments? Evaluation based on prior resective surgery, type of epilepsy, imaging abnormalities, and vagal nerve stimulation.

Objective: Adults with drug-resistant epilepsy (DRE) are among the most challenging to treat. This study assessed whether specific subpopulations of adult patients with refractory epilepsy responded differently to modified ketogenic diet (MKD) therapy.

Methods: Changes in seizure frequency, severity, and quality of life (QOL) were retrospectively analyzed based on pre-MKD surgical history, type of epilepsy, imaging findings, and vagal nerve stimulation (VNS) history among adults, ≥17 years of age, with DRE, receiving MKD therapy for three months.

Resecting critical nodes from an epileptogenic circuit in refractory focal-onset epilepsy patients using subtraction ictal SPECT coregistered to MRI.

OBJECTIVE The purpose of this study was to assess the positive predictive value of postresection outcomes obtained by presurgical subtracted ictal SPECT in patients with lesional (MRI positive) and nonlesional (MRI negative) refractory extratemporal lobe epilepsy (ETLE) and temporal lobe epilepsy (TLE). Specifically, outcomes were compared between partial versus complete resection of the regions of transient hyperperfusion identified using subtraction ictal SPECT coregistered to MRI (SISCOM) in relation to the ictal onset zone (IOZ) that was confirmed by electrocorticography (ECoG). That is, SISCOM was used to understand the long-term postsurgical outcomes following resection of the IOZ that overlapped with 1 or more regions of ictal onset-associated transient hyperperfusion.

[Obstructive sleep apnea syndrome in children as a risk of cardiovascular pathology development].

Objective: Our aim was to examine the predictors of cardiovascular disorders in children affected by obstructive sleep apnea syndrome (OSAS) based on the results of polysomnography and continuous monitoring of blood glycose.

Methods: Before the examination, parents filled in questionnaires concerning their children sleep quality. The procedure was followed by the study of the sleep by means of polysomnography (Embla s 7000, USA).

Tailored temporal lobectomy for medically intractable epilepsy: evaluation of pathology and predictors of outcome.

Background: There have been only a few large series that have used a tailored temporal lobectomy.

Objective: To clarify whether tailoring a temporal lobe resection will lead to equivalent epilepsy outcomes or have the same predictive factors for success when compared with standard resections.

Methods: Retrospective analysis of 222 patients undergoing a tailored temporal lobe resection.

Predicting white matter targets for direct neurostimulation therapy.

A novel depth electrode placement planning strategy is presented for propagating current to distant epileptic tissue during direct neurostimulation therapy. Its goal is to predict optimal lead placement in cortical white matter for influencing the maximal extent of the epileptic circuit. The workflow consists of three fundamental techniques to determine responsive neurostimulation depth lead placement in a patient with bilaterally independent temporal lobe epileptogenic regions.

Epilepsy surgery and vagal nerve stimulation: what all neurologists should know.

Epilepsy surgery treatment should be considered as standard of care for all patients with medically intractable partial-onset epilepsy who are found to be good surgical candidates based on their presurgical evaluation. Delaying surgical treatment continues to be a problem among neurologists. The early recognition of pharmacoresistance and patients' referral for presurgical evaluation can shorten the time to identify potential surgical candidates.

Epidural cylinder electrodes for presurgical evaluation of intractable epilepsy: technical note.

Background: This is a technical report describing a different technique for the insertion of epidural electrodes in the preoperative evaluation of epilepsy surgery. Our experience in 67 cases using this technique is analyzed.

Methods: Cylinder electrodes with multiple recording nodes spaced 1 cm apart along a Silastic core are placed into the epidural space under general anesthesia through single or multiple burr holes.

The use of monotherapy in patients with epilepsy: an appraisal of the new antiepileptic drugs.

The use of antiepileptic drugs (AEDs) in monotherapy is always preferred to a polytherapy regimen because monotherapy facilitates drug compliance, is associated with a lower risk of toxicity, and is less costly. In addition, the yield of polytherapy to render a patient seizure-free when monotherapy regimens did not is relatively low. The available data derived from randomized controlled trials suggest that standard and new AEDs appear to display comparable antiepileptic efficacy but they differ with respect to tolerability and toxicity, which may be related to their pharmacodynamic and pharmacokinetic properties.

Pharmacotherapy of Mood Disorders in Epilepsy: The Role of Newer Psychotropic Drugs.

Depression in patients with epilepsy (PWE) is a relatively common comorbidity that has a significant negative impact on their quality of life. Therefore, recognition and management of a comorbid depressive disorder is paramount to achieve successful comprehensive treatment in PWE. Depression in epilepsy may mimic primary depressive disorders, but in a significant percentage of depressed PWE, the clinical semiology has an atypical presentation and fails to meed any of the diagnostic criteria established in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

Treatment of psychosis, aggression, and irritability in patients with epilepsy.

Psychosis, irritability, and aggression in persons with epilepsy are frequently the focus of clinical intervention. These neuropsychiatric symptoms may occur due to the bidirectional relationship between psychosis and epilepsy, in which the potential etiopathogenic mechanisms are believed to be closely related to the seizure disorder itself and also may result from underlying brain injury or behavioral intolerance of antiepileptic or other medication. Epileptic patients are at heightened risk for mood disorders, psychotic disorders, and delerium.

Depression and epilepsy: how closely related are they?

Article abstract Depressive disorders (DDs) are the most common type of psychiatric co-morbidity in patients with epilepsy. They are more likely to occur in patients with partial seizure disorders of temporal and frontal lobe origin and are more frequent among patients with poorly controlled seizures. Despite their relatively high prevalence, DDs remain unrecognized and untreated in a large proportion of patients.

Valproate: a practical review of its uses in neurological and psychiatric disorders.

Valproate is an antiepileptic drug with a wide spectrum efficacy in the management of various types of seizures and epileptic syndromes. In addition to its efficacy in epilepsy, valproate has been found to have therapeutic effects in various psychiatric disorders, including manic states, bipolar, panic and schizophreniform disorders and in the prevention and acute treatment of migraine. Valproate is available in various formulations that differ primarily in their absorption profiles.

[Modern computer data base "necropsy protocol": potential and prospects].

Basic principles in developing computer variant of necropsy protocol with wide illustrative possibilities are presented. Perspectives in the use of this information base for research and practice and for teaching the staff of the research and clinical institutions are demonstrated.

[Bioenergy metabolism in lymphocytes in ischemic heart disease].

Blood lymphocyte energy metabolism was assessed in coronary patients. Among intracellular adenine nucleotides, ATP was shown to be particularly prone to change, declining in proportion to the progress of the disease in all patients. ADP (1st functional class, or FC) and AMP (1st and 3d FC) declined less markedly.

[Effect of gamma-oxybutyrate on energy metabolism and the cyclic nucleotide level in nerve tissue in experimental intracerebral hemorrhage].

Experimental intracerebral hemorrhage (EICH) was shown to cause a disorder of the functional state of the brain mitochondria. The rate of oxidation of NAD- and FAD-linked substrates in 3 and 4 states decreased 1 and 24 hours after hemorrhage. An injection of gamma-hydroxybutyrate 1 hour before decapitation increased the rate of mitochondrial respiration.

[Relationship between the rates of blood and dialyzing solution flow and determination of the efficiency of the "artificial kidney" dialyzing apparatus].

A mathematical model of the process of dialysis and of dialyzer is described. In this model it is presumed that the blood and dialyzing solution are stationary and homogenous, the diffusion through the film proceeds separately for each of the components (urea, creatinine, etc), the rate of the substance migration is proportional to the difference in the concentration of the substance on both sides of the film, the processes of the substance migration through the film do not affect the flow of the dialyzing solution and of the blood, the concentration of the components partaking in the dialysis is constant across the thickness of the fluids layers and along the breadth of the dialyzer. Recommendation on the selection of correlation for the dialyzing solution and blood flow rates are given and the influence of the film permeability on the dialyzer's clearance is determined.