Miracle-dz/UniFAR-FTUs huggingface dataset:
Postural instability/gait disturbance in Parkinson's disease has distinct subtypes: an exploratory analysis

Objective To test the hypothesis that postural instability with falling (PIF) and freezing of gait (FOG) are distinct subtypes of the postural instability/gait disturbance (PIGD) form of Parkinson's disease (PD). Methods 499 PD subjects from the NeuroGenetics Research Consortium were studied using logistic regression to examine, in a cross sectional analysis, predictors of FOG and PIF. Potential predictors were from four spheres; demographic, clinical motor, clinical non-motor and genetic. Results FOG and PIF were both associated with greater gait subscores and lower tremor subscores on the Unified Parkinson's Disease Rating Scale (p≤0.02). However, they differed with regard to demographic, non-motor and genetic predictors. FOG was associated with greater duration of disease, with ORs of 3.01 (95% CI 1.35 to 6.72) and 4.91 (95% CI 2.29 to 10.54) for third and fourth quartiles of duration, respectively, versus the lowest half of duration. The risk of having psychotic symptoms was also significantly increased (OR 3.02, 95% CI 1.41 to 6.49; p=0.004). FOG was inversely associated with the presence of the CYP2D6*4 allele (OR 0.41, 95% CI 0.21 to 0.80; p=0.009) suggesting a protective effect. PIF was associated with depression (OR 1.08, 95% CI 1.01 to 1.15; p<0.02) and was inversely associated with APOE ɛ4 (OR 0.21, 95% CI 0.05 to 0.87; p=0.03), again suggesting a protective effect. Conclusion FOG and PIF have different demographic, non-motor and genetic predictors suggesting that they may be pathophysiologically distinct subtypes of PIGD. These findings have implications in the discovery of therapeutic targets for these disabling features as well as for predicting outcomes of PD.
Visual extinction in relation to visuospatial neglect after right-hemispheric stroke: quantitative assessment and statistical lesion-symptom mapping

Background Visual neglect and extinction are two common neurological syndromes in patients with right-hemispheric brain damage. Whether and how these two syndromes are associated or share common neural substrates is still a matter of debate. Methods To address these issues, the authors investigated 56 patients with right-hemispheric stroke with a novel diagnostic test to detect extinction and neglect. In this computerised task, subjects had to respond to target stimuli in uni- and bilateral stimulation conditions with detection probabilities being assessed. A cluster-analytical approach identified 18 patients with neglect and 13 patients with extinction. Statistical lesion-symptom mapping analyses with measures for extinction and neglect were performed. Results Extinction and neglect co-occurred in a subset of patients but were also observed independently from each other, thereby constituting a double dissociation. Lesions within the right inferior parietal cortex were significantly associated with the severity of visual extinction. Visuospatial neglect was related to damage of fronto-parietal brain regions, with parieto-occipital areas affecting line bisection and dorsal fronto-parietal areas affecting cancellation task performance, respectively. Conclusion Quantifying lesion-induced symptoms with this novel paradigm shows that extinction and neglect are dissociable syndromes in patients with right-hemispheric stroke. Furthermore, extinction and neglect can be related to differential neural substrates, with extinction being related to focal brain damage within the right inferior parietal cortex.
Mechanical thrombectomy in severe acute stroke: preliminary results of the Solitaire stent

Intravenous recombinant tissue plasminogen activator (rTPA) therapy has limited recanalisation-rates in large artery occlusions (nadir of 5.9% in Carotid-T-Occlusions). 1 Therefore, we prospectively evaluated the Solitaire stent (versions AB and FR, ev3 Inc., Plymouth, Minnesota, USA) in mechanical thrombectomy in acute ischaemic stroke. Acute stroke patients were triaged on admission for potential mechanical thrombectomy. ### Inclusion criteria ### Exclusion criteria Eligible patients had immediate CT-angiography without delaying intravenous rTPA-thrombolysis if applicable according to the guidelines of the German Neurological Society (DGN). In case of occlusion of either the internal carotid artery (ICA), the MCA-M1-segment or the basilar artery (BA) mechanical thrombectomy was carried out. Up to four clot extraction maneuvers were performed. Any preceding stenosis was a priori stented. These patients received intravenous eptifibatide for 24 h to prevent in-stent-thrombosis; its short half-life would allow for emergency decompressive craniectomy. Combination of rTPA and eptifibatide is safe.2 NIHSS and mRS scores were assessed on admission and …
Prophylactic vs therapeutic blood patch for obstetric patients with accidental dural puncture – a randomised controlled trial

Epidural blood patch is a standard treatment for obstetric patients experiencing a severe post‐dural puncture headache. Patients who sustained an accidental dural puncture during establishment of epidural analgesia during labour or at caesarean delivery were randomly assigned to receive a prophylactic epidural blood patch or conservative treatment with a therapeutic epidural blood patch if required. Eleven of 60 (18.3%) patients in the prophylactic epidural blood patch group developed a post‐dural puncture headache compared with 39 of 49 (79.6%) in the therapeutic epidural blood patch group (p < 0.0001). A blood patch was performed in 36 (73.4%) of patients in the therapeutic group. The number of patients who needed a second blood patch did not differ significantly between the two groups: 6 (10.0%) for prophylactic epidural blood patch and 4 (11.1%) for therapeutic epidural blood patch. We conclude that prophylactic epidural blood patch is an effective method to reduce the development of post‐dural puncture headache in obstetric patients.
Predictive ability of preinjury stressful life events and post-traumatic stress symptoms for outcomes following mild traumatic brain injury: analysis in a prospective emergency room sample

Background A subset of persons with mild traumatic brain injury (mTBI) experience long-term difficulties. Preinjury stress has been hypothesised to play a role in long-term maintenance of symptoms. Objective To investigate the predictive ability of preinjury stressful life events and post-traumatic stress symptoms to health-related quality of life and emotional distress after mTBI. Methods Within 2 weeks of injury, 186 participants with mTBI who were admitted to an emergency centre completed an interview and questionnaires regarding preinjury functioning, including the Stressful Life Events Questionnaire and the Post-Traumatic Stress Disorder Checklist. Outcomes were assessed at 3 months after injury and included the depression and anxiety subscales of the Brief Symptom Inventory, and the physical and mental component scores of the 36-item Short-Form Health Survey (SF-36). The incidence and type of stressful life events were reported. Hierarchical regression analyses were used to determine the predictive utility of Stressful Life Events Questionnaire and Post-Traumatic Stress Disorder Checklist after controlling for age, injury severity (complicated versus uncomplicated mild) and preinjury depression. Results Several potentially life-altering stressful events were endorsed by at least 25% of participants as having been experienced prior to injury. The incidence of stressful life events was a significant predictor of all four outcome variables. History of post-traumatic stress symptoms was predictive of scores on the SF-36 mental health component. Conclusions A history of stressful events may predispose persons with mTBI to have poor outcomes. History of stress should be assessed during the early stages after mTBI to help identify those who could benefit from therapies to assist with adjustment and maximise recovery.
Solving a weighty problem: Systematic review and meta-analysis of nutrition interventions in severe mental illness

Background Nutrition interventions would appear fundamental for weight management and cardiometabolic risk reduction in people experiencing severe mental illness (SMI). Comprehensive evaluation of nutrition interventions is lacking. Aims To subject randomised controlled trials of nutrition interventions in people with SMI to systematic review and meta-analysis, and to measure anthropometric and biochemical parameters and nutritional intake. Method An electronic database search identified trials with nutrition intervention components. Trials were pooled for meta-analysis. Meta-regression analyses were performed on anthropometric moderators. Results Interventions led to significant weight loss (19 studies), reduced body mass index (17 studies), decreased waist circumference (10 studies) and lower blood glucose levels (5 studies). Dietitian-led interventions (6 studies) and studies delivered at antipsychotic initiation (4 studies) had larger effect sizes. Conclusions Evidence supports nutrition interventions as standard care in preventing and treating weight gain among people experiencing SMI.
Clinical utility of magnetic resonance imaging in first-episode psychosis

Background There is no consensus as to whether magnetic resonance imaging (MRI) should be used as part of the initial clinical evaluation of patients with first-episode psychosis (FEP). Aims (a) To assess the logistical feasibility of routine MRI; (b) to define the clinical significance of radiological abnormalities in patients with FEP. Method Radiological reports from MRI scans of two FEP samples were reviewed; one comprised 108 patients and 98 healthy controls recruited to a research study and the other comprised 241 patients scanned at initial clinical presentation plus 66 healthy controls. Results In the great majority of patients, MRI was logistically feasible. Radiological abnormalities were reported in 6% of the research sample and in 15% of the clinical sample (odds ratio (OR) = 3.1, 95% CI 1.26–7.57, χ2(1) = 6.63, P = 0.01). None of the findings necessitated a change in clinical management. Conclusions Rates of neuroradiological abnormalities in FEP are likely to be underestimated in research samples that often exclude patients with organic abnormalities. However, the majority of findings do not require intervention.
What is the clinically relevant change on the ADAS-Cog?

Objective To establish the minimal clinically relevant change (MCRC) on the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) for patients with mild Alzheimer's disease (AD). Design Cohort study. Setting 59 recruiting sites for the Alzheimer's Disease Neuroimaging Initiative. Patients Outpatients with AD in the Alzheimer's Disease Neuroimaging Initiative. Main outcome measures The authors applied anchor-based MCRC methodology comparing ADAS-Cog change against clinicians' judgement of clinically relevant worsening between baseline and 6 months in four domains: memory and non-memory cognitive performance; Clinical Dementia Rating Scale; and Functional Assessment Questionnaire. The analysis was repeated for the 6–12-month interval. To support these findings, the authors calculated distribution-based measures including half-baseline SD (1/2 SD) and SEM. Results 181 patients (baseline ADAS-Cog score 18.5±6.4) had ADAS-Cog data at 0 and 6 months. Those undergoing clinically significant worsening on any of the four anchor questions (n=41–47) had an average ADAS-Cog change of 3.1–3.8 points. Similar results were found for the 177 patients with 6–12-month data. The average 1/2 SD for the baseline ADAS-Cog score was 3.2, and the SEM was 3.7. Conclusions 3 points decline on the ADAS-Cog may be an appropriate MCRC for clinical trials of patients with early AD. However, further studies assessing the MCRC for improvement on the ADAS-Cog, using patient-based judgement as an anchor, and determining the minimal clinically relevant difference between change on two treatments are required. Clinical trial registration number http://clinicalTrials.gov Identifier: NCT00106899.
The Evaluatıon of The Knowledge Levels and Attitudes of Medical Students Who Have Accomplished Obstetric and Gynaecological Diseases Internship in a Medical School About Human Papilloma Virus Vaccine

Aim: Aim of the study was to determine medical school students’ knowledge levels and attitudes who accomplished Obstetric and Gynecology clerkship in a medical school about HPV vaccination and intention to suggest HPV vaccine to their patients. Method: This descriptive study was carried out in a medical school among 166 medical students accomplishing their internship in the Obstetrics and Gynaecological Diseases Department. Study data had been collected by questionnaire which had three part and 30 question. The data were evaluated by descriptive statistics. Results: Fifty five point four of the students stated that they felt informed about HPV vaccine, 72.9% of them stated that HPV was more serious for women. 95.8% of the participants thought they would suggest HPV vaccine to their patients and the most proposed group was adolescent girls (51.6%). 80.5% of students stated their possibility to suggest the vaccine would increase in case the vaccine would be free. The most important drawback points of the students in suggesting the vaccine to their patients were thinking high priced and not cost effectiveness of the vaccine (51.6%) and inducing unprotected, risky sexual intercourses (45.9%). Conclusion: In this study we determine the professional acception of HPV vaccine between students. Also we determine the most important factor in suggesting the HPV vaccine is the cost effectiveness of it.
Impact of DaTscan SPECT imaging on clinical management, diagnosis, confidence of diagnosis, quality of life, health resource use and safety in patients with clinically uncertain parkinsonian syndromes: a prospective 1-year follow-up of an open-label controlled study

Background This study assessed the impact of DaTscan on clinical management, diagnosis, confidence of diagnosis (CoD), quality of life (QoL), health resource use (HRU) and safety during a 1-year follow-up in patients with clinically uncertain parkinsonian syndromes (CUPS). Methods A total of 19 university hospital centres in Europe and the USA participated in this open-label, single-dose, prospective, clinical trial in patients with CUPS who were randomised to a DaTscan imaging group or to a no-imaging (control) group. The proportion of patients with changes in clinical management, diagnosis, CoD, QoL and HRU from baseline through 1 year post-DaTscan was compared between groups. Results There were 273 patients randomised (135 DaTscan, 138 control). Significantly more patients in the DaTscan imaging group had at least one change in their actual clinical management after 12 weeks (p=0.002) and after 1 year (p<0.001) compared with patients in the control group. In addition, significantly more DaTscan patients had changes in diagnosis and an increased CoD at 4 weeks, 12 weeks and 1 year (all p<0.001) compared with control patients. No significant differences in total score for QoL or HRU were observed between groups during the 1-year follow-up period. DaTscan was safe and well tolerated. One patient in the imaging group had an adverse event (headache) with suspected relationship to DaTscan post-administration. Conclusions DaTscan had a significant impact on clinical management, diagnosis and CoD in patients with CUPS. DaTscan is safe and well tolerated, and is a useful adjunct to differentiate a diagnosis of CUPS. Trial registration number http://ClinicalTrials.gov Identifier: NCT00382967.
Long-term fatty acid stability in human serum cholesteryl ester, triglyceride, and phospholipid fractions[S]

Fatty acid profiles of biological specimens from epidemiological/clinical studies can serve as biomarkers to assess potential relationships between diet and chronic disease risk. However, data are limited regarding fatty acid stability in archived specimens following long-term storage, a variable that could affect result validity. Our objective was to determine the effect of prolonged storage at −80°C on the fatty acid profiles of serum cholesteryl ester (CE), triglyceride (TG), and phospholipid (PL) fractions. This was accomplished by determining the fatty acid profile of frozen, archived, previously unthawed serum samples from 22 subjects who participated in a controlled feeding trial. Initial analysis was performed after trial completion and the repeat analysis after 8–10 years of storage using GC. No significant differences were observed among the majority of fatty acids regardless of lipid fraction. Reliability coefficients were high for the fatty acid classes (saturated fatty acid : 0.70, MUFA : 0.90, PUFA : 0.80). When differences were identified, they were limited to low abundance fatty acids (≤1.5 mol%). These differences were quantitatively small and likely attributable to technical improvements in GC methodology rather than sample degradation. Thus, our data demonstrate that storage at −80°C up to 10 years does not significantly influence serum CE, TG, or PL fatty acid profiles.
Long term outcome after conservative and surgical treatment of haemorrhagic moyamoya disease

Objective To investigate the long term outcomes after conservative and surgical treatment for haemorrhagic moyamoya disease. Methods 97 consecutive patients with haemorrhagic moyamoya disease from 1997 to 2009 were enrolled in this study (mean age 31±10 years; range 5–56 years). We reviewed the clinical charts and radiographs of patients at the first bleeding episode. Follow-up was obtained prospectively by questionnaires and radiographic examinations. Outcomes were compared based on initial treatment (conservative vs surgical). Results After a median follow-up of 7.1 years, 21 of the 97 (21.7%) patients developed a second episode of bleeding, and six patients (6.2%) died of intracranial rebleeding. The median interval from initial episode to subsequent rebleeding was 9.1 years (0.1–23.2 years). 17 of 43 (37.1%) conservatively treated patients and four of 54 (7.4%) surgically treated patients experienced a rebleeding event (OR 8.1; 95% CI 2.4 to 26.8; p<0.001). There was a difference in the Kaplan–Meier curve of rebleeding between the two groups (Breslow test p=0.047; log rank test p=0.05). The rebleeding ratio in patients who underwent direct bypass was lower than that in patients treated with indirect bypass alone (0% vs 28.5%, 95% CI 1.0 to 1.9; p=0.002). No significant correlation was found between rebleeding and the patient's age, sex, location of haemorrhage, hypertension status or presence of cerebral aneurysm (p>0.05). Conclusions There is a high risk of rebleeding after the first haemorrhagic episode in Chinese patients with haemorrhagic moyamoya disease. Revascularisation surgery can improve regional blood flow and have greater efficacy at preventing rebleeding than conservative treatment.
Disability in young people and adults after head injury: 12–14 year follow-up of a prospective cohort

Background There is a need to establish how long term outcome evolves after head injury (HI) and factors related to this, to inform opportunities for intervention. Objective To determine late outcome in adults 12–14 years after hospital admission for HI and to examine relationships between injury, early and late factors, and disability. Methods A prospective cohort with HI, whose outcome was reported previously at 1 and 5–7 years after injury, were followed up after 12–14 years. Participants were assessed using structured and validated measures of disability (Glasgow Outcome Scale-Extended), psychological well being, alcohol use and health status. Results Of 219 survivors followed-up at 5–7 years, 34 (15.5%) had died by 12–14 years. Disability remained common in survivors at 12–14 years (51%), as found at 1 and 5–7 years (53%). For those disabled at 1 year, outcome was poor, with 80% dead or disabled at 12–14 years. Older age at injury, a premorbid history of brain illness or physical disability and post-injury low self-esteem and stress were associated with disability at 12–14 years. Disability changed between 5–7 and 12–14 years in 55% of survivors, improving in 23%. Late changes in disability between 5–7 and 12–14 years were associated with self-perceptions of locus of control as being ‘powerful others’ at 5–7 years. Conclusions Disability is common 12–14 years after hospital admission with a HI. For some there is a dynamic process of change in disability over time that is associated with self-perceptions of control that could be a target for intervention based research.
Progressive changes in a recognition memory network in Parkinson's disease

Background In a previous functional MRI (fMRI) study, we found that patients with Parkinson's disease (PD) presented with dysfunctions in the recruitment of recognition memory networks. We aimed to investigate the changes in these networks over time. Methods We studied 17 PD patients and 13 age and sex matched healthy subjects. In both groups fMRI (recognition memory paradigm) and neuropsychological assessments were obtained at baseline and at follow-up. To analyse changes over time in functional networks, model free (independent component analysis) analyses of the fMRI data were carried out. Then, a cross correlation approach was used to assess the changes in the strength of functional connectivity. Results At follow-up, patients showed reduced recruitment of one network, including decreased activation in the orbitofrontal cortices, middle frontal gyri, frontal poles, anterior paracingulate cortex, superior parietal lobes and left middle temporal gyrus, as well as decreased deactivation in the anterior paracingulate gyrus and precuneus. Cross correlation analyses over time showed a decrease in the strength of functional connectivity between the middle frontal gyrus and the superior parietal lobe in PD patients. Conclusions Model free fMRI and cross correlation connectivity analyses were able to detect progressive changes in functional networks involved in recognition memory in PD patients at early disease stages and without overt clinical deterioration. Functional connectivity analyses could be useful to monitor changes in brain networks underlying neuropsychological deficits in PD.
Biópsia pulmonar incisional por toracoscopia paraxifoide transdiafragmática com dois portais em cães

There are many respiratory diseases in small animals, as well as the possibilities of diagnoses, as laboratory and radiographic exams, bronchoalveolar lavage and biopsies. This research aimed at assessing the results of transdiaphragmatic paraxiphoid thoracoscopies in pulmonary biopsies of thirteen clinically healthy dogs. Under general anesthesia, each dog was insufflated with 30ml kg-1 of air in each hemithorax; two trocars were placed between the xiphoid appendix and the costal arch through the diaphragm. An endoscope was introduced by the first portal; while the second portal was used to allow access to the nippers in the biopsy forceps. Then, these nippers were removed and replaced by chest tube drainage. During the procedures, respiratory frequency, heart rate, oxygen saturation, arterial pressure and central venous pressure (CVP), hemogasometric parameters were checked. Within 48 hours after the surgery, drains were or drain was removed, with minimal production of air and/or liquid. In conclusion, this is a fast and safe technique, which is free of trans and post surgical complications, thus allowing the collection of sufficient material for pulmonary histological evaluation.