To date, there are no definitive biomarkers for Parkinson's disease (PD) diagnosis. The detection of cerebrospinal fluid (CSF) alpha (α)-synuclein in PD patients has yielded promising but inconclusive results. To determine the performance of CSF α-synuclein as a diagnostic biomarker of PD and whether CSF α-synuclein can discriminate PD from other neurodegenerative diseases, a systematic search of all relevant studies investigating reproducible CSF α-synuclein quantification methods was conducted in electronic databases. A total of 17 studies that included 3311 patients were included in this systemic review and meta-analysis. The mean CSF α-synuclein concentration was significantly lower in PD patients compared to normal/neurological controls [weighted mean difference (WMD) -0.31; 95% CI, -0.45, -0.16; p < 0.0001] and patients with Alzheimer's disease (AD) [WMD -0.15; 95% CI, -0.26, -0.04; p < 0.0001]. There was no significant difference between PD patients and dementia with Lewy bodies (DLB) patients [WMD -0.03; 95% CI, -0.16, 0.09; p = 0.58] or patients with multiple system atrophy (MSA) [WMD 0.05; 95% CI, -0.04, 0.13; p = 0.25]. Sensitivity and specificity of CSF α-synuclein in the diagnosis of PD was 0.88 (95% CI, 0.84-0.91) and 0.40 (95% CI, 0.35-0.45), respectively. The positive and negative likelihood ratios of CSF α-synuclein in the diagnosis of PD were 1.41 (95% CI, 1.24-1.60), and 0.29 (95% CI, 0.15-0.56), respectively. The corresponding summary receiver operating characteristic (SROC) curve showed an area under the curve (AUC) of 0.73. The concentration of CSF α-synuclein may be a biomarker for the diagnosis of PD. The use of α-synuclein alone however is not sufficient as a single biomarker and it must therefore be used in conjunction with other documented and reliable biomarkers.

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The scope of this paper is to develop a new three-part wedge analysis method, introducing the effects of solid waste shear strength and retaining wall on the translational failure of landfills. A typical landfill can be divided into three parts: an active wedge lying on the back slope that tends to cause failure, a passive wedge, and a retaining wall resting on the foundation or liner system that helps to resist any movements. Using this method, the amount and direction of the interwedge force can be calculated, and the upper and lower bound solutions for the landfill stability, i.e., FS max and FS min , can be easily determined. When an average factor of safety, FS ave , is used as a solution replacing the true factor of safety, FS true , the upper bound of difference between FS ave and FS true is not more than 5% for all considered cases in this study. The retaining wall of the landfill seriously affects the value of the factor of safety; simply ignoring the retaining wall will lead to serious underestimation of the factor of safety. The factor of safety at the interface between active and passive wedges is defined as FS V . The values of FS V /FS ave vary between 1.95 and 2.05 and are concentrated around 2.0. The approximate solutions of FS with adequate accuracy can be obtained by assuming FS V = 2FS. Keywords Municipal solid waste Á Landfill Á Retaining wall Á Liner system Á Stability List of symbols B Top width of waste mass E A Resultant force of E HA and E VA E RA Resultant force from passive wedge acting on retaining wall E RP Resultant force from retaining wall acting on passive wedge E HA Normal force from passive wedge acting on active wedge E HP Normal force from active wedge acting on passive wedge, E HA = E HP E P Resultant force of E HP and E VP E VA Frictional force acting on side of active wedge E VP Frictional force acting on side of passive wedge, E VA = E VP F A Frictional force acting on bottom of active wedge F P Frictional force acting on bottom of passive wedge F R Frictional force acting on bottom of retaining wall FS Factor of safety for entire landfill FS A Factor of safety for active wedge FS ave Average factor of safety FS ave = (FS max ? FS min )/2 FS max Maximum factor of safety, i.e., upper bound solution FS min Minimum factor of safety, i.e., lower bound solution

Introduction: CNS ventriculitis is a serious complication following an intracranial insult that demands immediate treatment with broad-spectrum antibiotics in a critical care setting. Infections due to multi/extensive drug resistance (MDR/XDR) microorganisms are very challenging, which may demand an additional approach to the ongoing practice; intravenous and intraventricular administration of antibiotics.Aim: To study the efficacy and safety of thorough ventricular irrigation followed by daily intraventricular antibiotic administration in patients with MDR/XDR ventriculitis.Materials and Methods: A retrospective analysis was done on 19 inpatients with ventriculitis caused by Acinetobacter baumannii (AB) or Klebsiella pneumonia (KP), at Shanghai Tenth People's Hospital from January 2016 to October 2017. We reviewed our experience; the role of thorough ventricular irrigation with Colistin mixed normal saline, followed by intraventricular Colistin therapy. Treatment outcomes were evaluated based on the clinical symptoms, Cerebro-Spinal Fluid (CSF) culture, laboratory findings and complications.Results: A total of 19 patients were included (15 males and 4 females), with a mean age in years of 51, which ranged from 18–67. Fourteen patients had Acinetobacter baumannii (AB) and 5 had Klebsiella pneumoniae (KP). The average CSF sterilization period following ventricular irrigation and intraventricular Colistin was 6 days. Sixteen patients (84%) were cured, and 3 patients (15%) died during the course of the treatment.Conclusion: In addition to Intraventricular Colistin, thorough ventricular irrigation could increase the cure rate up to 84% in patients suffering from MDR/XDR CNS ventriculitis.

Background: To investigate predictors of postoperative acute intracranial hemorrhage (AIH) and recurrence of chronic subdural hematoma (CSDH) after burr hole drainage. Methods: A multicenter retrospective study of patients who underwent burr hole drainage for CSDH between January 2013 and March 2019. Results: A total of 448 CSDH patients were enrolled in the study. CSDH recurrence occurred in 60 patients, with a recurrence rate of 13.4%. The mean time interval between initial burr hole drainage and recurrence was 40.8 ± 28.3 days. Postoperative AIH developed in 23 patients, with an incidence of 5.1%. The mean time interval between initial burr hole drainage and postoperative AIH was 4.7 ± 2.9 days. Bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independent predictors of recurrence in the multiple logistic regression analyses. Preoperative headache was an independent risk factor of postoperative AIH in the multiple logistic regression analyses, however, intraoperative irrigation reduced the incidence of postoperative AIH. Conclusions: This study found that bilateral hematoma, hyperdense hematoma and anticoagulant drug use were independently associated with CSDH recurrence. Clinical presentation of headache was the strongest predictor of postoperative AIH, and intraoperative irrigation decreased the incidence of postoperative AIH.

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BackgroundSevere ventriculitis (SV) caused by multidrug-resistant bacteria is associated with high morbidity and mortality in neurosurgical patients. This study assessed the outcomes of patients with SV caused by Acinetobacter baumannii who were treated by intraventricular (IVT) lavage and colistin administration.MethodsThis retrospective study included consecutive patients with SV caused by A. baumannii who were admitted at the Neurosurgical Department of Shanghai Tenth People’s Hospital from January 2014 to September 2017. Patients’ medical records, radiographic images, and surgical notes were reviewed. The patients were followed up for at least 6 months after discharge.ResultsA total of 25 patients, including 20 male and five female, were enrolled in this study; the average age was 45.6 years. All patients underwent neurosurgery before infection, and all A. baumannii cultures from cerebrospinal fluid (CSF) showed extensive resistance to the tested antibiotics except for tigecycline and colistin. All the patients underwent IVT lavage followed by daily administration of colistin after surgery; 24 patients received a daily colistin dose of 100,000 IU, while one received 50,000 IU. The patients also received tigecycline-based systemic antibiotic treatment. The mean duration of IVT colistin was 13.4±2.8 days. The time required to obtain a negative CSF culture was 8.9±4.0 days. Of the 20 patients who were cured, eight underwent shunt surgery due to hydrocephalus before they were discharged to a rehabilitation center. Five patients died, including one who was re-admitted due to recurrence 1 month after discharge.ConclusionsIVT lavage and colistin treatment may be an effective treatment for SV caused by extensively drug-resistant A. baumannii. Future studies with a larger sample size may be needed to verify the findings in this study.