bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating Adhesion Reduction Efficacy of Type I/III Collagen Membrane and Collagen-GAG Resorbable Matrix in Primary Flexor Tendon Repair in a Chicken Model
Authors: Turner John B. , Corazzini Rubina L. , Butler Timothy J. , Garlick David S. , Rinker Brian D.
Published: December 2014

Background

Reduction of peritendinous adhesions after injury and repair has been the subject of extensive prior investigation. The application of a circumferential barrier at the repair site may limit the quantity of peritendinous adhesions while preserving the tendon's innate ability to heal. The authors compare the effectiveness of a type I/III collagen membrane and a collagen-glycosaminoglycan (GAG) resorbable matrix in reducing tendon adhesions in an experimental chicken model of a “zone II” tendon laceration and repair.

Methods

In Leghorn chickens, flexor tendons were sharply divided using a scalpel and underwent repair in a standard fashion (54 total repairs). The sites were treated with a type I/ III collagen membrane, collagen-GAG resorbable matrix, or saline in a randomized fashion. After 3 weeks, qualitative and semiquantitative histological analysis was performed to evaluate the “extent of peritendinous adhesions” and “nature of tendon healing.” The data was evaluated with chi-square analysis and unpaired Student's t test.

Results

For both collagen materials, there was a statistically significant improvement in the degree of both extent of peritendinous adhesions and nature of tendon healing relative to the control group. There was no significant difference seen between the two materials. There was one tendon rupture observed in each treatment group. Surgical handling characteristics were subjectively favored for type I/III collagen membrane over the collagen-GAG resorbable matrix.

Conclusion

The ideal method of reducing clinically significant tendon adhesions after injury remains elusive. Both materials in this study demonstrate promise in reducing tendon adhesions after flexor tendon repair without impeding tendon healing in this model.
The prospect of a British exit from the EU
Authors: Vojtíšková Vlad'ka
Published: December 2014

A referendum on whether the United Kingdom should remain a member of the EU is no longer science fiction. British Prime Minister David Cameron has committed to a referendum in 2017 if the Conservatives win the 2015 elections. Before that, Cameron wants to negotiate a ‘better deal’ with the EU. What is his understanding of this ‘deal’, and what would the prospects for Britain be if they fail to achieve this and vote for an exit from the Union? How should the EU react to this British challenge? Are there any areas that could be reformed in order to please the British, while avoiding a ‘Europe a la carte’? The article describes the political background and history that has led to the current situation and British prospects outside the EU. It concludes with Britain's demands for EU reform and a possible EU response.
The Effect of Unemployment on Household Composition and Doubling Up
Authors: Wiemers Emily E.
Published: December 2014

“Doubling up” (sharing living arrangements) with family and friends is one way in which individuals and families can cope with job loss, but relatively little research has examined the extent to which people use coresidence to weather a spell of unemployment. This project uses data from the Survey of Income and Program Participation (SIPP) to provide evidence on the relationship between household composition and unemployment across working ages, focusing on differences in behavior by educational attainment. Using the SIPP panels, I find that individuals who become unemployed are three times more likely to move in with other people. Moving into shared living arrangements in response to unemployment is not evenly spread across the distribution of educational attainment: it is most prevalent among individuals with less than a high school diploma and those with at least some college.
The Second Trimester Obstetric Scan (7 + 3 = 10): A Rational Approach (Including the “Rule of Three”)
Authors: Suresh Seshadri , Suresh Indrani
Published: December 2014

The second trimester targeted scan is done between 18 and 20 weeks. The primary objective of this scan is to do a detailed anatomical evaluation of the fetus and to maximize the detection of anomalies that may be present at this stage. A systematic method of ultrasound scanning of the fetus will ensure that a reasonably complete examination of the fetus is accomplished. A “rule of three” approach helps in ensuring that no major structures are missed out during the scan. It is a simple “checklist” approach which can be easily remembered. It not only helps in standardized training and performance but also helps in a systematic audit when anomalies are missed.
Induction of DKK1 by ox‐LDL negatively regulates intracellular lipid accumulation in macrophages
Authors: Zhang Yu , Ge Cheng , Wang Lin , Liu Xinxin , Chen Yifei , Li Mengmeng , Zhang Mei
Published: November 2014

Dickkopf1 (DKK1), a canonical Wnt/β‐catenin pathway antagonist, is closely associated with cardiovascular disease and adipogenesis. We performed an in vitro study to determine whether oxidized low‐density lipoprotein (ox‐LDL) increased the expression of DKK1 in macrophages and whether β‐catenin and liver X receptor α (LXRα) were involved in this regulation. Induction of DKK1 expression by ox‐LDL decreased the level of lectin‐like oxidized low‐density lipoprotein receptor‐1 (LOX‐1) via a Wnt/β‐catenin pathway and increased ATP‐binding cassette transporter A/G1 (ABCA/G1) levels via a signal transducer and activator of transcription 3 (STAT3) pathway. Lower LOX‐1 and higher ABCA/G1 levels inhibited cholesterol loading in macrophages. In conclusion, ox‐LDL may induce DKK1 expression in macrophages to inhibit the accumulation of lipids through a mechanism that involves downregulation of LOX‐1‐mediated lipid uptake and upregulation of ABCA/G1‐dependent cholesterol efflux.
Demonstration of a hidden interaction between the aortomitral continuity and the conduction system in a case of idiopathic left ventricular outflow tract ventricular tachycardia
Authors: Mizobuchi Masahiro , Enjoji Yoshihisa
Published: November 2014

We describe a case of idiopathic left ventricular outflow ventricular tachycardia. Monomorphic ventricular arrhythmia (VA) with a right bundle branch block morphology and an inferior axis was induced through exercise or isoproterenol infusion. During VA bigeminy, a spiked presystolic potential (PP) preceding the VA with a qrS pattern in the unipolar electrogram was recorded at the aortomitral continuity (AMC). Radiofrequency catheter ablation eliminated the VA despite the persistence of sinus‐PP bigeminy. Furthermore, these PP rates were dependent on the preceding sinus rhythm rates. The present case suggests a hidden interaction between the AMC and the conduction system.
Anatomy of Kuduro: Articulating the Angolan Body Politic after the War
Authors: Moorman Marissa J.
Published: December 2014

Kuduro, meaning “hard-ass” or “in a hard place,” is a contemporary genre of music and dance produced and consumed in Angola, especially in Luanda. This article maps kuduro historically and assesses it in its current moment. While the dance is full of invention and the genre has thrived in the informal economy, this alternative expression and the infrastructure it produces cannot be considered politically or economically liberatory. But the international “os Kuduristas” campaign promoted by two of the Angolan president’s children and companies they own shows the dangers of a culturally conservative discourse that dismisses kuduro as a vulgar popular phenomenon while hegemonic political and commercial forces embrace it.
Inscribing Identity and Agency on the Landscape: Of Pathways, Places, and the Transition of the Public Sphere in East Pokot, Kenya
Authors: Bollig Michael , Greiner Clemens , Österle Matthias
Published: December 2014

Drawing upon the dynamic interrelationship between human agency and space, this article sheds light on the constitution of and relation between “place” and “path” among the pastoral Pokot of East Pokot District in the Kenyan North Rift Valley. It discusses the transformation from a more mobile pastoralist model of spatialization, which relies on a flexible network approach combining paths and places, toward a more “place-making,” postpastoralist model linked to increasing sedentariness, privatization of land, a clearer definition of external and internal boundaries, and a rapid emergence of schools, churches, and other physical structures.
Ellipsoidal vortices in rotating stratified fluids: beyond the quasi-geostrophic approximation
Authors: Tsang Yue-Kin , Dritschel David G.
Published: December 2014

We examine the basic properties and stability of isolated vortices having uniform potential vorticity (PV) in a non-hydrostatic rotating stratified fluid, under the Boussinesq approximation. For simplicity, we consider a uniform background rotation and a linear basic-state stratification for which both the Coriolis and buoyancy frequencies,$f$and$N$, are constant. Moreover, we take$f/N\ll 1$, as typically observed in the Earth’s atmosphere and oceans. In the small Rossby number ‘quasi-geostrophic’ (QG) limit, when the flow is weak compared to the background rotation, there exist exact solutions for steadily rotating ellipsoidal volumes of uniform PV in an unbounded flow (Zhmur & Shchepetkin,Izv. Akad. Nauk SSSR Atmos. Ocean. Phys., vol. 27, 1991, pp. 492–503; Meacham,Dyn. Atmos. Oceans, vol. 16, 1992, pp. 189–223). Furthermore, a wide range of these solutions are stable as long as the horizontal and vertical aspect ratios${\it\lambda}$and${\it\mu}$do not depart greatly from unity (Dritschel et al.,J. Fluid Mech., vol. 536, 2005, pp. 401–421). In the present study, we examine the behaviour of ellipsoidal vortices at Rossby numbers up to near unity in magnitude. We find that there is a monotonic increase in stability as one varies the Rossby number from nearly$-1$(anticyclone) to nearly$+1$(cyclone). That is, QG vortices are more stable than anticyclones at finite negative Rossby number, and generally less stable than cyclones at finite positive Rossby number. Ageostrophic effects strengthen both the rotation and the stratification within a cyclone, enhancing its stability. The converse is true for an anticyclone. For all Rossby numbers, stability is reinforced by increasing${\it\lambda}$towards unity or decreasing${\it\mu}$. An unstable vortex often restabilises by developing a near-circular cross-section, typically resulting in a roughly ellipsoidal vortex, but occasionally a binary system is formed. Throughout the nonlinear evolution of a vortex, the emission of inertia–gravity waves (IGWs) is negligible across the entire parameter space investigated. Thus, vortices at small to moderate Rossby numbers, and any associated instabilities, are (ageostrophically) balanced. A manifestation of this balance is that, at finite Rossby number, an anticyclone rotates faster than a cyclone.
Deformation of a spherical capsule under oscillating shear flow
Authors: Matsunaga D. , Imai Y. , Yamaguchi T. , Ishikawa T.
Published: December 2014

The deformation of a spherical capsule in oscillating shear flow is presented. The boundary element method is used to simulate the capsule motion under Stokes flow. We show that a capsule at high frequencies follows the deformation given by a leading-order prediction, which is derived from an assumption of small deformation limit. At low frequencies, on the other hand, a capsule shows an overshoot phenomenon where the maximum deformation is larger than that in steady shear flow. A larger overshoot is observed for larger capillary number or viscosity ratio. Using the maximum deformation in start-up shear flow, we evaluate the upper limit of deformation in oscillating shear flow. We also show that the overshoot phenomenon may appear when the quasi-steady orientation angle under steady shear flow is less than$9.0^{\circ }$. We propose an equation to estimate the threshold frequency between the low-frequency range, where the capsule may have an overshoot, and the high-frequency range, where the deformation is given by the leading-order prediction. The equation only includes the viscosity ratio and the Taylor parameter under simple shear flow, so it can be extended to other deformable particles, such as bubbles and drops.
The effect of cell tilting on turbulent thermal convection in a rectangular cell
Authors: Guo Shuang-Xi , Zhou Sheng-Qi , Cen Xian-Rong , Qu Ling , Lu Yuan-Zheng , Sun Liang , Shang Xiao-Dong
Published: December 2014

In this study the influence of cell tilting on flow dynamics and heat transport is explored experimentally within a rectangular cell (aspect ratios ${\it\Gamma}_{x}=1$ and ${\it\Gamma}_{y}=0.25$). The measurements are carried out over a wide range of tilt angles ($0\leqslant {\it\beta}\leqslant {\rm\pi}/2\ \text{rad}$) at a constant Prandtl number ($\mathit{Pr}\simeq 6.3$) and Rayleigh number ($\mathit{Ra}\simeq 4.42\times 10^{9}$). The velocity measurements reveal that the large-scale circulation (LSC) is sensitive to the symmetry of the system. In the level case, the high-velocity band of the LSC concentrates at about a quarter of the cell width from the boundary. As the cell is slightly tilted (${\it\beta}\simeq 0.04\ \text{rad}$), the position of the high-velocity band quickly moves towards the boundary. With increasing ${\it\beta}$, the LSC changes gradually from oblique ellipse-like to square-like, and other more complicated patterns. Oscillations have been found in the temperature and velocity fields for almost all ${\it\beta}$, and are strongest at around ${\it\beta}\simeq 0.48\ \text{rad}$. As ${\it\beta}$ increases, the Reynolds number ($\mathit{Re}$) initially also increases, until it reaches its maximum at the transition angle ${\it\beta}=0.15\ \text{rad}$, after which it gradually decreases. The cell tilting causes a pronounced reduction of the Nusselt number ($\mathit{Nu}$). As ${\it\beta}$ increases from 0 to 0.15, 1.05 and ${\rm\pi}/2\ \text{rad}$, the reduction of $\mathit{Nu}$ is approximately 1.4 %, 5 % and 18 %, respectively. Over the ranges of $0\leqslant {\it\beta}\leqslant 0.15\ \text{rad}$, $0.15\leqslant {\it\beta}\leqslant 1.05\ \text{rad}$ and $1.05\leqslant {\it\beta}\leqslant {\rm\pi}/2\ \text{rad}$, the decay slopes are $8.57\times 10^{-2}$, $3.27\times 10^{-2}$ and $0.24\ \text{rad}^{-1}$, respectively.
THE BINDING FORCE OF AGREEMENTS TO NEGOTIATE IN GOOD FAITH
Authors: Trakman Leon E. , Sharma Kunal
Published: December 2014

This article evaluates the established judicial proposition that an agreement to negotiate in good faith is antithetical to the principles of the common law. English courts are reluctant to enforce such agreements on the ground that they constitute unenforceable “agreements to agree”. Recently, courts have started to recognise an exception in cases where parties agree to negotiate over a term mandated by an existing agreement, such as to review a price clause or resolve a dispute by undertaking negotiations in good faith. The primary arguments against enforcing an independent agreement to negotiate in good faith are threefold. First, parties engaged in good faith negotiations are assumed to lack a serious legal intention to contract. Second, such an agreement is substantively uncertain in nature and does not promise to produce a contract. Third, the failure of parties to conclude their negotiations does not lead to an easily identifiable loss. In light of these considerations, this article considers the viability of enforcing an agreement to negotiate in good faith in the absence of a pre-existing contract. It argues that the legal obstacles to recognising agreements to negotiate have been overstated. Given the commercial value of enforcing such agreements, it proposes that agreements to negotiate in good faith should be recognised and given legal content by common law courts.
THE LIMITS OF FREEDOM OF INFORMATION AND HUMAN RIGHTS, AND THE POSSIBILITIES OF THE COMMON LAW
Authors: Hughes Kirsty
Published: December 2014

ACCOUNTABILITY, transparency, and freedom of information are essential to democracy. These values are not absolute; hence the law is used to demarcate how much transparency, access, and freedom are allowed. The Freedom of Information Act 2000 (FOIA) provides a mechanism for accessing information held by public authorities. It has been heavily criticised for not providing sufficient access due to its wide exemptions and section 53 veto power. Nevertheless, it was thought that, where citizens seek information, they should use FOIA. In Kennedy v The Charity Commission [2014] UKSC 20, [2014] 2 W.L.R. 808, the Supreme Court found that this may not always be the appropriate method. The Supreme Court held, by a majority of 5:2, that Kennedy should not have pursued his claim under FOIA; instead he should have sought disclosure via the Charities Act 1993 (“Charities Act”) and judicial review. The majority took this opportunity to criticise the overuse of human rights, and to emphasise the significance of the common law and its role in ensuring accountability and transparency.
PROPRIETARY REMEDIES FOR BREACH OF FIDUCIARY DUTY
Authors: Conaglen Matthew
Published: December 2014

FHR bought a long lease for €211.5 million. Cedar Capital conducted the negotiations on FHR's behalf, but also received a €10 million commission from the vendor. On becoming aware of this commission, FHR sought to recover it from Cedar Capital. As its negotiating agent, Cedar Capital owed fiduciary duties to FHR, and had not obtained FHR's fully informed consent to the commission. Cedar Capital therefore had to account to FHR for the commission. However, applying the Court of Appeal's decision in Sinclair Investments (UK) Ltd. v Versailles Trade Finance Ltd. [2011] EWCA Civ 347, [2012] Ch. 453, Simon J. held that the remedy was purely personal; FHR could not assert a proprietary constructive trust over the €10 million: FHR European Ventures LLP v Mankarious [2011] EWHC 2999 (Ch). The Court of Appeal allowed an appeal as to remedy, distinguishing the facts from those in Sinclair v Versailles, but also casting some doubt on the correctness of that decision: [2013] EWCA Civ 17, [2014] Ch. 1. The Supreme Court was thus required to pass judgment on the voluminous debate as to whether English law should follow Lister & Co. v Stubbs (1890) 45 Ch.D. 1, or Attorney-General for Hong Kong v Reid [1994] 1 A.C. 324.
MARRIAGE DISSOLUTION AS A PRE-REQUISITE FOR LEGAL GENDER RECOGNITION
Authors: Dunne Peter
Published: December 2014

IN Hämäläinen v Finland (Application no. 37359/09), 16 July 2014, the Grand Chamber of the European Court of Human Rights held that Contracting States of the Council of Europe may require the dissolution of an existing marriage before extending the right to legal gender recognition.
“UMBRELLA EFFECTS” AND PRIVATE ANTITRUST ENFORCEMENT
Authors: Dunne Niamh
Published: December 2014

UMBRELLA effects arise where anti-competitive conduct by one or more market actors results in general price rises across the sector concerned. The Court of Justice of the European Union has, with its preliminary ruling in Case C-557/12, Kone and others v OBB-Infrastruktur AG, Judgment of 5 June 2014, EU:C:2014:1317, now addressed the potential legal implications of such umbrella effects. In confirming that the right to compensation stemming from breach of EU competition law extends to umbrella claims as a matter of principle, the Court of Justice has offered its most expansive, and arguably most emphatic, interpretation of the scope and importance of private antitrust enforcement to date.
Minocycline Protects Dopaminergic Neurons Against Long-Term Rotenone Toxicity
Authors: Radad Khaled , Moldzio Rudolf , Rausch Wolf-Dieter
Published: December 2014

Background:

In Parkinson's disease, most of current therapies only provide symptomatic treatment and so far there is no drug which directly affects the disease process.

Objectives:

To investigate the neuroprotective effects of minocycline against long-term rotenone toxicity in primary dopaminergic cell cultures.

Methods:

Embryonic mice of 14-days-old were used for preparation of primary dopaminergic cell cultures. On the 6th dayin vitro, prepared cultures were treated both with minocycline alone (1, 5, 10 and 20 μM) and concomitantly with rotenone (5 and 20 nM) and minocycline. Cultures were incubated at 37°C for six consecutive days. On Day 12in vitroculture medium was aspirated and used for measuring lactate dehydrogenase. Cultured cells were fixed in 4% paraformaldhyde and stained immunohistochemically against tyrosine hydroxylase.

Results:

Treatment of cultures with 5 and 20 nM of rotenone significantly decreased the survival of tyrosine hydroxylase immunoreactive neurons by 27 and 31% and increased the release of lactate dehydrogenase into the culture medium by 31 and 236%, respectively compared to untreated controls. Minocycline (1, 5, 10 μM) significantly protected tyrosine hydroxylase immunoreactive neurons by 17, 15 and 19% and 13, 22 and 23% against 5 and 20 nM of rotenone, respectively compared to rotenone-treated cultures. Minocycline (only at 10 μM) significantly decreased the release of lactate dehydrogenase by 79% and 133% against 5 and 20 nM of rotenone, respectively.

Conclusion:

Minocycline has neuroprotective potential against the progressive loss of tyrosine hydroxylase immunoreactive neurons induced by long-term rotenone toxicity in primary dopaminergic cultures.
Non Ruptured MCA Aneurysms Presenting with Insular Related Symptoms
Authors: Malak Ramez , Nguyen Dank Khoa , Bojanowski Michel W.
Published: December 2014

Objective:

To present a new semiological description of unruptured middle cerebral artery (MCA) aneurysms.

Methods:

We present a series of three MCA aneurysms presenting with progressive or paroxystic somatosensory symptoms in combination with visceral, motor, language or autonomic symptoms.

Results:

A surgical approach was proposed for two aneurysms, and both patients experienced complete resolution of their symptoms. The third aneurysm was successfully excluded by endovascular coiling but the symptoms persisted.

Conclusions:

To our knowledge this is the first description of unruptured aneurysms presenting with insular-related symptoms.
Quercetin Administration After Spinal Cord Trauma Changes S-100β Levels
Authors: Schültke E. , Griebel R. W. , Juurlink B. H. J.
Published: December 2014

Background:

It has been shown previously that S-100β levels in serum correspond with the severity of central nervous system (CNS) trauma. It also has been suggested that S-100β in CNS tissue is involved in neuroprotection and neuroregeneration. We have previously shown that administration of quercetin results in improved motor function in an animal model of spinal cord trauma.

Methods:

Mid-thoracic spinal cord compression injury was produced in adult maleWistar rats. Serum and tissue samples were acquired from quercetin-treated animals (25 μmol / kg) and saline controls at 6, 12 and 24 hours after the trauma. S-100β levels were measured using a luminometric assay in the damaged tissue and in the serum of the animals.

Results:

The increase in serum S-100β levels seen in saline controls after spinal cord trauma was ameliorated in the quercetin-treated animals at all time points, although the difference to saline controls became statistically significant only at 24 hrs after the trauma. Compared to tissue S-100β levels in healthy animals, values were significantly decreased in saline controls at all three time points, while they were decreased at 6 hrs and increased at both 12 and 24 hrs in quercetin-treated animals. At all three time points tissue S-100β levels were significantly higher in quercetin-treated animals than in saline controls.

Conclusions:

Administration of quercetin results in modification of S-100β levels in the setting of experimental spinal cord trauma. The kinetic patterns of the S-100β fluctuations in serum and tissue suggest that post-traumatic administration of quercetin decreases the extent of CNS injury.
Secondary Stroke Prevention: Practice Patterns in a Tertiary Care Stroke Service
Authors: Fan Janice C. , Mysak Tania M. , Jeerakathil Thomas J. , Pearson Glen J.
Published: December 2014

Background:

Stroke and transient ischemic attack (TIA) have a high personal and financial cost to society and prevention is critical. Outside of registries in Ontario, there has been little effort to determine whether care gaps exist for secondary preventative care within Canada. The objective of this study was to evaluate inpatient medical team compliance to four secondary stroke prevention interventions: antithrombotic therapy, antihypertensive therapy, lipid lowering therapy and smoking cessation.

Methods:

Adults admitted to the University of Alberta Hospital stroke service with a diagnosis of stroke or TIA between August 1st, 2005 and July 31st, 2006 were identified using International Classification of Diseases (10th Revision) codes. Two hundred charts were randomly selected for retrospective review. Compliance, defined as achievement of therapeutic targets or appropriate therapy for subtherapeutic targets, was assessed.

Results:

Among 190 eligible patients (mean age 67 years, 55 % male), 147 (77.4%) had a non-cardioembolic cerebral event while 43 (22.6%) had a cardioembolic cerebral event. We found high compliance for antithrombotic (92% [174/190]) and antihypertensive (95% [136/143]) agents, but suboptimal compliance for lipid lowering agents (68% [107/158]) and smoking cessation (27% [17/64]).

Conclusions:

There is room for improvement in early risk factor management for secondary prevention, even in specialized stroke centres. To optimize stroke preventative care, more interdisciplinary collaboration, investigation of reasons for suboptimal care, development of strategies to minimize care gaps and ongoing stroke care audits for quality improvement are needed.
Carotid Revascularization: An Update
Authors: O'Kelly Cian J. , Butcher Ken S. , Marchak B. Elaine , Findlay J. Max
Published: December 2014

Symptomatic extracranial internal carotid artery stenosis poses a high short-time risk of ischemic cerebral stroke, as high as 20% to 30% in the first three months. Timely performed carotid endarterectomy (CEA) has been shown to be highly effective in reducing this risk although, in recent years, there has been great interest in replacing this procedure with less invasive carotid angioplasty and stenting (CAS). In this update we review recent studies and provide recommendations regarding the indications, methods and timing of surgical intervention as well as the anaesthetic management of CEA, and we report on recently published randomized controlled trials comparing CEA to CAS. We also provide recommendations regarding the sometime neglected but important medical management of patients undergoing carotid intervention, including antithrombotic and antihypertension therapy, lipid lowering agents, assistance with smoking cessation, and diabetes control.
Familial Occurrence of Complex Regional Pain Syndrome
Authors: Shirani Peyman , Jawaid Ali , Moretti Paolo , Lahijani Elham , Salamone Alicia R. , Schulz Paul E. , Edmondson Everton A.
Published: December 2014

Background:

The etiology of complex regional pain syndrome (CRPS) is unknown. Different environmental and genetic factors have been postulated to contribute to CRPS.

Methods:

We reviewed the clinical data from a cohort of 69 patients with CRPS. Four families were identified with two or more members affected with CRPS yielding a total of nine patients. Six more patients reported the presence of pain symptoms in their family members, however; this could not be clinically confirmed.

Results:

The case histories of the nine individuals with ‘familial’ CRPS suggested a younger age at onset and more frequent history of migraine versus the non-familial patients. A pattern of inheritance could not be ascertained.

Conclusion:

This data supports the hypothesis that CRPS can be familial and hence may have a genetic basis in some families. Larger studies will be needed to ascertain clearer patterns of inheritance and to determine whether the clinical features of ‘familial’ CRPS are the same as the sporadic form.
Consensus Statement: The Development of a National Canadian Migraine Strategy
Authors: Becker W J , Christie S N , Mackie G , Cooper P
Published: December 2014

Background:

Migraine is a significant cause of suffering and disability in the Canadian population, and imposes a major cost on Canadian Society. Based on current medical science, much more could be done to provide better comprehensive medical care to the millions of individuals with migraine in Canada.

Objective:

To propose and design a national Canadian Migraine Strategy which could be implemented to reduce migraine related disability in Canada.

Methods:

A multidisciplinary task force of the Canadian Headache Society met for a Canadian Migraine Summit Meeting in Halifax, Nova Scotia in June, 2009. Pertinent literature was reviewed and a consensus document was produced based upon the round table discussion at the meeting.

Results:

The outline of a national Canadian Migraine Strategy was created. This strategy is based on the chronic disease management model, and would include: an outline of what constitutes appropriate migraine care for Canadians, educational programs (for health care professionals, individuals with migraine, and the general public), research programs, and the development of the necessary organizations and partnerships to develop further and implement the Canadian Migraine Strategy.

Conclusions:

Based upon the medical literature and expert discussion at the meeting, a national Canadian Migraine Strategy with a patient self-management focus has the potential to improve patient care and reduce headache related disability in Canada.
A Survey on the Impact of the Menstrual Cycle on Movement Disorders Severity
Authors: Castrioto Anna , Hulliger Sara , Poon Yu-Yan , Lang Anthony E. , Moro Elena
Published: December 2014

Background:

A possible influence of estrogens on the dopaminergic system has been hypothesized and investigated by several studies, and fluctuations in motor symptoms related to the menstrual cycle have been reported in some movement disorders patients. We designed a survey to quantify how frequently female patients with various movement disorders are affected by this phenomenon and its impact on symptom severity.

Methods:

A questionnaire was sent to 104 women between 18- and 60-years-old diagnosed with movement disorders and regularly followed at our centre.

Results:

From a total of 65 subjects who completed the questionnaire, 54 women reported the onset of their movement disorders before menopause. Twenty of them (37%) experienced changes in their movement disorders during the menstrual cycle. In particular, there was a significant worsening of symptom severity before (p=0.0005) and during menses (p=0.0004).

Conclusions:

The possible role of such changes should be taken into account when evaluating the efficacy of various therapeutic interventions in movement disorder patients.
Carotid Stenting in Asymptomatic Carotid Stenosis: The Calgary Experience
Authors: Shobha N. , Almekhlafi M. A. , Pandya A. , Couillard P. L. , Morrish W. F. , Wong J. H. , Hill M. D.
Published: December 2014

Background:

Although carotid endarterectomy is considered the ‘gold standard’ for standard risk symptomatic patients, the treatment of choice for asymptomatic patients remains controversial. Carotid stenting has demonstrated real-world outcomes consistent with established guidelines for carotid endarterectomy in asymptomatic high-surgical risk patients in recent prospective multicenter trials. We describe our experience with asymptomatic patients who underwent carotid stenting at our center in a routine clinical setting.

Methods:

This is a retrospective, longitudinal cohort study of patients who underwent carotid angioplasty and stenting at the Foothills Medical Center, Calgary, Canada between 1997 and 2007. The qualifying events were categorized as symptomatic and asymptomatic. The procedures were performed by four experienced neurointerventionists. The primary outcome was stroke or death at 30-day follow- up.

Results:

243 patients underwent 255 carotid stenting procedures. Their ages ranged from 50 to 83 years; the mean age was 72.0 ± 9.3 years; 67(26.3%) were women. Forty one patients (16.1%) were asymptomatic; 214 patients (83.9%) were symptomatic. The patients in the asymptomatic group were significantly younger - 66.0 ± 8.8 years compared to patients in the symptomatic group 73.2 ± 8.9 years (p<0.0001). Intraprocedurally one minor stroke (2.4%) occurred in the asymptomatic group. At 30-day follow-up, no deaths or further strokes were noted in the asymptomatic group; while eight deaths, six major and seven minor strokes occurred in the symptomatic group (p=0.22).

Conclusion:

Carotid stenting appears to be a safe procedure in asymptomatic patients with severe carotid stenosis in routine clinical settings as witnessed in this single center study.
Sources of Error in Neuropathology Intraoperative Diagnosis
Authors: Meyer Matthew , Keith-Rokosh Julia , Reddy Hasini , Megyesi Joseph , Hammond Robert R.
Published: December 2014

Objective:

The goal of this study was to optimize intraoperative neuropathology consultations by studying trends and sources of diagnostic error. We hypothesized that errors in intraoperative diagnoses would have sampling, technical, and interpretive sources. The study also audited diagnostic strengths, weaknesses and trends associated with increasing experience. We hypothesized that errors would decline and that the accuracy of “qualified” diagnoses would improve with experience.

Methods:

The pathologist's first 100 cases (P1), second 100 (P2), and most recent 100 (P3, after ten years in practice) formed the data set. Intraoperative diagnoses were scored as correct, minor error or major error using the final diagnosis as the gold-standard. Incorrect diagnoses were re-examined by two reviewers to identify sources of error.

Results:

Among the 300 cases there were 22 errors with 11 in P1, 9 in P2 and 2 in P3. Sampling contributed to 17 errors (77%), technical factors to 7 (32%) and interpretive factors to 16 (73%). Improvement in diagnostic accuracy between P1 and P2 (p=0.8143), or P2 and P3 (p=0.0582) did not reach significance. However, significant improvement was found between P1 and P3 (p=0.0184).

Conclusion:

The present study was a practical and informative audit for the pathologist and trainees. It reaffirmed the accuracy of intraoperative neuropathology diagnoses and informed our understanding of sources of error. Most errors were due to a combination of sampling, technical and interpretive factors. A significant improvement in diagnostic proficiency was observed with increasing experience.
Environmental and Familial Risk Factors of Parkinsons Disease: Case-Control Study
Authors: Sanyal Jaya , Chakraborty D. P. , Sarkar Biswanath , Banerjee Tapas Kumar , Mukherjee Subhash Chandra , Ray Bidhan Chandra , Rao V. R.
Published: December 2014

Background:

While the cause of Parkinson's disease (PD) remains unknown, evidence suggests certain environmental factors, such as well water drinking, herbicides, pesticides exposure and neurotoxins, may trigger the chain of oxidative reactions culminating in the death of dopaminergic neurons in substantia nigra to cause Parkinsonism. To investigate the possible impact of environmental risk factors for idiopathic PD, a case-control study was performed in the Eastern India.

Methods:

During the period from January 1st, 2006 and December 10th, 2009, 175 PD patients (140 men, 35 women) and 350 non-Parkinson age-sex matched controls were included in the study. Subjects were given a structured neurological examination and completed an administered questionnaire which elicited detailed information on demographic data, pesticides, herbicides family history, occupation, dietary and smoking habits.

Results:

The multivariate analysis revealed that family history of PD, pesticide exposure, exposure to toxins other than pesticides and herbicides, rural living and previous history of depression were associated with increased risk of PD, whereas, smoking appeared to be a protective factor. Well water drinking for at least five years, though a significant risk factor on univariate analysis (OR=4.5, 95% CI=2.1-9.9), could not be proved significant in multivariate analysis. Head trauma, vegetarian dietary habit, occupation involving physical exertion and exposure to domestic pets were not as significant risk factors.

Conclusion:

Results of our study support the hypothesis of multifactorial etiology of PD with environmental factors acting on a genetically susceptible host.
Use of Tissue Glues in Endoscopic Pituitary Surgery: A Cost Comparison
Authors: Kus Lukas H. , Rotenberg Brian W. , Duggal Neil
Published: December 2014

Background:

Post-operative cerebrospinal fluid (CSF) leaks are a common complication of endoscopic pituitary surgery and account for a significant proportion of hospital costs associated with this procedure. Tisseel® is a tissue glue commonly used as an adjunct in dural repair but is not optimal for this purpose. DuraSeal® has several properties advantageous for dural repair but is not widely accepted in Canada partly due to its increased cost.

Objective:

A cost analysis of DuraSeal® versus Tisseel® in endoscopic pituitary surgery.

Methods:

A cost analysis was performed based on typical endoscopic pituitary surgery cases performed at our tertiary care institution. Operating room, hospital admission, and surgical sealant costs were obtained directly while estimates of patient recovery time and post-operative CSF leak rates were based on consensus values reported in the literature. Outcomes were reported for various possible clinical scenarios of sealant use.

Results:

In a model where surgical sealant is employed only in high-risk cases, use of DuraSeal® allows for a yearly cost savings of at least $4486.72. If surgical sealant is used in all cases, regular use of DuraSeal® versus Tisseel® either marginally reduces yearly costs or increases them by a maximum of $7619.25, depending on the case volume and estimated post-operative CSF leak rate.

Conclusion:

In most clinical scenarios, use of DuraSeal® in endoscopic pituitary surgery may reduce overall yearly hospital costs compared to Tisseel®.
The Significance of Frontal Intermittent Rhythmic Delta Activity in Children
Authors: Menascu Shay , Mohamed Ismail , Tshechmer Shany M. , Shroff Manohar , Cortez Miguel A.
Published: December 2014

Objective:

To determine the correlation between frontal intermittent rhythmic delta activity (FIRDA) and the clinical and radiological correlates in children.

Methods:

Retrospective review of the EEG and imaging studies of 37 children with documented FIRDA.

Results:

FIRDA was associated with multiple neurological conditions and not necessarily with midline lesions. Patients with abnormal neurological exam had a longer FIRDA duration (average 9.5 seconds) compared to children with no reported abnormal examination (average of 6.5 seconds). FIRDA ranged from 2 to 2.5 Hz (n=15), 3 Hz (n=17) and from 1.5 to 3 Hz (n=5) and there was a significant association between the duration of FIRDA and abnormal laboratory tests (p. < 0.05, Student's T test).

Conclusion:

FIRDA was not correlated with midline brain lesions in children. FIRDA may be a non specific oscillation of an unhealthy pediatric brain with or without seizures.
Third Nerve Palsy: Analysis of 1400 Personally-examined Inpatients
Authors: Keane James R.
Published: December 2014

Background:

Most studies of third nerve palsy (TNP) antedate computerized imaging and focus primarily on chart review of referral outpatients.

Methods:

To compare a large contrasting population, I reviewed 1400 personally-examined municipal hospital inpatients with TNPs seen over 37 years.

Results:

TNPs were bilateral in 11%, complete in 33%, without other neurological signs (isolated) in 36%, and associated with recurrent cranial neuropathies in 7%. Third nerve damage occurred in the subarachnoid space in 32%, the cavernous sinus in 23%, the brainstem in 14%, as a nonlocalized peripheral neuropathy in 18% and at an uncertain location in 13%. Causes were trauma (26%), tumor (12%), diabetes (11%), aneurysm (10%), surgery (10%), stroke (8%), infection (5%), Guillain-Barre and Fisher syndromes (5%), idiopathic cavernous sinusitis (3%), benign self-limited (2%), miscellaneous (4%), and unknown (3%). Local causes, besides an abundance of trauma, included six cases involving cysticercosis, four with wound botulism, and one with coccidiomycotic meningitis. Of 234 patients with diabetes, microvascular ischemia was the cause of TNP in only two-thirds (five had aneurysms) and 53% of those with diabetic microvascular ischemia had pupillary involvement—often bilateral, suggesting concomitant autonomic neuropathy. Only 2% of aneurysms spared the pupil. Apainful onset occurred with 94% of aneurysm and 69% of diabetic cases.

Conclusions:

Bilateral TNPs, multiple cranial neuropathies, and accompanying neurological signs were common among our inpatients, as were causes rare in outpatient settings such as severe trauma, transtentorial herniation, midbrain strokes, and the Guillain-Barre syndrome. Few cases remained undiagnosed and nondiabetic ischemia was rare.
Functional Impairment in Patients with Sporadic Inclusion Body Myositis
Authors: Dunlap Heather V. , MacNeil Lauren G. , Tarnopolsky Mark A.
Published: December 2014

Introduction:

We conducted a retrospective chart review of 53 patients diagnosed with sporadic Inclusion Body Myositis (sIBM) who have been followed at the McMaster Neuromuscular Clinic since 1996.

Objectives:

We reviewed patient medical histories in order to compare our findings with similar cohorts, and analyzed quantitative strength data to determine functionality in guiding decisions related to gait assistive devices.

Methods:

Patient information was acquired through retrospective clinic chart review.

Results:

Our study found knee extension strength decreased significantly as patients transitioned to using more supportive gait assistive devices (P < 0.05). A decline to below 30 Nm was particularly indicative of the need for a preliminary device (i.e. cane)(P < 0.05). Falls and fear of falling poses a significant threat to patient physical well-being. The prevalence of dysphagia increased as patients required more supportive gait devices, and finally a significant negative correlation was found between time after onset and creatine kinase (CK) levels (P < 0.01).

Conclusion:

This study supports that knee extension strength may be a useful tool in advising patients concerning ambulatory assistance. Further investigations concerning gait assistive device use and patient history of falling would be beneficial in preventing future falls and improving long-term patient outcomes.
Referrals, Wait Times and Diagnoses at an Urgent Neurology Clinic over 10 Years
Authors: Wile D.J. , Warner J. , Murphy W. , Lafontaine A.L. , Hanson A. , Furtado S.
Published: December 2014

Background:

An urgent neurology assessment clinic was created at our institution to improve access to prompt neurological assessment, and has been in operation for over a decade. We assessed its timeliness and impact.

Methods:

The clinic database was examined retrospectively for trends in the volume and waiting time to assessments, neurologic diagnoses, and whether neurologic assessment changed patients’ diagnoses. Before and after implementation, the frequency of emergency department neurology assessments and hospital admissions for neurological investigation were compared.

Results:

In the first decade, 25145 referrals were received; 12460 patients were accepted and assessed within an average of 3.8 working days. The most common problems seen included headache and seizure (20.2% each). Overall, 44.6% of assessments resulted in a change to the referring diagnosis; this proportion varied by the type of problem seen (from 10.5% for seizures to 92.5% for psychiatric disturbances). From the pre- to post-opening periods, there were fewer emergency room neurological assessments (35.7% reduction) and fewer hospital admissions for neurological investigation (4.4/week to 2.2/week, 50% reduction).

Conclusions:

The urgent neurology clinic model at our institution has provided excellent service, including wait times of a few days, to a catchment of over two million Canadians for over a decade; clinic assessments have affected diagnoses and patient care.
Contralesional Spasticity of Conjugate Gaze in Striatocapsular Infarction
Authors: Park Jin-Woo , Choi Jeong-Yoon , Jung Jin-Man , Kwon Do-Young , Park Moon Ho , Kim Ji-Soo
Published: December 2014

A 44-year-old man developed sudden non-fluent aphasia and right hemiplegia due to left striatocapsular infarction (Figure). Neurologic examination revealed gaze deviation to the right with eyes closed, but not with eyes open (Video). There was no spontaneous or gaze-evoked nystagmus, even after elimination of visual fixation. Leftward pursuit was impaired in a craniotopic frame of reference, and horizontal saccades were hypometric in both directions. Head impulse test was normal in the horizontal plane and there were no visual field defects. The contralesional gaze deviation with eye closure persisted for ten days.
Decompressive Craniectomy: Contralateral Lesions and Metabolic Abnormalities
Authors: Zeiler F.A. , West M.
Published: December 2014

Objective:

To define the incidence of new contralateral intracranial lesions following decompressive hemicraniectomy for blunt traumatic brain injury, and explore the potential association with metabolic factors that contribute to coagulopathy.

Methods:

We retrospectively reviewed the records and imaging of all patients treated with hemicraniectomy for blunt traumatic brain injury at our institution from May 2007 up to and including January 2012.

Results:

Twenty patients were identified during the time period to have undergone decompressive craniectomy for blunt head injury. The average age and Glasgow Coma Scale on presentation was 44.1 years (range: 19 – 72 years) and 6.5 (range: 3 – 14) respectively. All but one patient presented with an extra-axial hematoma as their surgical indication for craniectomy. Seven patients (35.0%) developed new contralateral lesions post-craniectomy. The average peri-operative pH, bicarbonate (HCO3) and hematocrit (HCT) levels for those with new contralateral lesions were lower than those without new lesions. Five of the seven patients (71.4%) with new lesions had abnormalities on their laboratory results that have been know to be attributable to coagulopathy, with four (57.1%) having two or more abnormal results. Eight of 13 (61.5%) patients without new lesion had laboratory abnormalites, with five (38.5%) having two or more abnormalities identified.

Conclusions:

The incidence of new contralateral lesions post-craniectomy for blunt head injury is 35.0% in our experience. There is an association between the metabolic derangements linked to trauma related coagulopathy and the formation of new lesions.