bluuebunny/crossref_metadata_2025 huggingface dataset:
Afterword: The Littoral Museum of the Twenty-First Century
Authors: Cadieu Morgane
Published: May 2021

The museum, the mausoleum, and the memorial are key concepts for theorizing beaches and ports in twenty-first-century literature and cinema. On the littoral, these constructions suggest the very opposite of a sealed off monumentality to become living museums of women’s labor in modern and contemporary France (Sciamma, Varda), bodily mausolea of migration on the Senegalese shoreline (Diop), and shapeshifting war memorials in Atlantic and Pacific tidelands (Darrieussecq, Rolin, Virilio). Examples of anamorphic seascapes, especially in photography, underscore the reversibility of sand and cement in Japan (Narahashi, Ono), as well as the dereliction of Cuban beach architecture and American industrial harbors (Morales, Sekula). In art as in criticism, the waterfront stages gender and class crossings (Dumont) and tangles fields. The afterword thereby weaves the major threads of the special issue: textures, labor, and ruins; social mobility and migration; marine life, geological time, and the history of sensation.
Postoperative Complications and Long-Term Quality of Life After Multimodality Treatment for Esophageal Cancer: An Analysis of the Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP)
Authors: Jezerskyte E. , van Berge Henegouwen M. I. , van Laarhoven H. W. M. , van Kleef J. J. , Eshuis W. J. , Heisterkamp J. , Hartgrink H. H. , Rosman C. , van Hillegersberg R. , Hulshof M. C. C. M. , Sprangers M. A. G. , Gisbertz S. S. ,   on behalf of the Dutch UpperGI Cancer Group
Published: May 2021

Background

Esophagectomy has major effects on health-related quality of life (HR-QoL). Postoperative complications might contribute to a decreased HR-QOL. This population-based study aimed to investigate the difference in HR-QoL between patients with and without complications after esophagectomy for cancer.

Methods

A prospective comparative cohort study was performed with data from the Netherlands Cancer Registry (NCR) and Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP). All patients with esophageal and gastroesophageal junction (GEJ) cancer after esophagectomy in the period 2015–2018 were enrolled. The study investigated HR-QoL at baseline, then 3, 6, 9, 12, 18, and 24 months postoperatively, comparing patients with and without complications as well as with and without anastomotic leakage.

Results

The 486 enrolled patients comprised 270 patients with complications and 216 patients without complications. Significantly more patients with complications had comorbidities (69.6% vs 57.3%; p = 0.001). No significant difference in HR-QoL was found over time between the patients with and without complications. In both groups, a significant decline in short-term HR-QoL was found in various HR-QoL domains, which were restored to the baseline level during the 12-month follow-up period. No significant difference was found in HR-QoL between the patients with and without anastomotic leakage. The patients with grades 2 and 3 anastomotic leakage reported significantly more “choking when swallowing” at 6 months (ß = 14.5; 95% confidence interval [CI], − 24.833 to − 4.202; p = 0.049), 9 months (ß = 22.4, 95% CI, − 34.259 to − 10.591; p = 0.007), and 24 months (ß = 24.6; 95% CI, − 39.494 to − 9.727; p = 0.007) than the patients with grade 1 or no anastomotic leakage.

Conclusion

In general, postoperative complications were not associated with decreased short- or long-term HR-QoL for patients after esophagectomy for esophageal or GEJ cancer. The temporary decrease in HR-QoL likely is related to the nature of esophagectomy and reconstruction itself.
Λιθοτεχνίες της μεταβατικής τελικής νεολιθικής και πρώιμης εποχής του χαλκού Ι από την Αττική
Authors: Σπηλιωτακοπούλου Ιωάννα
Published: May 2021

Αντικείμενο της διατριβής είναι η μελέτη των λιθοτεχνιών οψιανού και πυριτόλιθου από τη θέση της Μερέντας Αττικής και η τοποθέτησή τους στο ευρύτερο χρονοπολιτισμικό και τεχνολογικό πλαίσιο της Μεταβατικής ΤΝ/ΠΕ Ι και ΠΕ ΙΙ εποχής. Συνολικά μελετήθηκαν 17323 λίθινα λαξευμένα τέχνεργα, από τα οποία περίπου τα 2500 εντάχθηκαν σε βάση δεδομένων για διεξοδική ανάλυση. Η μελέτη υιοθέτησε μια προσέγγιση που βασίζεται στην εξέταση των πρώτων υλών, της τεχνολογίας και της τυπολογίας των εργαλείων, με βασικό μεθοδολογικό εργαλείο αυτό των εγχειρηματικών αλυσίδων παραγωγής. Εκτός από αυτούς τους τρείς άξονες επιπλέον ορίστηκε και ένας τέταρτος, αυτός της χωρικής κατανομής του υλικού. Επιλέχθηκε υλικό από χώρους εσωτερικούς και εξωτερικούς, όπως οικίες και λάκκους απόρριψης και περιγράφηκε η φύση της κάθε συγκέντρωσης. Στην παρούσα μελέτη εξετάζεται επίσης η πιθανότητα να είχε συσταθεί εργαστήριο παραγωγής λίθινων εργαλείων στη Μερέντα, καθώς η μεγάλης κλίμακας παραγωγή σε σχέση με το μέγεθος του οικισμού την κάνουν να ξεχωρίζει από τα υπόλοιπα κέντρα της Μεταβατικής ΤΝ/ΠΕ Ι εποχής. Στο πλαίσιο αυτό γίνεται συζήτηση σχετικά με τα κριτήρια ταύτισης των εργαστηρίων λίθινων εργαλείων και σχετικά με την οργάνωση της παραγωγής στο κοινωνικοοικονομικό σύστημα της Μεταβατικής ΤΝ/ΠΕ Ι εποχής. Για την αξιολόγηση των δεδομένων της Μερέντας έγιναν συγκρίσεις με τις λιθοτεχνίες άλλων δημοσιευμένων θέσεων, ενώ συνεκτιμήθηκε πρωτογενές υλικό από τον οικισμό του Αγίου Κοσμά Αττικής. Σύμφωνα με τα στοιχεία που προέκυψαν η λιθοτεχνία της Μερέντας είναι ο «κρίκος» που συνδέει τις απλές τεχνολογίες λάξευσης πρώτων υλών που συνηθίζονται περισσότερο κατά την Νεολιθική εποχή με τα πιο εξελιγμένα σχήματα της Πρωτοελλαδικής ΙΙ εποχής. Τα παραγόμενα προϊόντα της Μερέντας, δηλαδή λεπίδες και φολίδες, χρησίμευαν ως υπόβαθρα εργαλείων για μια πληθώρα καθημερινών οικιακών εργασιών. Τα εργαλεία αυτά εντάσσονται σε ένα νέο κοινωνικοοικονομικό πλαίσιο που σχετίζεται με την εγκαθίδρυση στην Αττική κέντρων παραγωγής λαξευμένων εργαλείων από οψιανό, που διακινούνταν πιθανόν σε υπερτοπικό επίπεδο. Στην Αττική η ενασχόληση με τη λάξευση του λίθου πρέπει να ήταν κοινή πρακτική από την ΤΝ και εξής και πιθανόν ένα από τα ιδιαίτερα πολιτισμικά χαρακτηριστικά της, που την διαφοροποιούσαν από άλλες γειτονικές περιοχές.
Leben am Abgrund
Authors: Bargetzi Dagmar
Published: May 2021

Der vorliegende Aufsatz behandelt die Funde und Befunde einer Ausgrabung am Münsterplatz 7, die im Jahr 1985 stattfand. Auf der Grabungsfläche wurden elf Grubenstrukturen und Teilstücke von mehreren Mauern festgestellt, die sich mehrheitlich der spätkeltischen und römischen Zeit zuordnen liessen. Grube 8 war eine durch Hitze stark verfärbte Struktur, deren Form am ehesten mit Kalkbrenngruben vergleichbar ist.
The role of single nucleotide polymorphisms of IL-1A -889C>T (rs1800587), TNF-A -238G>A (rs361525), and VDR TaqI (rs731236) on susceptibility to herniated nucleus pulposus
Authors: Azharuddin Azharuddin , Ilmawan Muhammad , Fajar Jonny Karunia , Fahriani Marhami , Mamada Sukamto S. , Maliga Helnida Anggun , Nainu Firzan , Dhama Kuldeep , Harapan Harapan , Magetsari Rahadyan
Published: May 2021

Background: The objective of this study was to determine the role of single nucleotide polymorphisms (SNPs) in interleukin 1 alpha (IL-1A), tumor necrosis factor-alpha (TNF-A), and vitamin D receptor (VDR) genes on the susceptibility to herniated nucleus pulposus (HNP).

Methods: Four databases (PubMed, Embase, Cochrane, and Web of Science) were searched as of April 1st, 2021. Authors, publication year, targeted genes, genotype and allele frequency in each case and control groups were collected. Newcastle-Ottawa scale was used to evaluate the publication quality. The pooled estimates of association of IL-1A -889C>T (rs1800587), TNF-A -238G>A (rs361525), and VDR TaqI (rs731236) and susceptibility to HNP were assessed using Z test and presented as odd ratio (OR) and 95% confidence intervals (95%CI).

Results: We screened 3,067 unique studies for eligibility and three, two and nine studies on IL-1A -889C>T, TNF-A -238G>A, and VDR TaqI were included, respectively, in our meta-analysis. The studies consisting 369 HNP cases and 433 controls for IL-1A -889C>T, 252 cases and 259 controls for TNF-A -238G>A and 1130 cases and 2096 controls for VDR TaqI. Our pooled estimates indicated that there was no significant association of those SNPs with the susceptibility to HNP in any genotype, dominant model, recessive model, or allele comparations.

Conclusion: Although individual studies suggested the important role of gene expression dysregulation associated with SNPs in IL-1A, TNF-A, and VDR, our data indicated that IL-1A -889C>T, TNF-A -238G>A, and VDR TaqI had weak association with HNP susceptibility in both genotypes and allele distributions. However, since heterogeneity was identified among studies included in this meta-analysis, further meta-analysis with a larger population and subgroup analysis on specific population are warranted to support this finding.
COVID-19 vs. stakeholder engagement: the impact of coronavirus containment measures on stakeholder involvement in European energy research projects
Authors: Süsser Diana , Ceglarz Andrzej , Stavrakas Vassilis , Lilliestam Johan
Published: May 2021

The coronavirus disease 2019 (COVID-19) pandemic has affected societies and economies around the world, and the scientific community is no exception. Whereas the importance of stakeholder engagement in research has grown quickly for many EU projects, yet no research has studied the consequences of the pandemic on this. In this paper, we investigate the effects of the COVID-19 crisis on European energy research, in particular the stakeholder work, during the first wave of the coronavirus in spring and summer 2020. We pose the research questions: (i) How big of a problem are the coronavirus containment measures for stakeholder engagement? (ii) How have researchers coped with the situation, and (iii) How do they evaluate alternative stakeholder activities implemented? We conducted an online survey among European energy research projects with stakeholder engagement between June and August 2020. We found that only one of six engagement activities could be implemented as planned, whereas almost half were cancelled or delayed. The most common coping strategies were changing involvement formats – mainly to webinars or online workshops – or postponement. Webinars, online interviews, and online surveys were seen as the best online formats. Most respondents plan to continue using online formats to complement, but not to replace, physical meetings in future research. All long-term effects remain to be seen, but given the postponement of many stakeholder involvement activities, many projects may face problems at later stages of their realisation. These findings are highly relevant for funding institutions and provide important insights on coping strategies for fellow researchers beyond the energy field.
Dynamic Q-learning and Fuzzy CNN Based Vertical Handover Decision for Integration of DSRC, mmWave 5G and LTE in Internet of Vehicles (IoV)
Authors:   Department of Communications Engineering & Advanced Telecommunication Technology (ATT), School of Electrical Engineering, Faculty of Engineering, Universiti Teknologi Malaysia, Hussain Shaik Mazhar , Yusof Kamaludin Mohamad
Published: May 2021

Internet of vehicles commonly known as IOV is a newly emerged area which with the help of internet assisted communication provides the support to the vehicles. Due to the access of more than one radio access network, 5G makes the connectivity ubiquitous. Vehicle mobility demands for handover in such heterogeneous networks. Instead of using better technology for long ranges and other types of traffic, the vehicles are using devoted short range communications at short ranges. Commonly, networks for handovers were used to be selected directly or with the available radio access it used to connect automatically. With the help of this, the hand over occurrence now takes places frequently. This paper is based on the incorporation of DSRC, LTE as well as mm Wave on Internet of vehicles which is integrated with the Handover decision making algorithm, Network Selection and Routing. The decision of the handovers is to ensure that if there is any requirement of the vertical handovers using dynamic Q-learning algorithms in which entropy function is used to predict the threshold according to the characteristics of the environment. The network selection process is done using Fuzzy Convolution Neural Network commonly known as FCNN which makes the fuzzy rules by considering the parameters such as strength of its signal, its distance, the density of the vehicle, the type of its data as well the Line of Sight (LoS). V2V chain routing is presented in such a manner that V2V pairs are also selected with the help of jellyfish optimization algorithm considering three metrics – Vehicle metrics, Channel metrics and Vehicle performance metrics. OMNET++ simulator is the software in which system is developed. The performance evaluation is done according to its Handover Success Probability, Handover Failure, Redundant Handover, Mean Throughput, delay and Packet Loss.
ОЦЕНКА ЭФФЕКТИВНОСТИ ОБУЧЕНИЯ ПЕРСОНАЛА: МЕТОДОЛОГИЧЕСКИЙ АСПЕКТ
Authors: Shendel Tatyana A. , Yarkova Svetlana A.
Published: May 2021

В статье раскрыты значимость и актуальность оценки эффективности обучения персонала, рассмотрены показатели и методы изучения данного процесса. Предметной областью исследования явилось предприятие железнодорожного транспорта – структурное подразделение ОАО «Российские железные дороги». В результате оценки эффективности обучения персонала на предприятии определены проблемы, связанные с отсутствием целеполагания в обучении. Как следствие, отсутствуют показатели и критерии измерения полученного результата, что определило объективную потребность в их разработке как оптимального решения для предприятий железнодорожного транспорта. В качестве показателей оценки эффективности обучения персонала определены выполнение плана обучения, затраты на обучение персонала, индекс лояльности работника, удовлетворенность руководителя обучением персонала, использование полученных знаний в профессиональной деятельности, повышение производительности труда, процент возврата аппаратуры в гарантийный период, отказы технических средств. Особо ценным является то, что показатели эффективности отражают возвратность финансовых вложений на обучение персонала предприятия.
Цель – оценить эффективность обучения и предложить показатели измерения полученного результата для предприятий железнодорожного транспорта.
Метод или методология проведения работы: методы теоретического исследования (анализ и синтез информации), контент-анализ, аналитические и статистические методы, социологические исследования (интервью).
Результаты: определены проблемы при оценке эффективности обучения персонала на предприятии железнодорожного транспорта, предложены показатели и критерии измерения полученного результата.
Область применения результатов: предложенные показатели и критерии оценки эффективности обучения персонала могут быть использованы на крупных предприятиях различных отраслей народного хозяйства.
СТРАТЕГИЧЕСКОЕ РАЗВИТИЕ ТРАНСПОРТНОЙ СИСТЕМЫ КИТАЯ
Authors: Wang Xiugang , Lysochenko Alla A.
Published: May 2021

В последние годы, с быстрым социально-экономическим развитием Китая и ускорением процесса городского строительства, современная транспортная экономика как важная часть экономики в сфере услуг, стала основой национального экономического развития. Однако ряд проблем, таких как неравномерное развитие региональных перевозок, низкое качество транспортных услуг, ограничения внешних ресурсов требует разработку стратегии направленной на устойчивое развитие транспортной экономики.
Целью исследования статьи является анализ современной транспортной системы Китая и формирование предложений по дальнейшему ее стратегическому развитию.
Метод проведения работы: поставленная цель предопределила необходимость использования ряда подходов и приемов, обеспечивающих комплексный анализ и применение системно-функционального метода исследования. В его рамках использовались такие приемы как сравнительный анализ, факторный анализ, статистическое прогнозирование.
Результаты: представлены предложения по оптимизации транспортной структуры и осуществление комплексных стратегических корректировок транспортной системы; развитию системы уровня управления транспортной экономикой интенсивным путем, а также внедрения передовых технологий и создание интеллектуальной современной системы управления экономикой на транспорте.
Область применения результатов: полученные результаты целесообразно применять при разработке стратегии в транспортной сфере Китая как обобщенной модели и точечном определении развития категорий транспорта.
In the Shadow of Wepwawet
Authors: Rzeuska Teodozja I.
Published: May 2021

Asyut, known as Siut in ancient times, was the capital of the 13th Nome of Upper Egypt. It is situated precisely in the middle of Egypt at a crossroads of routes running from north to south and east to west. The site is mainly recognised as a place where Wepwawet and Anubis were worshipped and for being the burial ground of the nomarchs in the 1st Intermediate period/Period of Regions and the Middle Kingdom. Although the city’s name appears in texts dating back to the 5th Dynasty and is predated by depictions of Wepwawet, it is only recently that evidence of an early necropolis has been found on the gebel in Asyut. It was the German-Egyptian mission of the Asyut Project (Johannes Gutenberg University of Mainz/Free University in Berlin/Sohag University) working on the site for the last ten seasons, which managed to locate an early cemetery.
Pottery from Tell el-Murra Graves
Authors: Kazimierczak Magdalena
Published: May 2021

Excavations conducted at the Tell el-Murra cemetery in seasons 2011 and 2012 revealed five graves with pottery assemblages. Grave no. 3 contained pottery vessels which could be dated to the end of the Naqada IIIB period. The pottery vessels found here included two cylindrical jars (one with a cord impression and the second with an incised continuous line beneath the rim), as well as a quite elongated, ovoid jar with impressed halfbows on its shoulders. Two chronologically later graves (nos 1 and 2) should probably be dated to the Naqada IIIC2 period. The pottery assemblage of these graves included large, tall-shouldered jars with impressed halfbows and pot marks (grave no. 1), jars with rope band decorations, wine jars (grave no. 2), ovoid jars, barrel-shaped jars, small broad-shouldered jars, beer jars and undecorated cylindrical jars. Other pottery types included bowls with convex sides, a tray with an oval orifice, a red-polished plate and pot stands. Grave no. 7 seems to date to a different time period, as it contained rough ware beer jars and bowls with convex sides and simple rims. It therefore probably dates to the Naqada IIIC2/IIID period. The most recent of the graves containing pottery vessels (grave no. 5) was discovered in the 2012 season. It contained two pottery vessels: one was a miniature and the other was a bowl with convex sides, a simple rim, a slightly narrowing area of concave contour below the rim and a flat base. Based on pottery analysis, it should be dated to the second half of the 2nd Dynasty.
Beer Jars from Tell el-Murra Graves
Authors: Kazimierczak Magdalena
Published: May 2021

Over the five excavation seasons conducted between 2011 and 2015 at the Early Dynastic Tell el-Murra cemetery, 17 graves were discovered along with their pottery assemblages. Nine of them contained vessels which are generally considered to be beer jars. Amongst the 18 examples of this kind of jar, a few types can be distinguished that show an affinity to similar vessels from the other Early Dynastic sites of Tell el-Farkha, Minshat Abu Omar, Buto, Helwan, Abydos, and Kafr Hassan Dawood. These analogies indicate that the Tell el-Murra graves should be dated to the Naqada IIIC2/D period and in some cases an even more precise date can be obtained. In addition, the presence of beer jars within the pottery assemblages of the graves also provides us with information concerning the funerary customs of the inhabitants of the Tell el-Murra site.
Integration of 2D and TLS Data Using GIS to Create a Database for the Paphos Agora Project
Authors: Ćwiąkała Paweł , Matwij Karolina , Matwij Wojciech , Miszk Łukasz , Winiarska Weronika
Published: May 2021

Excavations in the Nea Paphos Hellenistic-Roman agora have been conducted by the Chair of Classical Archaeology of the Jagiellonian University of Krakow since 2011 under the direction of Professor E. Papuci-Władyka. The main goal of the excavation is to fully uncover the Agora and to reconstruct the ways in which this public space was used. One of the methodological goals set for the research was the creation of a state-of-the-art database (work on which began in 2013) that could import and adapt data obtained from modern equipment. Of equal importance was the implementation of a 3D-format within the database (this had been under discussion for over a decade) and the enabling of GIS software data integration. Faro Focus laser scanner data was chosen to form the graphical core as it fulfilled the most important visual documentation criteria for the Paphos Agora Project database. This article presents the main premises on which the new Nea Paphos Hellenistic-Roman Agora Project database is based (on the integration of 3D and 2D data from 2011–2014) and the different stages of its creation, which made use of the latest methods of developing such tools for the purposes of archaeological excavations.
The Symbolic Meaning of the Acorn – a Possible Interpretation
Authors: Wacławik Maciej
Published: May 2021

The acorn is a very popular literary and decorative motif in Greek and Roman culture that was used by many ancient authors to symbolise fertility and the possibility of creating new life. It was used as a decoration with this significance on many everyday objects, such as vessels and jewellery. The acorn was also very popular as a shape for the counterweights of Roman balances. On this group of objects, it is possible that the acorn symbolised the gods, who ensured the fairness of transactions between sellers and their customers. The gods used may have been Zeus, Hermes or Athena, with the latter being the most likely to appear.
Ancient Bruises: a Case of Skin Lesions due to Vitamin C Deficiency
Authors: Dipti Rao  , Roeland F. Stolk  , Maaike H. de Blauw  , Marcel M.C. Hovens  , Robert-Jan Hassing
Published: May 2021

Scurvy was a common 18th century disease caused by vitamin C deficiency. It presents with multiple non-specific symptoms and can lead to capillary fragility due to impaired collagen synthesis. We report the case of a 63-year-old woman who presented with fatigue, nausea and progressive skin lesions consisting of multiple ecchymoses on the legs as also described in the diary drawings of a navy doctor in the 19th century. The ascorbic acid level was undetectable low in the patient’s serum. However, treatment with 500 mg ascorbic acid daily dramatically improved the skin lesions within 5 days.
The STRIPassistant: a Digital Tool to Optimize Polypharmacy
Authors: Paul AF Jansen
Published: May 2021

The Structured Tool to Reduce Inappropriate Prescribing (STRIP) is a method to perform a medication review. Part of this method is the pharmaceutical analysis that is digitalized into the STRIPassistant (demo: www.ephor.eu). The effectiveness and time-efficiency of the STRIPassistant will be presented.
Chronic Miliarial Gout Associated with Carpal Tunnel Syndrome: A Very Rare Clinical Presentation
Authors: Victoria Sadovici-Bobeica  , Lucia Mazur-Nicorici  , Aliona Nicorici  , Virginia Salaru  , Natalia Loghin-Oprea  , Maria Garabajiu  , Valeriu Istrati  , Minodora Mazur
Published: May 2021

This case report describes an unusual form of gout, called miliarial gout, in association with carpal tunnel syndrome in a 54-year-old woman. Miliarial gout was first described in 2007 and is a very rare presentation of chronic tophaceous gout. The latter condition can cause carpal tunnel syndrome, but this association has not previously been described in association with miliarial gout. In addition, the authors discuss the use of the parsimony principle in internal medicine whereby a single cause is first sought for different symptoms presenting at the same time.
Platypnoea-Orthodeoxia Syndrome: An Intriguing Diagnosis
Authors: Vânia Rodrigues  , Tiago Gomes  , Adriana Santos Silva  , Rita Rocha  , Ana Ferrão
Published: May 2021

Platypnoea-orthodeoxia syndrome (POS) is an uncommon clinical entity characterized by dyspnoea and hypoxaemia induced by upright posture and relieved by recumbence. It is often associated with right-to-left shunting through a patent foramen ovale (PFO) or an atrial septal defect. We report the case of a 79-year-old woman with hypoxaemia initially attributed to a pulmonary infection but persisting after successful treatment. Being in the upright position triggered the hypoxaemia. A thoracic CT angiogram and ventilation/perfusion lung scan excluded a pulmonary embolism, but a transoesophageal echocardiogram with a bubble test showed a PFO with a right-to-left shunt, without pulmonary hypertension. The patient underwent percutaneous closure of the PFO which led to prompt symptom relief and full functional recovery.
From the Gut to the Heart: Cardiac Tamponade due to Lymphatic Metastasis
Authors: Ana Pãosinho  , Ana Luísa Esteves  , António João Pereira
Published: May 2021

Malignant pericardial effusion is common, being reported in 5–15% of all cancer patients. It most commonly arises from metastasis of lymphomas and of tumours of the lung, breast and, infrequently, the gastrointestinal tract. We describe the case of a 76-year-old woman who presented to the emergency room with cervical adenopathies and clinical signs of acute heart failure. The nodes were biopsied and found to be consistent with adenocarcinoma of the colon. CT showed thoracic lymphatic involvement but no evidence of other organ involvement. The patient developed cardiac tamponade and required emergent pericardiocentesis. To our knowledge, this is the first report of metastatic colon cancer without direct involvement of the pericardium or other solid organs.
Chorea, Pruritus and Polycythemia: Looking for Clues
Authors: Vânia Rodrigues  , Carolina Lopes  , Adilson Marcolino  , Madalena Pinto
Published: May 2021

Chorea is a movement disorder usually due to vascular, hereditary, metabolic or drug- induced causes, and has rarely been reported in association with polycythemia vera (PV). Polycythemic chorea is an uncommon clinical entity that occurs more often in elderly women. PV is a treatable cause of chorea and must be considered during the diagnostic approach. We report the case of a 75-year-old woman with involuntary movements of the mouth and face with subsequent involvement of the trunk and limbs who was admitted for investigation of the chorea. The patient had the haematological attributes of PV and a positive mutation in the janus kinase 2 (JAK2) gene, and was therefore treated with hydroxyurea which led to a marked reduction in the chorea and improvement in haematological parameters. Various aetiologies of chorea must be considered in the elderly. The present case illustrates the importance of considering PV in the differential diagnosis, since its treatment leads to chorea resolution, thus avoiding serious complications.
Ocular Melanoma Presenting as Masquerade Syndrome
Authors: Sara Simões Macedo  , Mónica Teixeira  , Andreia Correia  , António Novais  , Cátia Cabral
Published: May 2021

A masquerade syndrome is an ophthalmological entity where a neoplasm mimics an inflammatory condition. Ocular melanoma (chiefly uveal) may present with symptoms suggestive of intraocular inflammation such as endogenous endophthalmitis. Ocular melanoma is most commonly found in middle-aged and older caucasian patients. One-third of all uveal melanoma cases present asymptomatically. Early diagnosis facilitates treatment before ocular melanoma reaches metastatic stage IV. Current therapy options for stage IV patients are palliative care and clinical trial participation.eed for clinicians to be aware of rare metastases at the time of diagnosis.
Psychiatric Symptoms and Benzodiazepine Use Mask a Patent Foramen Ovale-Related Stroke: A Cautionary Tale
Authors: Manuel Martins Barbosa  , Elsa Araújo  , Marta Pereira  , Rui Marques Costa  , Alejandro Ballvé  , Marta Rubiero  , Carlos A Molina
Published: May 2021

Neurological and psychiatric diseases often present with overlapping features. Patients are sometimes seen by internal medicine, neurology and psychiatry clinicians and time can be important for determining whether a condition is organic or not. The authors present the case of a 31-year-old woman admitted to the emergency department with altered mental status and incomprehensible speech. She had a previous history of anxiety and smoking and was under therapy with benzodiazepines and combined hormonal contraceptives. After an acute neurological disorder was ruled out, the patient was transferred to the psychiatry department, where she was re-evaluated after 12 hours of observation and benzodiazepine washout. As speech impairment and confusion were still present, she was transferred to the Stroke Unit. A bilateral thalamic lesion containing a small focal haemorrhage and a moderate grade right-to-left shunt were identified. A patent foramen ovale was confirmed leading to the final diagnosis of acute ischaemic infarction secondary to a paradoxical embolism. Medical therapy was preferred over percutaneous closure. Risk factors were removed (smoking and hormonal contraceptives), and after the patient recovered completely acetylsalicylic acid 100 mg daily was initiated.
Cardiac Amyloidosis Associated with Apolipoprotein A-IV Deposition Diagnosed by Mass Spectrometry-Based Proteomic Analysis
Authors: Elisabete Martins  , Joana Urbano  , Sérgio Leite  , Adriana Pinto  , Raquel Garcia  , Rui Bergantim  , Pedro Rodrigues Pereira  , Paulo Pinho Costa  , Hugo Osório  , Isabel Tavares
Published: May 2021

Amyloidosis is a group of disorders characterised by the accumulation of extracellular deposits of insoluble protein aggregates. Clinical management depends on the accurate identification of the amyloid precursor and underlying cause. We describe a rare case of apolipoprotein A-IV cardiac amyloidosis, the diagnosis of which required mass spectrometry-based proteomic analysis.
Pituitary Apoplexy Following Systemic Anticoagulation
Authors: Ana Rita Mairos dos Santos  , Carlos Tavares Bello  , Alice Sousa  , João Sequeira Duarte  , Luís Barreto Campos
Published: May 2021

Pituitary apoplexy is a rare medico-surgical emergency that stems from an acute expansion of a pituitary adenoma from infarction or haemorrhage and where the treatment strategy is still controversial. Clinical presentation is highly variable and a high index of suspicion is needed to make the diagnosis. Furthermore, in less than half of cases, a precipitating event is identified. We report a case of a 74-year-old female who, after introduction of anticoagulation for pulmonary thromboembolism, presented with pituitary apoplexy heralded by acute adrenal insufficiency, headaches, visual symptoms and hypogonadotropic hypogonadism. Timely initiation of corticosteroids was crucial, and after stabilisation, a conservative treatment strategy was favoured with good long-term prognosis. Long-term follow-up of pituitary function also revealed new growth hormone deficiency.
Two Dabigatran Fast Reversals in a 4-month Period – a Case Report
Authors: Vítor Fagundes  , Mari Mesquita
Published: May 2021

Introduction: Idarucizumab is available for immediate reversal of dabigatran-induced anticoagulation in life-threatening bleeding or urgent surgery in patients with non-valvular atrial fibrillation (nvAF). Case description: We report a case of an 85-year-old female treated with dabigatran for nvAF, submitted to two fast reversal procedures with idarucizumab in a 4-month period. In the first emergency episode, the patient was admitted due to a fall-related cerebral haemorrhage and subdural haematoma. There was a fast reversal of the effects of dabigatran after idarucizumab administration, which allowed stoppage of the bleeding and a decrease in intracranial pressure, with full patient recovery. Four months later, the patient revisited the hospital complaining of diffuse abdominal pain while on the same antithrombotic therapy. Physical examination showed signs of peritoneal irritation and the use of idarucizumab to reverse the effects of dabigatran was decided upon to secure normal bleeding conditions before surgery. Discussion: Idarucizumab is an efficient, safe and feasible option for dabigatran-treated nvAF patients, when urgent anticoagulant effect reversal is needed.
Giant Cystic Mediastinal Lymphangioma
Authors: Ana Catarina Dionísio  , Ricardo Gomes  , Eduardo Cernadas  , Isabel Caballero  , José Proença  , Didia Lages  , Leopoldina Vicente
Published: May 2021

Cystic lymphangioma mainly occurs in children and develops from the lymphatic vessels. The present study reports the case of a 36-year-old female patient with a giant cystic mediastinal lymphangioma. She was asymptomatic and the diagnosis was accidental. Imaging studies are important for referral to the Cardio-Thoracic Surgery Department for surgical intervention in order to remove the lesion. It is important that in the case of an enlargement of the mediastinum observed in a thoracic X-ray, the possible diagnosis takes into consideration various hypotheses. Early diagnosis may prevent further growth and infiltration of structures that hinder the surgical approach.
Cervical Lymphadenopathy in a Nonagenarian Woman: What to Think?
Authors: Vanessa Meireles Chaves  , Fernando Nogueira  , Gilberto Pires da Rosa  , Sofia Tavares  , Inês Ferreira  , Ana Oliveira Monteiro  , Ester Ferreira
Published: May 2021

Tuberculosis remains a worldwide public health problem. Cervical tuberculous lymphadenitis (TBL) or scrofula is the most common form of extrapulmonary tuberculosis, affecting the cervical lymph nodes. We report the case of a 93-year-old woman presenting with cervical adenopathies with 3 months duration. Fine needle aspiration (FNA) biopsy yielded a noncaseous granulomatous process, but was negative for Mycobacterium tuberculosis (MT). As the adenopathies had grown, an excisional biopsy was performed. An extensive study of infectious aetiologies was performed, including for MT, with a negative outcome. Owing to the persistence of cervical lymphadenitis with caseous granulomas, a diagnosis of TBL was strongly suspected and presumptive treatment was initiated. Afterwards, diagnostic confirmation was obtained by isolation of MT in the lymph node culture. The patient presented a favourable clinical outcome. This case highlights that a high index of suspicion is essential for the diagnosis of TBL, especially in the elderly, and emphasizes the importance of pursuing diagnostic confirmation, in which FNA and excisional biopsy plays a key role.
Measles-induced Acute Disseminated Encephalomyelitis in a Non-vaccinated Patient
Authors: Deeba Ali  , Arnaud Detroz  , Yilmaz Gorur  , Lionel Bosquee  , Noel Lorenzo Villalba  , Benoît Cardos
Published: May 2021

We reported a case of measles-induced acute disseminated encephalomyelitis (ADEM) in a 40-year-old immunocompetent adult. The patient presented a week after the development of respiratory symptoms and a cutaneous rash, and was admitted to hospital for altered mental status. Blood tests showed hyperleukocytosis, thrombopenia and cytolysis. A lumbar puncture was consistent with acute meningitis and the patient was initially treated with antiviral and wide broad-spectrum antibiotics. Serology and PCR for measles came back positive.
An Overlapping Case of Miller Fisher Syndrome and the Pharyngeal-Cervical-Brachial Variant of Guillain-Barré Syndrome
Authors: Hélio Martins  , Joana Mendonça  , David Paiva  , Carlos Fernandes  , Jorge Cotter
Published: May 2021

A 55 years-old Caucasian male presented initially in the emergency room reporting myalgia, chills and fever. Physical exam and laboratory tests were unremarkable and he was discharged with symptomatic care. He returned to our ER two weeks later reporting dizziness, loss of balance, blurred vision, mild dysarthria and bilateral hand paresthesia. On examination he presented complete bilateral ophthalmoplegia, mild dysarthria, left finger-to-nose dysmetria, ataxia, areflexia and bilateral hand hypoesthesia without fever. Blood tests and head computed tomography were normal. The patient was admitted to the Internal Medicine department. On second day inwards the patient presented dysphagia. Head magnetic resonance angiogram showed no signs of ischemia or vascular disease and a lumbar puncture was performed but no pleocytosis, albumin-cytological dissociation or hypoglycorrhachia was present. Despite the normal results we suspected of a Guillain–Barré syndrome variant, and started treatment with intravenous immunoglobulin (IVIG) in a dose of 400mg per kilogram and continued for five days with immediate neurological improvement. We present a rare overlapping case of Miller Fisher syndrome and Pharyngeal-Cervical-Brachial variant of Guillain–Barré syndrome.
Diabetic Myonecrosis: An Uncommon Complication of a Common Condition
Authors: Michael Harrison Storandt  , Chandra Thondapi  , Abhishek Matta
Published: May 2021

Introduction: Diabetic myonecrosis is an uncommon complication of diabetes mellitus, most often occurring in patients with poorly controlled, insulin-dependent diabetes. Its etiology is poorly understood, with many suggesting microvascular occlusion to be a key factor resulting in necrosis of skeletal muscle. Case presentation: A 28-year-old male with a history of poorly controlled type I diabetes mellitus and end-stage renal disease requiring dialysis presented to the emergency department with severe pain of the lower extremities bilaterally. Results: Work-up included an x-ray, which demonstrated no acute fractures but extensive vascular calcification of the lower extremities, and Doppler ultrasonography, which showed no DVT. MRI demonstrated severe muscular edema with patchy, geographic areas of sparing, which, in conjunction with the patient’s clinical presentation, allowed for a diagnosis of diabetic myonecrosis. He underwent conservative treatment, consisting of rest and pain management, leading to resolution of symptoms. Discussion: Diabetic myonecrosis, although uncommon, can be easily diagnosed with a high degree of clinical suspicion. It typically presents in a patient with poorly controlled diabetes, and will commonly involve the proximal muscles of the lower extremity unilaterally, but may present bilaterally and involve the distal muscles, as demonstrated in this case. Diagnosis is made via MRI, and it is treated conservatively with pain management and rest. Most cases resolve with conservative management but recurrence is common.
Primitive Neuroectodermal Tumour Invading the Inferior Vena Cava
Authors: Ali Mir  , Marzieh Lashkari  , Fatemeh Jafari  , Behnam Molavi
Published: May 2021

In the present report, we describe our experience with a 44-year-old male with abnormal retroperitoneal primitive neuroectodermal tumours (PNETs) in our hospital, who was operated on with a spindle cell neoplasm diagnosis.
Persistent Facial Oedema and Erythema in a Woman, An Uncommon Manifestation of Chronic Cutaneous Lupus Erythematosus
Authors: Mónica García-Arpa  , María Rodríguez-Vázquez  , David Bellido-Pastrana  , Natalia Villasanti-Rivas  , Marcos Carmona-Rodríguez
Published: May 2021

Manifestations of chronic cutaneous lupus erythematosus are variable. Periorbital and facial swelling occurs in dermatomyositis and systemic lupus, but it has been rarely reported as a manifestation of exclusively cutaneous lupus. A 48-year-old woman presented with a 16-year history of asymptomatic, bilateral swelling and erythema of her face with marked worsening after sun exposure. No systemic symptoms were associated. A complete evaluation did not reveal other findings. Cutaneous biopsy showed features of lupus erythematosus. She was treated with photoprotection, topical tacrolimus, hydroxychloroquine and azathioprine with a partial response. Facial swelling with erythema represents quite an unusual manifestation of chronic cutaneous lupus erythematosus. Dermatomyositis, systemic lupus and Morbihan disease are the main differential diagnoses.
Left Lung and Pulmonary Artery Hypoplasia: A Rare Case of Hemoptysis
Authors: Guiomar Pinheiro  , Ana Margarida Alves  , Isabel Neves  , Teresa Sequeira
Published: May 2021

Pulmonary hypoplasia or agenesis is a rare congenital disorder that results in lung underdevelopment. This disease is usually found in children but rarely encountered in adults. We describe the case of an 84-year-old woman diagnosed with a unilateral pulmonary hypoplasia presenting simultaneously with left pulmonary artery hypoplasia. Due to this condition, the patient had a lifelong history of pulmonary infections that resulted in several bronchiectases in the affected lung. Moreover, the pulmonary artery hypoplasia led to the development of pulmonary hypertension and collateral circulation causing hemoptysis, giving rise to the patient attending the emergency department. Although we were able to medically manage the hemoptysis, it can be fatal and require surgical intervention. Hence, an early diagnosis is essential so that appropriate follow-up and prompt prevention and treatment of complications, such as pulmonary infections, hemoptysis and pulmonary hypertension, are achieved.
Acute Pyelonephritis Associated with Ruptured Abdominal Aortic Aneurysm: An Unusual Presentation
Authors: Rafael Ferreira Nascimento  , Carolina Morna  , Mariana Bilreiro  , Ines Correia
Published: May 2021

We describe a rare presentation of acute pyelonephritis associated with a ruptured abdominal aortic aneurysm. A 68-year-old female presented to the emergency department with a 3 day history of cystitis. General examination revealed the acute onset of pain in the left flank accompanied by fever and chills. Blood tests revealed leucocytosis 25,400x109L and C-reactive protein 495 mg/L (<6.1), while urinary sediment analysis revealed many leucocytes and gram-negative bacteria. The patient was admitted with acute pyelonephritis. On the third day of admission, the urine culture isolated Escherichia coli sensitive to the antibiotic prescribed; however, the patient clinically deteriorated. A computed tomography scan revealed a ruptured abdominal aortic aneurysm involving the left renal artery. The patient underwent an exploratory laparotomy but uncontrollable haemorrhage led to a fatal outcome. This case highlights a rare case of acute pyelonephritis associated with a ruptured abdominal aortic aneurysm. A computed tomography scan or abdominal ultrasound should be considered whenever a patient has acute pyelonephritis with a C-reactive protein >400 mg/L in order to exclude complications and other potentially fatal pathologies.
Blue Woman Syndrome and Thyrotoxicosis in a Patient on Amiodarone
Authors: Radovan Hojs  , Tadej Pedreski  , Nejc Piko  , Matevž Privšek  , Tadej Zorman  , Sebastjan Bevc
Published: May 2021

Amiodarone is an antiarrhythmic drug, in use from the 1960s, which acts on potassium transport in myocytes, causing a lengthening of the action potential and refractory period. Even though it is broadly prescribed, its use is limited by a relatively high occurrence of adverse reactions such as lung, thyroid or hepatic disease, skin changes and so on. The authors report a case of a female patient who was admitted due to chest pain. Due to the bluish skin pigmentation, other causes of amiodarone toxicity were investigated, and hyperthyroidism was detected. After amiodarone discontinuation and specific therapy, thyroid function returned to normal.
The Emphysematous Pancreatitis: A Rare Complication of Acute Necrotizing Pancreatitis
Authors: Niryinganji Révérien  , Mountassir Shuruk  , Siwane Abdellatif  , Tabakh Houria  , Touil Najwa  , Kacimi Omar  , Chikhaoui Nabil
Published: May 2021

Emphysematous pancreatitis is a rare and fatal complication of acute necrotizing pancreatitis. We report a radioclinical observation of a 61-year-old female patient who consulted for epigastric pain radiating to the back, associated with vomiting and elevated lipasaemia more than 3 times the normal value. The abdominal computerized tomography (CT) scan carried out on the fourth day of hospitalization, based on worsening of the clinical condition, showed pancreatic necrosis associated with the presence of air bubbles. Percutaneous puncture of a peripancreatic collection was positive for Escherichia coli. A diagnosis of emphysematous pancreatitis was established. The clinical and biological evolution of our patient was favourable with antibiotic treatment.
Epigastric Pain and Weight Loss – A Case of Wilkie’s Syndrome
Authors: Ana Lima Silva  , Daniela Antunes  , Joana Cordeiro Cunha  , Renato Nogueira  , Diana Fernandes  , Tatiana Salazar  , Carla Madureira Pinto
Published: May 2021

Superior mesenteric artery syndrome (SMA syndrome) or Wilkie’s syndrome is a rare etiology of duodenal obstruction due to compression of the third portion of the duodenum between the superior mesenteric artery and the aorta. Physical and laboratory findings are often non-specific but imaging methods are useful for diagnosing the condition. A 46-year-old female patient presented to the outpatient clinic of our internal medicine department with a 2-year history of epigastric pain, nausea, early satiety and weight loss of 15 kg. Previous studies were inconclusive. The patient underwent computed tomography enterography and its findings were consistent with SMA syndrome. Currently the patient is being followed by General Surgery and Nutrition and is under nutritional measures in order to optimize her body mass index to decrease possible surgical complications.This case report emphasizes the importance of clinical suspicion and careful investigation when considering less common etiologies for frequent gastrointestinal symptoms.
Bilateral Decompressive Craniectomy in Malignant Cerebral Venous Thrombosis
Authors: Eduardo Soriano-Navarro  , Vanessa Cano-Nigenda  , Fernanda Menéndez-Manjarrez  , Esmirna Farington-Terrero  , Juan José Méndez-Gallardo  , Alejandro García-Irigoyen  , Antonio Arauz
Published: May 2021

Introduction: Despite the extremely favourable prognosis of patients with cerebral venous thrombosis (CVT), death occurs in 10–15% of patients. In severe cases of malignant CVT with supratentorial haemorrhagic lesions, cerebral oedema and brain herniation, decompressive surgery may be the only life-saving treatment. Patient and methods: We present the case of a puerperal young woman with progressive headache, seizures and decreased alertness. Thrombosis of the entire superior sagittal sinus with bifrontal venous infarcts and midline shift was confirmed by magnetic resonance imaging with venography sequencing. Despite medical treatment with anticoagulation, progressive neurological deterioration was observed, so bilateral, frontal decompressive craniectomy was performed. Results: At the 6-month follow-up, we observed partial functional recovery with a modified Rankin score of 3. Discussion: Bilateral decompressive craniectomy may be a life-saving therapeutic option when medical therapy fails and there are clinical and radiological features of progression in both cerebral hemispheres.