bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the natural history of adult temporal lobe epilepsy
Authors: Hernandez-Ronquillo L , Tellez-Zenteno JF , Buckley S , Ladino-Malagon L , Adam W
Published: June 2015

Temporal lobe epilepsy (TLE) is the most common type of epilepsy in adults. The literature in this field supports the notion than many patients become candidates for surgery and little is known about the group of patients who do not require surgical treatment. This is a retrospective cohort study that included all patients with TLE assessed and followed by the Saskatchewan Epilepsy Program since 2007. Mild course was defined as patients not having seizures, using or not AEDs at last follow up. Severe course of TLE was considered in patients with continuous seizures and patients who had epilepsy surgery. Descriptive statistics were used. OR and CI were calculated. One hundred and fifty nine patients were included. Age of patients at last follow up was 46.04 + 14.4 (range 19-88) years. Mean follow up of patients was 43.46+ 22.6 (6 to 84) months. Fourth six patients (29%) were seizure-free with AEDS (mild course TLE) and 113 (61%) had severe course of TLE. Patients with mild course of TLE were older (p 0.002), with a late onset of epilepsy (p< 0.001) and their epilepsy evolution was shorter (p<0.001). Our study shows that not all the patients with TLE require surgery and that a fair percentage of patients can be controlled with medication.
New adrenergic baroreflex evaluation in Valsalva maneuver
Authors: Palamarchuk IS , Baker J , Kimpinski K
Published: June 2015

Background: Valsalva maneuver (VM) is a simple and non-invasive technique extensively utilized clinically to detect dysautonomia. VM provides detailed information of baroreflex sensitivity (BRS) which is an important cardiovascular and autonomic marker. However, the current approach for calculating its adrenergic component (BRSa1) is moderately reliable and fails to evaluate atypical VM patterns. Methods: We analyzed typical and atypical VM patterns of 89 young, healthy individuals (30 ±13 years) with the aim of improving BRSa evaluation. Objectives: 1) To determine a new BRSa calculation (BRSa2) applicable to different VM patterns; 2) correlate BRSa2 to BRSa1; 3) compare the internal consistency (ICC) between BRSa1 and BRSa2. Results: The BRSa2 calculation is a complex hemodynamic and time assessment equivalent to the slope in vagal BRS. In contrast to BRSa1, BRSa2 operates with hemodynamic indices easily detectable in any VM pattern. In atypical VM patterns, BRSa2 correlated with BRSa1: “flat-top responses” (r = 0.774, p < 0.01); rapid hemodynamic recovery (r = 0.461, p < 0.05). Most importantly, BRSa2 was more reliable than BRSa1 (ICC= 0.759 versus 0.469). Conclusion: BRSa2 is more reliable and allows atypical responses to VM to be analyzed, which clinically, could help differentiate natural physiological variances and mild adrenergic dysfunction.
Severe necrotizing myelopathy from toxacariasis
Authors: Magun R , Silva JE
Published: June 2015

We present a 25 year old female veterinarian technician presenting with rapidly progressive quadriplegia in less then 12 hours. Her symptoms occurred at work with initially bilateral hand weakness followed by arm and leg weakness. Before the end of the day she was on a ventilator in the ICU. MRI showed a hyperintense longitudinal T2 signal extending from the cervical medullary junction to T1. Extensive cervical spinal cord edema with cord expansion was noted. CSF showed normal protein and cell count with no oligoclonal banding. A post-infectious inflammatory process causing transverse myelitis was presumed and she was given IVIG, steroids, and plasmapheresis with no improvement. A serum ELISA test for IgG to Toxocara was reactive at titre of 1:800 at 3 weeks after her initial presentation. Her serum IgE levels was elevated at 169 x 10x3 U/L (Normal <87 x 10x3 U/L). At 4 weeks, she was commenced on albendazole at 800 mg per day for two months. A repeat serum ELISA test at 6 weeks and 2 weeks into her treatment with albendazole showed a declining titre of 1:200 consistent with recent Toxocara infection. At 10 weeks, her ELISA test was non-reactive. Unfortunately she did not respond to albendazole treatment and she shows minimal improvement now 1.5 years later.
Prognostic value of 8F-Florbetapir scan: a 36-month follow up analysis using ADNI data
Authors: Lu M , Pontecorvo M , Siderowf A , Joshi AD , Devous MD , Mintun MA , Montoya A
Published: June 2015

Background: The Alzheimer’s Disease Neuroimaging Initiative (ADNI) provides an opportunity to investigate the relationship between β-Amyloid neuropathology and patients’ long-term cognitive function change. We examined baseline 18F-florbetapir PET amyloid imaging status and 36-months’ change from baseline in cognitive performance in subjects with mild cognitive impairment (MCI). Method: The study included all ADNI subjects who underwent PET-imaging with 18F-florbetapir and had a clinical diagnosis of MCI at the visit closest to florbetapir imaging. β-Amyloid deposition was measured by florbetapir standard uptake value ratio (SUVR), and dichotomized as Aβ+(SUVR>1.1) or Aβ–(SUVR≤1.1). Cognitive scores, including ADAS11, MMSE and CDR sum of boxes (CDR-SB), were evaluated for up to 36 months. Results: Of 478 MCI-subjects who had at least one florbetapir scan, 153 had a cognitive evaluation at 36-month follow-up. Of those, 79 were Aβ– and 74 Aβ+. At 36-months, the Aβ+ vs. Aβ– group scores changed from baseline (LS means 4.03 vs. 0.26 for ADAS11; -2.61 vs.-0.40 for MMSE; 1.53 vs. -0.11 for CDR-SB [p< 0.0001 all comparisons]). Generalised estimating equation analysis on clinically significant cognitive change showed a marginal Odds Ratio=2.18 (95% CI: 1.47–3.21) for Aβ+ vs. Aβ– groups. Conclusion: MCI subjects with higher β-Amyloid deposition had greater deterioration in cognitive function over 36 months while subjects with no β-Amyloid accumulation tended to be stable.
Disease phenotype analyses of relapsing-remitting multiple sclerosis in Canada and Saudi Arabia
Authors: Alluqmani M , Alqermli M , Blevins G , Alotibi B , Giuliani F , Christopher P
Published: June 2015

Background: Multiple sclerosis (MS) exhibits a spectrum of clinical findings, especially in relapsing-remitting MS (RR-MS). To assess the effects of geographic location and ethnicity on RR-MS phenotype, we investigated RR-MS patients in Canada and Saudi Arabia. Methods: A retrospective cross-sectional analysis of patients receiving active care in MS Clinics was performed in Medina, Saudi Arabia and Edmonton, Alberta. Demographic and clinical data was collected for each patient. Results: 98 patients with treated RR-MS were recruited (n=51, Medina; n=47, Edmonton); 40 patients were Caucasian (Edmonton) while 46 patients were Bedouin (Medina). Although the disease duration was longer in the Edmonton (5.7+2.3 yr) compared to the Medina group (4.4+1.4 yr) (p<0.05), the mean age of RR-MS onset, relapse rate and EDSS change were similar. The female:male ratio was comparable in Edmonton (35:12) and Medina (32:19), as was the risk of optic neuritis. The likelihood of an infratentorial lesion-associated presentation differed (Edmonton, n=23; Medina; n=13) among groups (p<0.05). Spinal cord lesions on MRI were more frequent in Edmonton (n=18) compared to Medina (n=1) patients (p<0.05). Conclusions: Despite differences in location, ethnicity, and a predominance of infratentorial lesion burden the Edmonton group, the RR-MS phenotype displayed similar disease severity and trajectory in these cohorts.
Intravenous Immunoglobulins (IVIG) in Chronic Inflammatory Demyelinating Polyneuropathy ( CIDP ): time to maximal recovery
Authors: Baker S , Opala A
Published: June 2015

Background: The response of Chronic Inflammatory Demyelinating Polyneuropathy ( CIDP ) to Intravenous Immunoglobulins (IVIG) treatment is well established. However, determination whether patients who do not respond to 2 IVIG treatments or those whose condition stabilizes (ICE Trial) would benefit from additional treatments remains unclear. We aim to identify time period required to reach maximal strength gains from IVIG treatment (plateau). Furthermore, we will assess nerve conduction studies (NCS) changes over time with IVIG treatment. This will help in establishing a time course for treatment of CIDP with IVIG to maximize recovery. Methods: We performed a retrospective chart review of 27 patients with CIDP, with diagnosis confirmed by European Federation of Neurological Societies/Peripheral Nerve Society Guidelines (EFNS/PNS). Each patient’s strength response including: grip strength, knee extension, elbow flexion and dorsiflexion (using JAMAR Dynamometer) and NCS changes over time during IVIG treatment were analyzed. The primary outcome is duration of IVIG treatment, in months, required to reach a plateau in strength. Secondary outcome is NCS change including: Terminal Latencies, Conduction Velocities, Compound Sensory and Motor action potentials in nerves of upper and lower extremities over treatment time (emerging trends). Results: Pending (available by April 2015) Conclusion: Pending (available by April 2015)
A case series of non-bacterial thrombotic endocarditis associated with gynecological malignancies
Authors: Schabas AJ , Yip S , Teal PA , Mann SK
Published: June 2015

Background: Ischemic stroke secondary to NBTE is a rare complication of systemic malignancies. Although previously reported in gynecological cancers, this occurrence is infrequent. Furthermore, stroke pre-dating the gynecological malignancy diagnosis has rarely been reported. Methods: Case presentations and literature review. Results: Case1: A 48-year-old woman presented with acute dysarthria and left facial weakness caused by a right middle cerebral artery (MCA) infarct. Mitral valve vegetations were found on a transthoracic echocardiogram (TTE). A malignancy screen uncovered a pelvic endometrial adenocarcinoma. Case 2: A 49-year-old woman developed acute right hand weakness. A CT head scan showed a left pre-central gyrus infarct. Her TEE revealed aortic valve vegetations. An ovarian neoplasm was then discovered. Case 3: A 36-year-old woman with a known diagnosis of cervical squamous cell carcinoma developed acute left-sided weakness secondary to a right MCA stroke. Aortic valve vegetations were seen on TTE. Conclusions: We have reported three cases of NBTE where the underlying malignancy was gynecological. In the first two cases, the malignancy was discovered while investigating for the stroke mechanism, while the third had a known underlying malignancy. This series highlights the need to consider gynecological malignancies as an underlying cause of stroke in young women; and that the ischemic event can occur prior to the malignancy diagnosis.
Neurosurgery (Critical Care/Neuro Trauma)
Authors: Zeiler FA , Sader N , Kazina CJ , Teitelbaum J , Gillman LM , West M
Published: June 2015

Background: There exists the role for novel agents in the management of refractory intracranial pressure (ICP) via targeting cerebral acidosis, hyperemia, and excitotoxicity. Objective: We performed 4 separate systematic reviews to determine the effect of tromethamine (THAM), indomethacin, and ketamine on ICP. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to: February 2014 – THAM, July 2014 – Indomethacin, November 2013 - Ketamine), and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology. Results: Twelve articles were reviewed utilizing THAM while documenting ICP in neurosurgical patients. All but one study documented a decrease in ICP. Twelve original articles were reviewed utilizing indomethacin for ICP in neurological patients. All but one study documented a decrease in ICP. Seven articles were reviewed utilizing ketamine, documenting ICP in TBI patients, with 16 in non-trauma neurological patients. ICP did not increase in the studies during ketamine administration, and trended to decrease ICP. Conclusion: There exists Oxford level 2b, GRADE B evidence that THAM reduces ICP in the TBI and malignant ischemic infarct population. There exists Oxford level 2b, GRADE C evidence that indomethacin and ketamine reduce ICP in the adult severe TBI population.
Lifetime costs of traumatic brain injury identified in the emergency department in Ontario
Authors: Fu T , Jing R , Cusimano M
Published: June 2015

Background: Traumatic brain injury (TBI) is a leading cause of death and disability, yet there is limited research on its economic burden. We estimated the incidence and lifetime costs of TBI identified in the Emergency Department (ED) in Ontario, Canada between April 2009 and March 2010. Methods: ED visits for TBI were identified using a population-based database that is mandatory for ambulatory care facilities in Ontario. The authors calculated unit costs for medical treatment and productivity loss, and multiplied these by incidence estimates to determine the lifetime costs of identified TBI cases. Results: In 2009, there were over 133,000 ED visits for TBI in Ontario, resulting in a conservative estimate of $945 million in total lifetime costs. Costs were greater for males than females across nearly all age groups, with males incurring two-fold higher costs overall. Together, falls ($407 million), struck by/against ($309 million), and motor vehicle injuries ($161 million) represented 93% of lifetime costs associated with TBI. Conclusions: This study revealed a high incidence and economic burden associated with TBI identified in the ED. More research is needed to fully appreciate the burden of TBI across a variety of healthcare settings.
A pilot study exploring pupil response measurement in mild traumatic brain injury
Authors: Ting W , Topolovec-Vranic J , McGowan M , Cusimano MD
Published: June 2015

Background: Pupillometry, the measurement of pupil response dynamics via the pupillary light reflex, is seldom used in the assessment of mild traumatic brain injury (mTBI). We hypothesized that there would be quantifiable differences in detailed pupil response measurements in patients with acute and chronic mTBI. Methods: We conducted 49 bilateral pupillometry measurements, in acute mTBI patients at 1-week (N=11), 2-4w (N=9), and 3-7mo post-injury (N=3); 14 patients with persistent post-traumatic symptoms (PTS) once, and healthy controls across a first visit (N=7) and second visit 2-4w later (N=5). Results: The percentage of left pupil diameter change was significantly greater in the acute mTBI group at second visit (mean=36.3% (2.96)), compared to controls at second visit (mean=31.6% (4.39)) (F=5.87, p=0.0321). We did not identify significant differences between acute mTBI patients and controls at first visit, PTS patients versus controls, and within the acute mTBI group across three longitudinal visits. Conclusion: While these preliminary data suggest that pupillometry under these conditions does not distinguish between patients who had a recent mTBI or those with PTS and healthy controls, further research is warranted investigating pupil behavior and its clinical utility in mTBI.
Neurosurgery (General Neurosurgery)
Authors: Merali Z , Sharma S , MacDonald R , Massicotte E
Published: June 2015

Background: Critically ill neurosurgical patients require expedient access to neurosurgical centers (NC) to improve outcome. In Ontario, many patients are initially evaluated at a non-neurosurgical center (NNC) and subsequently transferred to a NC by a provincial service using air or ground vehicles. We characterized transfers from NNC to NC for critically ill patients. Methods: A retrospective observational analysis was undertaken. The cohort included patients in Ontario with emergent and urgent neurologic pathologies who underwent transfer from a NNC to NC between January 1, 2011 and December 31, 2013. Timing, clinical, and geographic data were collected for each transfer. Results: We identified 1103 emergent/urgent transfers. The mean transfer time to a NC was 3.4hrs (SD – 3.0) and varied by the geographic region of origin. 17% of patients bypassed a closer NC during transfer to their destination NC. Transfers that bypassed a closer NC travelled further (162km vs. 477km, p<0.001), took longer (3.1hrs vs. 3.9hrs, p<0.001), and in some regions were associated with a higher risk of in-transit clinical decline (3.0% vs. 8.3%, p<0.05) when compared with transfers that ended at the closest NC. Conclusions: Transport time to a NC varied across Ontario. Transfers occasionally bypassed the nearest NC, which may reflect neurosurgical bed availability, resource limitations, or patient needs.
Endoscopic third ventriculostomy (ETV) for treatment of adult hydrocephalus: long-term followup with 163 patients
Authors: Isaacs A , Urbaneja G , Yong H , Hamilton MG
Published: June 2015

Introduction: Treatment of specific patterns of symptomatic hydrocephalus in the adult patient may be accomplished with endoscopic third ventriculostomy (ETV) as an alternative to insertion of a ventriculoperitoneal (VP) shunt. This review examines a single center experience with ETV to treat hydrocephalus in symptomatic adult patients. Methods: Adult patients (≥18 years) with a diagnosis of hydrocephalus who were treated with ETV in Calgary between January 1994 and July 2014 were reviewed using a clinic database and registry. Results: 163 patients were identified (male=92; female=71). Mean age at the time of ETV was 46.5 years (range 18-83.4 years). 118 underwent ETV as a primary treatment and 45 patients underwent treatment after presenting with VP shunt failure (secondary ETV). 113/163 patients had a diagnosis of aqueductal stenosis, 22/163 had a diagnosis of tumor. Mean followup was 8.2 years (range 0.3-18.4 years). Symptoms in 149/163 (91.4%) of ETV patients were better or unchanged at last followup. 104/118 (88.1%) of primary ETV patients were shunt free at last followup. 39/45 (86.7%) of secondary ETV patients were shunt free at last followup. Conclusion: Endoscopic (ETV) treatment is an effective long-term treatment for a select population of adult patients with hydrocephalus.
Classification of facial pain: a 13-year population-based study
Authors: Barchet L , Kaufmann AM
Published: June 2015

Introduction: Accurate diagnosis and classification of facial pain is critical for assigning surgical treatment, avoiding misdirected interventions and studying outcomes. We conducted a population-based longitudinal study of patients with facial pain and compared diagnostic classification systems. Methods: Medical records for all Manitobans presenting to our centre with a primary complaint of facial pain from 2001 to 2013 were reviewed. We then applied diagnostic criteria from the International Classification of Headache Disorders (IHS-3), the International Association for the Study of Pain (IASP) and Burchiel’s system for comparisons. Results: There were 534 patients with facial pain (3.4/100,000/year) and two-thirds of these had conditions potentially amenable to neurosurgical interventions. Our most common diagnoses were typical trigeminal neuralgia(50%), atypical trigeminal neuralgia(7%), idiopathic trigeminal neuropathy(7%), idiopathic facial pain(11%); average ages were 65±14(22-99), 60±18(32-86), 55±16(28-83) and 48±12(28-82) with a female proportion of 55%, 59%, 65% and 80%, respectively. Other classification systems included no criteria for idiopathic trigeminal neuropathy. The classifications of “trigeminal neuralgia type-1 and type-2” did not differentiate between surgical and non-surgical candidiates. Conclusion: Published classification systems of facial pain have differing criteria for diagnosis of trigeminal neuralgia and none defines a large group with idiopathic trigeminal neuropathy. This may lead to considerable variability in determinations of potential surgical candidates and comparing outcomes of treatment.
A cadaveric study in endoscopic 3D visualization of posterior fossa neurovascular complexes
Authors: Klironomos G , Khan O , Mansouri A , Ebinu J , Gonen L , Radovanovic I , Zadeh G
Published: June 2015

Background: The use of 3D endoscopy for posterior fossa surgery gradually adopted. In this study we compare the 3D to classic 2D endoscopy in evaluating neurovascular complexes in posterior fossa. Methods: Twenty retrosigmoid craniotomies, with a maximal diameter of 2cm were performed under neuronavigation on 10 fresh cadaveric heads. The posterior fossa dura matter was opened with a C-shaped incision and the base of the dural flap was placed over the sigmoid sinus. We used 3D and 2D endoscopes, with 0 and 45 degree angulations, connected to high definition camera lenses for optimal visualization of posterior fossa structures. Results: The superior, middle and inferior neurovascular complexes of the cerebellopontine angle were better visualized with 3D comparing to 2D endoscope. A detailed view of the porus trigeminous and structures associated with the tentorial incisura was also attained with 3D endoscopy. Conclusion: The high quality and resolution obtained by 3D endoscopy makes it a potentially valuable surgical and teaching tool in the armamentarium for endoscopic posterior fossa surgery. The stereoscopic view of the critical neurovascular structures of the posterior fossa, offered by 3D images, allows for a more detailed dissection in the difficult area of the cerebellopontine angle.
Perioperative predictive factors of intracranial meningioma recurrence following surgical resection
Authors: Klironomos G , Mansouri A , Kilian A , Gonen L , Khan O , Zadeh G
Published: June 2015

Background: Meningiomas represent the commonest benign intracranial tumor and surgical resection is the first line treatment. Tumor recurrence after surgical resection is common. The aim of this study is to identify peri-operative predictors of meningioma recurrence following surgical resection Methods: This was a retrospective hospital-based study of all surgical cases between January 1990 and June 2014. Information regarding age, gender, peri-operative imaging parameters such as peri-tumoral edema or post-operative hemorrhage or residual, and grade were collected. Linear and volumetric measurements (of both tumor volume and volume of edema) were collected as well. Results: Overall, 464 patients were reviewed; n=154(34%) percent of patients were male. The grade distribution was: 296 (74.6%) were Grade I, 78 (19.6%) Grade II, and 23 (5.8%) Grade III. Post-operative tumor bed hemorrhage, noted in 119 (29.9%) of cases, and preoperative peri-tumoral edema volume were significant predictors of tumor recurrence following resection (P= 0.002 and 0.037, respectively). These parameters did not correlate with the MIB-1 index, tumour residual, grade of the tumour, or primary versus recurrent presentation. Conclusions: Pre-operative peri-tumoral edema and post-operative tumor bed hemorrhage are independent predictive of tumor recurrence. Identification of other molecular and/or radiological predictive of recurrence factors could add in our understanding of meningioma behavior.
Predictors of survival after second surgery for recurrent glioblastoma tumours
Authors: Kilian A , Parvez K , Monsalves E , Larjani S , Klironomos G , Zadeh G
Published: June 2015

Background: The impact of second surgery on recurrence remains unclear, with few definitive studies to date. This study sought to identify major predictors of survival after second surgery. Methods: A retrospective chart review was conducted for 21 patients who underwent elective surgery for GBM recurrence, at our institution, in the past 6 years. Kaplan Meier was applied to determine the significance of the variables on survival time. The Mann Whitney U test was used to determine whether the median survival time differed significantly between groups, for the factors of interest. Results: Among variables examined, age, less than ≥50 (P=0.04) was significant. Patients younger than 50, had a median survival period of 11.8 months, while patients, age 50 or older, survived a median time of 4.2 months. Though chemotherapy after reoperation was not found to statistically significantly extend survival time on Kaplan-Meier (P=0.08), the median survival time was found to be significantly higher in patients that received chemotherapy (10.6 months) after reoperation, compared with those who did not (3.9 months), using the Mann Whitney U test (P=0.05). Conclusions: These results confirm that younger patients survive longer after second surgery and indicate that a second round of chemotherapy may prolong survival.
Neurosurgery (Pediatric Neurosurgery)
Authors: Yang MM , Singhal A , Au N , Hengel AR
Published: June 2015

Background: Studies in the literature suggest preoperative laboratory investigations and cross-match are performed unnecessarily and rarely lead to changes in clinical management. This study explored whether preoperative laboratory investigations in neurosurgical children alter clinical management and to determine the utilization of cross-matched blood perioperatively in elective pediatric neurosurgical cases. Methods: We reviewed patient charts for elective neurosurgery procedures (2010-2014) at our institution. Variables collected include preoperative complete blood count (CBC), electrolytes, coagulation, group and screen, and cross-match. Instances of altered clinical management as a consequence of preoperative investigation were noted. The number of cross-matched blood transfused perioperatively was also determined. Results: 477 electively scheduled pediatric neurosurgical patients were reviewed. Preoperative CBC was done on 294 and 39.8% had at least one laboratory abnormality. Electrolytes and coagulation panels were abnormal in 23.8% and 24.5% respectively. The preoperative investigations led to a change in clinical management in three patients, two of which were associated with significant past medical history. 57.9% had blood cross-matched and 3.6% of patients received perioperative blood transfusions. The cross-match to transfusion ratio was 16. Conclusion: This study suggests that the results of preoperative laboratory exams have limited value, apart from cases with oncology and complex pre-existing conditions. Additionally, cross-matching might be excessively conducted in elective pediatric neurosurgical cases.
Neuroprotection of Early Locomotor Exercise Poststroke: Evidence From Animal Studies
Authors: Zhang Pengyue , Xianglei Jia , Hongbo Yang , Zhang Jichuan , Xu Ce
Published: June 2015

Early locomotor exercise after stroke has attracted a great deal of attention in clinical and animal research in recent years. A series of animal studies showed that early locomotor exercise poststroke could protect against ischemic brain injury and improve functional outcomes through the promotion of angiogenesis, inhibition of acute inflammatory response and neuron apoptosis, and protection of the blood-brain barrier. However, to date, the clinical application of early locomotor exercise poststroke was limited because some clinicians have little confidence in its effectiveness. Here we review the current progress of early locomotor exercise poststroke in animal models. We hope that a comprehensive awareness of the early locomotor exercise poststroke may help to implement early locomotor exercise more appropriately in treatment for ischemic stroke.
CACN Chair’s Select Abstract Presentations
Authors: Zeiler FA , Zeiler KJ , Teitelbaum J , Gillman LM , West M , Kazina CJ
Published: June 2015

Introduction: Our goal was to perform a systematic review of the literature on the use of intravenous lidocaine in pediatrics for status epilepticus (SE) and refractory status epilepticus (RSE) to determine its impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to November 2014), and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers. Results: Overall, 20 original studies were identified, with 19 manuscripts and 1 meeting abstracts. Two hundred and thirty-five pediatric patients were treated for 252 episodes of SE/RSE. Patients had varying numbers of anti-epileptic drugs (AEDs), 2 to 8, on board prior to lidocaine therapy. During 20 of the 252 (7.9%) episodes of SE/RSE, phenytoin was on board. The dose regimen of lidocaine varied, with some utilizing bolus dosing alone; others utilizing a combination of bolus and infusion therapy. Overall, 60.0% of seizures responded to lidocaine, with complete cessation and greater than 50% reduction seen in 57.6% and 12.3% respectively. Patient outcomes were sparingly reported. Conclusions: There currently exists level 2b, GRADE C evidence to support the consideration of lidocaine for SE and RSE in the pediatric population.
CNS/CSCN Chair’s Select Abstract Presentations
Authors: Furlan JC , Liu Y , Dietrich W , Norenberg MD , Croul S , Fehlings MG
Published: June 2015

Background: This study examines whether age is a key determinant for inflammatory response, oligodendroglial apoptosis and axonal survival after traumatic spinal cord injury (SCI). Methods: This study includes post-mortem spinal cord tissue from 64 cases of SCI (at cervical or high-thoracic level) and 38 controls cases. Each group was subdivided into younger and elderly individuals (≥65 years). Alternating sections from 2 to 3 segments caudal to SCI and age/sex/level-matched segments from controls were stained for: (i) neuroinflammation (neutrophils, macrophages, lymphocytes); (ii) apoptotic oligodendrocytes; (iii) axons; (iv) extent of degeneration. The number of cells or axons was counted in the motor and sensory areas within the spinal cord using unbiased stereological techniques. Results: Younger and elderly individuals had statistically similar number of inflammatory cells in most of the stages post-SCI. Younger and elderly individuals had similar number of oligodendrocytes in apoptosis in all stages following SCI. The number of preserved axons did not significantly differ between younger and elderly individuals with SCI and without prior CNS injury. Extend of degeneration within the spinal cord white matter did not significantly differ between the two groups. Conclusions: Our results indicate that age at the time of injury does not adversely affect the cellular inflammatory response, oligodendroglial apoptosis and axonal survival after traumatic SCI.
Potential effect of amyloid imaging on diagnosis and intended management of patients with cognitive decline: impact of appropriate use criterion
Authors: Dell’Agnello G , Pontecorvo MJ , Siderowf A , Lu M , Hunter C , Arora AK , Mintun MA , Montoya A
Published: June 2015

Background: Appropriate use criteria (AUC; Johnson et al, 2013) provide guidelines for selecting patients for whom amyloid PET could be useful. This study evaluated the impact of amyloid PET on diagnosis/management in patients likely to meet AUC. Methods: We examined 229 cases from a completed study of florbetapir amyloid PET (FBP-PET) in patients with a cognitive decline evaluation in whom Alzheimer’s Disease (AD) was suspected, but with <85% confidence in the diagnosis. All cases received a provisional diagnosis and management prior to FBP-PET. Information for 172 cases after 3-months’ follow-up was also available on actual diagnosis/management post-FBP-PET. Cases were classified as likely meeting AUC (AUC-like) or not. Results: 125/229(55%) subjects were AUC-like. NonAUC cases included typical AD, Mild Cognitive Impairment (MCI) due to AD, Cognitive Decline without objective evidence of impairment (CD) and dementia or cognitive impairment with specific nonAD diagnosis. 59/125(47%) AUC-like cases were amyloid positive (Aβ+). Among nonAUC cases, 29% (CD), 49%(MCI due to AD), 53%(non-AD) and 73%(typical AD) were Aβ+. Of 172 cases with follow-up information, diagnosis/management changed after FBP-PET in 58%/88% and 45%/77% of AUC-like and nonAUC, respectively. Conclusions: FBP-PET altered diagnosis/management in patients selected according to AUC. Additionally, AUC generally excluded patients with a relatively high (typical AD) or low (CD) probability of Aβ+ scan.
Timing of resumption of antithrombotic agents following surgical evacuation of chronic subdural hematomas: a retrospective cohort study
Authors: Guha D , Coyne S , Macdonald RL
Published: June 2015

Background: Antithrombosis (AT), with antiplatelets or anticoagulants, is a significant risk factor for the development of chronic subdural hematomas (cSDH). Resumption of AT following hematoma evacuation is variable, with scant evidence for guidance. Methods: We retrospectively analyzed 479 patients with surgically-evacuated cSDH at St. Michael’s Hospital from 2007-2012. Collected variables included type of AT, indication for AT, timing and type of postoperative complications, and restart intervals for AT agents. Postoperative complications were classified as major or minor hemorrhages, or thromboembolism. Results: Among all patients, 14.8% experienced major hemorrhage, 23.0% minor hemorrhage, and 1.67% thromboembolism. Patients on any preoperative AT were at higher risk of major hemorrhage (OR=1.93, p=0.014), experienced earlier major hemorrhage (mean 16.2 versus 26.5d, p=0.052) and earlier thromboembolism (mean 2.7 versus 51.5d, p=0.036). The type of agent did not affect complication frequency or timing. Patients restarted on any AT postoperatively were at decreased risk of major rebleed following resumption, than those not restarted (OR=0.06, p<0.01). Conclusions: Patients on preoperative AT experienced thromboembolism significantly earlier, at 3d postoperatively, with no increase in rebleed risk following AT resumption. We provide cursory evidence that resuming AT early, at 3d postoperatively, may be safe. Larger prospective studies are required for definitive recommendations.
Deficiencies in the reporting quality of RCTs in neurosurgery: How can we do better?
Authors: Mansouri A , Cooper B , Shin S , Kondziolka D
Published: June 2015

Background: Deficiencies in design and reporting of randomized controlled trials (RCTs) limit their validity. The quality of recent RCTs in neurosurgery was analyzed to assess adequacy of design and reporting. Methods: A high-yield search of the MEDLINE and EMBASE databases (2000-present) was conducted. The CONSORT and Jadad scales were used to assess the quality of design/reporting. A PRECIS-based scale was used to designate studies on the pragmatic-explanatory continuum. Spearman’s test was used to assess correlations. Regression analysis was used to assess associations. Results: Sixty-one articles were identified. Vascular was the most common sub-specialty (37%). The median CONSORT and Jadad scores were 36 (IQR 27.5-39) and 3 (IQR 2-3). Blinding, sample size calculation and allocation concealment were most deficiently reported. The quality of reporting did not correlate with the study impact. The majority of studies (83%) had pragmatic objectives; while pragmatic studies had compatible design factors, trials with explanatory objectives were less successful. Conclusions: The prevalence and quality of neurosurgical RCTs is low. Many study designs are not compatible with stated objectives. Given the role of RCTs as one of the highest levels of evidence, it is critical to improve on their methodology and reporting. Alternative methodologies merit discussion.
Lidocaine for status epilepticus in adults
Authors: Zeiler FA , Zeiler KJ , Kazina CJ , Teitelbaum J , Gillman LM , West M
Published: June 2015

Introduction: Our goal was to perform a systematic review of the literature on the use of intravenous lidocaine in adults for status epilepticus (SE) and refractory status epilepticus (RSE) to determine its impact on seizure control. Methods: All articles from MEDLINE, BIOSIS, EMBASE, Global Health, HealthStar, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to November 2014), and gray literature were searched. The strength of evidence was adjudicated using both the Oxford and GRADE methodology by two independent reviewers. Results: Overall, 13 studies were identified, with 11 manuscripts and 2 meeting abstracts. Seventy-six adult patients were treated for 82 episodes of SE/RSE. Patients had varying numbers of anti-epileptic drugs (AEDs), 1 to 12, on board prior to lidocaine therapy. During 69 of the 82 (84.1%) episodes of SE/RSE, phenytoin was on board. The dose regimen of lidocaine varied significantly. Overall, 70.7% of seizures responded to lidocaine, with complete cessation and greater than 50% reduction seen in 64.1% and 6.1% respectively. Patient outcomes were sparingly reported. Conclusions: There currently exists level 4, GRADE C evidence to support the consideration of lidocaine for SE and RSE in the adult population. Further prospective studies of lidocaine administration in this setting are warranted.
A generalised-Lagrangian-mean model of the interactions between near-inertial waves and mean flow
Authors: Xie J.-H. , Vanneste J.
Published: June 2015

Wind forcing of the ocean generates a spectrum of inertia–gravity waves that is sharply peaked near the local inertial (or Coriolis) frequency. The corresponding near-inertial waves (NIWs) are highly energetic and play a significant role in the slow, large-scale dynamics of the ocean. To analyse this role, we develop a new model of the non-dissipative interactions between NIWs and balanced motion. The model is derived using the generalised-Lagrangian-mean (GLM) framework (specifically, the ‘glm’ variant of Soward & Roberts,J. Fluid Mech., vol. 661, 2010, pp. 45–72), taking advantage of the time-scale separation between the two types of motion to average over the short NIW period. We combine Salmon’s (J. Fluid Mech., vol. 719, 2013, pp. 165–182) variational formulation of GLM with Whitham averaging to obtain a system of equations governing the joint evolution of NIWs and mean flow. Assuming that the mean flow is geostrophically balanced reduces this system to a simple model coupling Young & Ben Jelloul’s (J. Mar. Res., vol. 55, 1997, pp. 735–766) equation for NIWs with a modified quasi-geostrophic (QG) equation. In this coupled model, the mean flow affects the NIWs through advection and refraction; conversely, the NIWs affect the mean flow by modifying the potential-vorticity (PV) inversion – the relation between advected PV and advecting mean velocity – through a quadratic wave term, consistent with the GLM results of Bühler & McIntyre (J. Fluid Mech., vol. 354, 1998, pp. 301–343). The coupled model is Hamiltonian and its conservation laws, for wave action and energy in particular, prove illuminating: on their basis, we identify a new interaction mechanism whereby NIWs forced at large scales extract energy from the balanced flow as their horizontal scale is reduced by differential advection and refraction so that their potential energy increases. A rough estimate suggests that this mechanism could provide a significant sink of energy for mesoscale motion and play a part in the global energetics of the ocean. Idealised two-dimensional models are derived and simulated numerically to gain insight into NIW–mean-flow interaction processes. A simulation of a one-dimensional barotropic jet demonstrates how NIWs forced by wind slow down the jet as they propagate into the ocean interior. A simulation assuming plane travelling NIWs in the vertical shows how a vortex dipole is deflected by NIWs, illustrating the irreversible nature of the interactions. In both simulations energy is transferred from the mean flow to the NIWs.
Compensable Injury and Quality of Life
Authors: Athanasou James A.
Published: June 2015

This study examined the quality of life of compensable accident victims. The sample comprised 254 participants who completed the World Health Organization's EUROHIS Quality of Life scale as part of a vocational assessment. As hypothesised, there was substantially lower quality of life with a mean rating of 2.70 (SD = 0.74) on a five-point scale from very dissatisfied to very satisfied. There were statistically significant differences in quality of life, favouring those living in a rural vs city location, those living in areas of low unemployment and those with higher skill levels. Those who had a non-work accident had higher levels of quality of life as did those without a spinal cord injury or psychiatric sequelae. Participants who returned to work had the highest level of quality of life. The time since the personal injury averaged 3.58 years (SD = 3.61) and quality of life was not correlated positively with the effluxion of time (r = 0.057). A tentative process model of quality of life was proposed based on the significant factors from this study and divided the factors into three stages based on their occurrence across time as early, intermediate or late in relation to the injury.
Body-size trends of the extinct giant sharkCarcharocles megalodon: a deep-time perspective on marine apex predators
Authors: Pimiento Catalina , Balk Meghan A.
Published: June 2015

The extinct sharkCarcharocles megalodonis one of the largest marine apex predators ever to exist. Nonetheless, little is known about its body-size variations through time and space. Here, we studied the body-size trends ofC. megalodonthrough its temporal and geographic range to better understand its ecology and evolution. Given that this species was the last of the megatooth lineage, a group of species that shows a purported size increase through time, we hypothesized thatC. megalodonalso displayed this trend, increasing in size over time and reaching its largest size prior to extinction. We found thatC. megalodonbody-size distribution was left-skewed (suggesting a long-term selective pressure favoring larger individuals), and presented significant geographic variation (possibly as a result of the heterogeneous ecological constraints of this cosmopolitan species) over geologic time. Finally, we found that stasis was the general mode of size evolution ofC. megalodon(i.e., no net changes over time), contrasting with the trends of the megatooth lineage and our hypothesis. Given thatC. megalodonis a relatively long-lived species with a widely distributed fossil record, we further used this study system to provide a deep-time perspective to the understanding of the body-size trends of marine apex predators. For instance, our results suggest that (1) a selective pressure in predatory sharks for consuming a broader range of prey may favor larger individuals and produce left-skewed distributions on a geologic time scale; (2) body-size variations in cosmopolitan apex marine predators may depend on their interactions with geographically discrete communities; and (3) the inherent characteristics of shark species can produce stable sizes over geologic time, regardless of the size trends of their lineages.
Nation, Religion, Gender: The Triple Challenge of Middle-Class German-Jewish Women in World War I
Authors: Steer Martina
Published: June 2015

German-Jewish women are elusive figures in the current literature on World War I. Looking at the complexity of their wartime experience and its consequences for the Weimar years, this article deals with Jewish middle-class women's tripartite motivation as Germans, Jews, and females to make sacrifices for the war. To that end, it traces their efforts to help Germany to victory, to gain suffrage, and to become integrated into German society. At the same time, the article shows how these women not only transformed the war into an opportunity for greater female self-determination but also responded to wartime and postwar antisemitism. The experience of the war and the need for reorientation after 1918 motivated them to become more involved in the affairs of the German-Jewish community itself and to contribute significantly to shaping public Jewish life in Weimar Germany—but without giving up their German identity.
ATTITUDES TOWARDS AND PRACTICE OF SEXUALITY AMONG UNIVERSITY STUDENTS IN LEBANON
Authors: Salameh P. , Zeenny R. , Salamé J. , Waked M. , Barbour B. , Zeidan N. , Baldi I.
Published: June 2015

Sexuality is still a taboo in Middle Eastern countries, and Lebanon is no exception. This study’s objective was to evaluate attitudes towards sexuality and its practice among university students in Lebanon and assess their respective correlates. The cross-sectional study was carried out among students selected from seventeen universities across Lebanon. The participants received a self-administered standardized questionnaire that assessed their attitudes towards sexuality. It included questions on socio-demographic factors, risk-taking, risky behaviours and sexuality-related questions. Among 3384 students, 2700 (79.8%) answered the questions on sexuality. Around 15% had engaged in sexual activity, while 20% were regularly sexually active. Among males, 34.8% had never had sexual activity, 29.9% had tried it and 35.3% were regularly sexually active. Among females the results were respectively 85.1%, 5.3% and 9.6% (p<0.001). Only 36% regularly used condoms during their relationships. A liberal attitude towards sex, male sex, motives for risky behaviours, current cigarette smoking and problematic alcohol consumption were associated with sexual activity. Realizing that risky behaviours are dangerous, health concerns related to sexual relationships and a liberal attitude towards sex were associated with regular condom use. However, being bothered by condoms and female sex were inversely associated with condom use. Finally, participants who had motives for, and those who felt excited about risky behaviours, and those reporting current cigarette and waterpipe smoking and problematic alcohol consumption (β=0.600; p=0.002) embraced a more liberal attitude towards sex. Conversely, females (β=−7.58; p<0.001) and individuals who considered risky behaviours as dangerous reported an unfavourable attitude towards sexuality. A substantial proportion of Lebanese university students have regular sexual activity, but a low percentage use condoms for protection. Interventions are required among males in particular in view of these attitude and behavioural changes towards sexuality.
How Should We Approach the Economy of ‘Early Modern India’?
Authors: GHOSH SHAMI
Published: June 2015

Tirthankar Roy's recent synthesis on the economic history of early modern India claims to provide a new, overarching narrative placing this period within the broader sweep of the history of what Roy defines as ‘capitalism’ in India in the very long term. This article provides a detailed critique of Roy's monograph, suggesting that it suffers from some serious methodological deficits, arising not least from a future-oriented paradigm that imposes anachronistic concepts on this period, including the very notion of ‘India’. Furthermore, Roy's view of the economy as being fundamentally driven forward by the rise of a coastal polity, expanding inwards from Bombay, Madras, and Calcutta, sits awkwardly with his repeated claim that colonialism was of little significance for Indian economic history. Finally, this article suggests that this period might be more fruitfully approached not only by abandoning thetelosof what we know of India's future, but also by adopting both regionally focused and comparative approaches, turning away from long-distance trade as the primary lens through which to view the economy, and instead examining endogenous factors in the economies of individual regions and enriching our understanding of them by reference to studies of other world regions with comparable patterns of development in the same period. More nuanced ways of approaching economic change in the very long run, including the importance of developments in modes of consumption and market- and profit-oriented economic behaviour, are suggested as a better means of understanding both the economies of the late pre-colonial centuries in the Indian subcontinent and the development of capitalism, which should also be understood in a more specific manner than Roy allows.