bluuebunny/crossref_metadata_2025 huggingface dataset:
Coronary Artery Disease as a Relevant Risk Factor in Screening of Abdominal Aortic Ectasia and Aneurysm
Authors: Koshty Ahmed , Bork Magdalena , Böning Andreas , Gündüz Dursun , Pleger Sebastian Paul
Published: December 2018

Background The aim of this study was to investigate the prevalence of abdominal aortic aneurysm (AAA) and abdominal aortic ectasia (AAE) in coronary artery disease (CAD) patients in a multicenter setting to obtain significant data to establish an AAA screening program in our departments.

Methods Between January and September 2016, 500 patients with suspected or diagnosed CAD planned for coronary angiography or coronary artery bypass graft (CABG) underwent a sonographic examination of the infrarenal abdominal aorta to diagnose AAA or AAE. We calculated the prevalence of AAA and AAE in patients diagnosed of CAD and investigated factors potentially associated with the occurrence of AAA.

Results The overall prevalence in all grades of CAD for AAE was 35.1% and for AAA 5.4%. In patients with three-vessel CAD, the prevalence of AAE was 34% and of AAA 6.8%. Significant correlation was found between the three-vessel CAD and AAA (p = 0.039). The logistic regression analysis showed significant correlation between AAA and age > 65 years (p = 0.05). The multivariate analysis of risk factors and CAD revealed significant correlations between one-vessel CAD and arterial hypertension (AH) (p = 0.004) and age > 65 years (p = 0.001) as well as between three-vessel CAD and AH (p = 0.01), peripheral artery disease (p = 0.01), and age > 65 years (p = 0.03).

Conclusion Our results confirm, that in comparison to other data, the prevalence of AAA in patients with CAD is high. Thus, it is recommended to include patients with CAD, especially elderly patients with three-vessel CAD, in future AAA screening programs.
Effects of Interictal Epileptiform Discharges on Cognition
Authors: Jennekens-Schinkel Aag , Meekes Joost
Published: December 2018

Interictal epileptiform discharges (IEDs) are brief events (typically < 1 second, although some authors use a cutoff of up to 3 seconds) in the electroencephalogram (EEG), which are not accompanied by any overt change in behavior or consciousness. IEDs are associated with both chronic cognitive deficits and transient cognitive impairment (TCI). Higher IED load correlates with lower intelligence quotient (IQ) and poorer performance on tests of memory and executive function. TCI has mainly been observed during tasks that place high demands on attention, visuomotor speed, and working memory. There is evidence that IEDs may also directly interfere with episodic memory. Despite the evidence for associations between IEDs and cognitive dysfunction, there is currently scant evidence that IEDs, in fact, cause chronic cognitive deficit in humans. Although causality appears likely in the case of TCI, even here the conditions under which IEDs affect cognition are unclear. The evidence in favor of treating IEDs with medication is very limited. Attempts to treat IEDs should only be made when it is clear that cognitive impairment interferes with activities or participation. Such attempts require strong single-case designs and careful monitoring of both the EEG and cognitive function to establish the efficacy of treatment in individual patients.
Psychiatric Disorders in Children after Epilepsy Surgery: Acute, Subacute, and Chronic
Authors: Park Jun , Brooks Garrett
Published: December 2018

Psychiatric illness is highly prevalent among children with epilepsy and most commonly manifests as attentional deficits, mood dysregulation, and social isolation. While epilepsy surgery is increasingly utilized for seizure control in children with medically refractory epilepsy, its consequences with regard to psychiatric outcomes are still somewhat obscure. Epilepsy surgery may influence psychiatric outcomes in myriad ways, including through improved seizure control, decreased reliance on antiepileptic drugs, and by altering the course of a child's neurodevelopmental trajectory. This review surveys the current literature to elucidate the complex interactions between epilepsy surgery and psychiatric outcomes and attempts to delineate the progression of psychiatric manifestations in surgical patients over time. When compared with medical treatment, epilepsy surgery yields better social and behavioral outcomes in the early postoperative period; however, it is not clear that surgery is superior when assessing long-term social and behavioral metrics. Additionally, epilepsy surgery has shown promise in improving long-term cognitive outcomes, but these effects may not become apparent until several years after surgery. Moreover, longer preoperative seizure duration tends to be associated with worse psychiatric outcomes. Finally, surgical patients may be particularly vulnerable to the deleterious psychiatric effects of ongoing seizures.
Permittivity effects of particle agglomeration in ferroelectric ceramic-epoxy composites using finite element modeling
Authors: Kaufman Jonas L. , Tan Scott H. , Lau Kirklann , Shah Ashka , Gambee Robert G. , Gage Chris , MacIntosh Lupe , Dato Albert , Saeta Peter N. , Haskell Richard C. , Monson Todd C.
Published: December 2018

The size dependence of the dielectric constants of barium titanate or other ferroelectric particles can be explored by embedding particles into an epoxy matrix whose dielectric constant can be measured directly. However, to extract the particle dielectric constant requires a model of the composite medium. We compare a finite element model for various volume fractions and particle arrangements to several effective medium approximations, which do not consider particle arrangement explicitly. For a fixed number of particles, the composite dielectric constant increases with the degree of agglomeration, and we relate this increase to the number of regions of enhanced electric field along the applied field between particles in an agglomerate. Additionally, even for dispersed particles, we find that the composite method of assessing the particle dielectric constant may not be effective if the particle dielectric constant is too high compared to the background medium dielectric constant.
Finite element analysis of the wear fatigue resistance of gradient structure layers with different yield strength distributions
Authors: Wang Jian , Li Qimin
Published: December 2018

Finite element analysis (FEA) was performed to study the wear fatigue resistance of gradient structures (GSs) with different types of yield strength distributions under rolling-sliding contact. We found that the GS layer can reduce the plastic strain and surface deformation of the rail, which transfers a portion of the stress from the base layer to the gradient layer and thus enhances the wear fatigue resistance of the rail. The GS layer with a convex-shaped yield strength curve can most effectively reduce wear fatigue, followed by the GS layer with a linear-shaped yield strength curve, the GS layer with an inverse logistic-shaped yield strength curve, and the GS layer with a concave-shaped yield strength curve. The phenomenon of shakedown is also visible under repeated loading, and the GS rails step into stabilized states more easily than the original rail. The results show that the wear resistance of GSs can be improved by adjusting the yield strength curve through material processing methods or surface treatment methods, which can be used as a guideline for the wear fatigue-resistant design of heavy haul rail surfaces and other material processing methods and surface treatment methods.
Measurement of coherent surface acoustic wave attenuation in polycrystalline aluminum
Authors: Ryzy Martin , Grabec Tomáš , Österreicher Johannes A. , Hettich Mike , Veres István A.
Published: December 2018

Attenuation of Rayleigh-type surface acoustic waves induced by grain-boundary scattering is studied experimentally and theoretically by an effective medium approach. A frequency domain opto-acoustic laboratory setup, capable of measuring a coherent Rayleigh wave response by emulating an ensemble average via spatial averaging, is presented. Measurements are conducted on polycrystalline aluminum at ultrasonic frequencies from 10 MHz to 130 MHz. A constant effective phase velocity of 2893 m s−1 is found below 80 MHz. The effective attenuation coefficient varies in the whole frequency range by nearly two orders of magnitude, and shows classical scattering behavior, comprising stochastic and geometric scattering regimes. A semi-analytical attenuation model is presented, valid below the geometric limit. The model incorporates the material’s spatial two-point correlation function obtained from metallurgical micrographs. Comparisons to experimentally obtained attenuation coefficients show good quantitative agreement, with differences in the frequency power-law dependence. This study attempts to elucidate microstructure induced surface acoustic wave attenuation experimentally by means of a statistical approach. The proposed method and the obtained findings contribute to the understanding of wave propagation in heterogeneous media, and promote the use of surface acoustic waves in non-destructive microstructure characterization.
Charge transfer-tuned magnetism in Nd-substituted Gd5Si4
Authors: Kou R. H. , Gao J. , Ren Y. , Sanyal B. , Bhandary S. , Heald S. M. , Fisher B. , Sun C.-J.
Published: December 2018

We report a charge-transfer mechanism in tuning of magnetism of Nd-substituted Gd5-xNdxSi4 (x=1 and 2.5) compounds. The X-ray absorption near edge structure measurements demonstrated that Nd substitutions for Gd induce charge transfer of 5d electrons from Gd to Nd. The charge transfer weakens spin-orbital coupling of Gd but strengthens that of Nd. Consequently, the magnetization responses of the substituted compounds to low magnetic fields are increased while their saturation magnetization is reduced. Electronic structure calculations showed that the charge transfer stabilizes a ferromagnetic and a ferrimagnetic structure in the compounds with x = 1 and 2.5, respectively, but that it does not change the 5d–3p hybridization significantly. It is suggested that the charge transfer of 5d electrons may occur in other rare earth-substituted Gd5Si4 compounds allowing for tuning of their magnetism.
The frontiers of biomedical science and its application to animal science in addressing the major challenges facing Australasian dairy farming
Authors: Mitchell Murray D. , Crookenden Mallory A. , Vaswani Kanchan , Roche John R. , Peiris Hassendrini N.
Published: December 2018

Extraordinary advances are occurring in biomedical science that may revolutionise how we approach health and disease. Many have applications in the dairy industry. We have described one particular area of extracellular vesicles that have already proven to be of interest in diagnostics and prognostics for fertility and assessment of ‘transition’ cows (i.e. evaluation of the problems related to the risk of clinical diseases in dairy cows, such as mastitis and milk fever, during transition period). The addition of measurements of circulating RNA and DNA may prove of value in identifying dairy cows with higher risks of clinical diseases and potentially poor fertility. We describe the exciting opportunity provided by the possibility of generating exosomes to order as therapeutic agents to potentially enhance fertility. The even more radical concept of using exosomes to deliver a CRISPR-linked gene editing function is presented. Undoubtedly, the use of biomedical advances to assist the dairy industry is an obvious and practical approach that has significant merit.
Islamic tourism: the role of culture and religiosity.
Authors: Jamal A. , El-Bassiouny N.
Published: December 2018

This chapter aims to provide insights into the consumer behaviour of Muslim tourists and their significance as a potential target segment within the context of Halal tourism. More specifically, the chapter intends to discuss the role of religious commitment and culture in impacting Muslim tourist decision-making processes within the Halal tourism sector. The chapter first presents a brief overview of the Halal tourism sector, highlighting the need to target Muslim consumers. This is followed by a section that discusses Muslim tourist travel motivations, particularly in the context of guidance provided by the holy Quran. The chapter then presents and evaluates a stimulus-response model that assesses the extent to which the Muslim tourist consumer responds to the marketing efforts by the Halal tourism industry, and in doing so presents a conceptual framework of the industry-customer interface. The subsequent section describes the role of culture and its dimensions, drawing from the literature in marketing and social psychology. Finally, the chapter concludes with a discussion of recent research that discusses the interaction of religious commitment, cultural orientations and their potential implications for the Halal tourism industry.
Marketing approaches and problems of Islamic destinations.
Authors: Bılım Y. , Bıșkın F. , Kaynak İ. H.
Published: December 2018

The aim of this chapter is to evaluate the marketing approaches and to identify any marketing problems of Islamic destinations. Using published literature, case studies and on-line sources, the chapter examines why tourism development has not progressed in most parts of the Islamic world, as well as the main problems of Islamic travel and tourism development, the common marketing approaches of Islamic destinations, the problems with marketing, and how to solve these problems.
Sufi tourism: the impact of Sufi heritage on Islamic religious tourism.
Authors: Elhadary T.
Published: December 2018

This chapter attempts to explore the Sufi heritage and its effect in promoting Islamic religious tourism. It presents the similarities between religious and Sufi tourism. Moreover, the chapter discusses how religious tourism embodies the essence of Sufism in its search for love, peace and knowledge. The city of Konya (Turkey) is presented as a Sufi destination.
Holy foods and religious tourism: Konya and Mevlevi cuisine.
Authors: Yİlmaz M. , Güneș E. , Sormaz Ü.
Published: December 2018

This chapter discusses the dishes of Konya (Turkey) that reflect the rich culinary culture that Mevlana Celâleddîn-i Rumi described in his book, including the food for special occasions and food used in sacred regional and indoctrination ceremonies. The study also attempts to answer the following questions: (i) How did Mevlevi cuisine influence the Konya food culture? (ii) Are there any sacred books that describe Konya's food culture? (iii) Why are foods and beverages sacred? (iv) How can the forgotten foods be reintroduced?
The halal tourism: a business model opportunity.
Authors: Biancone P. P. , Secinaro S.
Published: December 2018

By focusing on Halal tourism, which is rooted in the Islamic culture and religion, this chapter demonstrates that the way to discover the world is changing and ethical tourism is moving forward. The chapter highlights ways to promote ethical and Halal tourism in the context of non-Muslim regions/countries. A case study is presented of the Halal to Company project, a university spin-off group that has ambitions to develop Halal ethical tourism in Italy.
New enzymes for peptide biosynthesis in microorganisms
Authors: Ogasawara Yasushi
Published: December 2018

Peptides, biologically occurring oligomers of amino acids linked by amide bonds, are essential for living organisms. Many peptides isolated as natural products have biological functions such as antimicrobial, antivirus and insecticidal activities. Peptides often possess structural features or modifications not found in proteins, including the presence of nonproteinogenic amino acids, macrocyclic ring formation, heterocyclization, N-methylation and decoration by sugars or acyl groups. Nature employs various strategies to increase the structural diversity of peptides. Enzymes that modify peptides to yield mature natural products are of great interest for discovering new enzyme chemistry and are important for medicinal chemistry applications. We have discovered novel peptide modifying enzymes and have identified: (i) a new class of amide bond forming-enzymes; (ii) a pathway to biosynthesize a carbonylmethylene-containing pseudodipeptide structure; and (iii) two distinct peptide epimerases. In this review, an overview of our findings on peptide modifying enzymes is presented.
Final report: key comparison EURAMET.AUV.A-K5
Authors: Avison Janine , Harris Peter , Robinson Stephen , Rodrigues Dominique , Guglielmone Claudio , Hof Christian , Sadikoglu Enver , Chushkov Marin , Zelenika Slobodan , Rosenkrantz Peter , Andersson Håkan , Fedtke Thomas , Koch Christian , Martin Nieves Medina , Ruiz Salustiano , Shawky Hany
Published: December 2018

This is the final (Draft B) report for key comparison EURAMET.AUV.A-K5 on the pressure calibration of laboratory standard microphones in the frequency range from 2 Hz to 10 kHz. Twelve national metrology institutes took part in the key comparison and the National Physical Laboratory piloted the project. Two travelling standard microphones were circulated to the participants and results in the form of regular calibration certificates were collected throughout the project. The analysis used the results for one of the microphones only and values for both sensitivity level and sensitivity phase and have been linked to the CCAUV.A K5 key comparison reference value (KCRV) via two linking laboratories (NPL and INRIM).

KEY WORDS FOR SEARCH

acoustics, microphones, metrology, key comparison, pressure calibration

Main text

To reach the main text of this paper, click on Final Report. Note that this text is that which appears in Appendix B of the BIPM key comparison database kcdb.bipm.org/.

The final report has been peer-reviewed and approved for publication by the CCAUV, according to the provisions of the CIPM Mutual Recognition Arrangement (CIPM MRA).
How to take fractional-order derivative experimentally?
Authors: Stupin D D , Lihachev A I , Nashchekin A V
Published: December 2018

In this study we demonstrate a simple and compact implementation of the fractional-order differentiator. At the heart of the proposed approach lies the “universal power law” of the capacitance dispersion of the interface between nanoporous TiN micro-electrode and NaCl 0.9% solution. Using of this phenomenon we take experimentally 0.68- and 0.77-order derivatives of various functions.
The G-protein coupled receptor ChemR23 determines smooth muscle cell phenotypic switching to enhance high phosphate-induced vascular calcification
Authors: Carracedo Miguel , Artiach Gonzalo , Witasp Anna , Clària Joan , Carlström Mattias , Laguna-Fernandez Andres , Stenvinkel Peter , Bäck Magnus
Published: December 2018

Aims

Vascular calcification, a marker of increased cardiovascular risk, is an active process orchestrated by smooth muscle cells. Observational studies indicate that omega-3 fatty acids protect against vascular calcification, but the mechanisms are unknown. The G-protein coupled receptor ChemR23 transduces the resolution of inflammation induced by the omega-3-derived lipid mediator resolvin E1. ChemR23 also contributes to osteoblastic differentiation of stem cells and bone formation, but its role in vascular calcification is unknown. The aim of this study was to establish the role of ChemR23 in smooth muscle cell fate and calcification

Methods and results

Gene expression analysis in epigastric arteries derived from patients with chronic kidney disease and vascular calcification revealed that ChemR23 mRNA levels predicted a synthetic smooth muscle cell phenotype. Genetic deletion of ChemR23 in mice prevented smooth muscle cell de-differentiation. ChemR23-deficient smooth muscle cells maintained a non-synthetic phenotype and exhibited resistance to phosphate-induced calcification. Moreover, ChemR23-deficient mice were protected against vitamin D3-induced vascular calcification. Resolvin E1 inhibited smooth muscle cell calcification through ChemR23. Introduction of the Caenorhabditis elegans Fat1 transgene, leading to an endogenous omega-3 fatty acid synthesis and hence increased substrate for resolvin E1 formation, significantly diminished the differences in phosphate-induced calcification between ChemR23+/+ and ChemR23−/− mice.

Conclusion

This study identifies ChemR23 as a previously unrecognized determinant of synthetic and osteoblastic smooth muscle cell phenotype, favouring phosphate-induced vascular calcification. This effect may be of particular importance in the absence of ChemR23 ligands, such as resolvin E1, which acts as a calcification inhibitor under hyperphosphatic conditions.
Trimodality therapy for superior sulcus tumour: experience of a single institution over 19 years
Authors: Uchida Shinsuke , Yoshida Yukihiro , Ohe Yuichiro , Nakayama Yuko , Motoi Noriko , Kobayashi Aki , Asakura Keisuke , Nakagawa Kazuo , Watanabe Shun-ichi
Published: December 2018

OBJECTIVES

Induction chemoradiotherapy followed by surgery is the standard treatment for superior sulcus tumours (SSTs). However, the protocols, chemotherapy agents and cycles used as well as the mode and intensity of radiotherapy vary between institutions. Thus, the objective of the study was to investigate the effects of trimodality therapy on the outcomes of patients with SSTs.

METHODS

Sixty patients with SSTs were enrolled between January 1999 and December 2017. Induction therapy consisted primarily of 2 cycles of mitomycin–vindesine–cisplatin or cisplatin–vinorelbine delivered concurrently to the tumour with 40–45 Gy of radiation. Surgery was performed 2–6 weeks after completion of induction therapy.

RESULTS

Fifty-four (90%) patients underwent radical surgical resection. Complete pathological resection was achieved in 44 patients (81%). There was no 30-day mortality. After a median follow-up of 57.0 months, 19 (35%) patients experienced recurrence, and 8 (15%) patients showed brain metastasis. A pathological complete response (PCR) was observed in 12 (22%) patients. The 5-year survival rate for the entire population (n = 54) was 69% (95% confidence interval 55–81%). The survival rate was better for patients who underwent complete resection than for those who underwent incomplete resection (73% vs 51%, P = 0.46). A better survival rate was evident in patients with PCR than in those without PCR (92% vs 62%, P = 0.12).

CONCLUSIONS

Trimodality therapy for SSTs was efficacious and associated with favourable outcomes, with acceptable morbidity and mortality. PCR in patients with resected SSTs reveals promising long-term survival prospects with the trimodality therapy.
LR_Gapcloser: a tiling path-based gap closer that uses long reads to complete genome assembly
Authors: Xu Gui-Cai , Xu Tian-Jun , Zhu Rui , Zhang Yan , Li Shang-Qi , Wang Hong-Wei , Li Jiong-Tang
Published: December 2018

Background

Completing a genome is an important goal of genome assembly. However, many assemblies, including reference assemblies, are unfinished and have a number of gaps. Long reads obtained from third-generation sequencing (TGS) platforms can help close these gaps and improve assembly contiguity. However, current gap-closure approaches using long reads require extensive runtime and high memory usage. Thus, a fast and memory-efficient approach using long reads is needed to obtain complete genomes.

Findings

We developed LR_Gapcloser to rapidly and efficiently close the gaps in genome assembly. This tool utilizes long reads generated from TGS sequencing platforms. Tested on de novo assembled gaps, repeat-derived gaps, and real gaps, LR_Gapcloser closed a higher number of gaps faster and with a lower error rate and a much lower memory usage than two existing, state-of-the art tools. This tool utilized raw reads to fill more gaps than when using error-corrected reads. It is applicable to gaps in the assemblies by different approaches and from large and complex genomes. After performing gap-closure using this tool, the contig N50 size of the human CHM1 genome was improved from 143 kb to 19 Mb, a 132-fold increase. We also closed the gaps in the Triticum urartu genome, a large genome rich in repeats; the contig N50 size was increased by 40%. Further, we evaluated the contiguity and correctness of six hybrid assembly strategies by combining the optimal TGS-based and next-generation sequencing-based assemblers with LR_Gapcloser. A proposed and optimal hybrid strategy generated a new human CHM1 genome assembly with marked contiguity. The contig N50 value was greater than 28 Mb, which is larger than previous non-reference assemblies of the diploid human genome.

Conclusions

LR_Gapcloser is a fast and efficient tool that can be used to close gaps and improve the contiguity of genome assemblies. A proposed hybrid assembly including this tool promises reference-grade assemblies. The software is available at http://www.fishbrowser.org/software/LR_Gapcloser/.
Evaluating visual analytics for health informatics applications: a systematic review from the American Medical Informatics Association Visual Analytics Working Group Task Force on Evaluation
Authors: Wu Danny T Y , Chen Annie T , Manning John D , Levy-Fix Gal , Backonja Uba , Borland David , Caban Jesus J , Dowding Dawn W , Hochheiser Harry , Kagan Vadim , Kandaswamy Swaminathan , Kumar Manish , Nunez Alexis , Pan Eric , Gotz David
Published: December 2018

Objective

This article reports results from a systematic literature review related to the evaluation of data visualizations and visual analytics technologies within the health informatics domain. The review aims to (1) characterize the variety of evaluation methods used within the health informatics community and (2) identify best practices.

Methods

A systematic literature review was conducted following PRISMA guidelines. PubMed searches were conducted in February 2017 using search terms representing key concepts of interest: health care settings, visualization, and evaluation. References were also screened for eligibility. Data were extracted from included studies and analyzed using a PICOS framework: Participants, Interventions, Comparators, Outcomes, and Study Design.

Results

After screening, 76 publications met the review criteria. Publications varied across all PICOS dimensions. The most common audience was healthcare providers (n = 43), and the most common data gathering methods were direct observation (n = 30) and surveys (n = 27). About half of the publications focused on static, concentrated views of data with visuals (n = 36). Evaluations were heterogeneous regarding setting and measurements used.

Discussion

When evaluating data visualizations and visual analytics technologies, a variety of approaches have been used. Usability measures were used most often in early (prototype) implementations, whereas clinical outcomes were most common in evaluations of operationally-deployed systems. These findings suggest opportunities for both (1) expanding evaluation practices, and (2) innovation with respect to evaluation methods for data visualizations and visual analytics technologies across health settings.

Conclusion

Evaluation approaches are varied. New studies should adopt commonly reported metrics, context-appropriate study designs, and phased evaluation strategies.
Neurologic Manifestations of Influenza A(H3N2) Infection in Children During the 2016–2017 Season
Authors: Rao Suchitra , Martin Jan , Ahearn M Alex , Osborne Christina , Moss Angela , Dempsey Amanda , Dominguez Samuel R , Weinberg Adriana , Messacar Kevin B
Published: December 2018

Among 182 children with influenza infection in 2016–2017, 18% had neurologic manifestations of influenza (NMI), including seizures and encephalopathy; 85% of these children were infected with the H3N2 strain. Children with NMI had 3.5-times-higher odds of having a neurologic comorbidity than those without NMI and a 10-fold increased odds of hospitalization.
Envenomation
Authors: Nickerson Jillian
Published: December 2018

Black widow envenomation (latrodectism) is dangerous and important to recognize and treat in the emergency department. Latrodectism can mimic acute abdomen and, in severe cases, cause seizures and respiratory distress. Antivenom is indicated in severe cases and in special populations including the young, elderly, and pregnant. This chapter discusses a patient who presents to the emergency department complaining of nausea, cramping, and severe pain in the legs and abdomen. He reports a spider bite while working in a wood pile. The chapter discusses the physical exam, testing, diagnosis, and treatment plan for latrodectism, which includes wound management, pain control, tetanus update, and observation.
Abdominal Pain
Authors: Canepa Carlo
Published: December 2018

The evaluation of abdominal pain in the recent traveler is discussed in this chapter. Concerning symptoms include fever, blood or mucous in the diarrhea, and severe abdominal pain. Many causes of diarrhea can be diagnosed clinically and managed symptomatically, but others such as parasitic or enteroinvasive bacterial causes are managed with antiparasitic or antibiotic medications in addition to hydration. This chapter highlights a patient with crampy, intermittent abdominal pain; diarrhea; and flatulence. He has recently been white-water rafting and used chlorine tablets to purify his drinking water. The author reviews exam and testing, diagnosis of Giardia, treatment, and subsequent confirmation of the diagnosis by stool sample.
Difficulty Breathing
Authors: Reed-Schrader Essie , Rivers William T.
Published: December 2018

This case reviews the presentation and management of anaphylaxis. Anaphylaxis is a clinical diagnosis defined as the involvement of two or more body systems (skin, respiratory, gastrointestinal, or cardiovascular) with or without the presence of hypotension or respiratory compromise. Epinephrine administered intramuscularly is life-saving and may be followed by the administration of antihistamines, steroids, and intravenous fluids. The recognition and management of anaphylaxis is discussed along with both prehospital and emergency department treatment considerations. The chapter focuses on the case of a pediatric patient who presents to emergency medical services with trouble breathing. The diagnosis is allergic reaction with anaphylaxis.
Chest Pain
Authors: Khan Aamer
Published: December 2018

This case discusses the risk factors and classification for aortic dissection, as well as diagnosis and management in the emergency department setting. It reviews the 2 classification structures, DeBakey and Stanford systems, commonly used for aortic dissections. The symptoms of aortic dissection can be variable, and therefore a wide differential must be considered. The authors discuss how to use D-dimer to rule out aortic dissection when the suspicion is low but pursuing further diagnostic testing when the suspicion is high. Management of aortic dissection in the emergency department setting involves aggressive blood pressure and heart rate management and immediate consultation with surgical expertise for definitive medical or surgical management.
Overdose
Authors: Marcolini Evie , Tomassoni Anthony
Published: December 2018

Salicylate intoxication can be fatal if not recognized and treated in a timely fashion. Presentation may be subtle, and complaints of tinnitus or observation of Kussmaul respirations (rapid, deep breathing secondary to acidosis) may be the clinician’s leading cues. Other signs may include hyperthermia, nausea, vomiting, shortness of breath, confusion, diaphoresis, cardiovascular instability, and/or anion gap acidosis. Salicylate intoxication may be mistaken for sepsis, pneumonia, or ketoacidosis. Exposure may be chronic or acute - either can be deadly. Understanding the mechanisms of salicylate toxicity will guide diagnosis and treatment. Deciding whether or not to intubate and /or dialyze the patient are often critical determinanants of outcome. This chapter reviews recognition and management of this rare but potentially life-threatening toxicity.
Hypoxia
Authors: Clare Drew
Published: December 2018

The case illustrates the approach to an intubated patient on mechanical ventilation with desaturation and clinical deterioration. Included is a list of potential etiologies, including airway obstruction, pneumothorax, mucus plug/atelectasis, aspiration or infection, and pulmonary embolus as well as a description of how to systematically evaluate these patients. Various imaging modalities are reviewed, including the findings of a chest X-ray and results of a limited bedside ultrasound. The case highlights the potential development of a delayed pneumothorax or hemothorax, despite an initially normal chest radiograph, particularly with the addition of positive pressure ventilation. The case highlights the importance of the focused assessment with sonography for trauma (FAST) exam.
Palpitations
Authors: Turner Colin
Published: December 2018

This case deals with the recognition and management of atrioventricular nodal re-entrant tachycardia (AVNRT), the most common narrow-complex tachyarrhythmia. The differential diagnosis of narrow-complex tachycardia is considered, with suggestions to aid in electrocardiographic and clinical distinction of various arrhythmias. Nonpharmacologic management strategies are outlined, including an emphasis on the Valsalva maneuver with postural modification, as recently examined in the REVERT trial. Finally, pharmacologic management is discussed, including the use of adenosine. Key management points include recognition of the differential diagnosis for regular, narrow-complex tachycardia, attempting nonpharmacologic maneuvers to terminate AVNRT, and, if necessary, administering adenosine as the first-line pharmacologic step.
Altered Mental Status
Authors: LeBlanc Jaclyn
Published: December 2018

Patients with hyponatremia may present with multiple symptoms, ranging from mild confusion to seizures to coma, depending on the extent of the derangement. Assessment of serum and urine osmolality, urine sodium, and fluid status is imperative in identifying the etiology and subsequent treatment of the condition. Hypovolemic hyponatremia should be corrected with fluids to raise the sodium a maximum of 8 to 10 mmol/L over 24 hours or 18 mmol/L over 48 hours. For patients with seizures, severe confusion, coma, or signs of brainstem herniation, hypertonic saline may be employed to raise the serum sodium level quickly. Serum sodium should be monitored every 2 to 6 hours during replacement to avoid overcorrection.
Limp
Authors: Yale Sarah , Mills David
Published: December 2018

This case illustrates the approach to a pediatric patient who presents with a limp in the setting of fever. There are several “red flag” symptoms suggestive of more emergent diagnoses that are crucial to be mindful of when assessing a limping child. Applying the Kocher criteria can help to identify patients at higher risk of septic arthritis who require further diagnostic evaluation and acute management. In addition, obtaining a complete history including eliciting the timeline of presentation (acute versus chronic) and any pertinent preceding events such as recent viral illness or trauma is highly relevant. The case reviews the presentation of a patient with toxic synovitis and includes the basic diagnostic workup, the recommended treatment approach, and the expected timeline of improvement.
Secondary Blast Injury
Authors: Simon Leslie V.
Published: December 2018

This case illustrates penetrating hand trauma due to secondary blast injury. Secondary blast injury is due to objects accelerated by the blast wind and is the most commonly encountered type of blast injury. Depending on the size of the fragments, secondary blast injury may present as blunt or penetrating trauma. This case addresses the evaluation of hand trauma after exposure blast caused by suicide bomber, management of foreign bodies due to blast injury, field management of flexor tendon laceration, open joints, and burns. The case also addresses postexposure prophylaxis in the setting of biological fragment exposure. Complicated causes often require specialist referral.
Heat Stroke
Authors: Berk Alexander
Published: December 2018

This case illustrates heat stroke presenting as altered mental status in a young healthy person. The differential diagnosis of altered mental status with hyperthermia is broad so a high clinical suspicion is needed to make the diagnosis of heat stroke. Infectious causes should always be ruled out. Once the diagnosis is made, treatment is aimed at actively cooling the patient, lowering temperature to a targeted goal of 102.2°F. Close attention should also be given to airway protection, correction of metabolic abnormalities, evaluation for rhabdomyolysis, and monitoring for cardiac dysrhythmias. All heat stroke patients should be admitted to the hospital for monitoring even after cooling goals are achieved.
Febrile Illness
Authors: Hofstetter Douglas , Austin Andrea , Maves Ryan
Published: December 2018

Malaria is a potentially life-threatening infection caused by several protozoa in the Plasmodium genus. Malaria is transmitted through the bite of a female Anopheles mosquito, which serves as the definitive host and vector of the disease. Geographically, malaria is normally found in warm, tropical climates that can support the Anopheles mosquito year-round. In uncomplicated malaria, signs and symptoms are often nonspecific. Due to the ongoing hemolysis, patients classically present with fevers followed by a characteristic paroxysm of chills, high fevers, and malaise. The classic gold standard for the diagnosis of malaria is light microscopy of Giemsa-stained peripheral blood smears. Pharmacotherapy depends on the suspected Plasmodium species, the local patterns of drug susceptibility, and the clinical status of the patient. Chemoprophylaxis is recommended for all individuals traveling to regions with endemic malaria.
Occipitocervical Dislocation
Authors: Dru Alexander B. , Hoh Daniel J.
Published: December 2018

This chapter covers the presentation, diagnosis, operative decision-making, surgical procedure, postoperative management, and evidence/outcomes of patients who have sustained atlanto-occipital dislocation (AOD). The format of the chapter walks the reader through the case in a logical manner with each section containing questions and oral board review pearls that are directly answered in the text. Each section has a combination of radiographic (x-ray, computed tomography scan, and three-dimensional reconstruction) and illustrative imaging to aid in the diagnosis and classification of AOD. This chapter is designed to provide residents or board-eligible neurosurgeons with an up-to-date review of this condition for both written and oral board certification.
Cervical Myelopathy
Authors: Hlubek Randall J. , Theodore Nicholas
Published: December 2018

Cervical spondylotic myelopathy is compression of the cervical spinal cord secondary to degenerative changes. Symptoms, which include gait disturbance, upper extremity paresthesia, weakness, and loss of dexterity, tend to progress gradually. The diagnosis of cervical spondylotic myelopathy cannot be made without imaging. T2-weighted magnetic resonance imaging allows for careful inspection of the spinal cord and can reveal hyperintensity that may represent myelomalacia secondary to chronic compression. Computed tomography (CT) myelography may be useful in patients for whom MR imaging is contraindicated. Flexion and/or extension cervical radiographs should be obtained for any patient who reports neck pain.
Cervical Radiculopathy
Authors: Karsy Michael , Eli Ilyas , Dailey Andrew
Published: December 2018

Degenerative cervical spondylosis resulting in cervical radiculopathy or myelopathy can be a significant source of morbidity for patients. Traditional surgical approaches have involved anterior or posterior cervical fusion with decompression; however, these techniques may result in higher cost compared with noninstrumented cases, reduction of spine mobility, and adjacent level disease. Anterior microforaminotomy, first described by Jho in 1996, involves a microdiscectomy and decompression of the cervical spine without arthrodesis. Posterior approaches to the foramina can also be an option. In this chapter, the authors describe the use of lateral disc foraminotomies in the treatment of cervical spine disease. These techniques are mainly for the treatment of cervical radiculopathy without instability or mechanical neck pain. Techniques for both anterior and posterior approaches, including pitfalls and key anatomical landmarks, are described.
Thoracic Disc Herniation
Authors: Umansky Derrick , Kalyvas James
Published: December 2018

Consensus in the literature supports surgery for severely symptomatic or disabling thoracic disc herniation only, with all others requiring observation or non-surgical intervention. For those patients requiring surgery, there are a variety of approaches that are used depending on symptomatology, spinal level, disc size, disc location relative to the canal and to the neural elements, presence of calcification, and overall health status of the patient. Dorsolateral/lateral approaches include transpedicular, transfacet pedicle-sparing, costotransversectomy, extracavitary, and parascapular; ventrolateral approaches include transthoracic thoracotomy, transthoracic thoracoscopy, and retropleural thoracotomy; finally, ventral approaches include transsternal and manubrial window.
Thoracic myelopathy has a broad differential diagnosis. The cause of which can be identified with a detailed history, physical exam, and properly selected imaging. In the following chapter, we discuss herniated thoracic discs (HTD) including the common presentations, imaging findings, and the surgical treatment options. Consensus in the literature supports surgical management for HTDs that are severely symptomatic and disabling. The surgical approaches depends on the spine level, disc size, disc location, presence of calcification, and overall health status of the patient. The improvement rate for myelopathic patients ranges from 71% to 97% and for back pain and radicular pain from 67% to 94%. The overall complication rate is approximately 15%.
Diskitis
Authors: Joseph Jacob R. , Smith Brandon W. , Oppenlander Mark E.
Published: December 2018

Spinal osteomyelitis/diskitis is a common problem encountered by neurosurgeons and requires urgent workup. Common risk factors include intravenous drug use or immunocompromised states. The presence or absence of neurologic deficit is critical in determining the treatment algorithm. Magnetic resonance imaging is the preferred imaging modality to diagnose osteomyelitis/diskitis, as well to identify concomitant epidural abscess. Inflammatory markers such as erythrocyte sedimentation rate and c-reactive protein can also be useful in diagnosis. Gram-positive organisms such as Staphylococcus aureus are the most common pathogens. Surgical indications include neurologic deficit, progressive deformity, recalcitrant pain, and inability to clear systemic infection without other source. Surgical goals are typically to decompress the neural elements, debride the infected disc or bone, and stabilize the spine if necessary.
History of Invasive EEG
Authors: Lüders Hans O.
Published: December 2018

‘History of Invasive EEG’ traces the development of electroencephalography (EEG) from the pioneering animal studies of Richard Caton (1875) up to the more recent development of stereoencephalography (SEEG) and large subdural electrodes. The following historical highlights are discussed: the first recording of EEG seizures in animals (PY Kaufman); the first recording of EEG in humans (Hans Berger); the first recording of interictal and ictal epileptiform discharges in humans (Hans Berger); the important role played by Reginald Bickford, Carl Sem-Jacobsen, and Jose Delgado in the development of chronically implanted invasive recordings; the development of stereotactic techniques for precise insertion of depth electrodes (Jean Talairach and Jean Bancaud); the use of large subdural plates for recording of EEG and cortical stimulation of extensive cortical regions.
Subdural Grid Electrode Placement: Approaches and Complications
Authors: McGovern Robert A. , McKhann Guy M.
Published: December 2018

Subdural grid electrode placement is a safe and effective technique for localizing an epileptic focus in medically refractory patients with discordant non-invasive testing. The specific approach taken is individualized on a patient-by-patient basis. However, the two goals of invasive monitoring with subdural electrodes are the same for every patient: define the volume of cortical tissue responsible for seizure onset and ‘map’ regions of functional tissue that may be impacted by resection of the epileptic focus. While complications are an accepted aspect of the procedure, they can be minimized through meticulous surgical technique, generous duroplasty, and careful postoperative sterility. Because of the heterogeneity of the published literature, we advocate standardized and data-registry-based outcome and complication measurements so that data can be more freely combined and analysed in the future.
Direct Current Shift Recordings
Authors: Wu Shasha , Towle Vernon L. , Miller Jonathan P. , Lüders Hans O.
Published: December 2018

Direct current (DC) shift, also called infraslow activity (IFA), refers to brain activity slower than 0.5 Hz. DC shifts have been shown to have a close temporal and spatial relationship with the conventional seizure onset zone and a smaller field than the conventional ictal electroencephalogram (EEG); therefore, they may have potential value in identifying the epileptogenic zone. Studies have shown that DC shifts can be reliably recorded intracranially from chronic subdural grids or depth electrodes using AC amplifiers with a long time constant (e.g. 10 s) in a compressed viewing window. Although the mechanism remains under debate, most investigators agree that DC shifts are generated by neuroglial cells or neuroglial cells together with pyramidal neurons. With the widespread use of digital EEG recording, DC shifts, together with high-frequency oscillations should be routinely analysed in invasive EEG recordings to provide complementary information in presurgical evaluation of epilepsy.
Subdural EEG in Frontal Lobe Epilepsy
Authors: Ikeda Akio
Published: December 2018

This chapter is concerned with the use of subdural EEG for location of the epileptogenic zone and for functional mapping in frontal lobe epilepsy (FLE), tasks that are both necessary before epilepsy surgery in various subtypes of FLE. It reviews clinical features of subtypes of FLE, individualized electrode arrays, and the recording and analysis of epileptiform abnormalities of ictal and interictal states. It then reviews the principles of functional mapping by cortical stimulation and by other methods, e.g. intrinsic EEG activity. Intrinsic EEG activity consists of Bereitschaftspotentials or readiness potentials, judgment-related potentials from pre-supplementary motor area (SMA), somatosensory evoked potentials from SMA proper and pre-SMA, and language-related potentials. It also reviews new methods such as event-related synchronization, event-related desynchronization, coherence analysis for functional mapping, wide-band EEG analysis of slow (DC) shifts and high-frequency oscillations, and three-dimensional EEG source analysis for epileptogenic mapping.
Invasive Studies of Sensorimotor Cortex Epilepsy
Authors: Edwards Jonathan , Kutluay Ekrem , Vandergrift William A.
Published: December 2018

Intracranial exploration of the sensorimotor cortex exemplifies the balance of preserving function while optimizing the surgical quest for seizure freedom. While surgical intervention in the sensorimotor region is certainly a ‘high-stakes’ undertaking, positive results can be obtained for carefully selected patients. In this chapter, the clinical features of sensorimotor epilepsy are reviewed and the anatomy of this critical functional region is described. The intrinsic rhythms that are commonly seen on intracranial sensorimotor recordings are also discussed. A description of sensorimotor mapping techniques and findings is followed by a discussion of special surgical considerations for patients with sensorimotor cortex epilepsy.