Application of Evans Index in Normal Pressure Hydrocephalus Patients: A Mini Review

With an ever-growing aging population, the prevalence of normal pressure hydrocephalus (NPH) is increasing. Clinical symptoms of NPH include cognitive impairment, gait disturbance, and urinary incontinence. Surgery can improve symptoms, which leads to the disease's alternative name: treatable dementia. The Evans index (EI), defined as the ratio of the maximal width of the frontal horns to the maximum inner skull diameter, is the most commonly used index to indirectly assess the condition of the ventricles in NPH patients. EI measurement is simple, fast, and does not require any special software; in clinical practice, an EI >0.3 is the criterion for ventricular enlargement. However, EI's measurement methods, threshold setting, correlation with ventricle volume, and even its clinical value has been questioned. Based on the EI, the z-EI and anteroposterior diameter of the lateral ventricle index were derived and are discussed in this review.

Automated Segmentation and Connectivity Analysis for Normal Pressure Hydrocephalus

Objective and Impact Statement. We propose an automated method of predicting Normal Pressure Hydrocephalus (NPH) from CT scans. A deep convolutional network segments regions of interest from the scans. These regions are then combined with MRI information to predict NPH. To our knowledge, this is the first method which automatically predicts NPH from CT scans and incorporates diffusion tractography information for prediction. Introduction. Due to their low cost and high versatility, CT scans are often used in NPH diagnosis. No well-defined and effective protocol currently exists for analysis of CT scans for NPH. Evans’ index, an approximation of the ventricle to brain volume using one 2D image slice, has been proposed but is not robust. The proposed approach is an effective way to quantify regions of interest and offers a computational method for predicting NPH. Methods. We propose a novel method to predict NPH by combining regions of interest segmented from CT scans with connectome data to compute features which capture the impact of enlarged ventricles by excluding fiber tracts passing through these regions. The segmentation and network features are used to train a model for NPH prediction. Results. Our method outperforms the current state-of-the-art by 9 precision points and 29 recall points. Our segmentation model outperforms the current state-of-the-art in segmenting the ventricle, gray-white matter, and subarachnoid space in CT scans. Conclusion. Our experimental results demonstrate that fast and accurate volumetric segmentation of CT brain scans can help improve the NPH diagnosis process, and network properties can increase NPH prediction accuracy.

The timed up and go test in idiopathic normal pressure hydrocephalus: a Nationwide Study of 1300 patients

Background The aim of this study was to describe the outcome measure timed up and go (TUG) in a large, nationwide cohort of patients with idiopathic normal pressure hydrocephalus (iNPH) pre- and post-operatively. Furthermore, to compare the TUG test to the 10-m walk test (10MWT), the iNPH scale, the modified Rankin scale (mRS) and the Mini Mental State Examination (MMSE), which are commonly applied in clinical assessment of iNPH. Methods Patients with iNPH (n = 1300), registered in the Swedish Hydrocephalus Quality Registry (SHQR), were included. All data were retrieved from the SHQR except the 10MWT, which was collected from patient medical records. Clinical scales were examined pre- and 3 months post-operatively. Data were dichotomised by sex, age, and preoperative TUG time. Results Preoperative TUG values were 19.0 [14.0–26.0] s (median [IQR]) and 23 [18–30] steps. Post-operatively, significant improvements to 14.0 [11.0–20.0] s and 19 [15–25] steps were seen. TUG time and steps were higher in women compared to men (p < 0.001) but there was no sex difference in improvement rate. Worse preoperative TUG and younger age favoured improvement. TUG was highly correlated to the 10MWT, but correlations of post-operative changes were only low to moderate between all scales (r = 0.22–0.61). Conclusions This study establishes the distribution of TUG in iNPH patients and shows that the test captures important clinical features that improve after surgery independent of sex and in all age groups, confirming the clinical value of the TUG test. TUG performance is associated with performance on the 10MWT pre- and post-operatively. However, the weak correlations in post-operative change to the 10MWT and other established outcome measures indicate an additional value of TUG when assessing the effects of shunt surgery.

Investigation of the Enrichment and Accumulation of Normal Pressure Shale Gas in Anchang Syncline Outside of Sichuan Basin

Gas shales from the Wufeng-Longmaxi Formation in Anchang syncline in northern Guizhou area of Sichuan Basin are stable in distribution and can be classified as type I shale gas reservoir with great resource potential. The exploration and development of shale gas in Anchang syncline have achieved great progress. However, the enrichment rule and accumulation pattern of shale gas in Anchang syncline are still not clear at the present. Gas pressure in the Wufeng-Longmaxi Formations shales in Anchang syncline is normal. The maximum tested gas production in the field ranges from 18,000 to 58,000 m3/d. However, gas production of shale wells varies greatly even in the same platform. In order to understand the shale gas enrichment and accumulation and improve the effective development of shale gas in this area, comparative analyses on the geological characteristics and preservation conditions of gas reservoirs in several typical wells were carried out from the perspective of geology, petrophysics, geophysics, and well logging. Results show that shale gas in Anchang syncline has the characteristics of accumulating in both deep central position and gently wings. Tectonic preservation condition is the key factor to high gas production in Anchang area. The hydrological conditions, syncline structure, fault distribution, and cap rock quality comprehensively control the gas pressure and gas bearing capacity of shale reservoir. According to these factors, an accumulation model of shales with normal gas pressure is established: syncline controls the distribution of gas reservoir; fault controls the boundary of the reservoir; preservation conditions controls gas capacity. The results are benefit for the rolling exploration and development of shale gas in Anchang area, and are important for the development of normal pressure shale gas in northern Guizhou area.

Numerical Approach in Superconductivity: An Advanced Study

The dependence of the critical temperature $T_c$ of high-temperature superconductors of various families on their composition and structure is proposed. A clear dependence of the critical temperature of high-temperature superconductors (hydrides, Hg- and Y-based cuprates) on the serial number of the constituent elements, their valence and crystal lattice structure has been revealed. For cuprates, it is shown that it is possible to obtain even higher temperatures of superconducting transitions at normal pressure by implanting mercury atoms into the crystal lattice of cuprate.

Lumboperitoneal Shunt Surgery Under Rachianesthesia

Purpose: In the very elderly, complications such as postoperative pneumonia or delirium, which are directly associated with longer hospitalization, are more frequent. In order to overcome these drawbacks, we switched from general anesthesia to rachianesthesia for the lumboperitoneal shunt (LPS) procedure in idiopathic normal pressure hydrocephalus (iNPH) patients. This is because iNPH suffers particularly elderly patients, and neuraxial anesthesia techniques such as rachianesthesia reportedly decrease postoperative complications in patients of very advanced age as compared with general anesthesia. Methods: We retrospectively analyzed 45 patients who underwent LPS in our institution, and divided them into two groups based on the anesthetic approach; 1) general anesthesia, 2) rachianesthesia. We analyzed these two groups with regard to postoperative delirium score and the hospital stay.Results: In the general anesthesia group, two patients had respiratory complications after the surgery. The mean postoperative delirium score using the intensive care delirium screening checklist (ICDSC) was 1.3 (1.4) and the length of hospital stay was 13.9 (4.7) days. In the rachianesthesia group, no patients had respiratory complications. The postoperative mean ICDSC was 1.3 (1.4), and the length of hospital stay was 10.8 (2.1) days. The statistical analysis showed the rachianesthesia group to have significantly shorter hospital stays.Conclusions: LPS under rachianesthesia is an alternative to performing this procedure under general anesthesia in elderly patients.

Numerical Simulation on the Effect of Rock Joint Roughness on the Stress Field

In view of the influence of Joint Roughness Coefficient (JRC), which is for quantitative description of the joint surface roughness, on the stress field of the rock mass, compression test and shear-compression test were simulated on models with different joint roughness. The photoelasticity technique is applied to examine the feasibility of numerical simulation. The results show that numerical simulation results are in agreement with the results of photoelastic experiments. The stress concentration area is distributed near the joint plane. Thus, the joint plane controls the shear strength of the rock. In compression test, the maximum shear stress of the model is proportional to JRC and the normal pressure. In shear-compression test, when the ratio of the axial shear to the normal pressure is small, the maximum shear stress is nonlinearly positively correlated with JRC. When the ratio of the axial shear to the normal pressure is relatively large, the relationship curve between the maximum shear stress and JRC is parabolic. When the JRC is small, as the ratio of the axial shear force to the normal pressure increases, the maximum shear stress changes abruptly, and the maximum shear stress after the mutation decreases significantly. The reason is that the upper and lower parts of the model have slipped, resulting in a redistribution of stress. In addition, when the JRC is 6 to 12, it is more likely to cause stress concentration.