bluuebunny/crossref_metadata_2025 huggingface dataset:
Levetiracetam in Clinical Practice: Efficacy and Tolerability in Epilepsy
Authors: Bilo Leonilda , de Leva Maria Fulvia , Meo Roberta
Published: December 2014

Background:

The aim of this study was to evaluate efficacy and tolerability of levetiracetam (LEV) in patients with different epilepsy syndromes.

Methods:

We evaluated epileptic patients seen in the previous 18 months, including all patients with present or past exposure to LEV. Tolerability of LEV therapy was evaluated in all patients; efficacy was evaluated only in patients who had received LEV for at least six months. Two hundred and two patients were included in the study. Patients were considered responsive when showing a > 50% reduction in seizures frequency and non-responders when seizure frequency was unchanged, worsened or showed a reduction < 50%.

Results:

Thirty patients did not complete six months of LEV treatment and dropped out. 57.4% of the patients with uncontrolled seizures treated for at least six months were responders, with 27.7% seizure free. Adverse effects were observed in 46 patients (23%) and were responsible for early drop out in 26. Adverse effects occurred significantly more often in females than in males (30.6% vs 13.2%); moreover, nearly 30% of women with adverse effects complained of more than one adverse effect, while this was never observed in male patients.

Conclusions:

Our study shows LEV as a well tolerated and effective treatment, both in monotherapy and as an add-on. Further investigations on larges samples are needed to investigate the issue of gender-related tolerability.
Electroencephalographic Features of Temporal Lobe Epilepsy
Authors: Jan Mohammed M. , Sadler Mark , Rahey Susan R.
Published: December 2014

Electroencephalography (EEG) is an important tool for diagnosing, lateralizing and localizing temporal lobe seizures. In this paper, we review the EEG characteristics of temporal lobe epilepsy (TLE). Several “non-standard” electrodes may be needed to further evaluate the EEG localization, Ictal EEG recording is a major component of preoperative protocols for surgical consideration. Various ictal rhythms have been described including background attenuation, start-stop-start phenomenon, irregular 2-5 Hz lateralized activity, and 5-10 Hz sinusoidal waves or repetitive epileptiform discharges. The postictal EEG can also provide valuable lateralizing information. Postictal delta can be lateralized in 60% of patients with TLE and is concordant with the side of seizure onset in most patients. When patients are being considered for resective surgery, invasive EEG recordings may be needed. Accurate localization of the seizure onset in these patients is required for successful surgical management.
Paramnésie De Réduplication D’évènement Après Hémorragie Du Noyau Caudé Droit
Authors: Pluchon C. , Salmon F. , Houeto J. L. , Listrat A. , Vandermarcq P. , Gil R.
Published: December 2014

Background:

Environmental reduplication which is characterized by reduplication of places has been reported in right hemispheric lesions, particularly but not only in the right frontal region. However, spatial delirium may follow right sub-cortical lesions.

Methods:

We describe a 53 years-old man who had a reduplicative paramnesia for event alone after an intracerebral haematoma of the right caudate nucleus.

Results:

MRI Scan showed also an extension of the right caudate nucleus haemorrhage into the ventricular system. Regional cerebral blood flow studied with 99Tcm-HMPAO showed a decrease of perfusion in the right dorso-lateral frontal cortex. To our knowledge, we reported the first case of reduplicative paramnesia of event associated with a right caudate nucleus injury. Similar right frontal deactivation was observed in two cases of reduplicative paramnesia for place, one of them after an infarction of the retro-lenticular portion of the right internal capsulae, the other after a right thalamo-capsular haemorrhage.

Conclusion:

We suggest that reduplicative paramnesia for event, like the previous cases reported of reduplicative paramnesia for place, may be linked to a subcortical lesion of the frontal lobe inducing a right functional frontal deactivation.
Classification of Symptomatic Chiari I Malformation to Guide Surgical Strategy
Authors: Shamji Mohammed F. , Ventureyra Enrique C. G. , Baronia Benedicto , Nzau Munyao , Vassilyadi Michael
Published: December 2014

Background:

Treatment options for Chiari I malformations include posterior fossa decompression (PFD) with additional techniques including laminectomy, intradural exploration, and duraplasty. Neuroimaging findings of cisterna magna volume, syringomyelia, and intraoperative ultrasonography may tailor surgical intervention.

Methods:

We developed an algorithm classifying symptomatic Chiari I patients into three groups to define minimum operation. Without syringomyelia, the presence of cisterna magna defined Group A and the absence defined Group B. Patients with syrinx formed Group C. Mild structural pathology (Group A) or adequate space following PFD (Group B, normal intraoperative ultrasound (IOUS)) should be treated by PFD alone. Conversely, presence of syringomyelia (Group C) or inadequate space following PFD (Group B, abnormal IOUS) should additionally have duraplasty. We applied this algorithm to patients treated at a single institution over 16 years.

Results:

Twenty-four symptomatic Chiari I malformation patients were divided into three groups that did not differ by age, gender, or extent of tonsillar ectopia. All patients treated by this algorithm experienced clinical and radiographic improvement. This included eight Group B patients who underwent PFD only (n=6) or additional duraplasty (n=2) decided by IOUS.

Conclusion:

Treatment of symptomatic Chiari I malformation may have inadequate outcome with conservative strategy or complications with aggressive strategy. This algorithm utilizes preoperative neuroimaging and intraoperative ultrasound to tailor intervention, with excellent clinical outcome and radiographic syrinx resolution on application to 24 patients. Further validation requires prospective multicenter evaluation with larger patient population.
Predicting Conversion to MS - The Role of a History Suggestive of Demyelination
Authors: Morrow Sarah A. , Fraser J. Alexander , Nicolle David , Kremenchutzky Marcelo
Published: December 2014

Background:

The ability to predict conversion to multiple sclerosis (MS) accurately when assessing a patient with a clinically isolated syndrome (CIS) is of paramount importance.Magnetic resonance imaging (MRI) is the best paraclinical tool currently available; however the significance of a history of an event suggestive of demyelination prior to CIS presentation has not been evaluated.

Methods:

Aretrospective chart review of all optic neuritis cases presenting as CIS to a single neuro-ophthalmologist in London, Ontario between 1990 to 1998 was performed. Data were collected regarding demographics, past medical history, history of present illness, and family history. Conversion to MS was determined by the McDonald criteria after ten years of follow-up. Bayesian statistics and logistic regression were used to determine the best predictors of conversion to MS from CIS.

Results:

One hundred and sixteen optic neuritis subjects were included in the analysis. After ten years, 42.2% had converted to MS. The best predictor of future conversion remained at least one brain lesion, disseminated in space, on MRI (sensitivity 0.90, specificity 0.75). However, if the subject additionally had a history suggestive of a demyelinating event in the past that had not been confirmed clinically, the specificity increased to 0.96. These two traits taken together had an odds ratio of 27.8 for conversion to MS in the next ten years (p<0.001).

Conclusions:

A history of an event suggestive of demyelination prior to presenting with optic neuritis as CIS increases the ability of the clinician to predict conversion to MS in the next ten years.
Selective 4 Vessels Angiography in Brain Death: A Retrospective Study
Authors: Savard Martin , Turgeon Alexis F. , Gariépy Jean-Luc , Trottier François , Langevin Stephan
Published: December 2014

Background:

In Canada, ancillary tests, such as selective four vessels angiography (S4VA), are sometimes necessary for brain death (BD) diagnosis when the clinical exam cannot be completed or confounding factors are present. Recent Canadian guidelines assert that brain death is supported by the absence of arterial blood flow at the surface of the brain and that venous return should not be considered. However, neuropathologic and angiographic studies have suggested that arteries might still be patent in BD patients. Current clinical practices in BD diagnosis following S4VA need to be better understood.

Methods:

We conducted a retrospective study of all S4VA performed for the determination of BD in a level 1 NeuroTrauma centre from 2003 to 2007. The objective of the study was to describe the prevalence of intracranial arterial, capillary (parenchymogram) and venous opacification in our study population. All tests were reviewed independently by two neuroradiologists. Disagreements were resolved by consensus.

Results:

Thirty two patients were declared BD following S4VA during the study period. Nine of these patients (28%) presented some proximal opacification of intracranial arteries (95% CI 15-45%). As opposed, none had a cerebral capillary and deep venous drainage opacification (95% CI 0-10%).

Conclusion:

The absence of cerebral deep venous drainage or parenchymogram might represent a better objective marker of cerebral circulatory arrest for brain death diagnosis when the use of S4VA is required. These findings open the path for further research in enhancing our interpretation of angiographic studies for brain death diagnosis.
Migraine Prevalence, Treatment and Impact: The Canadian Women and Migraine Study
Authors: Cooke Lara J. , Becker Werner J.
Published: December 2014

Background:

The prevalence of migraine headache varies somewhat across geographic regions. The last Canadian population-based study of migraine was in 1994. We report the findings of the Canadian Women and Migraine Survey. In addition to reporting migraine prevalence in Canadian women, the survey identified current consultation and treatment practices of women with migraine, and the psychological burden of migraine.

Methods:

The survey was conducted with a population-based sample of 1210 women using standard telephone research methods. Headache diagnoses were based on the International Headache Society (IHS) Classification.

Results:

Calculated prevalence of migraine headache was 26%. Only 51% of women with migraine had consulted a physician about their headaches. Women with migraines rely on over-the-counter medications and non-specific prescription medications. Less than 10% of women with migraine use triptans/dihydroergotamine for primary treatment. Ninety seven percent of women with migraine reported at least one psychosocial impact resulting from migraines.

Conclusions:

The prevalence of migraine in Canadian women appears static, and is again shown to be slightly higher than that reported in the United States. As in other epidemiologic studies, many women with migraine do not seek medical help for their headaches and perhaps as a result, few are using migraine-specific medications to treat their headaches. The impact of migraine on Canadian women is substantial with almost all women with migraine reporting adverse psychosocial effects of migraines on their lives.
Corpus Callosum and Cingulum Tractography in Parkinson's Disease
Authors: Wiltshire Katie , Concha Luis , Gee Myrlene , Bouchard Thomas , Beaulieu Christian , Camicioli Richard
Published: December 2014

Background:

In Parkinson's disease (PD) cell loss in the substantia nigra is known to result in motor symptoms; however widespread pathological changes occur and may be associated with non-motor symptoms such as cognitive impairment. Diffusion tensor imaging is a quantitative imaging method sensitive to the micro-structure of white matter tracts.

Objective:

To measure fractional anisotropy (FA) and mean diffusivity (MD) values in the corpus callosum and cingulum pathways, defined by diffusion tensor tractography, in patients with PD, PD with dementia (PDD) and controls and to determine if these measures correlate with Mini-Mental Status Examination (MMSE) scores in parkinsonian patients.

Methods:

Patients with PD (17 Males [M], 12 Females [F]), mild PDD (5 M, 1F) and controls (8 M, 7F) underwent cognitive testing and MRI scans. The corpus callosum was divided into four regions and the cingulum into two regions bilaterally to define tracts using the program DTIstudio (Johns Hopkins University) using the fiber assignment by continuous tracking algorithm. Volumetric MRI scans were used to measure white and gray matter volumes.

Results:

Groups did not differ in age or education. There were no overall FA or MD differences between groups in either the corpus callosum or cingulum pathways. In PD subjects the MMSE score correlated with MD within the corpus callosum. These findings were independent of age, sex and total white matter volume.

Conclusions:

The data suggest that the corpus callosum or its cortical connections are associated with cognitive impairment in PD patients.
Prevalence of Primitive Reflexes and Parkinsonian Signs in Dementia
Authors: Links K. A. , Merims D. , Binns M. A. , Freedman M. , Chow T. W.
Published: December 2014

Objective:

Primitive reflexes and parkinsonian signs are used by clinicians to differentiate among dementias. We reviewed our clinical sample to determine whether primitive reflexes were more prevalent in frontally-based dementias and whether parkinsonian signs were more common in dementia with Lewy bodies (DLB) than in other types of dementia.

Design:

We retrospectively reviewed charts from 204 patients with dementia who presented for consultation at Baycrest's Ross Memory Clinic between April, 2003, to December, 2007.

Results:

A greater proportion of subjects with DLB and dementia of the Alzheimer type with cardiovascular disease had primitive reflexes than subjects with frontotemporal dementia (FTD). Primitive reflexes were not positively predictive of FTD or vascular dementia (VaD). Dementia with Lewy bodies subjects were more likely to have parkinsonian signs than the other dementias, and bradykinesia and rigidity were positively predictive of FTD. The palmomental reflex was the most common primitive reflex in the sample, and cogwheeling was the most common parkinsonian sign. There was no significant difference between early- and late-stage groups in presence of primitive reflexes or parkinsonian signs.

Conclusions:

Primitive reflexes appear not to be clinically discriminative of frontally-based dementias such as FTD and VaD.
Nestin, A New Marker, Expressed in Müller Cells Following Retinal Injury
Authors: Xue Liping , Ding Peng , Xiao Libo , Hu Min , Hu Zhulin
Published: December 2014

Purpose:

To investigate whether nestin would be a useful marker for retinal injury and also to ascertain a better understanding of the roles of Müller cells in the injured retina by the use of damaged rat retina.

Methods:

A total of 33 adult female Wistar rats were used in this study. Three were used as controls and the remaining as retinal injury modes (6 for hypoxia; 15 for experimental glaucoma and 9 for optic nerve transection). Double immunofluorescence labeling was carried out between nestin and glutamine synthetase (GS), and between glial fibrillary acidic protein (GFAP) and GS antisera in normal and pathological retinae.

Results:

The results showed that there were no nestin nor GFAP staining in mature Müller cells of the normal retina. A major finding was that nestin expression was induced in Müller cells subjected to hypoxia, glaucoma and optic nerve transection.

Conclusions:

These results suggest that nestin as well as GFAP (even more sensitive than GFAP) are useful and reliable biomarkers for retinal damage. The more intense expression of nestin, GFAP and GS in the end-feet of Müller cells suggest that they may help to maintain the retinal structural integrity and to enhance functional recovery in various retinal diseases.
Wilder Penfield - Bioethicist
Authors: Sedney Cara L. , Bernstein Mark
Published: December 2014

Bioethics is a new discipline which developed as modern medical and scientific breakthroughs surpassed the ability of traditional medical ethics to contend with unique ethical dilemmas. It evolved into an interdisciplinary discourse regarding the ethical and societal implications of medicine and the biomedical sciences. Wilder Penfield (1891–1976), celebrated neurosurgeon and neuroscientist, is rarely thought of as a “bioethicist,” and his mention in texts on the history of bioethics is little more than a footnote. However, he appears to have contributed to the field of bioethics in a number of ways: through his solutions to the ethical problems posed by the unique form of surgery he developed; through his recognition of the limitations of traditional medical ethics; through his involvement of the public and other disciplines in ethical discussions; and through the impact that his work still has today in the area of bioethics termed “neuroethics.”
Lesions on DWI and the Outcome in Hyperacute Posterior Circulation Stroke
Authors: Lee Hye Mi , Kim Minjik , Suh Sang-il , Kim Ji Hyun , Oh Kyungmi , Koh Seong-Beom , Seo Woo-Keun
Published: December 2014

Background:

few studies have addressed the association between the characteristics of ischemic lesions detected by diffusion-weighted imaging (dWi) and the clinical outcome in patients with hyperacute posterior circulation ischemic stroke. this study demonstrates a relationship between the findings assessed by dWi and the outcome in patients with hyperacute posterior circulation ischemic stroke.

Methods:

We reviewed data from 118 patients who had posterior circulation ischemic stroke within six hours from the onset of their symptoms. the clinical outcome included early neurological deterioration (end) and a favorable outcome at three months after the onset of symptoms. using dWi, the lesion volume and the number and location of injured anatomical regions were analyzed to evaluate whether the results correlated with the clinical outcome measures.

Results:

the number of injured anatomical regions assessed by dWi was associated with the initial and delayed neurological status. Both the total volume and the number of injured anatomical regions associated with end and a favorable outcome. analysis of the location of the injured regions determined that only a pontine lesion independently associated with end. interestingly, four out of five patients who underwent decompressive craniectomy exhibited a large infarction volume but minor symptoms.

Conclusions:

in patients with hyperacute posterior circulation ischemic strokes, the lesions assessed by dWi were associated with the clinical outcome, regardless of the initial neurological status. dWi is an effective initial imaging tool for assessing the extent of lesions and clinical outcomes in patients with hyperacute posterior circulation ischemic stroke.
Navigation of Stents across Communicating Arteries for Aneurysm Embolization
Authors: Ahmed Muhammad Ejaz , Lum Cheemun , Lesiuk Howard , Iancu Daniela , dos Santos Marlise
Published: December 2014

Introduction:

Endovascular coiling of aneurysms crossing the Circle of Willis has been described in small case series. The technical challenges in manipulating a stent across the Circle of Willis lie in negotiating difficult angles and small arteries. We present our experience with treating aneurysms by stent assistance in which the Circle of Willis was crossed to facilitate optimal stent deployment.

Materials and methods:

We retrospectively reviewed the cases in our institution from January 2009 to June 2012 in which the Circle of Willis was traversed to facilitate optimal stent deployment. We measured the diameter of the communicating arteries traversed, caliber of the target arteries in which the stent was deployed and the most acute angle negotiated (“critical angle”). We compare our results with other published series in the literature.

Results:

Eight patients fulfilled the criteria: 5 males (45-66 years). There were three anterior and five posterior circulation aneurysms. Four of the aneurysms were ruptured. The PCOM was traversed in five cases, the ACOM in three cases. The mean diameter of the communicating artery was 1.17mm. The mean diameter of target arteries was 1.27mm. The “critical angle” was 72-147 degrees. In all patients, there was satisfactory obliteration of the aneurysm. There were two cases of minor SAH post procedure.

Conclusion:

Utilizing the Circle of Willis for optimal stent placement in aneurysm remodeling is technically feasible but challenging. This technique can be performed successfully in patients with acute SAH. The procedural risk must be balanced against potential complications such as SAH.
Peace Sign in Calcified Idiopathic Hypertrophic Pachymeningitis
Authors: Heckmann Josef G. , Oberst Gerhard
Published: December 2014

The peace sign (Figure 1a) was originally designed in 1958 by Gerald Holtom for the British nuclear disarmament movement. It derived from the semaphore alphabet “N” and “D” representing ‘nuclear’ and ‘disarmament’. We recently cared for an 81-year-old woman with isolated complex-partial seizures who responded well to a medical treatment with carbamazepine. Coronar cranial computed tomography (CCT) (Figure 1b) showed a marked calcification of the tentorium, the posterior supratentorial falx, and the cerebellar falx mimicking a peace sign. Magnet resonance tomography (MRT) showed on a fluid attenuation inversion recovery (FLAIR) sequence (Figure 1c) a diminished signal consistent with calcification. An MRT five years earlier showed marked contrast enhancement of the tentorium and falx and adjacent dura (Figure 1d) on a T1- weighted image. The large sinus had been open. At this time diagnosis of probable idiopathic hypertrophic pachymeningitis was made as the realized evaluation failed to reveal a cause. A lumbar puncture, however, was not performed. As her clinical signs and symptoms resolved spontaneously no specific therapy was initiated. It is suggested that during time the inflammed dura healed by calcification.
Diagnosing Vasospasm After Subarachnoid Hemorrhage: CTA and CTP
Authors: Wilson Craig D. , Shankar Jai Jai Shiva
Published: December 2014

Cerebral vasospasm is a potentially devastating complication in patients with aneurysmal subarachnoid hemorrhage. The purpose of this article is to review the use of computed tomogram (CT) angiography and CT perfusion in the diagnosis of cerebral vasospasm after aneurysmal subarachnoid hemorrhage and also assess their use in guiding treatment decisions. Both techniques are widely used for other indications but their use in cerebral vasospasm has not been well defined. Computed tomogram angiography can directly visualize arterial narrowing and CT perfusion is able to evaluate differences in perfusion parameters after aneurysmal subarachnoid hemorrhage with high sensitivity and specificity. CT perfusion is better at predicting which patients require endovascular treatment.
A History of Multiple Sclerosis Investigations in Canada Between 1850 and 1950
Authors: Ganesh Aravind , Stahnisch Frank W.
Published: December 2014

The medical profession's modern quandaries withMultiple Sclerosis(MS) largely began in 1849, with Friedrich von Frerichs' (1819–1885) early description of the clinical and pathological features of what he termedHirnsklerose(“brain sclerosis”). This manuscript is an overview of the century of research (1850–1950) that followed the emergence of this clinical entity, with a focus on the hitherto under-explored English Canadian perspective. Using journal articles, reviews, and case studies, this historiographical paper reviews what may be some of the earliest recorded cases of MS in Canada, and outlines the diagnostic challenges that confronted early Canadian physicians in their encounters with MS. Early Canadian attempts to characterize the aetiology and epidemiology of MS and treat it are also discussed. These activities were influenced by developments in the field in Europe and the United States, and helped set the stage for the modern era of immunologic and therapeutic research on MS.
Diagnostic Value of a Multidisciplinary Clinic for Intellectual Disability
Authors: van Karnebeek Clara , Murphy Tyler , Giannasi Wynona , Thomas Marion , Connolly Mary , Stockler-Ipsiroglu Sylvia
Published: December 2014

Background:

Identification of the underlying cause of intellectual disability (ID) is important as it improves genetic counselling, management, adaptation; yet its etiologic heterogeneity is challenging and often leads to an expensive work-up.

Methods:

To improve this diagnostic trajectory, the multidisciplinary Complex Diagnostic Clinic (CDC) was established for ID patients with unexplained complex systemic and/or neurologic features that were referred to the CDC and evaluated by three medical specialists followed by multi-disciplinary rounds. Analyses included surveys and interviews, (retrospective) chart review, costs calculations and comparison.

Results:

24 children (9 male) were evaluated during seven clinics held over 16 months. The average patient age was 7 years 11 months (range 9 months-18 years). All the children had previously been seen by 2–10 specialist services. The diagnostic yield of the CDC was higher than expected with confirmed and working diagnoses in 11 (46%) and 9 (38%) children respectively. Cost-savings included fewer trips to hospital and fewer tests via more streamlined evaluations. Positive feedback was received from both families and medical professionals.

Conclusions:

The CDC represents an innovative model of personalized care. Specialist collaboration in the interpretation of relevant clinical, biochemical and genomic data resulted in diagnoses, where none had previously been possible.
Outcome Predictors in Acute Basilar Artery Occlusion
Authors: Dornák Tomáš , Herzig Roman , Školoudík David , Šanák Daniel , Kuliha Martin , Roubec Martin , Köcher Martin , Procházka Václav , Král Michal , Veverka Tomáš , Hluštík Petr , Zapletalová Jana , Herman Miroslav
Published: December 2014

Objective:

To identify predictors of good outcome in acute basilar artery occlusion (BAO).

Background:

Acute ischemic stroke (AIS) caused by BAO is often associated with a severe and persistent neurological deficit and a high mortality rate.

Methods:

The set consisted of 70 consecutive AIS patients (51 males; mean age 64.5±14.5 years) with BAO. The role of the following factors was assessed: baseline characteristics, stroke risk factors, pre-event antithrombotic treatment, neurological deficit at time of treatment, estimated time to therapy procedure initiation, treatment method, recanalization rate, change in neurological deficit, post-treatment imaging findings. 30- and 90-day outcome was assessed using the modified Rankin scale with a good outcome defined as a score of 0–3.

Results:

The following statistically significant differences were found between patients with good versus poor outcomes: mean age (54.2 vs. 68.9 years; p=0.0001), presence of arterial hypertension (52.4% vs. 83.7%; p=0.015), diabetes mellitus (9.5% vs. 55.1%; p=0.0004) and severe stroke (14.3% vs. 65.3%; p=0.0002), neurological deficit at time of treatment (14.0 vs. 24.0 median of National Institutes of Health Stroke Scale [NIHSS] points; p=0.001), successful recanalization (90.0% vs. 54.2%; p=0.005), change in neurological deficit (12.0 vs. 1.0 median difference of NIHSS points; p=0.005). Stepwise binary logistic regression analysis identified age (OR=0.932, 95% CI=0.882–0.984; p=0.012), presence of diabetes mellitus (OR=0.105, 95% CI=0.018–0.618; p=0.013) and severe stroke (OR=0.071, 95% CI=0.013–0.383; p=0.002) as significant independent negative predictors of good outcome.

Conclusions:

In the present study, higher age, presence of diabetes mellitus and severe stroke were identified as significant independent negative predictors of good outcome.
Chemotherapy-induced Peripheral Neuropathy Among Paediatric Oncology Patients
Authors: Purser M.J. , Johnston D.L. , McMillan H.J.
Published: December 2014

Background:

Vinca alkaloids and platinum-containing chemotherapeutic drugs have the potential to cause chemotherapy-induced peripheral neuropathy (CIPN). This study determined the frequency of CIPN among children who were treated for acute lymphoblastic leukemia (ALL), lymphoma, brain tumour or Wilms tumour.

Procedure:

This retrospective cohort study reviewed 252 patients treated at the Children's hospital of Eastern Ontario from 2001-2011. Patients were considered to have CIPN if they developed clinical symptoms of CIPN such as limb paraesthesia, weakness and/or ataxia during chemotherapy and their treating neurologist or oncologist deemed that their symptoms were due to a peripheral cause. Patients were excluded if their treatment regime did not include chemotherapy.

Results:

The overall frequency of CIPN was 18.3% (46/252). Tumour-specific CIPN rates were: 18.9% (29/154) for ALL; 9.4% (3/32) for lymphoma; 17.9% (5/28) for Wilms tumour; and 23.7% (9/38) for brain tumour patients. Nerve conduction studies were completed for 17% of patients (all tumour types) and were abnormal in all but one patient. Among surviving CIPN patients (41/46), 93% showed no clinical deficits at their last examination, which was on average 56 months from time of diagnosis to last follow-up visit.

Conclusions:

The frequency of CIPN was less than that previously reported in adults receiving chemotherapy. Children with CIPN have a favourable outcome with most showing clinical improvement during the maintenance phase of treatment or after chemotherapy completion.
Impact of Glucose Fluctuation on Acute Cerebral Infarction in Type 2 Diabetes
Authors: Huang Jinxin , Zhang Xingguang , Li Juan , Tang Liya , Jiao Xiumin , Lv Xiaofeng
Published: December 2014

Objective:

This study aimed to describe the frequency and temporal profile of acute cerebral infarction (ACI) using a continuous glucose monitoring system (CGMS) in patients with and without type 2 diabetes mellitus (T2DM) and explore the impact of blood glucose fluctuations on the short-term prognosis of ACI.

Methods:

The subjects were divided into four groups: T2DM with acute cerebral infarction (DMCI, Group A, n=56); T2DM without acute cerebral infarction (DM-NCI, Group B, n=36); Acute cerebral infarction patients without T2DM (NDM-CI, Group C, n=54); Healthy control group (NG, Group D, n=36). The National Institutes of Health Stoke Scale (NIHSS) and modified Rankin scale (mRs) were collected in Group A and C. All subjects were monitored for 72 hours using the CGMS. Indices such as fasting blood glucose (FBG) and mean amplitude of glycemic excursions (MAGE) were calculated. Glycemic excursions were compared between Group A, B, C and Group D, respectively. Multiple linear regression analysis and logistic analysis was applied.

Results:

MAGE is related to NIHSS, homocysteine (HCY), HOMA-IR, FBG, CRP and IMT, while NIHSS is related to CRP, HCY, HOMA-IR, IMT. The factors impacting the short-term prognosis of ACI were NIHSS, HBA1C and MAGE.

Conclusion:

Larger glucose fluctuations are associated with more stroke risk factors and are associated with a poorer short-term prognosis. More attention should be paid to glucose fluctuations in patients with ACI and a history of T2DM.
The Human Microbiome in Multiple Sclerosis: Pathogenic or Protective Constituents?
Authors: Power Christopher , Antony Joseph M. , Ellestad Kristofor K. , Deslauriers André , Bhat Rakesh , Noorbakhsh Farshid
Published: December 2014

The human microbiome is comprised of commensal and pathogenic microorganisms, which exert diverse effects in close proximity to the site of intection as well as in remote tissues through immune-mediated mechanisms. Multiple infectious agents have been implicated in the pathogenesis of multiple sclerosis (MS) with variable findings depending on the agent, techniques, and disease phenotype. Herein, the contributions of individual infectious agents to MS and their effects on the immune and nervous systems are reviewed, focusing on herpes viruses, coronaviruses, retroviruses, and synchronic infections. While infectious agents are often assumed to be pathogenic, their effects might also be beneficial to the host in the long-term, depending on age and the type of immunogen/pathogen exposure, as proposed by the hygiene hypothesis. The human microbiome has potential impact on future diagnostic and therapeutic issues in MS.
Embedding theorems for LTL and its variants
Authors: KAMIDE NORIHIRO
Published: December 2014

In this paper, we prove some embedding theorems for LTL (linear-time temporal logic) and its variants:viz. some generalisations, extensions and fragments of LTL. Using these embedding theorems, we give uniform proofs of the completeness, cut-elimination and/or decidability theorems for LTL and its variants. The proposed embedding theorems clarify the relationships between some LTL-variations (for example, LTL, a dynamic topological logic, a fixpoint logic, a spatial logic, Prior's logic, Davies' logic and an NP-complete LTL) and some traditional logics (for example, classical logic, intuitionistic logic and infinitary logic).
ACCOUNTING FOR SPANISH BUSINESS CYCLES
Authors: López Jesús Rodríguez , García Mario Solís
Published: December 2014

We apply the business cycle accounting methodology proposed by Chari, Kehoe, and McGrattan to identify the sources of Spanish business fluctuations during two outstanding cyclical episodes: the recession alongside the transition to democracy in 1977 and the great recession of 2008. We find that the labor wedge played a key role during both recessions and that taxes and labor market institutions are likely behind the wedge movements. We conclude that any model that tries to understand the causes of recessions that occurred in the last three decades should focus on the labor wedge.
What factors are associated with frequent unhealthy snack-food consumption among Australian secondary-school students?
Authors: Niven Philippa , Scully Maree , Morley Belinda , Baur Louise , Crawford David , Pratt Iain S , Wakefield Melanie
Published: December 2014

Objective

To examine demographic and behavioural correlates of unhealthy snack-food consumption among Australian secondary-school students and the association between their perceptions of availability, convenience and intake with consumption.

Design

Cross-sectional survey of students’ eating, physical activity and sedentary behaviours using validated instruments administered via an online questionnaire.

Setting

Australian secondary schools across all states/territories.

Subjects

Secondary-school students aged 12–17 years participating in the 2009–10 National Secondary Students’ Diet and Activity (NaSSDA) survey (n 12 188).

Results

Approximately one in five students (21 %) reported consuming unhealthy snack foods ≥14 times/week (‘frequent snackers’). After adjusting for all covariates, older students and those with a BMI of ≥25 kg/m2 were less likely to be frequent snackers, while students who reported high fast-food and high sugar-sweetened beverage consumption and those who watched television for >2 h/d were more likely to snack frequently. Furthermore, after adjusting for all covariates and demographic factors, students who agreed that snack foods are usually available at home, convenient to buy and that they eat too many snack foods were more likely to be snacking frequently. Conversely, students who agreed that fruit is a convenient snack were less likely to be frequent snackers.

Conclusions

Frequent unhealthy snack-food consumption appears to cluster with other poor health behaviours. Perceptions of availability and convenience are factors most readily amenable to change, and findings suggest interventions should focus on decreasing the availability of unhealthy snack foods in the home and promoting healthier options such as fruit as convenient snacks.
Ist die Hysterektomie heutzutage ein obsoleter Eingriff?
Authors: Mueller Michael D.
Published: December 2014

Als Folge der allgemeinen Senkung der operativen Morbidität Anfang des Jahrhunderts und dem routinemäßigen Gebrauch von Antibiotika wurde die Indikation zur Hysterektomie in der Mitte des 20. Jahrhunderts sehr großzügig, manchmal möglicherweise zu großzügig, gestellt. Deshalb ist der Eingriff zum Teil in Verruf geraten. Andererseits wurden in den letzten Jahren neue Behandlungsmöglichkeiten bei verschiedenen gutartigen Gebärmuttererkrankungen entwickelt, welche es erlauben, eine Hysterektomie zu vermeiden. Es stellt sich deshalb die Frage, ob es heutzutage noch adäquat ist, bei gutartigen Erkrankungen eine Hysterektomie zu indizieren.
Gelegenheitsappendektomie: Standard oder ungerechtfertigtes Risiko?
Authors: Kaderli Reto
Published: December 2014

Der Begriff Gelegenheitsappendektomie bezeichnet die chirurgische Entfernung der Appendix während eines Eingriffes, der nicht in Zusammenhang mit einer Pathologie der Appendix steht. Die Diskussion über Nutzen und Risiken derselben wird kontrovers geführt. Eine Gelegenheitsappendektomie ist kontraindiziert bei Patienten mit instabilem Allgemeinzustand, Morbus Crohn, schwer zugänglicher Appendix, geplanter Bestrahlung, Immunsuppression, Gefässersatz oder anderem intraabdominalem Fremdmaterial. Sie sollte abhängig gemacht werden von der Grunderkrankung, der Operationstechnik (offen vs. laparoskopisch), sowie dem Alter des Patienten. Bei gesunden Patienten unter 25 Jahren sollte unabhängig von der Operationstechnik eine „Gelegenheitsappendektomie“ evaluiert werden. In jedem Fall bedarf es einer präoperativen Einverständniserklärung. Der Terminus „Gelegenheitsappendektomie“ umschreibt die Operation nur ungenau und sollte nicht mehr verwendet werden. Richtigerweise sollte von einer „geplanten Appendektomie in einem vorgängig definierten intraoperativen Setting“ gesprochen werden.
Die prophylaktische Mastektomie: unnötige Hysterie oder nötige Vorsorge
Authors: Olariu Radu , Shafighi Maziar , Constantinescu Mihai A.
Published: December 2014

Die prophylaktische Mastektomie ist eine weltweit anerkannte medizinisch notwendige und empfehlenswerte Therapie, die bei Patientinnen mit BRCA 1 und 2 Mutation und anderen Patientinnen mit erhöhtem Brustkrebsrisiko empfohlen werden kann. Die interdisziplinäre Beratung und Behandlung sollten in einem zertifizierten Brustzentrum erfolgen, in dem verschiedene Fachdisziplinen alle Aspekte der genetischen Beratung, der Mastektomie, der Rekonstruktion und der Nachsorge sicherstellen können.
Die moderne Krebsmedizin: Weniger wäre manchmal mehr
Authors: Fey Martin F.
Published: December 2014

Nicht alles, was in der Krebsmedizin angeboten wird, ist auch wirklich nötig. Unter den Früherfassungsmethoden wird die Mammographie kontrovers diskutiert, ebenso „screening“ auf Prostatakrebs mit PSA. In der medikamentösen Krebstherapie mehren sich erfreulicherweise die Beispiele von Tumoren, bei denen prädiktive Marker bestimmt werden können, die angeben, ob eine bestimmte Behandlung Aussicht auf Nutzen hat oder nicht. Trotzdem werden zu oft Chemotherapien oder neue molekulare Medikamente (z. B. Tyrosin-Kinase-Hemmer) in palliativer Absicht eingesetzt, die nur einen bescheidenen Nutzen mit sich bringen. Nachkontrollen mit apparativen Techniken und Labormarkern sind nur dann sinnvoll, wenn die Früherfassung asymptomatischer Rezidive durch Frühtherapie auch wirklich einen belegten Vorteil bietet – dies trifft weniger häufig zu als gemeinhin angenommen.
Nervensonographie intraneuraler Ganglien als Ursache schmerzhafter N.-peronaeus-Paresen: eine Fallserie
Authors: Schilg Lenka , Hägele-Link Stefan , Felbecker Ansgar , Gers Bettina , Weber Johannes , Tettenborn Barbara , Hundsberger Thomas
Published: December 2014

In seltenen Fällen liegen der erworbenen Schädigung des Nervus peronaeus mit konsekutiver Lähmung der innervierten Muskulatur intraneurale Ganglien zugrunde. Diese können im Gegensatz zu den druckbedingten Kompressionen chirurgisch im Rahmen der Erstdiagnose behandelt werden. Eine sorgfältige Anamnese in Kombination mit einer klinischen und elektrophysiologischen Untersuchung ist hierbei zielführend. Häufig passen einzelne Befunde nicht zu der klassischen Präsentation einer Druckläsion am Fibulakopf. Ergänzend stellt die hochfrequente dynamische Nervensonographie des N. peronaeus eine sensitive und kostengünstige bildgebende Untersuchungsmethode dar, um diese besondere Pathologie aufzudecken. Nachfolgend werden drei Patienten mit Paresen des N. peronaeus beschrieben, bei denen die Nervensonographie zur Diagnose von intraneuralen Ganglien des N. peronaeus führte.
Hüftgelenkersatz-Operationen: Grenze zwischen Normalverlauf und Komplikation
Authors: Attinger Marc , Siebenrock Klaus
Published: December 2014

Der Hüftgelenkersatz ist eine häufige und erfolgreiche Behandlung der symptomatischen Koxarthrose. Aufgrund der demografischen Entwicklung in der Schweiz muss in den kommenden Jahren mit einer deutlichen Zunahme des Bedarfs an Hüfttotalprothesen gerechnet werden. Die Standzeit der Hüfttotalprothese liegt bei ca. 85% nach 20 Jahren. Neue Prothesendesigns versuchen die Biomechanik des Kunstgelenks zu verbessern, weniger eigenen Knochen zu opfern und «minimal-invasive» Zugänge zum Hüftgelenk zu vereinfachen. Zu den schwerwiegenden Komplikationen in der Hüftprothetik gehören die Prothesenluxation, die aseptische Lockerung, der Protheseninfekt, die periprothetische Fraktur und das persistierende Hinken. Sie erfordern eine chirurgische Revision und sind meist mit erheblichem Aufwand verbunden. Entwickelt sich eine schmerzhafte Hüfttotalprothese, ist eine systematische und sorgfältige Abklärung notwendig. Die Zuweisung zum Spezialisten sollte deshalb früh in Erwägung gezogen werden.
Behandlungsstrategien für zerebrale kavernomatöse Malformationen
Authors: Stienen Martin N. , Bijlenga Philippe , Schaller Karl , Hildebrandt Gerhard , Gautschi Oliver P.
Published: December 2014

Zerebrale kavernomatöse Malformationen (CCM) sind Gefässmissbildungen zwischen dem arteriellen und venösen Gefässsystem, die ausschliesslich aus Endothelzellen bestehen. Sie treten bei ungefähr 0,1–4% der Bevölkerung auf und präsentieren sich je nach Grösse und Lokalisation vor allem bei jüngeren Patienten durch epileptische Anfälle, fokale Hirnblutungen, neurologische Defizite oder werden aufgrund unspezifischer Beschwerden zufällig im MRI entdeckt. Im klinischen Alltag existieren bezüglich des Managements von Kavernompatienten vier Möglichkeiten: die chirurgische oder konservative Therapie von inzidentiellen oder symptomatischen Befunden. Die Entscheidungsfindung bezüglich der optimalen Therapie muss im Wissen um den natürlichen Verlauf der Pathologie sowie den chirurgischen Möglichkeiten mit dem zu erwartenden klinisch-funktionellen Ergebnis nach Operation erfolgen. Eine vorsichtige Patientenselektion und eine entsprechende Expertise des Zentrums sind somit beim Management der CCM entscheidend.
Impact of Comorbid Depression on Serial Position Effects in Alzheimer’s Disease
Authors: Hofrichter Nienke A. , Dick Sandra , Riemer Thomas G. , Schleussner Carsten , Goerke Monique , Mell Thomas , Heinz Andreas , Rapp Michael A.
Published: December 2014

Hippocampal dysfunction and deficits in episodic memory have been reported for both Alzheimer’s disease (AD) and major depressive disorder (MDD). Primacy performance has been associated with hippocampus-dependent episodic memory, while recency may reflect working memory performance. In this study, serial position profiles were examined in a total of 73 patients with MDD, AD, both AD and MDD, and healthy controls (HC) by means of CERAD-NP word list memory. Primacy performance was most impaired in AD with comorbid MDD, followed by AD, MDD, and HC. Recency performance, on the other hand, was comparable across groups. These findings indicate that primacy in AD is impaired in the presence of comorbid MDD, suggesting additive performance decrements in this specific episodic memory function.
When Bystanders Increase Rather Than Decrease Intentions to Help
Authors: Greitemeyer Tobias , Oliver Mügge Dirk
Published: December 2014

The bystander effect refers to the phenomenon that the presence of others inhibits helping behavior. The present research examines the idea that the bystander effect reverses when effective helping would require many help-givers. In a between-participants experiment, the number of help-givers needed as well as the number of individuals who were asked for help was varied. When one help-giver was needed, the typical bystander effect occurred in that helping intention was greater when one individual was asked rather than many. In contrast, when many help-givers were needed, the bystander effect reversed in that helping intention was greater when many individuals were asked rather than one. Mediation analyses showed that perceived rationality and diffusion of responsibility accounted for the bystander effect, whereas only perceived rationality accounted for its reversal.
Lytic activity by temperate phages of Pseudomonas aeruginosa in long-term cystic fibrosis chronic lung infections
Authors: James Chloe E , Davies Emily V , Fothergill Joanne L , Walshaw Martin J , Beale Colin M , Brockhurst Michael A , Winstanley Craig
Published: December 2014

Pseudomonas aeruginosa is the most common bacterial pathogen infecting the lungs of cystic fibrosis (CF) patients. The transmissible Liverpool epidemic strain (LES) harbours multiple inducible prophages (LESϕ2; LESϕ3; LESϕ4; LESϕ5; and LESϕ6), some of which are known to confer a competitive advantage in an in vivo rat model of chronic lung infection. We used quantitative PCR (Q-PCR) to measure the density and dynamics of all five LES phages in the sputa of 10 LES-infected CF patients over a period of 2 years. In all patients, the densities of free-LES phages were positively correlated with the densities of P. aeruginosa, and total free-phage densities consistently exceeded bacterial host densities 10–100-fold. Further, we observed a negative correlation between the phage-to-bacterium ratio and bacterial density, suggesting a role for lysis by temperate phages in regulation of the bacterial population densities. In 9/10 patients, LESϕ2 and LESϕ4 were the most abundant free phages, which reflects the differential in vitro induction properties of the phages. These data indicate that temperate phages of P. aeruginosa retain lytic activity after prolonged periods of chronic infection in the CF lung, and suggest that temperate phage lysis may contribute to regulation of P. aeruginosa density in vivo.
A nairovirus isolated from African bats causes haemorrhagic gastroenteritis and severe hepatic disease in mice
Authors: Ishii Akihiro , Ueno Keisuke , Orba Yasuko , Sasaki Michihito , Moonga Ladslav , Hang’ombe Bernard M. , Mweene Aaron S. , Umemura Takashi , Ito Kimihito , Hall William W. , Sawa Hirofumi
Published: December 2014

Bats can carry important zoonotic pathogens. Here we use a combination of next-generation sequencing and classical virus isolation methods to identify novel nairoviruses from bats captured from a cave in Zambia. This nairovirus infection is highly prevalent among giant leaf-nosed bats, Hipposideros gigas (detected in samples from 16 individuals out of 38). Whole-genome analysis of three viral isolates (11SB17, 11SB19 and 11SB23) reveals a typical bunyavirus tri-segmented genome. The strains form a single phylogenetic clade that is divergent from other known nairoviruses, and are hereafter designated as Leopards Hill virus (LPHV). When i.p. injected into mice, the 11SB17 strain causes only slight body weight loss, whereas 11SB23 produces acute and lethal disease closely resembling that observed with Crimean–Congo Haemorrhagic Fever virus in humans. We believe that our LPHV mouse model will be useful for research on the pathogenesis of nairoviral haemorrhagic disease.