bluuebunny/crossref_metadata_2025 huggingface dataset:
074 First seizures in emergency department vs ward: study in an elderly population
Authors: Foster Emma , Holper Sarah , Kwan Patrick
Published: May 2018

Introduction

Seizures are common in hospitals, both as presentations to Emergency Departments (ED) and as hospital onset seizures (HOS), occurring in ward patients hospitalised for non-seizure reasons. Prompt identification of seizure aetiology is important, as it affects prognosis and management choices. Acute symptomatic seizures due to acute disturbance of brain function have a far lower risk of recurrence compared to unprovoked seizures. Timely investigations and specialist review assesses individual risk for seizure recurrence, which then guides therapeutic decisions including antiepileptic drug (AED) use. This study includes a larger proportion of older patients than usually reported, and as such, provides important insights into seizure aetiology and management strategies in this demographic.

Methods

This retrospective survey of medical charts reviewed patients aged 18 or over with a hospital separation coded as ICD-10 G40 (Epilepsy), G41 (Status epilepticus), or R56.9 (convulsions not otherwise specified), presenting between 1 January 2008 through 30 November 2016, to a large metropolitan private hospital. 97 episodes of ED attendance for first seizure and 54 episodes of HOS were identified.

Results

Median age was 70 years in ED-cohort and 80.5 years in HOS-cohort. Symptomatic seizure risk factors were identified in 62.89% of ED-cohort and 83.33% of HOS-cohort, including exposure to known epileptogenic drugs in 38.89% of HOS-cohort. Antiepileptic drugs (AEDs) were prescribed on discharge to 74.23% of ED-cohort and 81.48% of HOS-cohort, but far fewer had scheduled Neurologist review (58.76% of ED- and 35.19% of HOS-cohorts).

Conclusion

This study includes a larger proportion of older patients than usually reported, and as such, provides important insights into seizure aetiology and management strategies in this demographic. This includes caution when prescribing known epileptogenic drugs; mindful prescription of AED on discharge; and ensuring adequate Neurologist follow-up to monitor further seizure activity, addressing seizure risk factors, and ongoing need for AED.
076 The expanding clinical phenotype of NMDAR encephalitis
Authors: Qiu Jessica , Helou Jacob , Urriola Nicholas , Welgampola Miriam , Parratt John , Wong Toh Hock , Parratt Kaitlyn
Published: May 2018

Introduction

The classic phenotype of anti-N-methyl-d-aspartate receptor (NMDA-R) encephalitis is a constellation of prodromal psychiatric symptoms, seizures, movement disorder and progressive autonomic dysfunction, frequently associated with ovarian teratoma. We describe four cases illustrating the expanding phenotype of NMDA-R encephalitis. We present two cases from two tertiary hospitals

Case 1 A 31 year old woman presented with focal onset seizures. She developed epilepsia partialis continua. CSF and serum NMDA-R antibodies were detected and PET of the brain showed bi-frontal hyper-metabolism. The seizures resolved with immunotherapy.

Case 2 A 26 year old woman presented with vomiting and dysequilibrium. She was found to have torsional downbeat nystagmus with otherwise normal eye movements and vestibulo-ocular reflexes. She developed bilateral appendicular and truncal ataxia, head bobbing and ocular flutter. PET demonstrated diffuse cerebellar hyper-metabolism. CSF NMDA-R antibodies were detected and an ovarian teratoma was identified.

Case 3 A 67 year old right-handed woman was treated for HSV encephalitis. MRI of the brain demonstrated typical changes in the right anteromedial temporal lobe, inferior frontal lobe and insular cortex. Five months later, she deteriorated with progressive cognitive dysfunction and prominent orofacial dyskinesia. Initially both CSF and serum were negative for NMDAR antibodies, but repeat CSF and serum were positive.

Case 4 A 61 year old woman presented with progressive cognitive impairment over eight months initially characterised by difficulty with calculations and making mistakes at work but subsequent severe impairment of language, executive function and memory and the development of facile and disinhibited behaviour. PET demonstrated mesial bi-temporal hyopo-metabolism and NMDA-R antibodies were detected in serum. She recovered with immunotherapy.

Conclusion

NMDA-R encephalitis should be considered in various neurological presentations including explosive onset focal epilepsy, rapidly progressive dementia, post HSV encephalitis and rhombencephalitis. Early detection is important given the frequent response to immunotherapy.
077 Recurrent guillain-barre syndrome
Authors: Hooi Wai Foong , Hutton Elspeth , Day Bruce
Published: May 2018

Introduction

Recurrent Guillain-Barre syndrome (GBS) is very rare. It occurs in 2% to 5% of GBS patients. It is unclear as to why some patients have a recurrence and whether this occurs more frequently in a distinct group of patients. We report a case of a 75 year old man who had five discreet attacks of GBS in 30 years. He had an excellent response to intravenous immunoglobulin (IVIG) and achieved full clinical recovery after each attack.

Case

A 75 year old man presented to the hospital with progressive ascending pattern of numbness and weakness in upper and lower limbs. This was in the setting of 10 days history of upper respiratory tract infective (URTI) symptoms. Neurological examination revealed distal sensory loss and distal weakness in upper and lower limbs. Deep tendon reflexes were absent. Nerve conduction studies showed features in keeping with GBS. He was treated with 5 days of intravenous immunoglobulin (IVIG) with significant improvement. Interestingly, this was on the background of having had 4 previous attacks of GBS in 1986 (preceded by acute gout), 1997 (preceded by the flu), 2010 (preceded by small bowel obstruction) and 2016 (preceded by viral gastroenteritis). He responded to IVIG each time and returned to his premorbid level function promptly after each attack.

Conclusion

Recurrent GBS is rare. It is important for clinician to be able to distinguish between recurrent GBS, treatment related fluctuations (GBS-TRF) and chronic inflammatory demyelinating polyneuropathy as the treatment and outcomes are different for each of these conditions.

References

. Kuitwaard K, Van Koningsveld R, Ruts L, Jacobs B, Van Doorn P. Recurrent Guillain Barre Syndrome. J Neurol Neurosurg Psychiatry2009;80:56–59.

. Pyun SY, Jeong JH, Bae JS. Recurrent Guillain-Barré syndrome presenting stereotypic manifestations, positive antiganglioside antibodies, and rapid recovery. Clin Neurol Neurosurg2015Dec;139:230–3.

. Mossberg N, Nordin M, Movitz C, Nilsson S, Hellstrand K, Bergström T, Andersson B, Andersen O. The recurrent Guillain-Barré syndrome: A long-term population-based study. Acta Neurol Scand2012Sep;126(3):154–61.
078 Deep brain stimulation (DBS) for dyskinetic cerebral palsy: a pilot study
Authors: Duma Stephen R , Mahant Neil , Ha Ainhi , Kim Samuel , Phu Amy , Stewart Kirsty , Waugh Mary-Clare , Wolfe Nigel , Russell Dale C , Owler Brian , Krause Martin , Fung Victor SC
Published: May 2018

Introduction

Deep brain stimulation (DBS) targeting the internal segment of the globus pallidus (GPi) is effective for several forms of dystonia, particularly idiopathic isolated dystonia. DBS may also be helpful for some causes of chorea and other hyperkinetic disorders. A minority of people with cerebral palsy (CP) have dystonia or choreoathetoid movements (labelled dyskinetic CP). Treatment options to improve function for this group are limited. We aimed to investigate whether DBS is effective in reducing symptoms and improving function in dyskinetic CP.

Methods

This study was a randomised, placebo-controlled, double-blinded, crossover trial. Four participants (2M:2F, aged 11–48 year) with dyskinetic CP were included between 2010–2011. Participants underwent GPi DBS implantation and were randomised to active or sham stimulation for 3 months, following which their DBS stimulation was switched for a further 3 months. The Bourke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to rate the severity of dystonia at baseline, 3 months after initial treatment; and 3 months after crossover treatment. The study was terminated early due to slow recruitment.

Results

One participant had a reduction in BFMDRS score with active stimulation; this participant was the oldest and had the mildest BFMDRS score. The remainder of the participants had either no change or a slight increase in BFMDRS score. Despite this, in longer-term follow-up, 3 participants reported symptomatic improvement and continue active DBS treatment 7–8 years post-surgery.

Conclusion

We did not identify a benefit of GPi DBS for dyskinetic CP in our randomised controlled trial. However, 3 participants have had symptomatic improvement on long-term follow-up, consistent with other reports of benefit with GPi DBS. Limiting factors of the study include small sample size, participant heterogeneity and study design. It was noted that the final (efficacious) stimulation parameters required open label programming to achieve and were outside of those permitted by the protocol.
080 Electrodiagnostic and ultrasound correlates of clinical severity in ulnar neuropathy
Authors: Pelosi Luciana , Mulroy Eoin
Published: May 2018

Introduction

This is a retrospective review of 135 consecutive patients (M:F=71:64, mean age 52.6 years; 141 arms) referred to our institution with ulnar neuropathy over a two year period. We analysed electrodiagnostic and ultrasound findings in relation to clinical severity.

Methods

All patients underwent electrodiagnostic (AAN) and ultrasound examination of the symptomatic ulnar nerve(s). Clinical severity was graded on a 4 point scale from ‘very mild’ (symptoms only) to ‘severe’ (sensory loss plus marked atrophy of ulnar-innervated hand muscles).

Results

In ‘very mild’ neuropathies, the number of abnormal electrodiagnostic and ultrasound studies was 2 and 11 respectively, out of 54; in ‘mild’ neuropathies 19 and 25 out of 40; in ‘moderate’, 23 and 24 out of 24; and in ‘severe’, 23 and 23 out of 23. In 25 arms, (18 of which were clinically ‘severe’ or ‘moderate’), electrophysiology was abnormal but non-localising. Ultrasound showed abnormally large cross-sectional area at the elbow in 22 and diffuse nerve enlargement in three. Ultrasound identified nerve subluxation in 24 (17%) neuropathies, 58% of which were ‘very mild’, 25% ‘mild’ and 17% ‘moderate’ or ‘severe’.

Conclusion

In patients with symptoms but no clinical signs, electrophysiological evidence of ulnar neuropathy was present in 3.7%, whereas abnormal nerve ultrasound, often associated with subluxation, was demonstrated in 20%. Ultrasound increased the diagnostic yield of electrophysiology in the ‘very mild’ and, to a lesser extent, the ‘mild’ neuropathies by a combined 11%, and localised the lesion in all ulnar neuropathies with abnormal but non-localising electrophysiology. Nerve subluxation was disproportionately represented amongst the clinically ‘very mild’ neuropathies with abnormal ultrasound.
083 Response to immunosuppressive therapy in cerebral amyloid angiopathy-related inflammation
Authors: Tilling Jasmin , Trewin Benjamin , Levy Stanley
Published: May 2018

Introduction

Cerebral amyloid angiopathy (CAA) is a common age-related condition characterised by amyloid beta-peptide deposition affecting the medium sized cortical and leptomeningeal arteries, arterioles and capillaries. CAA-related Inflammation (CAA-I) is an increasingly recognised variant of CAA, which is thought to be due to perivascular auto-inflammation in response to amyloid deposition. We describe the clinical course of two cases of probable CAA-I.

Cases

A 71 year old man presented with new-onset seizures, headaches and subacute cognitive decline. MRI of the brain demonstrated confluent subcortical T2 white matter hyperintensities and cerebral oedema, with predominantly superimposed widespread cortico-subcortical micro-haemorrhages, in keeping with the diagnosis of CAA-I. A course of immunosuppresive therapy was commenced with five days of intravenous methylprednisolone, resulting in marked radiological and clinical improvement within two weeks.

A 76 year old female presented with subacute cognitive dysfunction and apraxia, and transient left-sided weakness. MRI scan of the brain initially demonstrated a right temporo-occipital infarct, leading to primary treatment for stroke, but subsequently evolved to reveal diffuse multi-lobar T2 white matter hyperintensities with leptomeningeal involvement. A provisional diagnosis of CAA-I was made and following a poor clinical response to a trial of corticosteroid therapy, treatment with intravenous cyclophosphamide was commenced.

Conclusion

These cases emphasise the importance of CAA-I as part of the differential diagnosis in patients presenting with symptoms of subacute cognitive decline, seizures, headaches and focal neurological deficits, given the potential for dramatic improvement with readily accessible immunosuppressive therapies.
091 Poems syndrome treated with autologous stem cell transplant
Authors: Devlin Michael , Costello Craig , Hodges Georgina , Urkude Ravindra
Published: May 2018

Introduction

Acquired demyelinating neuropathies comprise a diverse spectrum of individual diseases and pathophysiological processes. Differential diagnoses can be distinguished through assessment of region of involvement, time course, neurophysiology and ancillary testing. Where an atypical presentation of chronic inflammatory demyelinating polyradiculoneuropathy arises, further investigation and changes to management are required. We present a single case report from the Townsville Hospital.

Case

A 45 year old man presented with two months of altered sensation in the distal lower extremities. Lower limb weakness developed, and three months after symptoms onset the patient had bilateral foot drop, and developed sensory disturbance in the upper limbs. Electrophysiological testing revealed severely reduced lower limb CMAPs with demyelinating range conduction velocity without conduction block; upper limb SNAPs were normal in amplitude with conduction velocity slowing. A lumbar puncture revealed elevated CSF protein 870 mg/L without raised white cells. A trace lambda IgG band of uncertain significance was detected. IVIG was commenced and symptoms initially stabilised. After four months of monthly IVIG, symptoms worsened and neurophysiology revealed further neurogenic changes. Skeletal survey and whole Spine MR STIR sequences did not reveal any bony lesions, and bone marrow biopsy revealed 5% plasmacytosis. The patient’s functional status deteriorated to full-time wheelchair use despite escalation of therapy. Sural nerve biopsy revealed axonal loss and demyelination without inflammation. A final diagnosis of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, skin changes) syndrome was confirmed with vascular endothelial growth factor elevation, and the patient underwent an autologous stem cell transplant with significant improvement in symptoms and functional status by day 100.

Conclusion

POEMS syndrome is a rare disorder and should be suspected in atypical cases of CIDP particularly when treatment resistance is present. Extensive investigation is often required to meet diagnostic criteria for POEMS.
092 Early-onset dementia with white matter changes
Authors: Trewin Benjamin P , Baskin Jono , Satgunaseelan Laveniya , Levy Stanley
Published: May 2018

Introduction

We report a rare case of early-onset dementia with leukoencephalopathy in which the diagnosis was unclear until autopsy. As previously seen in case reports of this condition, there were a number of working diagnoses made, prefixed with ‘atypical’, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and Huntington disease.1

Case

A sixty-one-year old Caucasian female initially presented with 2 years of progressive chorea of her right upper limb, anxiety and memory difficulties. These symptoms steadily progressed over the next 5 years as she developed dementia and a progressive gait disturbance with pyramidal weakness. In the terminal stages of her illness, at sixty-six years of age, she had recurrent hospital admissions for pyrexia of unknown origin and finally refractory seizures and death. Her serum investigations were non-diagnostic; she was negative for both CADASIL and Huntington disease mutations. Her MRI demonstrated diffuse confluent white matter changes involving the corpus callosum and the vermis. She also had an abnormal electroencephalogram late in the course of her disease, with lateralised periodic discharges recorded during episodes of non-convulsive status epilepticus. Her autopsy revealed a leukoencephalopathy with pathognomonic histologic features of adult-onset leukoencephalopathy with axonal spheroids and pigmented glia (ALSP). Post-mortem genetic testing is currently underway.

Conclusion

Our case demonstrates the possibility of establishing an accurate diagnosis with pathology and genetic testing in cases of early-onset dementia with white matter changes. Recently elucidated entities offer diagnostic closure to patients, families and clinicians and can inform prognosis and genetic counselling. Furthermore, potential therapeutic options for leukodystrophies appear to be on the horizon.2 Our case report is the first to our knowledge to present with chorea and to exhibit vermian hyperintensity on T2-weighted MRI.

References

. Meyer-Ohlendorf M, Braczynski A, Al-Qaisi O, et al. Comprehensive diagnostics in a case of hereditary diffuse leukodystrophy with spheroids. BMC Neurology2015;15:103.

. van der Knaap MS, Wolf NI, Heine VM. Leukodystrophies: Five new things. Neurol Clin Pract2016;6:506–514.
098 A case of myasthenia gravis lambert eaton overlap syndrome (MLOS) in seronegative myasthenia gravis
Authors: Saleem Sameer , Patel Ronak , Gawarikar Yash
Published: May 2018

Introduction

Myasthenia gravis (MG) is an antibody-mediated autoimmune disease of neuromuscular transmission. 6 to 12 percent of MG are negative for acetyl choline receptor (AChR) and MuSK antibodies and are defined as seronegative MG. Lambert-Eaton myasthenic syndrome (LEMS) is an autoimmune condition with antibodies to presynaptic voltage-dependent calcium channel

Case

A 39 year old male presented with blurred vision and right-sided ptosis. Initial examination showed a pupil-sparing left complete third nerve palsy. Demyelination and intracranial aneurysms were ruled out with gadolinium-enhanced MRI/MRA. Outpatient follow-up 2 weeks later showed new onset proximal muscle weakness of the upper limbs with fatigability and a complex ophthalmoplegia with almost complete paralysis of gaze. A repeat MRI with gadolinium and CSF analysis were normal. His AChR and MuSK antibodies were negative; however, voltage-dependent calcium channel antibodies, ANA, dsDNA, and SSA were positive. Initial nerve conduction tests were normal, but repeat NCS on two separate occasions showed decrement on repetitive stimulation in the right trapezius with no evidence of facilitation post exercise. CT chest, abdomen and pelvis was normal. He improved with pulsed steroids and was discharged on a tapering dose of oral steroids, pyridostigmine and regular IVIG infusions as a steroid-sparing agent.

Conclusion

Lambert-Eaton myasthenic syndrome shares the same pathologic site and similar pathophysiology with MG but has a markedly different clinical and electro-physiological picture. There are reports of MG and LEMS overlap syndrome, however, they exhibit phenotypic characteristics of both LEMS and MG. Voltage-dependent calcium channel antibodies have not been described in patients with seronegative MG. Ours is potentially the first reported case of seronegative myasthenia with voltage-dependent calcium channel antibodies and only clinical and neurophysiological features of MG.
099 A case of possible Fahr’s disease
Authors: Saleem Sameer , Gawarikar Yash , Patel Ronak
Published: May 2018

Introduction

Idiopathic basal ganglia calcification (IBGC) or Fahr’s disease is an autosomal dominant, rare progressive neurological disorder, of unknown aetiology. It is characterised by abnormal deposition of calcium in the basal ganglia and other brain regions. We present the case of a woman with Fahr’s disease.

Case

63 year old woman presented with rapid cognitive decline on resuming work after a long holiday. Her co-morbidities included type 1 diabetes, Crohn’s disease and hypertension. She was slow at work, had difficulty concentrating, tired and forgetful in paying important bills. On initial clinical examination, she was fidgety without any choreiform movements or parkinsonian features. Addenbrooke’s cognitive assessment scored 90/100 but lost points in fluency and visuospatial. MRI brain showed bilateral symmetrical blooming artefacts suggestive of calcifications involving basal ganglia, thalami, cerebellar hemispheres and occipital cortices and also extensive white matter disease. CT brain confirmed intracerebral calcification involving the same areas in MRI. She had an ANA of 1280, dsDNA of 40, antiphospholipid Abs with b2GP1 IgG of 20 U/mL and a normal lumbar puncture. During follow-up, she had developed choreiform movements of her trunk and legs, bilateral dysdiadochokinesia, and bradykinesia on repetitive fine finger movements. Her Montreal cognitive assessment score was 24/30.

Conclusion

Fahr’s disease is a very rare condition with unknown prevalence. Typical age of presentation is between the 4th – 6th decades but early onset is reported. Symptoms include Parkinsonism, chorea, dystonia, cognitive impairment, seizures, headache or ataxia. The familial form of IBGC is genetically heterogeneous and both sporadic and familial forms are not associated with disorders of calcium or parathyroid hormone metabolism. Our case illustrates the high index of clinical suspicion necessary to diagnose rare conditions such as Fahr’s disease.
Downregulation of Cancer Stemness by Novel Diterpenoid Ovatodiolide Inhibits Hepatic Cancer Stem Cell-Like Traits by Repressing Wnt/β-Catenin Signaling
Authors: Liu Mingche , Bamodu Oluwaseun Adebayo , Kuo Kuang-Tai , Lee Wei-Hwa , Lin Yen-Kuang , Wu Alexander T.H. , M Hsiao , Tzeng Yew-Min , Yeh Chi-Tai , Tsai Jo-Ting
Published: May 2018

The hierarchical tumor propagation or cancer stem cells (CSCs) model of carcinogenesis postulates that like physiologic adult stem cell (ASC), the CSCs positioned at the apex of any tumor population form the crux of tumor evolution with a constitutive regenerative capacity and differentiation potential. The propagation and recurrence of the characteristically heterogeneous and therapy-resistant hepatocellular carcinoma (HCC), adds to accumulating evidence to support this CSCs model. Based on the multi-etiologic basis of HCC formation which among others, focuses on the disruption of the canonical Wnt signaling pathway, this study evaluated the role of cembrane-type phytochemical, Ovatodiolide, in the modulation of the Wnt/[Formula: see text]-catenin pathway, and its subsequent effect on liver CSCs’ activities. Our fluorescence-activated cell sorting (FACS) and quantitative RT-PCR analyses of side population (SP) indicated that CD133+ cells were [Formula: see text]-catenin-overexpressing, more aggressive, and resistant to the conventional anticancer agents, Cisplatin and Doxorubicin, when compared to [Formula: see text]-catenin-downregulated group. We demonstrated that marked upregulation of [Formula: see text]-catenin and its downstream targets effectively enhanced hepatosphere formation, with an associated induction of CD133, OCT4 and Sox2 expression and also caused an significant enhancement of HCC proliferation. However, treatment with Ovatodiolide induced downregulation of [Formula: see text]-catenin and its downstream effector genes, abolished hepatosphere formation and reversed the [Formula: see text]-catenin-associated enhancement of HCC growth. In summary, we demonstrated for the first time that Ovatodiolide suppressed the canonical Wnt signaling pathway, and inhibited the generation of liver CSCs; Thus, projecting Ovatodiolide as a putatively effective therapeutic agent for anti-HCC target therapy.
GROWTH MECHANISM OF NICKEL-PLATED COATING ON PRIMER-MODIFIED POLY(ETHYLENE TEREPHTHALATE) SHEET
Authors: SUN ZHIPING , HUANG JUNJUN
Published: May 2018

In this work, the growth mechanism of nickel-plated coating on primer-modified poly(ethylene terephthalate) (PET) sheets was investigated systematically. Results showed the surface structure of primer-modified PET sheets would chemisorb Sn and Pd, which are used as the catalyst for the electroless nickel plating. Nickel particles were formed on the plated PET surface. The crystal preferential orientation transformed from (200) plane to (111) plane and nickel particles grew with the increase of thickness of plated coating. The growth of nickel particles mainly included lateral growth and vertical growth. Cracks and then shed were formed in the nickel coating when the thickness exceeded about 228[Formula: see text]nm.
Brownian representations of cylindrical continuous local martingales
Authors: Yaroslavtsev Ivan
Published: May 2018

In this paper, we give necessary and sufficient conditions for a cylindrical continuous local martingale to be the stochastic integral with respect to a cylindrical Brownian motion. In particular, we consider the class of cylindrical martingales with closed operator-generated covariations. We also prove that for every cylindrical continuous local martingale [Formula: see text] there exists a time change [Formula: see text] such that [Formula: see text] is Brownian representable.
Three-Dimensional Numerical Study on the Interaction Between Dam-Break Wave and Cylinder Array
Authors: Wu Tso-Ren , Vuong Thi-Hong-Nhi , Lin Jun-Wei , Chu Chia-Ren , Wang Chung-Yue
Published: May 2018

Energy dissipation mechamism is the key to study tsunami hazard mitigation. Numerical method is adopted to study the interaction between bores and square cylinders. The model solves the three-dimensional Navier–Stokes equations with Large-Eddy Simulation turbulence model. The Volume-of-fluid (VOF) method is used to track the complex free surface. We focus the investigation on the effect of cylinder height on the flow field. The results show that the turbulence diffusion is the main mechanism for energy dissipation. The flow patterns are significantly different within and beyond the cylinder array. The taller cylinders cause smaller velocity magnitude in the downstream area. In addition, a larger value of velocity magnitude and vorticity near the bottom is identified in the tall-cylinder case. These unique featuers make different dissipation rates.
A numerical study on the buckling and vibration of nanobeams based on the strain and stress-driven nonlocal integral models
Authors: Faraji Oskouie M. , Ansari R. , Rouhi H.
Published: May 2018

In this paper, the free vibration and buckling behaviors of nanoscale beams with different boundary conditions are analyzed using the integral formulation of Eringen’s nonlocal elasticity theory. To this end, both strain- and stress-driven nonlocal integral models are employed. The nanobeams are modeled according to the Euler–Bernoulli beam theory. Moreover, a novel numerical approach is proposed for solving the obtained governing equations. By this numerical method, which uses matrix differential and integral operators, the integral governing equation is directly solved and the difficulties related to converting the integral governing equation into the differential one are bypassed. Comparisons are made between the predictions of strain and stress-driven models about the vibration and buckling responses of nanobeams subject to various end conditions. The results indicate that based on the stress-driven model, the frequency and critical buckling load increase with increasing the nonlocal parameter, whereas they decrease when the strain-driven integral model is used.
Advances in Electronic Phenotyping: From Rule-Based Definitions to Machine Learning Models
Authors: Banda Juan M. , Seneviratne Martin , Hernandez-Boussard Tina , Shah Nigam H.
Published: May 2018

With the widespread adoption of electronic health records (EHRs), large repositories of structured and unstructured patient data are becoming available to conduct observational studies. Finding patients with specific conditions or outcomes, known as phenotyping, is one of the most fundamental research problems encountered when using these new EHR data. Phenotyping forms the basis of translational research, comparative effectiveness studies, clinical decision support, and population health analyses using routinely collected EHR data. We review the evolution of electronic phenotyping, from the early rule-based methods to the cutting edge of supervised and unsupervised machine learning models. We aim to cover the most influential papers in commensurate detail, with a focus on both methodology and implementation. Finally, future research directions are explored.
Fuzzy Approach in Rail Track Degradation Prediction
Authors: Karimpour Mostafa , Hitihamillage Lalith , Elkhoury Najwa , Moridpour Sara , Hesami Reyhaneh
Published: May 2018

Rail transport authorities around the world have been facing a significant challenge when predicting rail infrastructure maintenance work. With the restrictions on financial support, the rail transport authorities are in pursuit of improved modern methods, which can provide a precise prediction of rail maintenance timeframe. The expectation from such a method is to develop models to minimise the human error that is strongly related to manual prediction. Such models will help rail transport authorities in understanding how the track degradation occurs at different conditions (e.g., rail type, rail profile) over time. They need a well-structured technique to identify the precise time when rail tracks fail to minimise the maintenance cost/time. The rail track characteristics that have been collected over the years will be used in developing a degradation prediction model for rail tracks. Since these data have been collected in large volumes and the data collection is done both electronically and manually, it is possible to have some errors. Sometimes these errors make it impossible to use the data in prediction model development. An accurate model can play a key role in the estimation of the long-term behaviour of rail tracks. Accurate models can increase the efficiency of maintenance activities and decrease the cost of maintenance in long-term. In this research, a short review of rail track degradation prediction models has been discussed before estimating rail track degradation for the curves and straight sections of Melbourne tram track system using Adaptive Network-based Fuzzy Inference System (ANFIS) model. The results from the developed model show that it is capable of predicting the gauge values with R2 of 0.6 and 0.78 for curves and straights, respectively.
A Case of Hyperacute Severe Thrombocytopenia Occurring Less than 24 Hours after Intravenous Tirofiban Infusion
Authors: Meghrajani Vineet , Sabharwal Nitin , Namana Vinod , Elsheshtawy Moustafa , Topi Bernard
Published: May 2018

Thrombocytopenia is defined as a condition where the platelet count is below the lower limit of normal (<150 G/L), and it is categorized as mild (100–149 G/L), moderate (50–99 G/L), and severe (<50 G/L). We present here a 79-year-old man who developed severe thrombocytopenia with a platelet count of 6 G/L, less than 24 hours after intravenous tirofiban infusion that was given to the patient during a percutaneous transluminal coronary angioplasty procedure with placement of 3 drug-eluting stents. The patient’s baseline platelet count was 233 G/L before the procedure. Based on the timeline of events during hospitalization and laboratory evidence, it was highly likely that the patient’s thrombocytopenia was the result of tirofiban-induced immune thrombocytopenia, a type of drug-induced immune thrombocytopenia (DITP) which occurs due to drug-dependent antibody-mediated platelet destruction. Anticoagulant-mediated artefactual pseudothrombocytopenia was ruled out as no platelet clumping was seen on the peripheral blood smears. The treatment of DITP includes discontinuation of the causative drug; monitoring of platelet count recovery; or treatment of severe thrombocytopenia with glucocorticoids, IVIG, or platelet transfusions depending on the clinical presentation. The most likely causative agent of this patient’s thrombocytopenia—tirofiban—was discontinued, and the patient did not develop any signs of bleeding during the remainder of his hospital stay. His platelet count gradually improved to 24 G/L, and he was discharged on the sixth hospital day.
Extensive Craniocervical Abscess after Transoral Ganglionic Local Opioid Analgesia at the Superior Cervical Ganglion for Atypical Trigeminal Neuralgia: Report of a Severely Complicated Case
Authors: Sproll Christoph , Turowski Bernd , Depprich Rita , Kübler Norbert R. , Rapp Marion , Lommen Julian , Holtmann Henrik
Published: May 2018

Ganglionic local opioid analgesia (GLOA) describes the application of low-dose opioids close to sympathetic as, for example, to the superior cervical ganglion. GLOA can be effective in different pain syndromes affecting the head and face region and has been considered to be a safe technique with few complications reported so far. We present the case of a patient who received a single, transoral GLOA for a refractory trigeminal neuralgia. The patient subsequently developed an extensive epidural abscess at the craniocervical junction, requiring ultimately transoral odontoid resection and dorsal stabilisation. This severe complication challenges the role of transoral infiltration therapies in analgetic medicine.
Contagious Bovine Pleuropneumonia: Seroprevalence and Risk Factors in Gimbo District, Southwest Ethiopia
Authors: Mamo Yosef , Bitew Molalegne , Teklemariam Tsegaye , Soma Murga , Gebre Debebe , Abera Temesgen , Benti Tefera , Deneke Yosef
Published: May 2018

Contagious bovine pleuropneumonia (CBPP) is a highly contagious disease of cattle which is one of the great plagues which continues to devastate the cattle herds on which so many people are dependent in Africa. Cross-sectional study was conducted from October 2015 to August 2016 to determine the seroprevalence of CBPP in cattle and associated risk factors in Gimbo district, Southwest Ethiopia. A total of 384 serum samples were collected and tested for the presence of specific antibodies against Mycoplasma mycoides subspecies mycoides small colony (MmmSC), using a competitive enzyme-linked immunosorbent assay (cELISA). Univariable and multivariable logistic regression analysis were performed to determine the association between risk factors and seroprevalence of CBPP. An overall seroprevalence of CBPP was 8.1% (31/384) and it was ranging from 0% to 20% across different Peasant associations (PAs). The seroprevalence of CBPP among adult animals was 8.5% (25) and in young 6.6% (6), in good body condition animals 6.6% (18) and in poor 11.5% (13), in dry season 11.9% (20) and in rainy 5.1% (11), and in highland altitude 2.5% (3), midland 3.8% (5), and lowland 17.4% (23). Among the potential predisposing factors assessed, altitude was found significantly (p = 0.02, OR = 7.3) associated with the seroprevalence of contagious bovine pleuropneumonia and other risk factors had no significant (P > 0.05) influence. The present study showed that the overall seroprevalence of CBPP in Gimbo district was high and this indicates a need for intervening and implementing control measures to prevent further spread of the disease in the district through the use of better and coordinated vaccination program.
In Vivo Antiplasmodial Activity of Two Sahelian Plant Extracts on Plasmodium berghei ANKA Infected NMRI Mice
Authors: Bonkian Léa Nadège , Yerbanga R. Serge , Koama Benjamin , Soma Aboubakar , Cisse Mamoudou , Valea Innocent , Tinto Halidou , Ouedraogo Jean Bosco , Guigemde T. Robert , Traore/Coulibaly Maminata
Published: May 2018

Up to now, the control of malaria remains a challenge. The World Health Organization (WHO) recommends the use of artemisinin‐based combination therapies (ACTs) for uncomplicated malaria treatment. Despite this guideline, many people in Burkina Faso use herbal medicine as primary treatment against malaria. The aim of this study was to assess the in vivo activity of Guiera senegalensis J. F. Gmel and Bauhinia rufescens Lam. leaves extracts against Plasmodium berghei ANKA. A four‐day treatment of leaves decoction of each plant was administrated orally to 7 groups of six NMRI (Naval Medical Research Institute) mice infected with Plasmodium berghei ANKA strain. The control group received distilled water as treatment while the treated groups each received daily 100, 250, and 500 mg extract/kg body weight. Thin blood smears were performed on day five and the percentage of reduction of parasitaemia was determined compared to the control. The percentages of reduction of the parasitaemia at the doses of 100, 250, and 500 mg extract/kg body weight were, respectively, 57.5%, 35.9%, and 44.9% for Guiera senegalensis and 50.6%, 22.2%, and 25.7% for Bauhinia rufescens. Our findings on antiplasmodial activity of these two plants justify the traditional use by local populations against malaria. Thus, the isolation of the active compounds from these two plants is suggested for possible antimalarial candidate drugs.
Correlates of Falls among Community-Dwelling Elderly in Thailand
Authors: Worapanwisit Titaporn , Prabpai Somkid , Rosenberg Ed
Published: May 2018

Nearly every nation is experiencing rapid population aging. One area of major concern is health; a major health risk for older adults is falling, and there are multiple negative consequences of falling. This is a global concern yet is underresearched in many nations. This study examines demographic, health, and environmental correlates of falling among community-dwelling Thai elderly. Data were collected from a sample of 406 adults aged 60–69. Significant (p<0.05) fall correlates were urban residence, older age, greater BMI, impaired and uncorrected vision, chronic health conditions, medication use and medication side effects, poor muscle tone, and hazardous indoor and outdoor home environments. Results lead to recommendations for interventions to reduce fall risk that are both evidence-based and culturally acceptable.
El Agua, los Electrolitos y el Equilibrio Acido-Básico: Los Electrolitos, (el sodio)
Authors: Foradori C. Arnaldo
Published: May 2018

Sin resumen
"Virus Lento" y Sistema Nervioso
Authors: Soza M. Marco Antonio
Published: May 2018

Sin resumen
Coledocoduodenostomía Externa (CDE) Experiencia Clínica
Authors: Cubillos O. Lorenzo , Sepúlveda D Rolando
Published: May 2018

Sin resumen
Tema X. Evaluación del débito Cardiaco y Nomograma de Starr-Jackson
Authors: Badía C. Waldemar
Published: May 2018

Sin resumen
Flora bacteriana habitual.
Authors: Montiel Avedaño Francisco
Published: May 2018

Sin resumen
Cuarto informe de avance de la reforma curricular. Modificaciones de cuarto y quinto años.
Authors: Velasco Fuentes Nicolás , Moreno Bolton Rodrigo
Published: May 2018

Sin resumen
Etica clínica. Principios básicos y modelos de analisis.
Authors: Taboada Rodríguez Paulina
Published: May 2018

Sin resumen
Consideraciones éticas sobre el aborto terapéutico.
Authors: Besio Rollero Mauricio
Published: May 2018

Sin resumen
Complicaciones hemodinámicas en una faco-vitrectomía: sospecha de una embolia aérea
Authors: Mosqueira Podestá Loreto Alejandra , Medina Paulina
Published: May 2018

La embolia aérea es una complicación quirúrgica potencialmente fatal, que debe manejarse rápida y precozmente, por lo que su reconocimiento temprano es esencial. Al tener una amplia gama de posibles manifestaciones clínicas, la sospecha diagnóstica en base al procedimiento quirúrgico es fundamental. Presentamos el caso de una paciente de 69 años sometida a una faco-vitrectomía con anestesia general que sufrió un colapso hemodinámico brusco durante la fase de intercambio aire/fluido.
Evaluación por médicos especialistas de curso de urgencias ginecó-obstétricas utilizando metodología de simulación clínica.
Authors: Zamboni Milena , Pertossi Apala Emiliano , Barriga Cosmelli Maria Isabel , Pineda Alarcon Rodrigo , Vargas Inocentti Paula , Farias Jofre Marcelo , Poblete Lizana Jose Andres
Published: May 2018

Introducción: La Simulación clínica es una herramienta de aprendizaje complementaria a los métodos tradicionales en la práctica clínica. Permite desarrollar habilidades y destrezas en escenarios seguros. La División de Ginecología y Obstetricia de la Universidad Católica (UC) imparte un curso de emergencias obstétricas para especialistas utilizando esta metodología. Presentamos la evaluación de los especialistas que realizaron el curso en el año 2016. Materiales y métodos: se realizó un curso de simulación de escenarios de emergencia en obstetricia, con un total de 16 horas separadas en 2 días. Con simuladores de alta y mediana complejidad. Tutoriados por instructores acreditados por el Institute of Medical Simulation de la Universidad de Harvard. Al finalizar el curso los participantes respondieron una encuesta escrita de diversos tópicos del curso. Resultados: participaron 93 especialistas. 76% de los participantes estuvo completamente de acuerdo y 23% de acuerdo con que la práctica con modelos simulados mejora la destreza relacionada con la realización de los procedimientos propuestos en el curso. El 100% de ellos indica que recibió retroalimentación considerada como útil durante las sesiones de entrenamiento y consideran que están completamente de acuerdo o de acuerdo con que esta metodología les permite cometer errores en forma segura. Conclusiones: la implementación de la metodología de simulación clínica en la docencia de emergencias obstétricas es muy bien evaluada por los especialistas, ya que entrega retroalimentación académica útil de cada caso y les permite cometer errores sin riesgos para los pacientes con un alto nivel de realismo.
Encuestas en salud pública: interrogando la comunidad
Authors: Jiménez De la Jara Jorge Adolfo
Published: May 2018

Cuando me preguntan cual es mi imagen o metáfora preferida para explicar la salud pública digo:El fonendoscopio de la salud pública son las encuestas, grupales o poblacionales, procesadas con rigor y validez científica. El bisturí es la palabra, la comunicación a la comunidad, esencialmente preventiva generadora de conductas racionales, protectoras y virtuosas.
Retained Herrick Plug
Authors: Hellman Justin B. , Strong Edward Bradley , Lin Lily Koo
Published: May 2018

A 79-year-old female with a history of keratoconjunctivitis sicca presented with several years of epiphora of both eyes. Thirteen years earlier, intracanalicular Herrick lacrimal plugs (Lacrimedics, Eastsound, WA, USA) had been placed in both eyes to treat her dry eye syndrome. After 13 years the patient felt the epiphora was intolerable and underwent endoscopic dacryocystorhinostomy (DCR) of the left, then the right side. Intraoperatively, during the right endoscopic DCR, a Herrick lacrimal plug was found in the common canaliculus into the lacrimal sac. Postoperatively, the patient did well with improved epiphora. The Herrick plug is designed to be intracanalicular, and this case illustrates that the plug can migrate and be retained for many years. Collared punctal plugs have a lower risk of this type of complication.
Cerebral Functional Magnetic Resonance Imaging and Multifocal Visual Evoked Potentials in a Patient with Unexplained Impairment of Visual Function: A Case Report
Authors: Haugen Olav H. , Andréasson Sten , Ersland Lars , Craven Alexander R. , Hugdahl Kenneth
Published: May 2018

We present a case of a young female with a slowly progressing visual impairment who was examined with multifocal visual evoked potentials and functional magnetic resonance imaging (fMRI) for underlying neuronal abnormality. The fMRI examination consisted of presenting black-and-white checkerboard stimuli, and her activation patterns were compared to the patterns from 4 normal-sighted subjects. The results showed clear differences in neuronal activation between the patient and the controls in the occipital and parietal lobes. Although we have shown neuronal correlates in a case of unexplained visual loss, it is still an open question as to whether this has an organic or functional cause, which should be the subject for future research.
Novel Therapeutic Strategies for Solid Tumor Based on Body’s Intrinsic Antitumor Immune System
Authors: Duan Haifeng
Published: May 2018

The accumulation of mutated somatic cells due to the incompetency of body’s immune system may lead to tumor onset. Therefore, enhancing the ability of the system to eliminate such cells should be the core of tumor therapy. The intrinsic antitumor immunity is triggered by tumor-specific antigens (TSA) or TSA-sensitized dendritic cells (DC). Once initiated, specific anti-tumor antibodies are produced and tumor-specific killer immune cells, including cytotoxic T lymphocytes (CTL), NK cells, and macrophages, are raised or induced. Several strategies may enhance antitumor action of immune system, such as supplying tumor-targeted antibody, activating T cells, enhancing the activity and tumor recognition of NK cells, promoting tumor-targeted phagocytosis of macrophages, and eliminating the immunosuppressive myeloid-derived suppressor cells (MDSCs) and Treg cells. Apart from the immune system, the removal of tumor burden still needs to be assisted by drugs, surgery or radiation. And the body’s internal environment and tumor microenvironment should be improved to recover immune cell function and prevent tumor growth. Multiple microenvironment modulatory therapies may be applied, including addressing hypoxia and oxidative stress, correcting metabolic disorders, and controlling chronic inflammation. Finally, to cure tumor and prevent tumor recurrence, repairing or supporting therapy that consist of tissue repair and nutritional supplement should be applied properly.