bluuebunny/crossref_metadata_2025 huggingface dataset:
Canadian Association of Neurosciences Review: Prion Protein and Prion Diseases: The Good and the Bad
Authors: Gains Malcolm J. , LeBlanc Andrea C.
Published: December 2014

In the 1700's a strange new disease affecting sheep was recognized in Europe. The disease later became known as “Scrapie” and was the first of a family of similar diseases affecting a number of species that are now known as the Transmissible Spongiform Encephalopathies (TSEs). The appearance of a new disease in humans linked to the consumption of meat products from infected cattle has stimulated widespread public concern and scientific interest in the prion protein and related diseases. Nearly 300 years after the first report, these diseases still merit the descriptor “strange”. This family of diseases is characterized by a unique profile of histological changes, can be transmitted as inherited or acquired diseases, as well as apparent sporadic spontaneous generation of the disease. These diseases are believed by many, to be caused by a unique protein only infectious agent. The “prion protein” (PrPC), a term first coined by Stanley Prusiner in 1982 is crucial to the development of these diseases, apparently by acting as a substrate for an abnormal disease associated form. However, aside from being critical to the pathogenesis of the disease, the function of PrPC, which is expressed in all mammals, has defied definitive description. Several roles have been proposed on the basis ofin vitrostudies, however, thus far,in vivoconfirmation has not been forthcoming. The biological features of PrPCalso seem to be unusual. Numerous mouse models have been generated in an attempt to understand the pathogenesis of these diseases. This review summarizes the current state of histological features, the etiologic agent, the normal metabolism and the function of the prion protein, as well as the limitations of the mouse models.
Human Tonotopic Maps and their Rapid Task-Related Changes Studied by Magnetic Source Imaging
Authors: Ozaki Isamu , Hashimoto Isao
Published: December 2014

A brief review of previous studies is presented on tonotopic organization of primary auditory cortex (AI) in humans. Based on the place theory for pitch perception, in which place information from the cochlea is used to derive pitch, a well-organized layout of tonotopic map is likely in human AI. The conventional view of tonotopy in human AI is a layout inwhich the medial-to-lateral portion of Heschl's gyrus represents high-to-low frequency tones. However, we have shown that the equivalent current dipole (BCD) in auditory evoked magnetic fields in the rising phase of N100m response dynamically moves along the long axis of Heschl's gyrus. Based on analyses of the current sources for high-pitched and low-pitched tones in the right and left hemispheres, we propose an alternative tonotopic map in human AI. In the right AI, isofrequency bands for each tone frequency are parallell to the first transverse sulcus; on the other hand, the layout for tonotopy in the left AI seems poorly organized. The validity of single dipole modelling in the calculation of a moving source and the discrepancy as to tonotopic maps in the results between auditory evoked fields or intracerebral recordings and neuroimaging studies also are discussed. The difference in the layout of isofrequency bands between the right and left auditory cortices may reflect distinct functional roles in auditory information processing such as pitch versus phonetic analysis.
Acute Chorea with Bilateral Basal Ganglia Lesions in Diabetic Uremia
Authors: Park Jong-Ho , Kim Han-Joon , Kim Seong-Min
Published: December 2014

Uremia is a syndrome of clinical and metabolic abnormalities, which develops in parallel with the deterioration of renal function. Uremic encephalopathy is one of many manifestations of acute or chronic renal failure. It is usually applied to patients with cortical involvement, such as confusion, seizure, tremor, myoclonus, or asterixis. Some cases of acute extrapyramidal movement disorders associated with bilateral basal ganglia lesions, especially parkinsonism have been reported in uremic patients. Here, we report a diabetic uremic patient who developed acute chorea associated with bilateral basal ganglia lesions.
Cardioembolism: A Rare Cause of Jaw Claudication
Authors: Toffoli Daniela , Élysée Stanley , Dominguez Manuel J. , Lanthier Sylvain
Published: December 2014

Jaw claudication (JC) results from ischemia of the masticatory muscles, typically caused by temporal arteritis and other arteriopathies affecting the external carotid artery (ECA).

We documented a case of JC resulting from cardioembolic occlusion of the ECA and searched both English and French literature on the Medline database (1966-October 2006) to identify previous reports. We combined the keywords “jaw claudication” with either “cardiogenic embolism”, “cardiac embolism”, “cardioembolism”, “etiology”, “cause”, or “carotid occlusion”.
Systemic Lupus Erythematosus and Right Leg Weakness
Authors: Steckley J. L. , Tartaglia M. C. , Reddy H. , Huang S. , Hammond R. , Hyson C.
Published: December 2014

A 40-year old female presented to the emergency room at London Health Sciences Centre with a one week history of gradually progressive right leg weakness which had caused several falls. She also described numbness of the right arm and leg. In the two weeks leading up to admission she experienced gradually worsening shortness of breath, fatigue, anorexia, confusion, night sweats and somnolence. She also developed a herpetic rash of the right upper thigh which was treated with acyclovir and gabapentin.

Her past medical history was significant for a diagnosis of systemic lupus erythematosis (SLE) for seven years, treated at the time of admission with azathioprine 50 mg TID (several years duration), prednisone 5 mg BID, and hydroxyquine 400 mg daily. She also had a history of asthma and occasionally required Ventolin treatment. She had a 25 pack-year smoking history.
Bowel Injury following Lumbar Discectomy using Minimally Invasive Retractors
Authors: Cenic Aleksa , Sne Niv , Lisi Michael , Okrainac Allan , Reddy Kesava
Published: December 2014

Prevalence of symptomatic lumbar disc herniation is 1-3% in the adult population. When conservative therapy (e.g., physiotherapy, anti-inflammatories, epidural injections, etc.) fails, open microsurgical discectomy is regarded as the treatment of choice.With this procedure, the incidence of injury to visceral bowel is reported to be 3.8 per 10,000 cases. With the recent advent of tubular retractor systems, an increasing number of surgeons are using this minimally invasive procedure to replace traditional open microsurgical discectomy. The advantages include a smaller skin incision and a muscle splitting rather than muscle incising technique. As a result post-operative pain, blood loss and length of hospital stay may decrease significantly. Multiple studies have compared the two surgical techniques with regards to their clinical outcomes. The results of these studies reveal equal if not superior clinical outcomes with the minimally invasive technique. Despite the success of the minimally invasive microdiscectomy, none of the studies reported any intraoperative complications using this novel technique.
Rapid Evaluation after High-Risk TIA is Associated with Lower Stroke Risk
Authors: Wu Caren M. , Manns Braden J. , Hill Michael D. , Ghali William A. , Donaldson Cam , Buchan Alastair M.
Published: December 2014

Background:

Current ‘standard of care’ for patients presenting with a ‘high-risk’ TIA varies, with use of several outpatient and inpatient approaches. We describe the clinical outcomes and costs for high risk TIA patients who received care in a ‘rapid evaluation unit’, and compare these to a historical ‘high-risk’ cohort.

Methods:

The study cohort was comprised of patients with TIA admitted to a ‘rapid evaluation unit’ during the period March 2002 to April 2003. The comparison cohort was established by screening Calgary Health Region ER discharge records to identify all patients presenting with a diagnosis of TIA during the year 2000. A ‘high-risk standard care cohort’ was then identified based on the clinical admission criteria used to select patients for the rapid evaluation unit. Outcomes (stroke within 90 days, death) and costs were identified using chart review and provincial administrative data.

Results:

The early risk of stroke in the high risk standard care group (392 patients) was 9.7%, compared to 4.7% in the rapid evaluation cohort (189 patients) (p=0.05). Median 1-year costs post TIA were CAN$8360 for patients in the rapid evaluation cohort, compared with CAN$4820 for patients in the high risk standard care group (p<0.001).

Conclusions:

The risk of early stroke was lower for patients in the rapid evaluation cohort compared to the high risk standard care cohort, suggesting that the use of rapid evaluation programs in patients with TIA at high risk of stroke may be beneficial, but incur greater costs over the course of the first year.
Intra-Familial Incidence and Characteristics of Hot Water Epilepsy
Authors: Kaplan Yuksel , Kurt Semiha G. , Karaer Hatice , Sarikaya Basar , Bebek Nerses
Published: December 2014

Objective:

To assess the clinical features of several members of the same family diagnosed with both hot water epilepsy (HWE) and cerebral lesions.

Methods:

Age at onset and types of seizure, precipitating factors, EEG findings, and neuroimages were evaluated.

Results:

The family consisted of six generations, including one consanguineous parent. Of eight family members diagnosed with epilepsy, seven suffered from HWE. Age at onset of seizures ranged within childhood. Seven patients with HWE experienced complex partial seizures, with or without secondary generalization; one experienced simple partial seizures as well as complex partial seizures. Three patients experienced spontaneous seizures as well as HWE. Interictal EEG revealed abnormalities in two patients. Magnetic resonance imaging revealed cerebral lesions in one patient, probably attributable to ischemic changes. Magnetic resonance images were consistent with findings of ischemic gliosis in two patients, and either demyelinating or ischemic gliosis in one patient.

Conclusions:

Descriptions of HWE families with different ethnic backgrounds may permit more definite conclusions regarding the mechanisms epileptogenesis, and the genetic defects that underlie this disease.
A Review of Ancillary Tests in Evaluating Brain Death
Authors: Heran Manraj K.S. , Heran Navraj S. , Shemie Sam D.
Published: December 2014

The neurological determination of death (NDD) is primarily considered to be clinical. However, situations may arise where confounding factors make this clinical assessment difficult or impossible. As a result, ancillary tests have been developed in order to aid in the confirmation of brain death. As assessment of neuronal electrical activity; electroencephalography (EEG) is no longer recommended in this determination, tools assessing cerebral perfusion, as reflected by the presence or absence of cerebral blood flow (CBF), are the mainstay of NDD. The preferred ancillary test currently is Hexamethylpropylene amine oxime-single photon emission computed tomography (HMPAO SPECT) radionuclide angiography. When this is not available, or is equivocal, 4-vessel cerebral angiography can be used to determine the presence or absence of intracranial blood flow. However, as cerebral angiography has its own limitations, other techniques are sought by physicians in the Intensive Care and Neuro-intensive Care settings to replace cerebral angiography. In this article, we briefly review the history of diagnosis of brain death, pathophysiologic issues in making this determination, and currently available CBF imaging techniques, discussing each in turn with respect to their utility in the diagnosis of brain death.
Unruptured Cerebral Aneurysms Presenting with Ischemic Events
Authors: McLaughlin Nancy , Bojanowski Michel W.
Published: December 2014

Background:

Patients harboring an unruptured cerebral aneurysm may present with ischemic events. The goal of this study is to assess the clinical and radiological characteristics and the outcome following treatment of these patients.

Methods:

The study population included 463 patients with unruptured cerebral aneurysms treated between January 2000 and November 2006. Patients with aneurysms manifesting with ischemic events were included. Outcome was assessed 12 months following aneurysm treatment using the modified Rankin scale.

Results:

Eleven patients were included in this series. An acute ischemic lesion in the symptomatic territory was demonstrated in six patients. The aneurysms were located on the internal carotid artery (n=4), middle cerebral artery (n=4), superior cerebellar artery (n=2) and basilar artery (n=1). They measured 10mm or less (n=7); 11-20mm (n=2); more than 21mm (n=2). Five aneurysms were partially thrombosed on imaging. Five patients were referred for coiling. Of these, one patient had an unsuccessful coiling attempt, one had a residual neck, and three presented an aneurysm recurrence. Six patients were treated surgically. Symptomatic thromboembolism occurred after surgery in three patients. Complete aneurysm exclusion was documented in five of six operated patients. Nine of the ten treated patients had a favorable outcome.

Conclusion:

Even though aneurysms presenting with ischemic events are often small and located on the anterior circulation, in this series the risk of thromboembolic events following aneurysm treatment is noteworthy. This information is relevant given the possible benign natural history in terms of stroke and risk of bleeding for some of these aneurysms.
Oscillatory Characteristics of Nociceptive Responses in the SII Cortex
Authors: Hsiao Fu-Jung , Chen Wei-Ta , Liao Kwong-Kum , Wu Zin-An , Ho Low-Tone , Lin Yung-Yang
Published: December 2014

Objective:

This study is aimed to explore the frequency characteristics of pain-evoked neuromagnetic responses in the secondary somatosensory (SII) cortices.

Methods:

Thulium-laser nociceptive stimuli to the left hand dorsum of 10 right-handed healthy adults. The pain stimuli were rated as mild, moderate, and severe levels according to subjects' reports on a 10-point visual analog scale. We analyzed their cortical responses with wavelet-based frequency analyses and equivalent current dipole (ECD) modeling.

Results:

For each pain level, we found an increase of theta (4-8 Hz) and alpha (8-13 Hz) power in bilateral SII areas at 180-210 ms after stimulus onset. The power was larger for the moderate than for the mild pain level (p < 0.05), but there was no statistical power difference of these oscillations between moderate and severe pain stimulus conditions (p = 0.7). Within the SII area, we did not observe particular difference in theta and alpha ECD locations between varying pain level conditions.

Conclusions:

The 4-13 Hz activities, peaking from 180 to 210 ms, are oscillatory correlates of SII activation in response to nociceptive stimulation, but their power may code the magnitude of pain stimuli only up to moderate level, as rated subjectively. This measure could be potentially used to evaluate SII activation in further pain studies.
The Thumb Rolling Test: A Novel Variant of the Forearm Rolling Test
Authors: Nowak Dennis A.
Published: December 2014

Background:

Neurologists use a variety of tests to detect subtle upper motor neuron lesion causing a mild motor impairment of the upper limb. The forearm and index finger rolling tests are some of these. Their sensitivity varies, but in general these tests appear to be more likely to be abnormal in mild motor impairment of the arm and hand due to a cortico-spinal tract lesion than tests of power, muscle tone or reflexes. Thumb rolling involves more distal limb segments than forearm rolling and distal limb segments are typically more affected than proximal limb segments after cerebral lesions to the cortico-spinal tract.

Methods:

Thumb rolling was tested, in comparison to pronator drift, forearm rolling and index finger rolling, for its sensitivity to detect a cerebral lesion of the cortico-spinal tract in 17 consecutive patients with mild pure motor stroke affecting only one arm and hand.

Results:

Thumb rolling is more sensitive (88%) than pronator drift (47%), forearm rolling (65%) and index finger rolling (65%) to detect a cerebral lesion of the cortico-spinal tract in mild pure motor stroke of the upper limb.

Conclusion:

The thumb rolling test may be a valuable adjunct clinical test to detect a subtle lesion of the cortico-spinal tract causing mild pure motor stroke of the arm and hand when the remainder of routine neurological examination is unremarkable.
Reflections on the TEAM Trial: Why Clinical Care and Research Should be Reconciled
Authors: Raymond Jean
Published: December 2014

The current clinical and research environment is one that renders any true enquiry into the value of commonly performed surgical acts practically impossible. Drawing from the recent failure of Trial on Endovascular Aneurysm Management (TEAM), a trial on the endovascular management of unruptured intracranial aneurysms, I attempt to identify some principles that sustain the current ways of doing clinical research that have paradoxically become major obstacles to trials that aim to assess the potential benefit or harm due to interventions as currently practiced. Clinical research and practice must coalesce into “clinical care trials” if we are to provide patients with optimal, prudent care in the context of uncertainty. This may require a major change in the mentalities of clinicians, scientists, and patients alike, and the adoption of novel strategies for public agencies to support the integration of clinical research and care.
Stereopsis in Drug Naïve Parkinson's Disease Patients
Authors: Kim Seung-Hyun , Park Ji-Hye , Kim Yu Hwan , Koh Seong-Beom
Published: December 2014

Background:

Motor deficits associated with Parkinson's disease (PD) have been well described, yet little attention has been paid to non-motor symptoms, especially cortical visual dysfunction. We investigated stereopsis, as well as the relationship between stereopsis and other cognitive function, in a sample of PD patients.

Methods:

We used Titmus stereotest plates for assessing stereopsis. Fifty-nine subjects (29 PD patients and 30 normal controls) were included in this study. The included patients underwent a neurological examination, clinical rating scale and neuropsychological tests.

Results:

Drug naïve PD patients showed decreased stereopsis on the Titmus fly stereopsis test (Pearson χ2=23.80, p<0.001) compared to PD patients with normal stereopsis. The Hoehn-Yahr stages and Unified Parkinson's Disease Rating Scale motor scores were significantly higher in patients with PD with abnormal stereopsis than in patients with PD with normal stereopsis (p=0.026; p=0.046). The frequency of abnormal visual perception/constructive function was greater in patients with PD with abnormal stereopsis compared to patients with PD with normal stereopsis (Pearson χ2=5.11, p=0.024).

Conclusion:

These findings suggest that stereopsis deficits and visual perception/constructive dysfunction are common in de novo PD patients.
The Toronto Observational Study of Natalizumab in Multiple Sclerosis
Authors: Krysko Kristen M. , O'Connor Paul W.
Published: December 2014

Background:

Natalizumab is indicated for the treatment of relapsing multiple sclerosis (MS) with insufficient response to first-line disease-modifying therapy (DMT). We studied the efficacy of natalizumab for treatment of MS in a single centre observational design.

Methods:

A retrospective observational study of 146 patients [66% female; mean age 37.4; 72% relapsing remitting MS (RRMS), 28% secondary progressive MS (SPMS)] referred for natalizumab treatment at St. Michael's Hospital MS Clinic between 2007 and August 2009. Data included demographic, clinical (Expanded Disability Status Scale (EDSS) and annualized relapse rate (ARR)) and patient self-report measures.

Results:

The mean duration of treatment was 20 months in those treated with natalizumab and 97% had received prior DMTs. Eighty-three patients (57%) received at least 12 months of natalizumab treatment. In those who received at least 12 months of treatment, baseline ARR and EDSS were 1.6 and 2.7 in RRMS patients versus 1.0 and 5.4 in SPMS with relapses. The ARR decreased with natalizumab treatment to 0.38 (76% reduction, p<0.001) in RRMS versus 0.32 in SPMS patients (68% reduction, p=0.01). There was a treatment associated 11% reduction in EDSS to 2.4 (p=0.04) in RRMS, but no significant change in SPMS. Eighty-five percent of patients reported improved overall quality of life (QOL) and 62% indicated improved energy.

Conclusions:

There was a major reduction in relapse rate, stabilization in EDSS and improvement in QOL and energy in some patients on natalizumab, all similar to treatment effects in the pivotal trial.
Does Day Length Affect Cognitive Performance in Memory Clinic Patients?
Authors: Lacny Catherine , Kirk Andrew , Morgan Debra G. , Karunanayake Chandima
Published: December 2014

Objective:

To determine whether day length affects cognitive performance in rural and remote memory clinic patients.

Methods:

A rural and remote memory clinic in Saskatoon, Saskatchewan provided an opportunity to examine how cognitive performance on the Mini-Mental State Exam (MMSE) is influenced by day length. Saskatchewan is an ideal location to test this association as day length varies greatly both seasonally and geographically. Following an initial assessment by the Rural and Remote Memory Clinic (RRMC) team in Saskatoon, patient follow-up appointments were performed either in-person or via telehealth videoconference. At each follow-up appointment the clinic neurologist administered the MMSE. The relationship between day length and MMSE scores at the sixweek follow-up appointment was analyzed in 154 patients. The mean daily temperature was controlled for in the analysis. Bivariate correlate and linear regression analyses were conducted.

Results:

There was no significant association between MMSE scores and either minutes of day length or mean daily temperature.

Conclusion:

Day length does not appear to have significant effect on cognitive performance of rural and remote memory clinic patients.
Factors Predictive of Obliteration After Arteriovenous Malformation Radiosurgery
Authors: Herbert C. , Moiseenko V. , McKenzie M. , Redekop G. , Hsu F. , Gete E. , Gill B. , Lee R. , Luchka K. , Lee A. , Haw C. , Toyota B. , Martin M.
Published: December 2014

Objective:

To investigate predictive factors of complete obliteration following treatment with linac-based stereotactic radiosurgery for intracerebral arteriovenous malformations.

Methods:

Archived plans for 48 patients treated at the British Columbia Cancer Agency and who underwent post-treatment digital subtraction angiography to assess obliteration were studied. Actuarial estimates of obliteration were calculated using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards models were used for analysis of incidence of obliteration. Log-rank test was used to search for parameters associated with obliteration.

Results:

Complete nidus obliteration was achieved in 38/48 patients (79.2%). Actuarial rate of obliteration was 75.9% at 4 years (95% confidence interval 63.1%-88.6%). On univariate analysis, prescribed dose to the margin (p=0.002) and dose to isocentre (p=0.022) showed statistical significance. No parameters were significant in a multivariate model. According to the log-rank test, prescribed dose to the margin of >20 Gy (p=0.004) and dose to the isocentre of >25 Gy (p=0.004) were associated with obliteration.

Conclusion:

Reported series in the literature suggest a number of different factors are predictive of complete obliteration of arteriovenous malformations following radiosurgery. However, differing definitions of volume and complete obliteration makes direct comparison between series difficult. This study demonstrates that complete obliteration of the nidus following linear accelerator-based stereotactic radiosurgery for arteriovenous malformations appears to be most closely related to the prescribed marginal dose. In particular, a marginal dose of >20Gy is strongly associated with obtaining complete obliteration of the nidus.
Serum-Positive and -Negative AQP4 Antibody NMO in Chinese Patients
Authors: Long Youming , Lu Zhengqi , Hu Xueqiang
Published: December 2014

Objective:

To compare the clinical features of our sero-negative and sero-positive neuromyelitis optica (NMO) patients.

Methods:

Thirty-nine patients with NMO were recruited and analyzed retrospectively. Serum aquaporin 4 (AQP4) antibody status was determined by a cell-based assay. For the sero-negative patients, cerebrospinal fluid (CSF) and serum samples were re-tested using the cell-based assay and an indirect immunofluorescence assay.

Results:

By the cell-based assay, 30 patients (76.92%, 30/39), were positive for AQP4 antibodies in serum and 37 patients (94.9%, 37/39), had a CSF-positive antibody status. Seven NMO patients (17.9%, 7/39) were sero-negative by the cell-based assay but demonstrated positive CSF results. By indirect immunofluorescence, the remaining two patients, who had no AQP4 antibodies in serum or CSF by the cell-based assay, were positive for IgG antibodies in serum, which selectively targeted the central nervous system microvessels, pia, subpia, Virchow-Robin space, kidney, and stomach. There were no significant differences between the sero-positive and sero-negative NMO groups among their demographic and clinical data.

Conclusions:

Repeating the test using a different assay or CSF is helpful to clarify whether sero-negative NMO patients do in fact carry AQP4 antibodies.
Dynamic Radiosurgery at the Toronto - Bayview Regional Cancer Centre, 1988-2007
Authors: Davey P. , Schwartz M. , O'Brien P. , Gillies B.
Published: December 2014

Dynamic radiosurgery was first developed in Montreal and was subsequently adopted at the Toronto-Bayview Regional Cancer Centre in 1988. At that time radiosurgery was in its infancy in Canada. The opportunity of offering highly conformal radiation treatments for intracranial targets presented numerous technical challenges notably in the area of quality assurance. This review chronicles the development of radiosurgery at the Toronto-Bayview Regional Cancer Centre and summarises the successes and failures of the program over the following two decades.
A Review of Cases of Human Cysticercosis in Canada
Authors: Del Brutto Oscar H.
Published: December 2014

Objective:

Review of human cysticercosis in Canada, to estimate the magnitude of the disease and to describe the pattern of disease expression in this country.

Methods:

MEDLINE and manual search of case reports and case series of patients with cysticercosis diagnosed in Canada. Abstracted data included year of diagnosis, citizenship status, clinical manifestations, and form of cysticercosis.

Findings:

A total of 21 articles reporting 60 patients were found. Forty (67%) of these patients were diagnosed in the past two decades. Most cases came from Ontario (n=43) and Quebec (n=14). Immigrants accounted for 96% of the 28 cases in whom citizenship information was available. Neurocysticercosis was observed in 55 patients, and isolated compromise of striated muscles in the remaining five. Seizures was the primary or sole manifestation of the disease in 72% of patients, and most of them had parenchymal brain cysticerci (either viable cysts or calcifications). Two of seven patients were positive for Taenia eggs. In no case were household contacts of the patients investigated for taeniasis.

Conclusions:

An increasing number of patients with cysticercosis have been reported from Canada in the past two decades, suggesting that the prevalence of this parasitic disease may be on the rise. While most cases occur in immigrants, it is possible that at least some of these patients had acquired the disease in Canada.
Neuropsychiatric Lupus: Classification Criteria in Neuroimaging Studies
Authors: Netto Tania M. , Zimmermann Nicolle , Rueda-Lopes Fernanda , Bizzo Bernardo C. , Fonseca Rochele P. , Gasparetto Emerson L.
Published: December 2014

This systematic review described the criteria and main evaluations methods procedures used to classify neuropsychiatric systemic lupus erythematosus (NPSLE) patients. Also, within the evaluations methods, this review aimed to identify the main contributions of neuropsychological measurements in neuroimaging studies. A search was conducted in PubMed, EMBASE and SCOPUS databases with the terms related to neuropsychiatric syndromes, systemic lupus erythematosus, and neuroimaging techniques. Sixty-six abstracts were found; only 20 were completely analyzed and included. Results indicated that the 1999 American College of Rheumatology (ACR) criteria is the most used to classify NPSLE samples together with laboratorial, cognitive, neurological and psychiatric assessment procedures. However, the recommended ACR assessment procedures to classify NPSLE patients are being used incompletely, especially the neuropsychological batteries. Neuropsychological instruments and neuroimaging techniques have been used mostly to characterize NPSLE samples, instead of contributing to their classifications. The most described syndromes in neuroimaging studies have been seizure/cerebrovascular disease followed by cognitive dysfunctions as well as headache disorder.
Sleep-laughing – Hypnogely
Authors: Trajanovic Nikola N. , Shapiro Colin M. , Milovanovic Srdjan
Published: December 2014

Objective:

To explain relatively common phenomenon of laughing during sleep and help to better define criteria for differentiating between physiological and pathological sleep-laughing.

Methods:

Observational study of patients who underwent a sleep assessment in a referential tertiary health facility.

Results:

A total of ten patients exhibited sleep laughing, nine of whom had episodes associated with rapid eye movement (REM) sleep. Also, in one of the patients sleep-laughing was one of the symptoms of REM sleep Behaviour Disorder, and in another patient sleep-laughing was associated with NREM sleep arousal parasomnia.

Conclusion:

The collected data and review of literature suggests that hypnogely in majority of the cases presents as a benign physiological phenomenon related to dreaming and REM sleep. Typically, these dreams are odd, bizarre or even unfunny for a person when awake. Nevertheless, they bring a sense of mirth and a genuine behavioural response. In a minority of cases, sleep-laughing appears to be a symptom of neurological disorders affecting the central nervous system. In these patients the behavioural substrate differs when compared to physiological laughing, and the sense of mirth is usually absent.
Delays in Carotid Endarterectomy: The Process is the Problem
Authors: Blacquiere Dylan , Sharma Michael , Jetty Prasad
Published: December 2014

Background:

Current recommendations for carotid endarterectomy (CEA) for symptomatic carotid stenosis state benefit is greatest when performed within two weeks of symptoms. However, only a minority of cases are operated on within this guideline, and no systematic examinations of reasons for these delays exist.

Methods:

All CEA cases performed at our institution by vascular surgery for symptomatic carotid stenosis after neurologist referral in 2008-2009 were reviewed. Dates of symptom onset, initial presentation, referral to and evaluation by neurology and vascular surgery, vascular imaging, and CEA were collected, and the length of time between each analysed. Reasons for delays were noted where available.

Results:

Of 36 included patients, 34 had CEA more than two weeks after symptom onset. Median time to CEA from onset was 76 days (IQR, 38-105 days). Longest intervals were between surgeon assessment and CEA (14 days; IQR, 9-21 days), neurology referral and neurologist assessment (9 days; IQR, 2-26 days), vascular imaging and referral to vascular surgery (9 days; IQR, 2-35 days) and vascular surgery referral and assessment (8 days; IQR, 6-15 days). Few patients (44.1%) had reasons for delays identified; of these, process-related delays were related to delayed vascular imaging, delayed referral by primary care physicians, or multiple conflicting referrals.

Conclusions:

There are significant delays between symptom onset and CEA in patients referred for CEA, with delay highest between specialist referral and evaluation. Strategies to reduce these delays may be effective in increasing the proportion of procedures performed within two weeks of symptom onset.
Immune Cell Infiltrates in Atypical Teratoid/Rhabdoid Tumors
Authors: Lu Jian-Qiang , Wilson Beverly A. , Yong V. Wee , Pugh Jeffrey , Mehta Vivek
Published: December 2014

Objective:

Atypical teratoid/rhabdoid tumor (AT/RT) is a highly malignant tumor of the central nervous system. Its pathogenesis remains unknown. Like glioblastomas, AT/RTs contain brain cancer stem cells (CSCs) that suppress the immunity of patients and are resistant to conventional chemotherapy and radiation therapy. Considerable infiltration of immune cells, including macrophages/microglia, dendritic cells and T-cells, has been noted in glioblastomas, which correlates with poor prognosis. The present study examines the significance of infiltrating immune cells in four cases of AT/RT; including one associated with an autoimmune disease, Henoch-Schonlein purpura.

Methods:

Tumor tissues from four patients with AT/RT were analyzed and compared with those from four patients with glioblastomas. The frequency of immune cells, including CD68+, CD4+, and CD8+ cells, was assessed by scoring for statistical analysis.

Results:

The infiltration of immune cells was identified in the case of AT/RT associated with HSP and three other cases of infratentorial AT/RTs. Moderate infiltration of CD68+ macrophages/microglia and CD4+ cells was noted in AT/RTs with no significant difference from that in glioblastomas (p> 0.05). However, the infiltration of CD8+ T-cells was significantly higher in AT/RTs than that in glioblastomas (p< 0.05); CD4+/CD8+ ratio was significantly lower in AT/RTs than that in glioblastomas (p< 0.05). In addition, eosinophils were found in all AT/RTs, but not in glioblastomas.

Conclusions:

These findings suggest an immune microenvironment of AT/RTs with more immune effectors than glioblastomas. Our observation contributes to understanding the growth environment of AT/RTs for which adjuvant immunotherapy may be potentially beneficial.
Delays in Initiation of Acyclovir Therapy in Herpes Simplex Encephalitis
Authors: Hughes Peter S. , Jackson Alan C.
Published: December 2014

Background:

Diagnosis of herpes simplex encephalitis (HSE) is based on clinical findings, MRI, and detection of herpes simplex virus (HSV) DNA in cerebrospinal fluid (CSF) using polymerase chain reaction amplification. Delays in starting treatment are associated with poorer clinical outcomes. We assessed the timing of initiation of acyclovir therapy in HSE.

Methods:

Inpatient databases from seven hospitals in Winnipeg, Manitoba were used to identify individuals diagnosed with encephalitis and HSE from 2004 to 2009. The time taken to initiate therapy with acyclovir and the reasons for delays were determined.

Results:

Seventy-seven patients were identified; 69 (90%) received acyclovir; in the others a non-HSV infection was strongly suspected. Thirteen patients were subsequently confirmed to have HSE. Acyclovir was initiated a median of 21 hours (3-407) after presentation in encephalitis cases, and a median of 11 hours (3-118) in HSE. The most common reason for delay was a failure to consider HSE in the differential diagnosis, despite suggestive clinical features. Where therapy was delayed in HSE patients, the decision to begin acyclovir was prompted by transfer of the patient to a different service (55%), recommendations by consultants (18%), imaging results (18%), and CSF pleocytosis (9%).

Conclusions:

Delays in initiating acyclovir for HSE are common, and are most often due to a failure to consider HSE in a timely fashion on presentation. In order to improve patient outcomes, physicians should be more vigilant for HSE, and begin acyclovir therapy expeditiously on the basis of clinical suspicion rather than waiting for confirmatory tests.
Cerebrospinal Fluid IL-21 Levels in Neuromyelitis Optica and Multiple Sclerosis
Authors: Wu Aimin , Zhong Xiaonan , Wang Honghao , Xu Wen , Cheng Chen , Dai Yongqiang , Bao Jian , Qiu Wei , Lu Zhengqi , Hu Xueqiang
Published: December 2014

Background:

Neuromyelitis optica (NMO) and multiple sclerosis (MS) are inflammatory demyelinating diseases of human central nervous system (CNS) with complex pathogenesis. IL-21/IL-21R regulates activation, proliferation and survival of both T cells and B cells, which are involved in the pathogenesis of NMO and MS. High levels of serum IL-21 were observed in NMO patients. However, concentration of cerebrospinal fluid (CSF) IL-21 in MS and NMO patients still remain unknown.

Object:

To detect the CSF concentration of IL-21 in NMO and MS patients and to evaluate its relationship with disease activity, particularly concerned about its impact on humoral immunity.

Methods:

CSF IL-21 was detected by an enzyme-linked immunosorbent assay (ELISA) in NMO patients (n=21), MS patients (n=20) and controls (n=16).

Results:

CSF concentration of the IL-21 was noticeably elevated in NMO (p=0.012) and borderline significantly increased in MS (p=0.115). In addition, this occurrence was associated with humoral immune activity as shown by a correlation between IL-21 and complement in NMO cohort (p=0.023) and high IL-21 levels in autoantibody-positive subgroup (p=0.027).

Conclusions:

The concentration of CSF IL-21 was noticeably elevated and might have a positive correlation with humoral immune activity in NMO.
Rosette-forming Glioneuronal Tumors in the Posterior Third Ventricle
Authors: Alnaami Ibrahim , Aronyk Keith , Lu Jian-Qiang , Johnson Edward S. , O'Kelly Cian
Published: December 2014

Rosette-forming glioneuronal tumor (RGNT) is a rare brain tumor found almost exclusively within the fourth ventricle. These grade I tumors were first included in the World Health Organization (WHO) Classification for the central nervous system in 20071. Since then, approximately 49 cases have been published.

There are no reported cases of RGNT within the third ventricle, although this tumor has also been described in the pineal region, the tectum and within the aqueduct. Supratentorial localization is quite rare, with only three published: one was found in the septum pellucidum, another within the optic nerve in neurofibromatosis type 1 (NF1) patient and one in a patient with multiple RGNT in the lateral ventricle. The authors report the first case series in the literature of RGNT occurring within the posterior third ventricle.
Epilepsy Surgery in Childhood
Authors: Muro Valeria L. , Connolly Mary B.
Published: December 2014

Historically, epilepsy surgery has been considered a treatment of last resort. Advances in neuroimaging, particularly high resolution magnetic resonance imaging (MRI) techniques and functional neuroimaging, advances in neuroanesthesia and neurosurgery have all contributed to the development of safe and effective epilepsy surgery in infants and children. Furthermore, epilepsy surgery may prevent the chronic deleterious effects that uncontrolled epileptic seizures have on brain development. The main challenges that clinicians face are early identification of infants and children who have epilepsy which is amenable to epilepsy surgery, the timing of epilepsy surgery and the investigation of patients where no lesion is demonstrable on MRI. It is imperative that children be followed after epilepsy surgery to assess the long-term outcomes not only in relation to seizure control, but also to assess quality of life, psychoeducational achievement, and psychiatric co-morbidity.
Use of DALYs in economic analyses on interventions for infectious diseases: a systematic review
Authors: OOSTVOGELS A. J. J. M. , DE WIT G. A. , JAHN B. , CASSINI A. , COLZANI E. , DE WAURE C. , KRETZSCHMAR M. E. E. , SIEBERT U. , MÜHLBERGER N. , MANGEN M.-J. J.
Published: December 2014

A systematic literature review was performed on full economic evaluations of infectious disease interventions using disability-adjusted life years (DALY) as outcome measure. The search was limited to the period between 1994 and September 2011 and conducted in Medline, SciSearch and EMBASE databases. We included 154 studies, mostly targeting HIV/AIDS and malaria with most conducted for African countries (40%) and <10% in high-income countries. Third-payer perspective was applied in 29% of the studies, 25% used the societal perspective and 12% used both. Only 16% of the studies took indirect effects (i.e. herd immunity) of interventions into account. Intervention, direct healthcare and indirect non-healthcare costs were taken into account in respectively 100%, 81% and 36% of the studies. The majority of the studies followed the Global Burden of Disease method for DALY estimations, but most studies deviated from WHO cost-effectiveness guidelines. Better adherence to freely accessible guidelines will improve generalizability between full economic evaluations.
‘A Victorian community overseas’ transformed: demographic and morphological change in suburban Melbourne, Australia, 1947–1981
Authors: O’HANLON SEAMUS
Published: December 2014

One of the world's great Victorian-era suburban metropolises, Melbourne, Australia, was transformed by mass immigration and the redevelopment of some of its older suburbs with low-rise flats and apartments in the post-war years. Drawing on a range of sources, including census material, municipal rate and valuation books, immigration and company records, as well as building industry publications, this article charts demographic and morphological change across the Melbourne metropolitan area and in two particular suburbs in the mid- to late twentieth century. In doing so, it both responds to McManus and Ethington's recent call for more histories of suburbs in transition, and seeks to embed the role of immigration and immigrants into Melbourne's urban historiography.
Urban planning by obliteration of both waterways and opponents: the infilling of canals during the 1950s reconstruction of central Tokyo
Authors: HASEGAWA JUNICHI
Published: December 2014

This article examines the infilling of canals constructed in early modern times and subsequent development on newly created land in central Tokyo in the 1950s, following the curtailment of official war-damage reconstruction after World War II. New developments included a high-rise central station building, a four-storey amusement complex, an underground entertainment street and an elevated motorway. The Tokyo Metropolitan Government and Japanese National Railways were driving forces in infilling and development, which resulted in enormous political and social reactions in the local communities, newspapers and the National Diet (Parliament).
HOW CAN WE EVER KNOW WHAT WE KNOW?
Authors: Magee Bryan
Published: December 2014

The conception of knowledge that human beings have – what knowledge is, how we get it, and how we can be sure it is knowledge – is something that has always been changing. It changes historically, and it changes in the personal life of each one of us. It is changing even as I write, and will continue to change.
New low-cost broadband CPW-fed planar antenna
Authors: Dakir Rachid , Zbitou Jamal , Mouhsen Ahmed , Tribak Abdelwahed , Sanchez Amediavilla , Latrach Mohamed
Published: December 2014

The narrow bandwidth of microstrip antennas is one of the most important features that restrict its wide usage. This paper presents a new coplanar waveguide-fed compact rectangular microstrip antenna with the improvement of the bandwidth using the slot geometry and cutting rectangular periodic edges for the patch radiator. To develop this structure, we have conducted many optimization and investigation using Momentum Software integrated into ADS “Advanced Design System” and comparison of the results with CST Microwave Studio. The comparison between the simulation and measurement results permits to validate the final achieved antenna with an improvement of the bandwidth. This antenna has wide matching input impedance ranging from 1.7 to 3.5 GHz with a return loss less than −10 dB, corresponding to bandwidth 69.7% at 2.6 GHz as a frequency center. The antenna achieved is a low cost, planar, and easy to be fabricated, thus promising for multiple applications in wireless communication systems. Details of the proposed antenna design and both simulated and experimental results are described and discussed.
Premature guinea pigs: a new paradigm to investigate the late-effects of preterm birth
Authors: Berry M. , Gray C. , Wright K. , Dyson R. , Wright I.
Published: December 2014

Preterm birth is common and the associated short-term morbidity well described. The adult-onset consequences of preterm birth are less clear, but cardiovascular and metabolic health may be adversely affected. Although large animal models of preterm birth addressing important short-term issues exist, long-term studies are hampered by significant logistical constraints. Current small animal models of prematurity require terminal caesarean section of the mother; both caesarean birth and early maternal care modify offspring adult cardio-metabolic function.

We describe a novel method for inducing preterm labour in guinea pigs. With support comparable to that received by moderately preterm human infants, preterm pups are viable. Growth trajectories between preterm and term-born pups differ significantly; between term equivalent age and weaning ex-preterm animals demonstrate increased weight and ponderal index.

We believe this novel paradigm will significantly improve our ability to investigate the cardio-metabolic sequelae of preterm birth throughout the life course and into the second generation.
Caspase-1 cleavage of transcription factor GATA4 and regulation of cardiac cell fate
Authors: Aries A , Whitcomb J , Shao W , Komati H , Saleh M , Nemer M
Published: December 2014

Caspase-1 or interleukin-1β (IL-1β) converting enzyme is a pro-inflammatory member of the caspase family. An IL-1β-independent role for caspase-1 in cardiomyocyte cell death and heart failure has emerged but the mechanisms underlying these effects are incompletely understood. Here, we report that transcription factor GATA4, a key regulator of cardiomyocyte survival and adaptive stress response is an in vivo and in vitro substrate for caspase-1. Caspase-1 mediated cleavage of GATA4 generates a truncated protein that retains the ability to bind DNA but lacks transcriptional activation domains and acts as a dominant negative regulator of GATA4. We show that caspase-1 is rapidly activated in cardiomyocyte nuclei treated with the cell death inducing drug Doxorubicin. We also find that inhibition of caspase-1 alone is as effective as complete caspase inhibition at rescuing GATA4 degradation and myocyte cell death. Caspase-1 inhibition of GATA4 transcriptional activity is rescued by HSP70, which binds directly to GATA4 and masks the caspase recognition motif. The data identify a caspase-1 nuclear substrate and suggest a direct role for caspase-1 in transcriptional regulation. This mechanism may underlie the inflammation-independent action of caspase-1 in other organs.