bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis and Uretheroscopy Undeleayed Therapy of Complicated Uretheral Calculosis
Authors: Passavanti G. , Pizzuti V. , Paolini R. , Bartalucci A , Franci L. , Lazzi L.
Published: June 2018

Diagnosis and therapy of uretheral calculosis have developed considerably with the introduction of new technologies. We attempted to verify whether their combined use can produce a quick and invasive-less solution, to complicated uretheral calculosis (persistent pain, marked hydronefrosis and/or infection).

23 patients showing complicated uretheral calculosis, underwent echography wich revealed medium grade hydronefrosis in 10 of them, and high grade hydronefrosis in 13. 15 had a body temperature higher than 38 °C. We immediately carried out infusional and antibiotic therapy and spiral TC without contrast within 24 hours. TC documented lithiasis of the pelvic urether in 12 cases, lithiasis of the medium lumbar urether in 9, and lithiasis of the proximal urether in 2. Diameter of stones was from 5 to 10 mm. Within the following 24 hours we performed a uretheroscopy with ballistic wave lithotripsy. The uretheral catheter was taken out the next day. After ecographic check 18 patients were given medical therapy and sent home, while 5 patients underwent infusional therapy for 3 days in day-hospital. Clinical, ecographic and radiographic check after one month showed complete regression of pain, hydronefrosis and infection. First choice treatment for uretheral stones is ESWL, however since the machine is not always available and the success rate is about 50–60% we resolved to carry out a combined treatment for complicated uretheral lithiasis, which enabled us to treat complicated colic in 72 hours, which proved effective both in terms of time saving and patients disconfort as opposed to a deferred treatment. We therefore propose this procedure as first choice for this type of sindrome, also taking into account that the necessary endoscopic instrumentation is always readily available.
In vitro Antiproliferative Activity of Psoralenes and Mytomicyn C on Reconstituted Bladder Mucosa
Authors: Fandella A. , Maccatrozzo L. , Merlo F. , De Angeli S. , Del Pup L. , Febas E. , Anselmo G.
Published: June 2018

In this study, we used a new experimental model, proposed by our group, based on in vitro reconstitution of the human neo-bladder to improve pharmacological studies targeted at optimizing endocavity therapy of superficial bladder cancer. In the light of this, we evaluated the antiproliferative activity on neoplastic and normal origin human urothelium of two psoralen derivatives, 4-methyl-11-dimethilaminopropoxy-benzopsoralen (G50-E) and 8-methoxypsoralen (8-MOP), which are photosensitized by UVA radiation (photochemotherapy PUVA). The pharmacological treatment effects were evaluated by cytotoxic assay based on intramitochondrial capture of MTT, and by using scanning electron microscopy (SEM). Moreover, the cytotoxic effects exerted by the two psoralen derivatives on the neo-bladders were compared to those of mytomicin C, a reference drug for the treatment and prophylaxis of superficial carcinoma bladder relapse. Qualitatively, these investigations confirmed the cytotoxic activity of both psoralen derivatives tested, but, nevertheless, they did not allow a quantitative evaluation of cellular damage.
FISH Assay for THE Detection of Bladder Cancer
Authors: Bassi P.F. , De Marco V. , Lamon C. , Longo F. , Volpe A. , Aragona M. , Gardi M. , Cavazzana A. , Fassina A.
Published: June 2018

We evaluated the sensitivity and specificity of fluorescence in situ hybridization (FISH) performed on the urine specimens of patients under follow-up for superficial bladder cancer. Thirty-seven patients were enrolled and underwent cystoscopy, urinary cytology or biopsy and FISH examination. Urinary cytology and FISH were evaluated in exfoliated urothelial cells from bladder washings. A mixture of fluorescent labeled probes to the centromere of chromosomes 3, 7 and 17, and locus 9p21 was used to assess urinary cells for chromosomal abnormalities indicative of malignancy. Nine patients (24.3%) showed an abnormal cystoscopy, but only five patients showed transitional cell carcinoma at histology. Eighteen patients (48.6%) showed an abnormal FISH: one patient (2.7%) had a positive cytology, and three patients (8.1%) showed an atypical cytology. Patients with both positive cystoscopy and histological examination had a positive FISH, while only one patient had a positive cytology. Patients with positive cystoscopy and negative histological examination had a negative FISH. Three patients with negative cystoscopy and suspicious cytology had a positive FISH.

Ten patients (27%) with both negative cystoscopy and cytology had a positive FISH. The sensitivity of the FISH assay was 100%, 50% for the cytology and 62% for the cystoscopy. The specificity of the FISH assay, cytology and cystoscopy were 66%, 100% and 86%, respectively. The sensitivity of the FISH assay in detecting non-invasive urothelial tumors is worth further studies.
Andro-Sexuologist'S Role in the Sexual Rehabilitation of Patients after Pelvic Surgery
Authors: Bianchessi I. , Christodoulakis K. , Rovereto B.
Published: June 2018

Cancer patients are special patients: time is the most important factor of their life. The choice of the appropriate moment to talk about their sexuality represents a fundamental step, which cannot coincide with talking about cancer. For the patient and his family cancer means anguish and death; sex needs relaxation and joy (life).

Patient self-filled questionnaires are important and useful tools for physicians but not for patients; interviews with patients and their partners cannot be replaced by questionnaires that do not take into account a patient's cultural background and feelings of the moment. Answers can be sincere but untrue. It could be better to interview both partners before performing biopsy; later on the physician alone could fill in a simple form including the partner's opinions.

Partners are normally involved in all interviews from the beginning, as well as in the choice of treatment drugs; they undergo a full immersion in a behavioural or dynamic rehabilitation of the couple.

Therapy timing plays an essential role; the couple should be as relaxed as possible. Stomized patients need special caring by the whole therapeutic team.

We studied behavioural changes and differences among patients treated between 1999 and 2004 in our clinic.

We then propose some tips for a good sexual rehabilitation, which respects the couple sexuality helping to rediscover joy of love.
Effects of surgery, medical therapy and combined therapeutical approach on spermatogenesis in patients suffering from varicocele: a prospective and comparative analysis
Authors: Fischietti G. , Di Crosta G.
Published: June 2018

The definite mechanisms through which varicocele affects spermatogenesis are still not completely understood, and consequently the exact role of the various approaches available for its treatment is still under debate.

In this study a comparison of medical treatment, surgery and combined approach is reported.

Material and Methods.

The study was conducted as a prospective evaluation of 189 patients suffering from varicocele and oligoasthenospermia. Patients were randomized in three groups on the basis of the different therapeutic approach: group A, treated only with varicocelectomy; group B, treated with varicocelectomy associated with hormonal therapy; group C, treated only with hormonal therapy. Randomization criteria were based on patient's preference. Spermiogram tests were carried out at baseline and after 3, 6 and 12 months from therapy.

Results.

Our results show that patients undergoing a combined therapeutical approach (surgery associated with hormonal therapy) and medical therapy alone achieve a greater improvement of seminal parameters than patients treated by surgery only.

Conclusion.

Data reported in this study are in accordance with Literature review. Furthermore, the association between varicocelectomy and early use of hormonal therapy seems to improve testis functional rehabilitation with a early evidence of sperm parameters improvement. In the light of these results of ours, we should conclude that surgical treatment is not effective for the spermatogenesis improvement.
Perception of chronic pelvic pain in women: predictors and clinical implications
Authors: Graziottin A.
Published: June 2018

Pain is a complex subjective experience, associated with neurovegetative, affective and cognitive rapid changes. Biological, psychosocial and contextual factors may contribute. Chronic inflammation, of whatever cause, is the leading contributor to chronic pain. The mast cell directs both the inflammatory process and the shift to chronic pain, mediating through the production of Nerve Growth Factor (NGF) and other neurotrophic molecules. Women, in the fertile age, are biologically more vulnerable to chronic inflammation, as fluctuations of estrogens are agonist factors of mast cells degranulation, mostly in the premenstrual phase. Pain is defined as “nociceptive” when it indicates an ongoing damage; “neuropathic” when it becomes a disease per se.

Chronic Pelvic Pain (CPP) indicates an invalidating, persistent or recurrent pelvic pain, persisting for more than 6 months. CPP is the main complaint of 10–15% of gynaecologic consultations, leading to 40% of diagnostic laparoscopies and 15% of hysterectomies. Comorbidity, i.e. the coexistence of pathologies and painful syndromes in different pelvic organs, is another common feature. Cystitis, vulvar vestibulitis, endometriosis, irritable bowel syndrome all play an important role and contribute to identifying the hyperactive mast cell and related chronic inflammation as the common pathophysiologic factor. The paper reviews nociception characteristics, the emerging role of mast cells, the pathophysiology of comorbidity, biological, psychosexual and contextual predictors, and stresses the need to move from a “hyperspecialistic” perspective to a multisystemic reading of CPP, with special attention to the urologic perspective.
A 7-case anatomopathology revision in the presence of renal relapse after conservative therapy: implications on surgical technique
Authors: Antonelli A. , Tardanico R. , Zani D. , Perucchini L. , Zanotelli T. , Cozzoli A. , Cunico S. Cosciani , Simeone C.
Published: June 2018

Anatomopathology revision of the cases which underwent second surgery because of a renal neoplasm relapsing after conservative surgery in order to find possible relations with the surgical technique.

Materials and Methods.

At our institution, Nephron-sparing surgery (NSS) is currently indicated as elective technique for neoplasms smaller than 4cm in diameter. The technique involves the removal of the neoplasm with a margin of healthy parenchyma and with the perilesional fat. The patients are monitored with a first CT check after 4 months and then with ultrasound/CT checks every 6 months in the first 2 years and then once a year. In the present study we analyze the records of the cases in the period 1994–2005 undergoing a second operation for a renal tumor relapsing in the operated kidney after NSS. All specimens were reviewed by a single experienced uro-pathologist, who determined the size of the surgical margins and the relations between the seat of recidivism and the seat of the preceding enucleoresection.

Results.

Seven cases with renal relapse were found out of 267 undergoing conservative surgery in the same period (incidence: 2.6%). The diagnosis had always been made lacking any other disease localizations at a complete re-staging; the average relapse latency was 19.4 months (8–46 months). In 5 cases the second tumor was found in the seat of the previous NSS: for these cases the minimum margin of the enucleoresection was lower than 3mm (median minimum margin: 1.6 mm). Differently, in the remaining 2 cases, both with a wider surgical margin (median minimum margin: 12.0 mm), the seat of the first and that of the second neoplasm were distant. In particular, in one case a multifocal relapse with a spread microvascular embolization was found, while in the other the two neoplasms showed a different histotype.

Discussion and Conclusions.

In the 5 cases with a little resection margin and relapsing tumor in the seat of the enucleoresection, the persistence of a peritumoral microscopic neoplastic disease can be assumed. In the other 2 cases showing a wider surgical margin the relapse can be attributed to the widespread microscopic multifocality in one case, and to the development of a second de novo neoplasm in the other case. The extension of the surgical margin seems then to have played a role in determining a relapse in the seat of enucleoresection.
Echo-assisted percutaneous nephrolithotomy in the supine position. Technical notes
Authors: Turci A.
Published: June 2018

The adoption of supine position in percutaneous nephrolithotomy and the routine use of echography during the procedure allow for a reduction of surgical time, radiological exposure of patient and surgeons, and of anaesthesiological risks; moreover, it permits a combined anterograde-retrograde approach to the kidney in case of very complex lithiasis.

The urologist's knowledge and experience of echography devices allows for a high lowering of the learning curve time.
Stone Cone® in ureteroscopic ballistic lithotripsy of proximal ureteral stones
Authors: Arancio M. , Guglielmetti S. , Delsignore A. , Landi A. , Marchetti C. , Mina A. , Marcato M. , Martinengo C.
Published: June 2018

Stone Cone® (Microvasive-Boston Scientific Corp, USA) is a device which prevents retrograde calculus migration during endoscopic ureterolithotripsy. We have studied the safety and efficacy of this device in endoscopic ureterolithotripsy with ballistic energy in proximal ureteral stones.

Materials and Methods.

From 01/02/2006 to 01/02/2008 we carried out 36 ureterorenoscopies (URS) for proximal ureteral stones (average age: 46, range: 15–73). A ballistic energy was used for stones fragmentation. In 18 patients (Group A) we carried out URS with the aid of Stone Cone®, which was not used in the other 18 patients (Group B). Semirigid 8 Ch or 10 Ch Storz ureteroscope and ballistic lithotriptor Swiss Lithoclast Master EMS® were used. In cases of migration, edema, and ureteral damage, a ureteral stent was used.

Results.

In Group B patients (URS performed without Stone Cone®) the migration of the whole stone, or of clinically significant fragments, occurred 8 times (45%). All of these patients underwent external shockwave lithotripsy (ESWL) at a center equipped with a lithotriptor. A ureteral stent was placed in 14 cases (78%). In Group A, the migration of a stone requiring ESWL treatment occurred only once (5%). The ureteral stent was placed 8 times (45%). We had no significant complications during the procedure.

Conclusions.

The Stone Cone® is a safe and easy-to-use device. The cost of this device can be balanced by the reduction of postoperative ESWL treatments for lithiasic fragments pushing up into the kidneys (p<0.01), and of ureteral stent applications at the end of the procedure (p<0.05).
Fibromyxoid Sarcoma of the Kidney. A Case Report
Authors: Arancio Matteo , Ranzoni Stefania , Delsignore Alessandro , Maffei Nicola , Landi Giuseppe , Mina Alessandro , Marcato Maurizio , Martinengo Carlo
Published: June 2018

Low grade fibromyxoid sarcoma is an uncommon soft tissue tumor.

We present the case of a 83–year-old female who developed large mass in the right kidney. A nephrectomy was performed. The tumor measured 18,5×17,5×11,5 cm and on pathology evaluation was diagnosed as low grade fibromyxoid sarcoma. Currently, the patient is doing well without evidence of local recurrence and distant metastasis.

Low grade fibromyxoid sarcoma of the Kidney is a very rare tumor. The metastasizing potential is high. Sometimes long interval between tumor presentation and metastasis is observed. The treatment of choice is surgery. The role of radiotherapy and chemotherapy is uncertain.
Rirs through Semi-Rigid Ureteroscope and Holmium Laser in the Treatment of Ureteral Stones Retropulsion
Authors: Ruoppolo M. , Milesi R. , Gozo M. , Fragapane G.
Published: June 2018

Retrograde displacement of ureteral stones into the renal cavities during ureteroscopic lithotripsy represents a frequent and adverse event that leads to additional procedures (ESWL, PCNL, Retrograde Intra-renal lithotripsy with flexible instruments, DJ stent placement and subsequent EWSL) to obtain full clearence of calculi. All these procedures require a further time of treatment.

Between 1/2008 and 3/2009, a total of 48 patients harbouring proximal (21 cases) and distal (27 cases) ureteral stones underwent Holmium Laser lithotripsy. In 3 patients previous percutaneous nephrostomy was performed to drain the excretory way. In 12 cases (25%) stone retropulsion occurred; in 3 patients in the upper calix and in 5 in the renal pelvis. Only in 4 cases the stone migrated in the lower or medium calix. In 8 cases we attempted the immediate treatment of intrarenal displaced stones by advancing the semi-rigid instrument into the renal cavities. In 2 cases the treatment aborted because of the shortness of ureteroscope. The instillation of lubricating lidocaine jelly prevented in 3 cases furher displacement of stone. Washing with saline solution through nephrostomic catheter allowed an effective mobilization of stone and an easy lasertripsy

RIRS was successful in 4 cases. When flexible devices or immediate ESWL are not available, rigid or semi-rigid retrograde lithotripsy with holmium laser immediately performed after ureteral stone displacement represents a safe and effective method to treat displaced stones. Several tricks are required to obtain a good stone-free rate.
Emphysematous pyelonephritis: Case report and literature overview
Authors: Ziegelmüller Brigitte Katharina , Szabados Bernadett , Spek Annabel , Casuscelli Jozefina , Stief Christian , Staehler Michael
Published: June 2018

Introduction:

Emphysematous pyelonephritis is a rare necrotizing infection of the kidney with a poor prognosis. If it occurs in patients with a reduced general condition, this infection is life threatening. Early diagnosis is made by computed tomography. Treatment options are drainage and intensive care or immediate nephrectomy in severe cases.

Case description:

A 73-year-old woman in a poor general condition presented with a fulminant urosepsis. Computed tomography revealed an impressive abscess formation of the right kidney with free air retro and intraperitoneal. The diagnosis of emphysematous pyelonephritis was made. Besides septicemia, she had a multiorgan failure including kidney and liver function deterioration. Nephrectomy was performed immediately. The postoperative course was successful with a complete stabilization of the kidney and liver function and reconvalescence of the patient.

Discussion:

The widespread availability of imaging techniques leads to early diagnosis and a reduction of mortality of renal and periphrenic abscesses and even of emphysematous pyelonephritis. However, severe cases have a poor outcome and require aggressive and immediate therapy. Besides systemic antibiotic therapy and percutaneous and surgical drainage, radical nephrectomy is a viable therapy option and should be performed immediately in patients with several risk factors, poor prognosis, and extensive findings.

Conclusion:

Radical nephrectomy being performed immediately seems to be the optimal management in patients with acute emphysematous nephritis and urosepsis.
Stabilization of Cr-rich tannery waste in fly ash matrices
Authors: Daniil Andreana , Dimitrakopulos George P , Varitis Savvas , Vourlias George , Kaimakamis George , Pantazopoulou Erasmia , Pavlidou Eleni , Zouboulis Anastasios I , Karakostas Theodoros , Komninou Philomela
Published: June 2018

In the present work, the stabilization/solidification of a Cr-rich ash obtained from the anoxic incineration of tannery hazardous wastes was studied. Chromium in the starting waste was exclusively in amorphous form and in trivalent state. The waste was embedded in fly ash-based cementitious material matrices. Calcium and sodium hydroxides, as well as sodium silicate, were used as activators. The proposed process combines mechanical activation with hydrothermal curing. Successful immobilization of chromium was achieved, as attested by standard leaching tests. Backscattered electron images revealed the existence of the C-S-H gel, and elemental mapping by energy dispersive X-ray spectroscopy showed a good interdispersion of chromate and aluminosilicate species, verifying that chromium was well distributed in the final amorphous cementitious matrix. X-ray diffraction confirmed the absence of Cr-rich crystalline phases of calcium aluminosilicates, where chromium can enter in hexavalent state. The stiffness of the stabilized samples was reduced with increasing the amount of added Cr-rich ash, as attested by measurements of the dynamic Young’s modulus.
Botulinum Toxin-A and Scar Reduction: A Review
Authors: Honeybrook Adam , Lee Walter , Woodward Julie , Woodard Charles
Published: June 2018

Pathologic scars remain a therapeutic enigma. Several therapeutic modalities have been described for the prevention and treatment of hypertrophic and keloid scars, but the optimal management approach has not yet been defined. This article reviews the newly emerging, off-label treatment, botulinum toxin-A (BTXA) for scar reduction. Eight in vitro, 9 in vivo animal, and 23 human clinical studies were deemed relevant to this review. Studies were conducted between 2000 and 2018. Clinical studies were of various methodologic qualities and comprised of 8 blinded randomized control trials, 7 cohort studies, and 7 case series/reports. Across all 23 human clinical studies, 521 patients were recruited, 20 studies were in favor of BTXA to reduce scars, 2 studies had equivocal results, and 1 study showed no benefit. The efficacy of BTXA to reduce scars appears promising and the clinical literature currently favors its use over placebo controls as a safe scar reduction alternative. The efficacy of this modality in comparison with other more widely accepted scar reduction methods is less clear. Further understanding of the molecular mechanism of action of BTXA upon scars and treatment modality cost-effectiveness comparisons remain to be explored. Large-scale randomized control trials of high methodologic quality, using objective measurement scales, must be produced to truly determine the efficacy of this innovative treatment.
Access to general social protection for immigrants in advanced democracies
Authors: Schmitt Carina , Teney Céline
Published: June 2018

Immigration has become a central socio-political issue in most advanced democracies. While research mainly focuses on immigrant-specific policies in the area of immigration, integration and citizenship, we still know very little about the incorporation of immigrants into mainstream social policies. By analysing cross-national differences in the inclusion of immigrants into general social protection across 27 rich democracies on the basis of comparative indicators from the Migrant Integration Policy Index (MIPEX) dataset, we seek to address this gap in a quantitative study. A cross-national comparison of these indicators shows a particularly large variation in the inclusiveness of the access to social protection for immigrants across countries. By drawing on the welfare state and integration regime literature, we assess the power of two contrasting perspectives, namely, the post-national welfare state and the welfare chauvinism models, in explaining this large cross-national variation in immigrants’ access to social security and social housing. Our overall findings suggest that both the welfare chauvinist and the post-national welfare state models comprise two theoretical perspectives that turn out to be fruitful to interpret cross-national variation in immigrants’ access to social protection. According to the welfare chauvinism model, we find robust evidence that left-wing cabinets are particularly reluctant to open general social protection schemes to immigrants. By contrast and in line with expectations derived from the post-national welfare state model, countries with an overall generous welfare state and countries facing large immigration flows tend to provide immigrants with more generous access to social protection.
“Your words matter!” Relevance of individual participation in xMOOCs
Authors: Riehemann Jens , Hellmann Jens H , Jucks Regina
Published: June 2018

Massive open online courses are increasingly popular. One characteristic of most massive open online courses is that they are offering educational contents to masses of different individual learners. At the same time, a particular challenge for the individual learner could be the massiveness of such courses, that is, that one is part of a large crowd of other learners. Being one of many other individuals can have negative consequences on learning activities because an individual might experience a sense of virtual crowding. The experiment described in this article investigated how course type (xMOOC vs virtual seminar) and relevance of individual participation (low vs high) impact online learners’ engagement. Results showed that participants in an xMOOC condition referred to themselves and their peers to a greater extent when their participation was introduced as being highly relevant. Implications for the design of xMOOCs are discussed.
Governance monitors or market rebels? Heterogeneity in shareholder activism
Authors: Benton Richard A , You Jihae
Published: June 2018

Agency theory is the dominant theory of shareholder activism and argues that activist investors function as external governance monitors. Agency theory predicts that activist investors will tend to target firms who exhibit governance and performance problems. However, given limited resources and time, activist investors must often decide between selecting targets with particularly strong agency and performance problems and those where their activism efforts are most likely to succeed. Social movement scholars point out that, in social movement contexts, the corporate opportunity structure affects when and where activism is likely to arise. We draw on insights from social movement scholarship and agency theory to advance a theory of heterogeneity in shareholder activism. We argue that an activist’s access to power and resources shapes its target selection, particularly the activist’s preference for targeting firms with greater agency problems or where contextual factors favor chances of success. Whereas more powerful activists are able to wield their power as effective governance monitors against firms with substantial agency problems, less powerful activists must strategically select targets of opportunity by choosing firms where contextual factors improve their odds of success. We test these propositions using an innovative relational approach that can simultaneously incorporate firm traits, activist identities, and endogenous dynamics.
Rapid Progression of Knee Pain and Osteoarthritis Biomarkers Greatest for Patients with Combined Obesity and Depression: Data from the Osteoarthritis Initiative
Authors: Jacobs Cale A. , Vranceanu Ana-Maria , Thompson Katherine L. , Lattermann Christian
Published: June 2018

Objective

To compare the progression of biochemical biomarkers of osteoarthritis (OA), knee pain, and function between nonobese patients (NON), obese patients without depression (OBESE), and obese patients with comorbid depression (O + D).

Design

Utilizing the FNIH OA Biomarkers Consortium dataset, we categorized knee OA patients into NON, OBESE, and O + D groups based on body mass index and Center for Epidemiological Studies–Depression (CES-D) scores. Subjective symptoms (Knee injury and Osteoarthritis Outcome Score Quality of Life subscale (KOOS QOL), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Physical Function scores, and the Short Form–12 (SF-12) Physical Component Score [PCS]) and objective measures of cartilage degradation and bone remodeling (urinary CTXII and CTXIα) were compared among groups at baseline and 2-year follow-up.

Results

Of the 600 patients, 282 (47%) were NON, 285 (47.5%) OBESE, and 33 (5.5%) O + D. The O + D group had significantly worse pain and function both at baseline and 2-year follow-up ( P < 0.001 for all comparisons) as evidenced by self-reported measures on KOOS QOL, WOMAC Pain, WOMAC Physical Function, and SF-12 PCS. The O + D group also demonstrated significant increases in CTXII ( P = 0.01) and CTXIα ( P = 0.005), whereas the NON and OBESE groups did not.

Conclusions

The combination of inferior knee pain, physical function, and significantly greater increases in biomarkers of cartilage degradation and bony remodelling suggest a more rapid progression for obese OA patients with comorbid depression. The link between systemic disease, inflammatory burden, and progressive cartilage degradation is in line with increasing concerns about a degenerative synovial environment in early osteoarthritic knees that progress to treatment failure with biologic restoration procedures.
A rare case of atypical/anaplastic meningioma with MDM2 amplification
Authors: Wylleman Robbert , Debiec-Rychter Maria , Sciot Raf
Published: June 2018

We report the exceptional occurrence of murine double minute clone 2 amplification in an atypical meningioma and its recurrent anaplastic meningioma arising in the right frontal lobe of a 75-year-old man. Murine double minute clone 2 amplification was shown by array comparative genomic hybridization and confirmed by fluorescence in situ hybridization. This is a rare finding with only one similar report in the literature. Awareness of this finding is indicated and should not lead to misdiagnosis of other entities that more commonly show this feature.
Direct and indirect effects of central and general adiposity on cardiovascular diseases: The Tehran Lipid and Glucose Study
Authors: Bakhtiyari Mahmood , Schmidt Nicole , Hadaegh Farzad , Khalili Davood , Mansournia Nasrin , Asgari Samaneh , Mansournia Mohammad A
Published: June 2018

Aim

The mechanisms linking body mass index to cardiovascular disease are still not clearly defined. The purpose of this study was to find out how much of the effect of central and general adiposity on cardiovascular disease is mediated through blood pressure, cholesterol, and glucose, and how much is independent of these factors.

Methods and results

The study population included participants, aged ≥30 years, free of cardiovascular disease at baseline with median follow-up of 13.9 years. The total effects were broken down into natural direct and indirect effects using the inverse odds weighting method in the context of survival models. Systolic blood pressure, total serum cholesterol, and fasting plasma glucose as the primary measure of blood glucose were used as mediators. Blood pressure and cholesterol with indirect hazard ratios of 1.09 (95% confidence interval: 1.006–1.18) and 1.35 (95% confidence interval: 1.12–1.62) were the most important mediators for overweight-cardiovascular disease and obesity-cardiovascular disease relationships, respectively. The proportion mediated of overweight was 22% (6–47%) for blood pressure, 18% (5–37%) for blood glucose, and 20% (7–43%) for cholesterol. The same measure for obesity was 65% (35–91%) for cholesterol. For central adiposity, blood pressure, glucose, and cholesterol were the most important mediators with proportion mediated of 36% (17–72%), 23% (9–48%), and 21% (8–45%), respectively.

Conclusions

The findings of this study show that proper control of cardiometabolic risk factors of blood pressure, blood glucose, and dyslipidemia in an adult population can be effective to significantly reduce the effects of general and abdominal adiposity on cardiovascular diseases.
Agnosia Interferes With Daily Hygiene in Patients With Dementia
Authors: Hamdy R. C. , Kinser A. , Culp J.E. , Kendall-Wilson T. , Depelteau A. , Copeland R. , Whalen K.
Published: June 2018

Patients with dementia, particularly Alzheimer’s disease, may not recognize that their clothes are dirty. They may see the food stains and discoloration of the clothes and yet because of their agnosia are unable to integrate these observations and deduce that their clothes are dirty and need to be changed. They will, therefore, resist attempts to get them to change clothes, especially if these clothes happen to be their favorite ones. This often causes caregivers to become frustrated, especially, if it represents a change in the patient’s previous habits of only wearing clean clothes. In this case study, we present a 72-year-old woman with moderate Alzheimer’s disease who lives with her daughter, who adamantly refuses to change the clothes she has been wearing for a few days and which are now clearly dirty. We report the interaction, highlight what went wrong in the patient–daughter interaction, and discuss how the catastrophic ending could have been avoided or averted.
Psychosis
Authors: Schrimpf Lindsey A. , Aggarwal Arpit , Lauriello John
Published: June 2018

PURPOSE OF REVIEW

Psychosis is a psychiatric condition that has significant overlap with neurologic disease. This article is intended to educate the neurologist on the psychiatric manifestations of psychosis and its evaluation, diagnosis, and treatment. How to differentiate a primary psychiatric cause of psychosis from psychosis secondary to a medical or neurologic condition is also reviewed.

RECENT FINDINGS

Current research in psychotic disorders has focused increasingly on negative symptoms and cognitive impairment in psychotic illness, as it is now recognized that these cause the greatest impact on functional deficits for patients. A number of new medications have also been introduced to target negative symptoms and cognitive deficits in psychotic illness. These have new implications in terms of treatment overlap with medications being prescribed by providers in psychiatry, neurology, and general practice.

This article discusses the current methods for evaluating, diagnosing, and treating psychosis. Psychosis as a primary mental health disorder is a diagnosis of exclusion, as psychosis can be a direct symptom of underlying medical or neurologic disease. Delirium and dementia are the two most important disorders to rule out. This article will help readers be more prepared to assess and treat the patient with psychosis.
Obsessive-Compulsive Disorder
Authors: Richter Peggy M. A. , Ramos Renato T.
Published: June 2018

PURPOSE OF REVIEW

This article reviews current knowledge regarding diagnosis, pathophysiology, and treatment trends in obsessive-compulsive disorder (OCD), a severe, underrecognized, and chronic condition frequently encountered in neurologic practice.

RECENT FINDINGS

With a lifetime prevalence estimated at 2.5%, OCD is a common condition that can also present comorbidly with neurologic disease. The core symptoms of OCD are obsessions and compulsions. Obsessions are intrusive repetitive thoughts, urges, images, or impulses that trigger anxiety and that the individual is not able to suppress. Compulsions are repetitive behaviors or mental acts occurring in response to an obsession with the intention of reducing the distress caused by obsessions. Neuroimaging, neuropsychological, and pharmacologic studies suggest that the expression of OCD symptoms is associated with dysfunction in a cortico-striato-thalamo-cortical circuit. Evidence-based treatments for OCD comprise pharmacotherapy and cognitive-behavioral therapy. Selective serotonin reuptake inhibitors (SSRIs) are the first-line drugs recommended for OCD, but significant differences exist in their use for OCD compared to their use for other mood and anxiety conditions, including the need for higher dosage, longer trials necessitated by a longer lag for therapeutic response, and typically lower response rates. Cognitive-behavioral therapy, based on the principles of exposure and response prevention, shows results superior to pharmacologic treatments with lower relapse rates on long-term follow-up and thus should be considered in the treatment plan of every patient with OCD.

OCD and obsessive-compulsive symptoms are frequently encountered in the neurologic clinic setting and require a high index of suspicion to effectively screen for them and an illness-specific therapeutic approach.
Coding for Behavioral Neurology and Psychiatry
Authors: Villanueva Raissa , Cohen Bruce H.
Published: June 2018

Medical coding is highly technical, and proper use of both Current Procedural Terminology (CPT) and the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is difficult because of the considerable detail of the code definitions, the changes implemented yearly, and the vast change a few years ago with the transition to ICD-10-CM. Although basic office visit and hospital visit Evaluation and Management (E/M) codes have not changed in decades, new cognitive care codes have been added to the cognitive codes that fall under E/M. Accuracy in documentation is essential as the basis for precision in coding, which will result in both best practice and proper payment from payers.
Clinical Assessment of Prefrontal Lobe Functions
Authors: Henri-Bhargava Alexandre , Stuss Donald T. , Freedman Morris
Published: June 2018

PURPOSE OF REVIEW

Whereas it was previously thought that there was a single overarching frontal lobe syndrome, it is now clear that several distinct cognitive and behavioral processes are mediated by the frontal lobes. This article reviews these processes and the underlying neuroanatomy and provides an approach to the assessment of prefrontal lobe functions at the bedside.

RECENT FINDINGS

Cognitive and behavioral frontal lobe functions are mediated by the prefrontal regions rather than the frontal lobes as a whole. At least five separate prefrontal functions have been defined: energization, task setting, monitoring, behavioral/emotional regulation, and metacognition. Energization is mediated by the superior medial prefrontal cortices bilaterally, task setting by the left lateral frontal cortex, monitoring by the right lateral prefrontal cortex, behavioral/emotional regulation by the orbitofrontal cortex, and metacognition by the frontal poles. Only task setting and monitoring are considered executive functions.

Distinct cognitive and behavioral processes are mediated by different parts of the frontal lobe. Lesions in these areas result in characteristic clinical deficits that are discussed in this article. Key messages are that prefrontal regions mediate the higher cortical functions (as opposed to the frontal lobes in general) and that prefrontal functions are not equivalent to executive functions.
Bedside Approach to the Mental Status Assessment
Authors: Tang-Wai David F. , Freedman Morris
Published: June 2018

PURPOSE OF REVIEW

This article presents a clinically useful approach to obtaining the history and performing the mental status examination of patients with cognitive, language, or behavioral problems.

RECENT FINDINGS

Laboratory and imaging biomarkers are being developed for accurate diagnosis of neurobehavioral disorders, yet few are currently available for clinical use. Moreover, not all centers have access to these potential tools. Practicing clinicians are therefore left primarily with their skills of history taking and examination. Although geared for research, diagnostic criteria have been refined over the past several years and can nevertheless aid the clinician with the diagnosis of disorders such as mild cognitive impairment, Alzheimer disease, frontotemporal dementia, dementia with Lewy bodies, the primary progressive aphasias, corticobasal syndrome, vascular cognitive impairment, and posterior cortical atrophy. Regularly revised criteria reflect ongoing knowledge gained from in-depth studies of these disorders.

The focused history and mental status examination remain essential tools for the evaluation and diagnosis of neurologic disorders affecting cognition, language, and behavior.
Resuscitation of Endotheliopathy and Bleeding in Thoracic Aortic Dissections: The VIPER-OCTA Randomized Clinical Pilot Trial
Authors: Stensballe Jakob , Ulrich Annette G. , Nilsson Jens C. , Henriksen Hanne H. , Olsen Peter S. , Ostrowski Sisse R. , Johansson Pär I.
Published: June 2018

BACKGROUND:

Thoracic aorta dissection is an acute critical condition associated with shock-induced endotheliopathy, coagulopathy, massive bleeding, and significant morbidity and mortality. Our aim was to compare the effect of coagulation support with solvent/detergent-treated pooled plasma (OctaplasLG) versus standard fresh frozen plasma (FFP) on glycocalyx and endothelial injury, bleeding, and transfusion requirements.

METHODS:

Investigator-initiated, single-center, blinded, randomized clinical pilot trial of adult patients undergoing emergency surgery for thoracic aorta dissection. Patients were randomized to receive OctaplasLG or standard FFP as coagulation factor replacement related to bleeding. The primary outcome was glycocalyx and endothelial injury. Other outcomes included bleeding, transfusions and prohemostatics at 24 hours, organ failure, length of stay in the intensive care unit and in the hospital, safety, and mortality at 30 and 90 days.

RESULTS:

Fifty-seven patients were included to obtain 44 evaluable on the primary outcome. The OctaplasLG group displayed significantly reduced damage to the endothelial glycocalyx (syndecan-1) and reduced endothelial tight junction injury (sVE-cadherin) compared to standard FFP. In the OctaplasLG group compared to the standard FFP, days on ventilator (1 day [interquartile range, 0–1] vs 2 days [1–3]; P = .013), bleeding during surgery (2150 [1600–3087] vs 2750 [2130–6875]; P = .046), 24-hour total transfusion and platelet transfusion volume (3975 mL [2640–6828 mL] vs 6220 mL [4210–10,245 mL]; P = .040, and 1400 mL [1050–2625 mL] vs 2450 mL [1400–3500 mL]; P = .027), and goal-directed use of prohemostatics (7/23 [30.4%] vs 13/21 [61.9%]; P = .036) were all significantly lower. Among the 57 patients randomized, 30-day mortality was 20.7% (6/29) in the OctaplasLG group and 25% (7/28) in the standard FFP group (P = .760). No safety concern was raised.

CONCLUSIONS:

In this randomized, clinical pilot trial of patients undergoing emergency surgery for thoracic aorta dissections, we found that OctaplasLG reduced glycocalyx and endothelial injury, reduced bleeding, transfusions, use of prohemostatics, and time on ventilator after surgery compared to standard FFP. An adequately powered multicenter trial is warranted to confirm the clinical importance of the findings.
Study of Solvent Effect in 2, 5-DPAPMC Dye Using Different Solvent Polarity Parameters and Estimation of Dipole Moments
Authors: J Thipperudrappa
Published: June 2018

The solvent effect on absorption and fluorescence spectra of      a ketocyanine      dye 2,5-di[(E)-1-(4- dipropylaminophenyl)     methylidine]-1-cyclopentanone (2,5-DPAPMC) is analysed using Lippert-Mataga bulk polarity function, Reichardt’s microscopic solvent polarity parameter and Kamlet’s multipl e linear regression approach. The spectral properties better follows Reichardt’s microscopic solvent polarity parameter than Lippert-Mataga bulk polarity parameter. This indicates the presence of both general solute – solvent interactions and specific   interactions.   Kamlet’s multiple linear regression   approach indicates the major role of polarizability/dipolarity solvent influence than HBD and HBA. The spectral data in different solvents is used to estimate excited state dipole moment using theoretically determined ground state dipole moment. The excited state dipole moment of dye is found to be larger than its corresponding ground state dipole moment and, ground and excited state dipole moments are not parallel, but subtends an angle of 29 o .
Nutritional Quality Evaluation of Indian Fish- Trichiurus Lepturus
Authors: K Shameem
Published: June 2018

Trichiurus Lepturus constitute one of the most important commercial fishes of India. Nowadays the major health problem arises due to malnutrition and lack of excellent sources for the nutrient food supply. Fisheries are one of the most promising healthy food sources that humans and other animals depend. Hence nutrient profiling is important to know the calorific value of food for the edible purpose. This study was aimed to find the nutritional quality evaluation of the fish Trichiurus lepturus collected from Cochin, Kerala and to suggest the calorific value of fish Trichiurus lepturus . It was found that the fish Trichiurus lepturus is a chief source of fats and proteins. The high concentration of fat may be an indication of high calorific value than compared to other fishes since the portion of calorific value lead by fat more.
Variable Viscosity Effects on Penetrative Convection in a Fluid Layer
Authors: Y H Gangadharaiah
Published: June 2018

The effect of variable viscosity on the onset of penetrative convection simulated via internal heating in a fluid layer. The upper surface of a fluid layer is assumed to be deformably free and dependence of viscosity is assumed to be exponential. The resulting eigen value problem is solved using a regular perturbation technique with wave number a as a perturbation parameter. The viscosity parameter, surface deformation and the presence of internal heat source play a decisive role on the stability characteristics of the system.
Emergence of Extensively Drug Resistant (XDR) Strains of Mycobacterium Tuberculosis in TB Patients in Kerala, India
Authors: Biljo V Joseph Leny Jose
Published: June 2018

We report the detection of extensively drug resistant strains of Mycobacterium tuberculosis in Kerala, India. Earlier we had reported that 22 of 206 local isolates were multidrug resistant. Now, we tested the same isolates for their resistance to ofloxacin and amikacin. Six among the MDR isolates showed resistance to both drugs and therefore fall under XDR category.
Phytochemical Extraction and Antibacterial Studies of Caesalpinia bonducella Seed Extracts
Authors: Savaliya Navanit Pethani Savaji
Published: June 2018

Caesalpinia bonducella (Linn.) Flem. is an Indian herb belonging to Family Caesalpiniaceae. The seeds contain an alkaloid caesalpinine, bitter principles such as bonducin, saponins and other oils. In the present study, antibacterial activities of the extracts were studied by agar well diffusion method. C. bonducella seeds were porously powdered mechanically and were subjected to successive sequential soxhlet extraction using petroleum ether, chloroform, ethanol and water as the solvents. The bacterial cultures Pseudomonas aeruginosa, Shigella dysenteriae, Proteus mirabilis, Staphylococcus aureus and Enterococcus faecalis were selected for the study. Dry powder of each extract was dissolved in 1 ml of 0.5% DMSO solution to get a concentration of 5, 10, 15 and 20 mg/ml. Each extract was checked for antibacterial activity by introducing 100 μl of each extract into triplicate wells. Controls were maintained with respective solvents. Ciprofloxacin (5 mg/ml) was used as standard antibiotic. Results were subjected to analysis of variance. Chloroform extract have showed good antibacterial activity against Proteus mirabilis, Pseudomonas aeruginosa