bluuebunny/crossref_metadata_2025 huggingface dataset:
Shape‐Persistent Arylene Ethynylene Organic Hosts for Fullerenes
Authors: Yu Chao , Jin Yinghua , Zhang Wei
Published: December 2014

Shape‐persistent host molecules that are constructed solely through covalent bonds have been extensively investigated as alternatives to supramolecular architectures, which have shown interesting applications such as guest encapsulation and release, catalysis, and molecular recognition. Similar to the supramolecular self‐assembly process, recent rapid development of dynamic covalent chemistry has enabled the covalent assembly of complex organic molecules that exhibit a finite cavity of well‐defined shape and size. Alkyne metathesis represents an emerging dynamic covalent reaction, which provides rigid and linear acetylene linkages. In this account, we describe the dynamic assembly of shape‐persistent arylene ethynylene cages with various shapes and sizes through one‐step alkyne metathesis. The controlled cage–fullerene binding and the potential application of these cages in fullerene purification are also discussed.
A Tetranuclear Gadolinium(III) Macrocyclic Complex: Towards High Relaxivity with the Rigid Linkers for Magnetic Resonance Imaging Contrast Agent
Authors: Zhang Wenwen , Lu Cuige , Zhao Guiyan , Zhang Jinrui , Fang Xinxiu , Wang Pixin , Fang Xuexun , Xu Jingwei , Yang Wei
Published: December 2014

A tetranuclear neutral MRI contrast agent, (Gd‐DO3A)4‐TPM, was designed and synthesized by appending four Gd‐DO3A moieties upon the tetraphenylmethane derivatives. The longitudinal relaxivity of (Gd‐DO3A)4‐TPM measured at 20 MHz, 37 °C and pH 7.0 is 6.8 mM–1·s–1 per Gd atom, which is one‐fold higher than that of the mononuclear clinical agent [Gd(DOTA)(H2O)]–. In addition, the thermodynamic stability of (Gd‐DO3A)4‐TPM was higher than that of [Gd(DTPA)(H2O)]2–. The luminescence lifetime study on the (Eu‐DO3A)4‐TPM analogue suggested that the complex contains one inner water molecule coordinated to each Ln3+ ion. The cytotoxicity study of (Gd‐DO3A)4‐TPM indicated quite low toxicity.
Structural and Vibrational Properties of the CF3XXCF3 (X = O, S, Se, Te) Molecules
Authors: Coronel Angelina C. , Fernández Lis E. , Varetti Eduardo L.
Published: December 2014

The structural and vibrational data for the CF3XXCF3 (X = O, S, Se, Te) molecules were compared using DFT quantum chemistry calculations. The experimental vibrational frequencies and their assignments to the different normal modes of vibration could be confirmed. The data was also used to define a scaled quantum mechanics force field and sets of derived internal force constants for each molecule. A linear relationship between the experimental X–X bond lengths and the corresponding force constants was found. Additionally, some calculations for the mixed molecule CF3SOCF3 were made.
“Is General Surgery Still Relevant to the Subspecialised Trainee?” A 10 Year Comparison of General Versus Specialty Surgical Practice
Authors: Fleming C. A. , Khan Z. , Andrews E. J. , Fulton G. J. , Redmond H. P. , Corrigan M. A.
Published: December 2014

Background

The splintering of general surgery into subspecialties in the past decade has brought into question the relevance of a continued emphasis on traditional general surgical training. With the majority of trainees now expressing a preference to subspecialise early, this study sought to identify if the requirement for proficiency in managing general surgical conditions has reduced over the past decade through comparison of general and specialty surgical admissions at a tertiary referral center.

Methods

A cross‐sectional review of all surgical admissions at Cork University Hospital was performed at three individual time points: 2002, 2007 & 2012. Basic demographic details of both elective & emergency admissions were tabulated & analysed. Categorisation of admissions into specialty relevant or general surgery was made using International guidelines.

Results

11,288 surgical admissions were recorded (2002:2773, 2007:3498 & 2012:5017), showing an increase of 81 % over the 10‐year period. While growth in overall service provision was seen, the practice of general versus specialty relevant emergency surgery showed no statistically significant change in practice from 2002 to 2012 (p = 0.87). General surgery was mostly practiced in the emergency setting (84 % of all emergency admissions in 2012) with only 28 % elective admissions for general surgery. A reduction in length of stay was seen in both elective (3.62–2.58 bed days, p = 0.342) & emergency admissions (7.36–5.65, p = 0.026).

Conclusions

General surgical emergency work continues to constitute a major part of the specialists practice. These results emphasize the importance of general surgical training even for those trainees committed to sub‐specialisation.
Metabolic pathway engineering for fatty acid ethyl ester production in Saccharomyces cerevisiae using stable chromosomal integration
Authors: de Jong Bouke Wim , Shi Shuobo , Valle-Rodríguez Juan Octavio , Siewers Verena , Nielsen Jens
Published: December 2014

Fatty acid ethyl esters are fatty acid derived molecules similar to first generation biodiesel (fatty acid methyl esters; FAMEs) which can be produced in a microbial cell factory. Saccharomyces cerevisiae is a suitable candidate for microbial large scale and long term cultivations, which is the typical industrial production setting for biofuels. It is crucial to conserve the metabolic design of the cell factory during industrial cultivation conditions that require extensive propagation. Genetic modifications therefore have to be introduced in a stable manner. Here, several metabolic engineering strategies for improved production of fatty acid ethyl esters in S. cerevisiae were combined and the genes were stably expressed from the organisms’ chromosomes. A wax ester synthase (ws2) was expressed in different yeast strains with an engineered acetyl-CoA and fatty acid metabolism. Thus, we compared expression of ws2 with and without overexpression of alcohol dehydrogenase (ADH2), acetaldehyde dehydrogenase (ALD6) and acetyl-CoA synthetase (acs  SE  L641P) and further evaluated additional overexpression of a mutant version of acetyl-CoA decarboxylase (ACC1S1157A,S659A  ) and the acyl-CoA binding protein (ACB1). The combined engineering efforts of the implementation of ws2, ADH2, ALD6 and acs  SE  L641P  , ACC1S1157A,S659A and ACB1 in a S. cerevisiae strain lacking storage lipid formation (are1Δ, are2Δ, dga1Δ and lro1Δ) and β-oxidation (pox1Δ) resulted in a 4.1-fold improvement compared with sole expression of ws2 in S. cerevisiae.
Applications of genome-scale metabolic network model in metabolic engineering
Authors: Kim Byoungjin , Kim Won Jun , Kim Dong In , Lee Sang Yup
Published: December 2014

Genome-scale metabolic network model (GEM) is a fundamental framework in systems metabolic engineering. GEM is built upon extensive experimental data and literature information on gene annotation and function, metabolites and enzymes so that it contains all known metabolic reactions within an organism. Constraint-based analysis of GEM enables the identification of phenotypic properties of an organism and hypothesis-driven engineering of cellular functions to achieve objectives. Along with the advances in omics, high-throughput technology and computational algorithms, the scope and applications of GEM have substantially expanded. In particular, various computational algorithms have been developed to predict beneficial gene deletion and amplification targets and used to guide the strain development process for the efficient production of industrially important chemicals. Furthermore, an Escherichia coli GEM was integrated with a pathway prediction algorithm and used to evaluate all possible routes for the production of a list of commodity chemicals in E. coli. Combined with the wealth of experimental data produced by high-throughput techniques, much effort has been exerted to add more biological contexts into GEM through the integration of omics data and regulatory network information for the mechanistic understanding and improved prediction capabilities. In this paper, we review the recent developments and applications of GEM focusing on the GEM-based computational algorithms available for microbial metabolic engineering.
The Crosstown Initiative: Art, Community, and Placemaking in Memphis
Authors: Thomas Elizabeth , Pate Sarah , Ranson Anna
Published: December 2014

This case study examines an arts organization at the center of an urban neighborhood revitalization effort and its contributions to creative placemaking and inclusive community building. The study documents innovative arts practices and explores their meaning for a local context, an understudied city in the Mid‐South region of the United States. It builds on the research team’s ongoing work as teachers, students, and scholars in partnership with the arts organization. It includes systematic participant observation, interviews with stakeholders, and a review of historical and contemporary media coverage. We found that the organization and its practices provided a rich context for exploring an expanded sense of community including bridging social capital and place‐based frameworks. Analysis suggests that the organization’s intentional arts based practices bring multiple understandings of community and art into meaningful dialogue through the generation of creative and social friction. These practices illustrate one context‐specific strategy addressing the tensions in a community–diversity dialectic (Townley et al. in Am J Commun Psychol 47:69–85, 2011).
Clinical Outcomes following Collagenase Injections Compared to Fasciectomy in the Treatment of Dupuytren's Contracture
Authors: Muppavarapu Raghuveer C. , Waters Michael J. , Leibman Matthew I. , Belsky Mark R. , Ruchelsman David E.
Published: December 2014

Introduction

The aim of this study is to compare the efficacy of collagenase injections with that of fasciectomy in the treatment of Dupuytren's contracture.

Methods

This is a case–control retrospective study. We reviewed the electronic medical records from January 2009 through January 2013, identifying 142 consecutive patients who underwent either fasciectomy or collagenase injection. Exclusion criteria for both groups were age <18 years, pregnant women, and arthroplasty or arthrodesis of the treated joint. Follow-up data beyond 1-year duration was available for 117 of the patients: 44 patients who had undergone fasciectomy, and 73 patients who had received collagenase injection. The primary outcome measure in this study was resolution of joint contracture to 0–5° deficit of full extension. Data was analyzed using two-sample t tests for continuous data and chi-square test for categorical data. A significant P value was set at <0.05.

Results

At the latest follow-up, significantly more joints treated with fasciectomy met the primary outcome measure. Metacarpophalangeal (MP) joints responded better than the proximal interphalangeal (PIP) joints for both treatments. At the latest follow-up (14.2 months for collagenase, 16.3 months for fasciectomy), 46 % of MP joints treated with collagenase and 68 % of MP joints treated with fasciectomy maintained resolution of joint contracture. Sub-analysis of the affected joints based on the severity of initial contracture demonstrated that MP and PIP joints with contractures <45° responded better than more severely contracted joints (>45°).

Conclusions

Fasciectomy yields a greater mean magnitude of correction for digital contractures at the latest follow-up when compared to collagenase. Both treatments were more effective for treatment of MP joint contracture compared to PIP joint contracture. Level of Evidence Level III, therapeutic.
Präimplantationsdiagnostik
Authors: Hehr Andreas , Frister Helmut , Fondel Sabine , Krauß Susann , Zuehlke Christine , Hellenbroich Yorck , Hehr Ute , Gillessen-Kaesbach Gabriele
Published: December 2014

Für Paare mit hohem Risiko der Nachkommen für eine monogen-erbliche oder chromosomal-bedingte Erkrankung kann die Präimplantationsdiagnostik (PID) heute eine Option einer verantwortlichen Familienplanung sein. Voraussetzung für eine PID ist die Befruchtung von Eizellen im Reagenzglas (In-vitro-Fertilisation, IVF). Die Behandlungsergebnisse entsprechen weitgehend denen einer normalen Kinderwunschbehandlung mit intrazytoplasmatischer Spermieninjektion (ICSI) ohne PID. Die Grenzen und Chancen, aber auch der hohe Aufwand, sind frühzeitig und ergebnisoffen in einer interdisziplinären Beratung zu thematisieren, um dem Paar eine informierte Entscheidung und Abwägung der PID gegenüber anderen Alternativen im Rahmen der Familienplanung zu ermöglichen.

In diesem Beitrag werden der aktuelle internationale Kenntnisstand zur PID, einschließlich ihrer verschiedenen Anwendungsbereiche, sowie mögliche zukünftige Entwicklungen vorgestellt. Breiten Raum nimmt der rechtliche Rahmen für die eng begrenzte Durchführung einer PID in Deutschland ein, der durch den Deutschen Bundestag mit der Verabschiedung des Gesetzes zur Regelung der Präimplantationsdiagnostik (Präimplantationsdiagnostikgesetz, PräimpG) 2011 und der nachfolgenden Rechtsverordnung 2012 definiert wurde. Abschließend wird der derzeitige Stand der Umsetzung in Deutschland skizziert und eine nationale Koordination und Vernetzung der PID-Zentren angeregt, um zeitnah unter optimaler Nutzung der Ressourcen und Erfahrungen für ein möglichst breites Spektrum an seltenen Erkrankungen eine qualitätsgesicherte PID in Deutschland anbieten zu können.
Energy Dependence: The EU's Greatest Energy Security Challenge?
Authors: Urutchev Vladimir
Published: December 2014

The article provides an overview of the risks and challenges that the EU is facing in the current geopolitical situation as Europe relies too heavily on oil and gas imports from Russia. This energy dependence is not the only threat to the security of the energy supply, but it is the biggest one and presents the toughest challenge of all. Even when the Ukraine issue has been resolved, the question of energy dependence will remain and solutions must be found as a matter of urgency. Combining our energy infrastructures and perhaps uniting our negotiating power vis-à-vis third countries could help us to reduce dependence, improve the security of supply and increase European competitiveness as a result of lower energy prices overall. The existing internal energy market directives must be implemented and new policies established as we move towards a true European energy union.
Multilevel governance as way towards a more involved and accountable political union
Authors: Lebrun Michel
Published: December 2014

The Committee of the Regions has defined multilevel governance as ‘coordinated institutional action by the European Union, the member states and local and regional authorities, based on partnership and aimed at drawing up and implementing EU policies’ (Committee of the Regions 2009, 12). The economic downturn has proven that the EU needs a governance model based on partnership, cooperation and mutual respect. In addition, the current economic crisis has created a negative reaction to the euro and more generally to European integration, which is seen by many as a top-down process in which citizens have no say. Brussels and central governments are seen by Euro-disenchanted citizens as more and more distant. To bridge the gap that exists between Europe and Europeans, the EU needs to offer a new approach which is comprehensive and inclusive at all levels of governance.
How are pluripotent cells captured in culture?
Authors: Kinoshita Masaki
Published: December 2014

In mice, three pluripotent stem cell lines have been established from different stage of developing embryo, which are embryonic stem (ES) cell, post‐implantation epiblast stem cell (EpiSC), and embryonic germ (EG) cell. ES cell and EG cell share many common features including factor requirement, colony morphology, and gene expression pattern. On the other hand, EpiSC needs different external signal inputs, exhibits flattened colony morphology, and a different set of gene expression patterns. In addition, the germ line competency of EpiSCs is still unclear. To distinguish the differences between them, they are defined by the words “naïve” and “primed” pluripotent cells, respectively. This article introduces how pluripotent stem cell lines are established in culture, and how much those cells in vitro are similar or relevant to their in vivo origin and the knowledge about transcription factors to support this state.
Treatment of Postherpetic Neuralgia Using a Thoracic Transforaminal Epidural Steroid Injection
Authors: Mehta Priyesh , Maher Patrick , Singh Jaspal Ricky
Published: December 2014

A 64‐year‐old male patient with a history of herpes zoster exposure presented with severe, constant, burning pain in the left T10 dermatome consistent with postherpetic neuralgia. Previous treatment included oral and topical medications as well as an intercostal nerve block; however, these treatment options did not provide significant relief. The patient was treated with a single‐level T10 thoracic transforaminal epidural steroid injection for refractory postherpetic neuralgia. He reported complete resolution of his symptoms at 2‐ and 12‐week follow‐ups. This case illustrates transforaminal epidural steroid injections may be a successful treatment option for postherpetic neuralgia.
African Women’s Movements in the Twentieth Century: A Hidden History
Authors: Berger Iris
Published: December 2014

This article begins by exploring the efforts of African women’s movements from the 1990s onward to end violent civil conflicts and to insist on guarantees of gender equity in newly formed governments. It attempts to explain these recent successes first by examining the complex relationships between international women’s movements and African women’s groups from the Second World War onward, particularly from the era of the U.N. Decade for Women beginning in 1975. The article then turns to a broader problem: exploring the connections between contemporary women’s activism and deeper currents in African history that link the precolonial period with the more recent past. By examining a variety of twentieth-century women’s protests, it argues that cloaked in the language of political, economic, and environmental grievances, these movements also reflect a hidden history of women’s influence as public healers, empowered not only to cure individuals, but also to mend broader relationships in the community.
Reversals of Exile: Williams Sassine’sWirriyamuand Tierno Monénembo’sPelourinho
Authors: Small Audrey
Published: December 2014

This essay examines two novels by exiled Guinean writers in which physical space functions as a central point of reference for very different, though related, considerations of traumatized memory, identity, and exile. In Williams Sassine’sWirriyamu(1976), a violent and violated rural landscape becomes emblematic of a specific traumatic event occurring within the time frame of the novel and of contemporary political reality; while in Tierno Monénembo’sPelourinho(1995), a present-day cityscape provides consistently uncertain territory for thinking through a trauma that transcends history, that of the transatlantic slave trade. This article seeks to examine some of the ways in which contemporary trauma theory may be useful in reading Francophone West African fiction as well as some of the limitations of this theory in its applications to this corpus.
FINALITY OR FAIRNESS?
Authors: Heaton Stephen
Published: December 2014

THE finality of proceedings, resource constraints, a presumption of guilt, and the existence of the Criminal Cases Review Commission (“CCRC”) all combine to outweigh the principle of fairness for a convicted individual. Such was the stark conclusion of the Supreme Court in dismissing Kevin Nunn's application to force prosecution authorities to grant access to material which he believed would help him get his conviction quashed: R. (Nunn) v Chief Constable of Suffolk Constabulary [2014] UKSC 37, [2014] 3 W.L.R. 77.
Let's talk about you and me
Authors: ZEIJLSTRA HEDDE
Published: December 2014

A recent development in Dutch concerns the deictic interpretation of the second-person singular pronounje, which may refer to the speaker only. In such examples the subject refers to the speaker – not the hearer – but at the same time, these examples come along with an implicature stating that the hearer would have done the same thing if s/he were in the speaker's situation. Why is it the case that a second-person singular pronoun may refer to the speaker only? And why is it that when speaker-referringjeis used, it always comes along with an implicature of the kind described above? In this article I argue that this behavior of Dutchjeis a consequence of its semantically unmarked status with respect to the first-person singular pronounik. Along the lines of Sauerland (2008), I propose that Dutchjeonly carries one feature, [PARTICIPANT], whereasikcarries two features: [SPEAKER] and [PARTICIPANT]. Consequently,jemay in principle refer to all participants in the conversation, enablingjeto refer to the speaker as well. The fact thatjedoes not normally refer to the speaker but to the hearer only then follows as some kind of blocking effect resulting from application of the principle of Maximize Presupposition. The paper concludes by spelling out the predictions that this analysis makes for the cross-linguistic variation with respect to the readings that participant and other pronouns may yield.
Acute Stroke Imaging Part II: The Ischemic Penumbra
Authors: Butcher K. , Emery D.
Published: December 2014

In acute ischemic stroke, the volume of threatened but potentially salvageable tissue, i.e. the ischemic penumbra, is critical to the success of all acute therapeutic interventions, most notably thrombolysis. Despite the availability of both CT and MRI based techniques to detect and assess the penumbra, advanced imaging of this type remains under-utilized. Although the optimal selection criteria are still being refined and technical improvements are ongoing, rapid imaging of the penumbra appears to be the most promising approach to expanding the acute thrombolysis population, as well as tailoring treatment based on specific pathophysiological findings. This second article in a two-part series reviews current evidence for penumbral-based treatment selection and discusses the barriers to implementation of these advanced imaging techniques in acute stroke management protocols.
NIPPV: Prevalence, Approach and Barriers to Use at Canadian ALS Centres
Authors: Ritsma Benjamin R. , Berger Michael J. , Charland David A. , Khoury Michael A. , Phillips Joel T. , Quon Michael J. , Strong Michael J. , Schulz Valerie M.
Published: December 2014

Objective:

The purpose of this study was to evaluate Canadian amyotrophic lateral sclerosis (ALS) centres with respect to: 1) the prevalence of Non-invasive positive pressure ventilation (NIPPV) and invasive mechanical ventilation via tracheostomy (TV) utilization, 2) the approach to NIPPV use, focusing upon the currently employed initiation criteria and 3) the barriers influencing NIPPV administration.

Methods:

A descriptive survey research design aimed to obtain quantitative data and open-ended responses from an active physician at each of the 15 multidisciplinary Canadian ALS centres.

Results:

The principal findings of this study were: 1) NIPPV and TV are used in 18.3% and 1.5% of patients at Canadian ALS centres, respectively, 2) symptoms of respiratory insufficiency, namely orthopnea (clinical significance rated at 9.00/10 ± 1.48), dyspnea (8.27 ± 1.95) and morning headache (7.55 ± 1.21) are the most significant indicators for NIPPV initiation, 3) the primary barriers to NIPPV utilization are patient intolerance (70% of centres) and inaccessibility of respirologists and ventilation technologists (50% of centres).

Conclusions:

Variability in NIPPV use has an impact upon the management of Canadian ALS patients. The establishment of more definitive NIPPV initiation criteria, emphasizing respiratory symptoms, and the attenuation of barriers to NIPPV use should be targeted so as to ensure optimal care for all ALS patients.
Depression in Parkinson's Disease
Authors: Jasinska-Myga Barbara , Putzke John D. , Wider Christian , Wszolek Zbigniew K. , Uitti Ryan J.
Published: December 2014

Objective:

To examine predictive factors associated with onset of depression among individuals diagnosed with Parkinson's disease (PD).

Background:

Depression may precede or follow symptomatic parkinsonism in PD. It is frequently treatable but often overlooked.

Methods:

The clinical series comprised 685 individuals who were diagnosed with PD and followed by one neurologist (RJU) from 1994 to 2007. The primary outcome was time to depression following the onset of PD. Diagnosis of depression was based on clinical assessment of depressive symptoms from patients (and spouse/family/caregiver) and antidepressant usage. A number of demographic, historical and clinical predictive factors were examined, including gender, age at symptomatic onset, disease duration, onset characteristics, clinical ratings, antiparkinsonian medications, cognitive status, depression history, and familial history of PD and other neurodegenerative disorders.

Results:

Seventy-two percent of patients developed depression within ten years of symptomatic PD onset, and the mean time to depression was 7.9 years (median: 5.7 years). Factors associated with depression included longer PD duration, greater impairment in activities of daily living, and positive family history of motor neuron disease (MND).

Conclusions:

A high rate of individuals with PD develop depressive symptoms during the course of the disease. Based on first clinic visit characteristics, most factors examined were not helpful in identifying individuals with an increased risk of depression. However, disease duration, functional limitations and family history of MND should lead clinicians to an increased vigilance for identifying depression.
Autopsy as Gold Standard in FDG-PET Studies in Dementia
Authors: Durand-Martel Pascali , Tremblay Dominic , Brodeur Catherine , Paquet Nancy
Published: December 2014

Positron emission tomography (PET) imaging with F18-fluorodeoxyglucose (FDG) is increasingly used as an adjunct to clinical evaluation in the diagnosis of dementia. Considering that most FDG-PET studies in dementia use clinical diagnosis as gold standard and that clinical diagnosis is approximately 80% sensitive or accurate, we aim to review the evidence-based data on the diagnostic accuracy of brain FDG-PET in dementia when cerebral autopsy is used as gold standard. We searched the PubMed and Medline databases for dementia-related articles that correlate histopathological diagnosis at autopsy with FDG-PET imaging and found 47 articles among which there were only 5 studies of 20 patients or more. We were able to conclude that sensitivity and specificity of FDG-PET for Alzheimer's disease are good, but more studies using histopathological diagnosis at autopsy as gold standard are needed in order to evaluate what FDG-PET truly adds to premortem diagnostic accuracy in dementia.
Deregulated Expression of the Per1 and Per2 in Human Gliomas
Authors: Xia He-chun , Niu Zhan-feng , Ma Hui , Cao Shuan-zhu , Hao Shao-cai , Liu Zhong-tao , Wang Fan
Published: December 2014

Background:

Growing evidence shows that the deregulation of the circadian clock plays an important role in the development of malignant tumors, including gliomas. However, the molecular mechanisms of genes controlling circadian rhythm in glioma cells have not been explored.

Methods:

Using reverse transcription polymerase chain reaction and immunohistochemistry techniques, we examined the expression of two important clock genes, Per1 and Per2, in 33 gliomas.

Results:

In this study, out of 33 gliomas, 28 were Per1-positive, and 23 were Per2-positive. The expression levels of Per1 and Per2 in glioma cells were significantly different from the surrounding non-glioma cells (P<0.01). The difference in the expression rate of Per1 and Per2 in high-grade (grade III and IV) and low-grade (grade 1 and II) gliomas was insignificant (P>0.05). While there was no difference in the intensity of immunoactivity for Per2 between high-grade gliomas and low-grade gliomas (r=-0.330, P=0.061), the expression level of Per1 in highgrade gliomas was significantly lower than that in low-grade gliomas(r=-0.433, P=0.012).

Conclusions:

In this study, we found that the expression of Per1 and Per2 in glioma cells was much lower than in the surrounding non-glioma cells. Therefore, we suggest that disturbances in Per1 and Per2 expression may result in the disruption of the control of normal circadian rhythm, thus benefiting the survival of glioma cells. Differential expression of circadian clock genes in glioma and non-glioma cells may provide a molecular basis for the chemotherapy of gliomas.
Reproducibility of Semi-Automated Measurement of Carotid Stenosis on CTA
Authors: White Jeremy H. , Bartlett Eric S. , Bharatha Aditya , Aviv Richard I. , Fox Allan J. , Thompson Andrew L. , Bitar Richard , Symons Sean P.
Published: December 2014

Purpose:

To compare the reproducibility of semi-automated vessel analysis software to manual measurement of carotid artery stenosis on computed tomography angiography (CTA).

Methods:

Two observers separately analyzed 81 carotid artery CTAs using semi-automated vessel analysis software according to a blinded protocol. The software measured the narrowest stenosis in millimeters (mm), distal internal carotid artery (ICA) in mm, and calculated percent stenosis based on NASCET criteria. One observer performed this task twice on each carotid, the second analysis delayed two months in order to mitigate recall bias. Two other observers manually measured the narrowest stenosis in mm, distal ICA in mm, and calculated NASCET percent stenosis in a blinded fashion. Correlation coefficients were calculated for each group comparing the narrowest stenosis in mm, distal ICA in mm, and NASCET percent stenosis.

Results:

The semi-automated vessel analysis software provided excellent intraobserver correlation for narrowest stenosis in mm, distal ICA in mm, and NACSET percent stenosis (Pearson correlation coefficients of 0.985, 0.954, and 0.977 respectively). The semi-automated vessel analysis software provided excellent interobserver correlation (0.925, 0.881, and 0.892 respectively). The interobserver correlation for manual measurement was good (0.595, 0.625, and 0.555 respectively). There was a statistically significant difference in the interobserver correlation between the semi-automated vessel analysis software observers and the manual measurement observers (P < 0.001).

Conclusion:

Semi-automated vessel analysis software is a highly reproducible method of quantifying carotid artery stenosis on CTA. In this study, semi-automated vessel analysis software determination of carotid stenosis was shown to be more reproducible than manual measurement.
Botulinum Toxin Type A and Acute Drug Costs in Migraine with Triptan Overuse
Authors: Christie Suzanne N. , Giammarco Rose , Gawel Marek , Mackie Gordon , Gladstone Jonathan , Becker Werner J.
Published: December 2014

Background:

Patients with chronic migraine and medication overuse are significant consumers of health care resources.

Objective:

To determine whether botulinum toxin type A prophylaxis reduces the cost of acute migraine medications in patients with chronic migraine and triptan overuse.

Methods:

In this multicenter, open-label study, patients with chronic migraine (≥15 headache days/month) who were triptan overusers (triptan intake ≥10 days/month for ≥3 months) received botulinum toxin type A (95-130 U) at baseline and month three. Headache (HA) frequency and medication use were assessed with patient diaries, and headache-related disability by means of the MIDAS and Headache Impact Test-6 questionnaires.

Results:

Of 53 patients enrolled (mean age ± standard deviation, 46.5 years ± 8.4; 47 [88.7%] females), 48 (90.6%) completed the study at month six. Based on headache diaries, significant (P≤0.0002) decreases from baseline were observed for days per month with headache/migraine, days with any acute headache medication use, days with triptan use, and triptan doses taken per month. A significant (P<0.0001) increase from baseline in headache-free days per month was also observed. Prescription medication costs for acute headache medications decreased significantly, including significant reductions in triptan costs (mean reduction of -C$106.32 ± 122.87/month during botulinum toxin type A prophylaxis; P<0.0001). At baseline, 78% of patients had severe disability (MIDAS score) and 86.8% had severe impact due to headache (HIT-6 scores); at month six, this decreased to 60% and 68%, respectively.

Conclusions:

Botulinum toxin type A prophylactic therapy markedly decreased costs related to acute headache medication use in patients with chronic migraine and triptan overuse.
Prevalence of Glaucoma in Hospitalized Older Adults with Alzheimer's Disease
Authors: Pelletier Andrée-Anne , Théorêt Marie-Ève , Boutin Tanguy , Kergoat Marie-Jeanne , Massoud Fadi , Latour Judith , Chayer Céline , Kergoat Hélène
Published: December 2014

Objective:

To determine the prevalence of glaucoma in older adults with dementia of the alzheimer's type (DAT).

Methods:

retrospective chart review: the prevalence of glaucoma was determined in older adults with a diagnosis of DAT or mixed dementia (DAT with vascular contribution) admitted to the geriatric and neurology units of the Centre hospitalier de l'université de Montréal and the hôpital Maisonneuve-rosemont between april 2008 and april 2009 (n=220; DAT group). they were matched for age and date of hospitalisation to the first 220 individuals without dementia (control group) recruited from other medical units in the same hospitals: gastroenterology, internal medicine or cardiology. a diagnosis of glaucoma was deemed positive if recorded in the chart or if there was a medication compatible with this diagnosis. Chi-square tests were used for between-group comparisons.

Results:

Subjects' age ranged from 66 to 101 years. the prevalence of glaucoma was 6.8% in our study population (n=30/440). glaucoma was significantly more prevalent in the DAT group (n= 21; 9.5%) than in the control group (n= 9; 4.1%) [χ1 2 = 5.15; p = 0.023].

Conclusions:

the prevalence of glaucoma was higher in a group of older adults with DAT than in a comparable control group. these results underscore the importance of providing regular eyecare for persons affected by DAT.
Temporal Lobectomy with Delayed Amnesia Following a New Lesion on the Other Side
Authors: Salmon Andrea , Hayman-Abello Brent , Connolly Barbara , McLachlan Richard S.
Published: December 2014

Purpose:

To describe a delayed severe complication of temporal lobectomy for intractable epilepsy.

Method:

A case of amnesia occurring 24 years after surgery is described and five similar cases from the literature reviewed.

Results:

Mean age at surgery (5 right) was 40 years (19-62 years), 3 female. Four of five tested had impaired visual and verbal memory preoperatively but not sufficient to contraindicate surgery. Pathology was mesial temporal sclerosis in 3, 1 cavernoma, 1 dysembryoplastic neuroepithelial tumor (DNET) and 1 normal. Postoperatively, four were seizure free 3-12 years off medication and two continued with seizures. There was no unexpected postoperative memory change until incapacitating anterograde amnesia developed 1-24 years after surgery. In five patients, including ours, this followed definite or possible status epilepticus with new mesial temporal sclerosis on the opposite side in the four that were investigated by MRI. One patient developed a glioblastoma in the opposite temporal lobe.

Conclusion:

Continuing or late recurrence of seizures from the remaining temporal lobe after temporal lobectomy can result in incapacitating amnesia if status epilepticus occurs. Other new lesions on the opposite side to surgery can have the same effect.
Prognostic Tests and Antiepileptic Drug Withdrawal After Epilepsy Surgery
Authors: Harroud Adil , Weil Alexander G. , Bouthillier Alain , Nguyen Dang Khoa
Published: December 2014

Approximately one in three patients with a successful epilepsy surgery will have seizure recurrence following antiepileptic drugs (AED) withdrawal. The value of postoperative testing for predicting seizure relapse after AED tapering is not clear. The purpose of this study was to review the literature for evidence on the use of postoperative investigations before AED discontinuation after successful epilepsy surgery. We were unable to identify studies on the prognostic value of postoperative magnetic resonance imaging and AED blood levels. The literature review yielded seven studies on the predictive value of electroencephalography. Four studies found no association between interictal discharges (IED) and seizure relapse. These studies suffered from various limitations due to their retrospective design and generally small cohorts. Two of the three studies reporting a positive association were prospective and provided strong evidence of an increased risk of seizure recurrence with presence of postoperative IED in successfully operated patients undergoing AED withdrawal.
Neurophobia Inception: A Study of Trainees' Perceptions of Neurology Education
Authors: Fantaneanu Tadeu A. , Moreau Katherine , Eady Kaylee , Clarkin Chantalle , DeMeulemeester Christine , Maclean Heather , Doja Asif
Published: December 2014

Objectives:

We wanted to examine the extent to which “neurophobia” exists among medical students and determine if students’ perceptions of neurology differ by year of study while exploring the factors that contribute to the development of “neurophobia”.

Methods:

We used a two-phase, sequential, mixed-methods explanatory design in this single centre study. Phase 1 involved the collection and analysis of a questionnaire administered to students in the first three years of medical school. Phase 2 involved focus groups of a subgroup of students who demonstrated evidence of neurophobia in Phase 1.

Results:

In total, 187 (39 %) undergraduate medical trainees responded to the questionnaire (response rates of 37%, 44% and 19% for first-, second- and third-year students, respectively). 24% of respondents indicated that they were afraid of clinical neurology and 32% were afraid of the academic neurosciences. Additionally, 46% of respondents thought that clinical neurology is one of the most difficult disciplines in medicine. Phase 2 findings revealed that many students reported negative preconceptions about neurology and commented on neurology’s difficulty. Some experienced changes in these conceptions following their neurology block. Past clinical, educational, and personal experiences in neurology impacted their comfort level.

Conclusions:

This study shows that the level of comfort towards clinical neurology increases following students’ participation in second-year neurology blocks, but that third-year students continue to show signs of neurophobia with lower comfort levels. It provides insight into why neurophobia exists amongst medical students and sheds light on pre-existing and emerging factors contributing to this sense of neurophobia.
A Unique Model for ONSD Part II: Inter/Intra-operator Variability
Authors: Zeiler F.A. , Unger B. , Zhu Q. , Xiao J. , Kirkpatrick A.W. , Kramer A.H. , Aleassa E.M. , Gillman L.M.
Published: December 2014

Objective:

To evauluate our novel ultrasound model for measurement of optic nerve sheath diameter (ONSD) and determine the intra- and inter-operator variability associated with this technique.

Methods:

We conducted ten measurements of ONSD per model amongst eight different models with a single experienced operator to examine intra-operator variability. Similarly, we had seven different operators measure the OSND twice in eight different models, in order to determine inter-operator variability analyzed with a three level linear statistical model.

Results:

For intra-operator variability, the intra-cluster correlation coefficients for the experienced and novice operators were 0.643 and 0.453 respectively. This displayed improvement in intra-operator variability with experience. The inter-cluster correlation coefficient was 0 for the group of novice operators, indicating negligible difference amongst multiple operators in measuring any given model of ONSD. A strong, statistically significant, linear relationship between the actual model disc size and the ultrasound ONSD measures was identified, implying the reliability of the images produced by our novel model.

Conclusions:

Utilizing a novel model for ONSD ultrasonography, we have determined the intraoperator reliability of ONSD measurement to be moderate, with no appreciable difference amongst multiple operators. Improvement in measurement reliability has been demonstrated between expert and novice operators with our model, indicating the potential benefit of simulation platforms for teaching the technique of ONSD ultrasound.
Hospitalized Head and Spine Injuries on Saskatchewan Farms
Authors: Paton Gillian R. , Hagel Louise , Fourney Daryl R.
Published: December 2014

Introduction:

With over 44,000 individual farms, farm dwellers account for 11% of the population of Saskatchewan. There is limited data on brain and spine injuries acquired on farms. The objective of this study was to evaluate the epidemiology of head and spine injuries on Saskatchewan farms to assist the development of injury prevention initiatives.

Methods:

Using the Canadian Centre for Agricultural Health and Safety's Saskatchewan Farm Injury Surveillance Database, farm-related head and spine injuries hospitalized > 24 hours were examined (1990-2007). We collected information regarding the type and mechanism of injury as well as the geographic location of both the injury and treatment.

Results:

The database captured 390 brain injuries and 228 spine injuries, including 16 spinal cord injuries. The majority of patients were male (73.3% of head injuries and 84.2% of spine injuries). The highest risk age groups were 50-59 years, with 24.1% of the spine injuries, and 40-49 years, with 19.2% of the head injuries. The most common causes of injury were falls and/or machinery-related. The average annual incidence of farm-related spine and head injury were 10.8 and 17.6 per 100,000 farm population, respectively. All patients included in this study were hospitalized for over 24 hours, with 44.7% of spine injuries spending over one week in hospital, and 20% of head injuries spending over three days in hospital.

Conclusions:

Injury prevention initiatives should be targeted towards males aged 40-59 years residing in the southern areas of the province, with increased awareness towards the dangers of falls and operating tractors.
Endoscopic Third Ventriculostomy for Hydrocephalus Due to Tectal Glioma
Authors: Diaz Roberto Jose , Girgis Fady M. , Hamiltonn Mark G.
Published: December 2014

Background:

Tectal gliomas commonly present with hydrocephalus from obstruction of the aqueduct of Sylvius. The creation of a ventriculostomy in the floor of the third ventricle (ETV) has been previously reported to by-pass aqueduct obstruction. The goal of this study was to determine the safety and efficacy of ETV in the presence of an obstructing tectal glioma.

Methods:

We retrospectively reviewed the clinical presentation, management, and clinical outcome after ETV in patients diagnosed with tectal glioma and obstructive hydrocephalus in our institution over a period of 15 years. Shunt freedom at follow-up was the main outcome variable. Long-term clinical outcome was assessed at the most recent clinic visit. Clinical outcome was ranked as excellent, good, or poor according to resolution of symptoms and patient functional status.

Results:

The median age at presentation was 16.5 years (range: 6.4 to 59 years) and the most common presenting symptom was headache. Eleven patients had ETV as a primary procedure and three patients underwent ETV as a substitute for shunt revision at the time of shunt failure. At follow-up (median 3.9 years, range: 2.2 to 7 years) 13 of 14 patients remain shunt independent with excellent (n=9) or good outcomes (n=5).

Conclusions:

In patients with tectal glioma causing obstructive hydrocephalus, ETV can be performed safely in the primary setting or as a substitute for shunt revision. A high rate of shunt freedom (78%-100%) at prolonged follow-up can be expected in this patient population.
Current Concepts in the Neuropathology and Pathogenesis of Multiple Sclerosis
Authors: Wayne Moore G.R.
Published: December 2014

Multiple sclerosis (MS) has been classically regarded as an inflammatory demyelinating disease of the central nervous system. In recent years, the classification and pathogenesis of the disease have become controversial, particularly with respect to whether an individual patient demonstrates a single or multiple pathogenetic mechanisms in the establishment of the focal plaque of MS. It is also becoming increasingly apparent that there is a significant neurodegenerative component in the disease, involving not only plaques but the non-plaque parenchyma as well. Magnetic resonance imaging, together with histopathologic studies, will continue to shed light on the pathogenesis of these focal and diffuse abnormalities in MS.
Retrenchment and refinement interworking: the tower theorems
Authors: BANACH RICHARD , JESKE CZESŁAW
Published: December 2014

Retrenchment is a flexible model evolution formalism that compensates for the limitations imposed by specific formulations of refinement. Its refinement-like proof obligations feature additional predicates for accommodating design data describing the model change. The best results are obtained when refinement and retrenchment cooperate, the paradigmatic scheme for this being the commuting square or tower, in which ‘horizontal retrenchment rungs’ commute with ‘vertical refinement columns’ to navigate through a much more extensive design space than permitted by refinement alone. In practice, the navigation is accomplished through ‘square completion’ constructions, and we present and prove a full suite of square completion theorems.
Nötig oder unnötig? Rückenoperationen im kritischen Blick
Authors: Raabe Andreas , Beck Jürgen , Ulrich Christian
Published: December 2014

Rückenleiden gehören zu den häufigsten Volkskrankheiten und weisen eine hohe spontane Besserungs- oder Rückbildungsrate auf. Bis auf schwere neurologische Störungen sind Operationen nur dann indiziert, wenn 1) eine klare Symptomatik besteht, 2) eine klare, fast immer mechanisch wirksame Ursache diagnostiziert werden kann, die die Symptomatik erklärt, 3) konservative Behandlungsmöglichkeiten ausgeschöpft sind und die Beschwerden weiter bestehen und 4) die „Spontanheilungszeit“ abgewartet wurde. Nach den Kriterien der evidenzbasierten Medizin ist die Chirurgie bei Bandscheibenvorfällen, Spinalkanalstenose und symptomatischer Spondylolisthesis der konservativen Therapie überlegen, wenn nach definierten Indikationen die Operation erfolgt. Leider wird die Evidenzlage zuweilen von der Indikation getrennt. Zurückhaltung ist angebracht, wenn ohne die genannten Kriterien und mit dem Argument einer prophylaktischen oder ansonsten bestehenden neurologischen Gefährdung Operationen vorgeschlagen werden.