Miracle-dz/UniFAR-FTUs huggingface dataset:
MR spectroscopy indicates diffuse multiple sclerosis activity during remission

Objective: To test the hypothesis that diffuse abnormalities precede axonal damage and atrophy in the MRI normal-appearing tissue of relapsing-remitting (RR) multiple sclerosis (MS) patients, and that these processes continue during clinical remission. Methods: Twenty-one recently diagnosed mildly disabled (mean disease duration 2.3 years, mean Expanded Disability Status Scale score of 1.4) RR MS patients and 15 healthy matched controls were scanned with MRI and proton MR spectroscopic imaging (1H-MRSI) at 3 T. Metabolite concentrations: N-acetylaspartate (NAA) for neuronal integrity; choline (Cho) for membrane turnover rate; creatine (Cr) and myo-inositol (mI) for glial status were obtained in a 360 cm3 volume of interest (VOI) with 3D multivoxel 1H-MRSI. They were converted into absolute amounts using phantom replacement and normalised into absolute concentrations by dividing by the VOI tissue volume fraction obtained from MRI segmentation. Results: The patients’ mean VOI tissue volume fraction, 0.92 and NAA concentration, 9.6 mM, were not different from controls’ 0.94 and 9.6 mM. In contrast, the patients’ mean Cr, Cho and mI levels 7.7, 1.9 and 4.1 mM were 9%, 14% and 20%, higher than the controls’ 7.1, 1.6 and 3.4 mM (p = 0.0097, 0.003 and 0.0023). Conclusions: The absence of early tissue atrophy and apparent axonal dysfunction (NAA loss) in these RR MS patients suggests that both are preceded by diffuse glial proliferation (astrogliosis), as well as possible inflammation, demyelination and remyelination reflected by elevated mI, Cho and Cr, even during clinical remission and despite immunomodulatory treatment.
New Aspects of Myofascial Trigger Points: Etiological and Clinical

SUMMARY Objectives: To identify important new developments in our understanding of the nature and clinical characteristics of myofascial trigger points [TrPs]. Findings: Recent research studies reinforce the credibility of three key features of an integrated hypothesis that is designed to explain the pathophysiology of TrPs: increased acetylcholine effect, increased muscle-fiber tension, and local release of sensitizing substances. Electromyographic studies of TrPs support an increased acetylcholine effect that produces endplate noise. Nine histological studies of animal and human subjects identify features that indicate abnormally increased muscle-fiber tension and help to account for the taut bands observed clinically. Microdialysis studies by Jay Shah, MD and colleagues at the National Institutes of Health compared, in nine subjects, the findings in active TrPs to findings in latent TrPs and in normal muscles [nine examinations]. They found a significantly reduced pressure pain threshold and pH at the three active TrPs. In active TrPs, seven pain-related substances were significantly increased: substance P, calcitonin gene-related peptide, bradykinin, serotonin, norepinephrine, tumor necrosis factor, and interleukin-1β. Using shockwave generators, Wolfgang Bauermeister, MD located active TrPs in the gluteus medius and/or gluteus minimus muscles in all of 114 patients with sciatica. In another study, treatment of idiopathic low back pain with piezoelectric generated shockwaves resulted in 80 percent reduction of pain in 15 of 20 patients after 10 treatments. Treatment with electrohydraulic shockwaves reduced the pain 85 percent in 18 of 20 patients after six treatments. Conclusions: The microdialysis findings in TrPs help to validate the integrated hypothesis and to explain the painfulness of TrPs. Either an electrohydraulic or piezoelectric shockwave device can be used to locate and treat TrPs. Clinically, the electrohydraulic method seems preferable.
Comparison of Portable Spring Balancer with Mobile Arm Support in Aiding Self-Feeding in Quadriplegic Patients with High Cervical Injuries : Rate of Adaptation to Both Devices

This study aimed to identify the most effective type of upper extremity orthosis in aiding self-feeding in quadriplegic patients with high cervical injuries by comparing a portable spring balancer and a mobile arm support. A single-subject A-B-C-B-C design was used in the study, in which a subject was tested at baseline (A) followed by alternate use of a portable spring balancer (B) and a mobile arm support (C) for two rounds. Four subjects were requested to eat yogurt with the aid of one of the devices. The amount of yogurt consumed was compared between the two devices. Three of four subjects were able to eat much more the yogurt with portable spring balancer than with the mobile arm support. Only one subject used the mobile arm support more effectively than the portable spring balancer. The subjects’ physical condition, specifically, muscle strength of the upper arm and tolerance appeared to be factors that influence how patients adapt to these devices. In conclusion, both the portable spring balancer and mobile arm support are effective feeding aids for quadriplegic patients with high cervical injuries. These orthoses function differently for patients with different physical characteristics.
Clinical research for rare cancers: is it a reality in the global regulatory landscape? The international rare cancer initiative

Introduction: Rare cancers together account for about 22% of new cancer diagnoses each year, which is more than any single common cancer. They constitute a serious public health problem with distinctive challenges. Compared with common cancers, less is known about their etiology and molecular pathology, and therapeutic options are mostly poorly evidence based with outcomes that are on average inferior to those of more common cancers. There is, therefore, a pressing need for well-organized clinical research to address these deficiencies. The International rare cancer initiative (IRCI) was formed in 2011 with the aim of stimulating and facilitating the development of international clinical trials for patients with rare cancers, and so helping to establish better, more evidence-based treatments. As of October 2013, 8 clinical trials are in design, in set up or recruiting, in seven rare cancer types, giving IRCI a good understanding of the current research conditions for rare cancer. Areas covered: This paper sets the scene of clinical research in rare cancers and presents an overview of organizational, methodological, regulatory and financial challenges facing researchers in this field. It also proposes possible steps to improve the research environment for the future. Expert opinion: Based on our observations, we believe that measures should be taken to improve the integration of research across international boundaries, to improve the funding of academic research and to better integrate the research capacity of industry with the public sector for the greater benefits of patients and society.
Normalization on Temporal Modulation Transfer Function for Robust Speech Recognition

In this paper, we proposed a robust speech feature extraction algorithm for automatic speech recognition which reduced the noise effect in the temporal modulation domain. The proposed algorithm has two steps to deal with the time series of cepstral coefficients. The first step adopted a modulation contrast normalization to normalize the temporal modulation contrast of both clean and noisy speech to be in the same range. The second step adopted an edge-preserved smoothing to attenuate the low modulation components while preserving the high modulation components (edges). We tested our algorithms on speech recognition experiments in both additive noise condition (AURORA-2J data corpus) and reverberant noise condition (convolution of clean speech utterances from AURORA-2J with a smart room impulse response signal). For comparison, the ETSI advanced front-end algorithm (AFE) is used. Our results showed that the algorithm got: (1) for additive noise, 57.26% relative word error reduction (RWER) rate for clean conditional training (59.37% for AFE), and 33.52% RWER rate for multi-conditional training (35.77% for AFE), and (2) for reverberant noise, 51.28% RWER rate (10.17% for AFE).
Myasthenia gravis and other neuromuscular junction disorders

Myasthenia gravis is the most common autoimmune disease affecting the neuromuscular junction and is characterised by painless fatigable muscle weakness. It is caused by autoantibodies against neuromuscular junction proteins, either the nicotinic acetylcholine receptor (AChR) or the muscle specific tyrosine kinase (MuSK). Mutations in neuromuscular junction proteins cause congenital myasthenic syndromes. Other antibody mediated conditions affecting the neuromuscular junction include Lambert Eaton myasthenic syndrome and neuromyotonia. Figure 1 The neuromuscular junction and the proteins involved in neuromuscular transmission. Several of the proteins at the neuromuscular junction are targets for autoimmune disorders (AChR and MuSK in myasthenia gravis, VGCC in Lambert–Eaton myasthenic syndrome and VGKC in neuromyotonia). Genetic mutations can affect several of these proteins (AChR, Rapysn, MuSK, Dok-7, etc) causing congenital myasthenic syndromes. ACh, acetylcholine; AChE, acetylcholinesterase; AChR, acetylcholine receptor; MuSK, muscle specific tyrosine kinase; VGCC, voltage gated calcium channel; VGKC, voltage gated potassium channel; VGSC voltage gated sodium channel.
Legal issues facing radiographers in Nigeria

Medical litigation cases are on the rise globally. Professional negligence is the cause of most medical litigations. The knowledge and attitude of radiographers to ethical/medico-legal issues in radiographic practice in Nigeria were assessed. A cross-section of radiographers was selected using convenience sampling method. A structured questionnaire was used to obtain the needed data. Data were analysed with SPSS computer software version 17.0 while Chi square was used to test for statistical significance at p = 0.05. More than 10% of radiographers in Nigeria were not aware of the increased demands in patient rights. Moreover, more than 10% did not know or were not sure of their ethical duty to the patient while more than 10% do not understand medical negligence with its implications. These results are statistically significant (p < 0.05). The awareness and attitude of radiographers to ethical and medico-legal issues are poor. Adherence to professional ethics of radiographic practice is advised to avoid a .
Effect of bolus injection of 20 ml saline with arm elevation on the onset time of vecuronium administered via a peripheral vein: a randomised controlled trial

We investigated whether a bolus injection of 20 ml saline with arm elevation might shorten the onset time of vecuronium administered via a dorsal hand vein. Thirty patients were randomly allocated to the bolus saline group or control group. General anaesthesia was induced and maintained with remifentanil and propofol. Vecuronium 0.1 mg.kg−1 was administered to all patients, followed in the treatment group by bolus injection of 20 ml saline and arm elevation. Response to train‐of‐four stimulation was measured by acceleromyography at the adductor pollicis muscle. The mean (SD) lag time was 47.2 (14.5) s in the bolus saline group and 67.9 (12.2) s in the control group (p = 0.0002). The time to 95% block of T1 was 104.6 (29.9) s in the bolus saline group and 128.3 (15.8) s in the control group (p = 0.011). Bolus saline injection results in shortened lag time and onset time of neuromuscular block with vecuronium.
White matter hyperintensities in post-stroke depression: a case control study

Objective Despite extensive research on post-stroke depression (PSD), the role of white matter hyperintensities (WMHs) in its pathogenesis remains uncertain. The aim of this study was to evaluate the relationship between WMHs and PSD in Chinese patients with first or recurrent stroke. Methods A cohort of 994 patients with acute ischaemic stroke admitted to the acute stroke unit of a university-affiliated regional hospital in Hong Kong was recruited. A psychiatrist administered the Structural Clinical Interview for DSM-IV to all patients and made a diagnosis of PSD 3 months after the index stroke. 78 (7.8%) patients had PSD; 78 stroke patients matched according to age and sex but without PSD served as a control group. The severity and location of WMHs were evaluated with MRI. Results In comparison with the non-PSD group, patients in the PSD group were more likely to have severe deep WMHs (12.8% vs 1.3%; p=0.009). Severe deep WMHs remained an independent predictor of PSD in the multivariate analysis with an OR of 13.8 (p=0.016). Conclusion The results suggest that WMHs may play a role in the development of PSD. The importance of WMHs in the treatment and outcome of PSD warrants further investigation.
Best Practices for Lowering the Risk of Cardiovascular Disease in Diabetes

In Brief Cardiovascular disease (CVD) is a common complication of diabetes; nearly 80% of all people with diabetes will die from macrovascular complications. Dyslipidemia, hypertension, hypercoagulability, poor glycemic control, smoking, obesity, and lack of physical activity are just some of the multiple risk factors responsible for the increased risk of CVD in diabetes. A multi-pronged approach to address these risk factors is imperative. Although nonpharmacological therapy is the cornerstone of treatment, some pharmacological treatments are almost always warranted. These may include statins for dyslipidemia and their pleiotropic effects, tight blood pressure control (especially with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers), antiplatelet therapy, and appropriately tight glycemic control based on comorbidities. Evidence has shown that this approach can reduce the risk of CVD in diabetes but that these strategies continue to be underutilized.
SURVIVAL IN OLD AGE: PHYSICAL, PSYCHOLOGICAL AND SOCIAL CORRELATES OF LONGEVITY *

This study involved a sub‐group of a panel of community volunteers—37 long‐lived persons (20 men, 17 women) and 37 short‐lived persons (20 men, 17 women). The findings suggest that group characteristics of long‐term survivors differ sharply from those of short‐term survivors in old age. Moreover, it seems that there is no single factor which contributes to longevity; rather, there is a constellation of biological, psychological, and social factors amounting to what may be best described as elite ***status. Persons with high intelligence, sound financial status, well‐maintained health, and intact marriages may be expected to live significantly longer than their less intelligent and poorer brothers and sisters whose health is also declining and whose marriages are no longer intact. Many of the factors identified here as contributing to longevity are not readily subject to individual, social, or political manipulation, with the possible exception of financial factors.
Therapeutic effect of inhaled budesonide (Pulmicort® Turbuhaler) on the inflammatory response to one‐lung ventilation

This prospective, double‐blind trial was designed to evaluate the effect of inhaled budesonide on lung function and the inflammatory response to one‐lung ventilation. One hundred patients scheduled for lobectomy were allocated randomly to pre‐operative nebulised budesonide or saline. Bronchoalveolar lavage fluid samples were collected from either the collapsed or the ventilated lung both before one‐lung ventilation and 30 min after re‐expansion of the lung. The concentrations of serum and bronchoalveolar lavage fluid cytokines were determined. Budesonide treatment, compared with saline, reduced both peak (mean (SD) 3.7 (0.4) vs 2.5 (0.2) kPa) and plateau (mean (SD) 3.1 (0.2) vs 2.2 (0.1) kPa, respectively, p < 0.001 for both) ventilatory pressures. Thirty minutes after re‐expansion, lung compliance increased in the budesonide group compared with saline (57.5 (4.1) vs 40.1 (3.5) ml.cmH2O‐1, respectively p < 0.001). Budesonide also reduced the concentrations of tumour necrosis factor‐α, interleukin‐1β, interleukin‐6 and interleukin‐8 in bronchoalveolar lavage fluid, but increased interleukin‐10 30 min after re‐expansion (p < 0.05 for all measures). Pre‐operative nebulisation of budesonide may be effective in improving ventilatory mechanics and reducing the inflammatory response to one‐lung ventilation during thoracic surgery.
Loss of vision

Visual loss is not uncommon and many patients end up seeing neurologists because of it. There is a long list of possible causes but in most patients visual loss is associated with visual field loss. This means that for practical purposes the differential diagnosis can usually be narrowed down to a manageable shortlist by consideration of where in the visual pathway the lesion is likely to be, along with the time course of the visual loss. This article provides a practical approach to the diagnosis and appropriate investigation of such patients, dividing them into four groups: those in whom vision is lost transiently, acutely, subacutely (ie, days to weeks) and over a longer time frame (months to years). In addition, there is a discussion of those patients in whom visual loss is not obviously accompanied by any visual field loss.
An evidence-based algorithm for the utility of FDG-PET for diagnosing Alzheimer's disease according to presence of medial temporal lobe atrophy

Background Imaging biomarkers for Alzheimer's disease include medial temporal lobe atrophy (MTLA) depicted on computed tomography (CT) or magnetic resonance imaging (MRI) and patterns of reduced metabolism on fluorodeoxyglucose positron emission tomography (FDG-PET). Aims To investigate whether MTLA on head CT predicts the diagnostic usefulness of an additional FDG-PET scan. Method Participants had a clinical diagnosis of Alzheimer's disease (n = 37) or dementia with Lewy bodies (DLB; n = 30) or were similarly aged controls (n = 30). We visually rated MTLA on coronally reconstructed CT scans and, separately and blind to CT ratings, abnormal appearances on FDG-PET scans. Results Using a pre-defined cut-off of MTLA ⩾5 on the Scheltens (0–8) scale, 0/30 controls, 6/30 DLB and 23/30 Alzheimer's disease had marked MTLA. FDG-PET performed well for diagnosing Alzheimer's disease v. DLB in the low-MTLA group (sensitivity/specificity of 71%/79%), but in the high-MTLA group diagnostic performance of FDG-PET was not better than chance. Conclusions In the presence of a high degree of MTLA, the most likely diagnosis is Alzheimer's disease, and an FDG-PET scan will probably not provide significant diagnostic information. However, in cases without MTLA, if the diagnosis is unclear, an FDG-PET scan may provide additional clinically useful diagnostic information.
An Improved Dynamic Latch Based Comparator for 8-Bit Asynchronous SAR ADC

High speed analog to digital converters (ADC), memory sense amplifiers, RFID applications, data receivers with low power and area efficient designs has attracted a wide variety of dynamic comparators. This paper presents an improved design for a dynamic latch based comparator in achieving higher speed of conversion targeting 8-bit asynchronous successive approximation register (ASAR) ADC. The comparator has two different stages comprising of a dynamic differential input gain stage and an output latch. The objective of improving the speed of conversion is done by removing the dead time required for reset in the differential input stage. In the proposed work the output node in the differential gain stage requires lesser time to regain higher charge potential. The proposed methodology has been designed and simulated using 180nm CMOS technology operated on a single 1V power supply and achieves complete 8-bit conversion in 75nsec.
Do patients whose psychogenic non-epileptic seizures resolve, ‘replace’ them with other medically unexplained symptoms? Medically unexplained symptoms arising after a diagnosis of psychogenic non-epileptic seizures

Background In clinical practice, it is sometimes observed that patients in whom psychogenic non-epileptic seizures (PNES) cease, develop another medically unexplained symptom (MUS). Methods In order to determine how many patients develop new MUS post diagnosis and whether patients whose attacks cease are more likely to do so, new MUS were recorded 6–12 months after the diagnosis of PNES in 187 consecutive patients. Results Compared with baseline, the overall proportion of patients with MUS increased slightly, from 70.1% to 76.5%, with 44/187 patients (23.5%) developing new MUS. There were no significant differences between attack free and non-attack free patients. Binary logistic regression analysis showed that predictors of new MUS diverged between attack free and non-attack free patients. Among patients continuing to have attacks, those with previous health related psychological trauma were 18.00 times more likely to develop new MUS (p<0.0005). In patients who became attack free, patients drawing disability benefits were 5.04 times more likely to have new MUS (p=0.011). Conclusions The results suggest that almost 25% of patients develop new MUS following a diagnosis of PNES, although most of those have MUS pre-diagnosis. Patients with a history of health related psychological trauma whose attacks continue after diagnosis are at particularly high risk of developing new MUS. The data do not support the hypothesis that PNES that resolve are likely to be ‘replaced’ by other MUS.
Assessing Self-Repair on FPGAs with Biologically Realistic Astrocyte-Neuron Networks

This paper presents a hardware based implementation of a biologically-faithful astrocyte-based selfrepairing mechanism for Spiking Neural Networks. Spiking Astrocyte-neuron Networks (SANNs) are a new computing paradigm which capture the key mechanisms of how the human brain performs repairs. Using SANN in hardware affords the potential for realizing computing architecture that can self-repair. This paper demonstrates that Spiking Astrocyte Neural Network (SANN) in hardware have a resilience to significant levels of faults. The key novelty of the paper resides in implementing an SANN on FPGAs using fixed-point representation and demonstrating graceful performance degradation to different levels of injected faults via its self-repair capability. A fixed-point implementation of astrocyte, neurons and tripartite synapses are presented and compared against previous hardware floating-point and Matlab software implementations of SANN. All results are obtained from the SANN FPGA implementation and show how the reduced fixedpoint representation can maintain the biologically-realistic repair capability
SHORT PR INTERVAL ASSOCIATED WITH A PROLONGED QRS COMPLEX: A CLINICAL AND EXPERIMENTAL STUDY

Twelve years ago Wolff, Parkinson and White 1 described a syndrome appearing in healthy young people subject to attacks of paroxysmal tachycardia. Electrocardiograms taken during the intervals between attacks showed wide QRS complexes with short PR intervals. Isolated cases had been previously reported by Wilson, 2 Wedd 3 and Hamburger, 4 but the complete picture had not been appreciated. This syndrome, though uncommon, is now well known, 5 and it is recognized that the bizarre electrocardiograms do not necessarily represent cardiac damage. It occurs in all age groups with the exception that it has not yet been recognized in a newborn infant. It is more common in males, and most persons have attacks of paroxysmal tachycardia of either supraventricular or ventricular origin. In some of the cases reported atropine or exercise has caused the electrocardiographic pattern to return to a normal configuration, but this is not an invariable finding. A