bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective study on Incontinence‐Associated Dermatitis and its Severity instrument for verifying its ability to predict the development of pressure ulcers in patients with fecal incontinence
Authors: Park Kyung Hee , Choi Heejung
Published: February 2016

Fecal incontinence with loose stools is a risk factor for skin damage that may develop into a pressure ulcer (PU). The aim of this study was to determine the feasibility of applying the Incontinence‐Associated Dermatitis and its Severity (IADS) instrument to patients with fecal incontinence as a tool to predict PU development. This prospective study enrolled 120 intensive care unit patients with bowel incontinence of Bristol Stool type 5, 6, and 7. Trained nurses evaluated IADS scores and the occurrence of PUs daily for 7 days. Patients with higher IADS scores were significantly more likely to develop a PU (odds ratio = 1·22, 95% confidence interval = 1·12–1·33). The receiver operating characteristic curve analysis revealed the area under curve to be 0·790, suggesting that higher IADS scores are associated with an increased likelihood of developing a PU (sensitivity 72·5%, specificity 71·2%, using a cut‐off value of 8/9). Our results suggest that the IADS instrument can serve as a tool for predicting the occurrence of PUs in patients with fecal incontinence. Patients with IADS scores that exceed eight points should be classified as being at risk of developing a PU, and placed under intensive care as a proactive measure to prevent PU development.
Effects and Mechanism of Combinational Chemical Agents on Solution‐Derived K0.5Na0.5NbO3 Piezoelectric Thin Films
Authors: Wang Yumei , Yao Kui , Sharifzadeh Mirshekarloo Meysam , Tay Francis Eng Hock
Published: February 2016

Sodium potassium niobate (KNN) piezoelectric ceramic thin films were prepared by a chemical solution deposition method, in which the introduction of appropriately combinational organic stabilizing agents, including monoethanolamine (MEA), diethanolamine (DEA), and ethylenediaminetetraacetic acid (EDTA), dramatically suppressed the volatile loss of the alkali ions, improved the crystallinity, and promoted crystal orientation of the perovskite phase in the resulting KNN thin films. Theoretical analyses including ab initio calculation based on molecular model indicated that stronger binding structure could form comprising the alkali ions and the combinational EDTA‐(DEA‐MEA) chemical agents than the cases of using individual binding agents separately. Outstandingly large effective piezoelectric strain coefficient d33 under the substrate clamping condition was achieved. The theoretical and experimental results provide the insight on the underlying interaction mechanism between the multiple stabilizing chemical agents and metal ions, and the guidance for establishing the methodology for producing high quality oxide thin films from chemical solutions with dedicatedly designed combinational stabilizing agents.
Synthesis and Crystal Structure Characterization of Oxysilicate Apatites for Stabilization of Sr and Rare‐Earth Elements
Authors: Wang Jingxian , Wei Fengxia , Lim Soo Min , Liu Erjia , Guet Claude , White Tim , Dong ZhiLi
Published: February 2016

Strontium (Sr) containing rare‐earth oxysilicate apatite AI4AII6(SiO4)6O2 is considered a good matrix to accommodate radionuclide as its cation sites can incorporate lanthanide elements other than Sr. Here, we report a study on the synthesis of Nd8Sr2(SiO4)6O2 and Yb8Sr2(SiO4)6O2, which adopt P63/m apatite symmetry, as well as the characterization of crystallographic structures using X‐ray diffraction and electron microscopy. It is found that AI position is shared by Nd, Yb and Sr, and AIO6 polyhedra are face‐connected, forming column structures, which are linked to SiO4 tetrahedra, creating continuous channels. The Rietveld refinement shows that Nd and Yb prefer the AII position in the channel. The twisted angle of adjacent triangle faces in an AI‐O polyhedron along [001] is a critical parameter to identify the channel volume and its value varies when different cations are incorporated. The twisted angles for Nd‐apatite and Yb are 24.2° and 22.7° The findings provide a new insight into nuclear waste stabilization by apatite‐type structure.
Amorphization by Mechanical Milling for Making IR Transparent Glass‐Ceramics
Authors: Xue Bai , Calvez Laurent , Allix Mathieu , Delaizir Gaëlle , Zhang Xiang‐Hua
Published: February 2016

In this article, we put forward the possibility to prepare amorphous powder from chalcogenide compositions usually located out of the glassy domain when synthesized via a conventional melt‐quenching technique. Both X‐ray diffraction and DSC techniques were used to demonstrate that the original Ge15Ga20S65 composition can be prepared in the amorphous state by using mechanical milling starting from raw metallic elements. Subsequent hot‐pressing by spark plasma sintering in a graphite die above the glass transition temperature leads to sintered pellets presenting a high rate of nanocrystals of about 30 nm. These as‐made glass–ceramic materials present promising transparency in the infrared range.
Epistemic Injustice and Illness
Authors: Kidd Ian James , Carel Havi
Published: February 2016

This article analyses the phenomenon of epistemic injustice within contemporary healthcare. We begin by detailing the persistent complaints patients make about their testimonial frustration and hermeneutical marginalization, and the negative impact this has on their care. We offer an epistemic analysis of this problem using Miranda Fricker's account of epistemic injustice. We detail two types of epistemic injustice, testimonial and hermeneutical, and identify the negative stereotypes and structural features of modern healthcare practices that generate them. We claim that these stereotypes and structural features render ill persons especially vulnerable to these two types of epistemic injustice. We end by proposing five avenues for further work on epistemic injustice in healthcare.
Rose's Prevention Paradox
Authors: Thompson Christopher
Published: February 2016

Geoffrey Rose's ‘prevention paradox’ occurs when a population‐based preventative health measure that brings large benefits to the community – such as compulsory seatbelts, a ‘fat tax’, or mass immunisation – offers little to each participating individual. Although the prevention paradox is not obviously a paradox in the sense in which philosophers understand the term, it does raise important normative questions. In particular, should we implement population‐based preventative health measures when the typical individual is not expected to gain from them? After canvassing other attempts to address the paradox, I argue that what is significant about the prevention paradox is that it involves intra‐personal trade‐offs; the costs and benefits of the choice to implement or not implement a preventative health measure fall on the same individuals. The intra‐personal nature of these trade‐offs has two implications. First, the solutions to the paradox proposed by other authors are deficient. Second, the policy choice to not implement some preventative health measures can be normatively justified.
On the Significance of Membership in Approaches to Global Justice: Putting Carens in Context
Authors: Risse Mathias
Published: February 2016

My main theme is to compare Carens' take on membership with Michael Blake's and mine. Both Carens and Blake think membership matters enormously in the context of global justice. But they develop this point very differently. However, from the standpoint of my theory (pluralist internationalism), Carens’ and Blake's accounts have symmetrical shortcomings. Neither view takes a genuinely globally balanced approach to immigration.
Genomewide association study of immune traits in chicken F2 resource population
Authors: Sun Y. , Li Q. , Hu Y. , Sun Y. , Liu R. , Zheng M. , Wen J. , Li P. , Liu L. , Zhao G.
Published: February 2016

Immune traits play pivotal roles in animal immune capacity development and disease resistance. Single nucleotide polymorphisms (SNPs) are common forms of genetic variations among individuals, which are thought to account for the majority of inherited phenotypic variations. In this study, we performed genomewide association, using the Illumina 60K SNP BeadChip studies to detect molecular markers and candidate genes associated with immune traits in an F2 population. Sixteen immune traits were measured. We identified 85 significant SNPs (p < 2.98 × 10−6) with 5% as the genomewide significance threshold, 380 SNPs of suggestive significance (p < 5.96 × 10−5) from simple model (general linear model, GLM) and 15 SNPs of suggestive significance (p < 5.96 × 10−5) from the compressed mixed linear model (MLM), which were also found in GLM (six significant SNPs and seven suggestive SNPs). Three significant SNPs (GGaluGA151406, Gga_rs14554319 and Gga_rs13593979) and candidate genes (LYRM4 and KTN1) were found to be associated with avian influenza antibody titres, and the first two SNPs are from the results of two‐model analysis. For the immune organs, through the analysis of GLM, 19 SNPs were found to be significantly associated with the thymus weight, 61 SNPs were significantly associated with the bursa of Fabricius weight, six of which were located within a 34‐Mb region (125 846 474–159 649 698 bp) on chicken chromosome 1 (GGA1). A candidate region relevant to haematological traits from GLM was found in GGA4 and 9 loci were located on it. Three loci (GGaluGA348521, Gga_rs16098446 and GGaluGA348518) within 179 kb (16 286 868–16 466 134 bp) on GGAZ from GLM provided evidence that this genomic segment may be relevant to red blood cell volume distribution width (RDW). Our study provides a list of significant SNPs and candidate genes that will be valuable information for unveiling the underlying molecular mechanism of immune regulation.
Environmental predictors of species richness in forest landscapes: abiotic factors versus vegetation structure
Authors: Zellweger Florian , Baltensweiler Andri , Ginzler Christian , Roth Tobias , Braunisch Veronika , Bugmann Harald , Bollmann Kurt
Published: February 2016

Aim

To investigate the performance and relative importance of abiotic and biotic predictors of species richness of three taxa in forest‐dominated landscapes across an environmentally heterogeneous mountain region.

Location

Switzerland (central Europe).

Methods

We used a broad set of nationally available environmental predictors grouped into (1) climate, (2) topography and soil and (3) 3‐D vegetation structure derived from airborne Light Detection and Ranging (LiDAR) data to spatially predict the forest species richness of vascular plants, butterflies and breeding birds. We used presence data of 212 plant, 157 butterfly and 92 bird species from multiple transect samples in > 220 1 km2 squares at elevations between 261 and 2123 m a.s.l. across 41,248 km2. We applied an ensemble modelling approach consisting of five modelling techniques and evaluated their predictive performance using the cross‐validated percentage of explained variance of each predictor group separately and the combinations thereof. We investigated the relative importance and response of each predictor and partitioned the variation into independent and shared components per variable group.

Results

Climate performed best in predicting forest species richness across taxa. Vegetation structure particularly improved the predictions of butterfly and bird species richness, while soil pH was an important predictor for forest plant species richness. Climate appeared to be mainly indirectly related to butterfly species richness, via correlations with habitat type and structure. The strength and direction of the relationships between the predictors and species richness were taxon‐specific with low cross‐taxon congruence.

Main conclusions

The growing availability of LiDAR data offers powerful new tools for describing vegetation structure and associated animal habitat quality across large areas. This will further our understanding of niche‐driven assembly processes in forest landscapes. Although climate was the dominant factor controlling species richness across taxa from different trophic levels, the taxon‐specific distributional pattern and response to environmental conditions emphasize the difficulty of accounting for a range of taxa in prioritising biodiversity conservation measures.
Uncovering the spatio‐temporal drivers of species trait variances: a case study of Magnoliaceae in China
Authors: Liu Hui , Lundgren Marjorie R. , Freckleton Robert P. , Xu Qiuyuan , Ye Qing
Published: February 2016

Aim

Analyses of the relationships between evolutionary history, environmental constraints and associated trait variances can reveal how species distributions were shaped. Phylogenetic comparative models can be used to disentangle the relative roles of spatial and phylogenetic factors in explaining trait variances. Here, we analyse variances in plant traits and environmental variables of the widely distributed and early diverging Magnoliaceae within a phylogeographical context to test whether species distributions have been limited more by evolutionary or spatial constraints in this family.

Location

China.

Methods

The phylogenetic relatedness and geographical distributions of 183 Magnoliaceae species in China were analysed for phylogenetic clustering or over‐dispersion. The phylogenetic signals of 15 plant traits and 12 environmental variables were determined, and the relative contributions of phylogeny and space to each quantitative trait were distinguished using four comparative models.

Results

Species richness gradually decreased from south to north, with phylogenetic clustering along the southern coast, and in northern and central China. Strong phylogenetic signals were found in leaf form, flowering sequence, diameter at breast height, leaf length and width, mean and minimum mean annual temperature, and minimum mean annual precipitation. Variances of plant diameter, length and width of leaves and tepals, and fruit length were strongly associated with phylogenetic relatedness. In contrast, variances of plant height, flowering and fruiting time, and all of the 12 environmental variables (mean, minimum, maximum and range of altitude, temperature and precipitation) were associated with both spatial proximity and phylogenetic distance between species.

Main conclusions

Phylogenetic niche conservatism was identified in most of the studied plant traits across the Magnoliaceae. In contrast, environmental variables showed weak phylogenetic signals, but strong spatial signals. These results suggest that the present tropical‐temperate distributional pattern of the Magnoliaceae is driven by the ecophysiological adaptation of plant traits under both geographical separation and environmental constraints.
Clinical Outcomes of Single‐ versus Dual‐Chamber Implantable Cardioverter Defibrillators: Lessons from the Israeli ICD Registry
Authors: KONSTANTINO YUVAL , HAIM MOTI , BOXER JEREMY , GOLDENBERG ILAN , FELDMAN ALEXANDER , MICHOWITZ YOAV , GLIKSON MICHAEL , SULEIMAN MAHMOUD ,   On behalf of the Israeli Working Group on Pacing and Electrophysiology
Published: February 2016

Clinical Outcome of Single‐ versus Dual‐Chamber ICDs

Objective

To compare the clinical outcomes of a single‐ versus dual‐chamber ICD for primary prevention of sudden cardiac death in a large, national ICD registry.

Methods

Data were collected from the prospective Israeli ICD Registry. Baseline characteristics and clinical outcomes including mortality, admissions for heart failure (HF), and ICD therapy were compared between the two groups.

Results

A total of 1,125 subjects, 37% with a single‐chamber and 63% with a dual‐chamber ICD, constructed the baseline cohort. Approximately 80% had ischemic heart disease (IHD). Mean follow‐up was 22 months, mean ejection fraction was 30%, and mean QRS width was 103 milliseconds in both groups. During follow‐up, there were no significant differences in the rate of mortality, admissions for HF, appropriate or inappropriate therapy, or in time to any of the clinical outcomes. Using multivariate analysis, single‐chamber ICD was not associated with increased risk of death or admission for HF. In a subgroup of patients with IHD, single‐chamber ICD was associated with a higher rate of inappropriate therapy.

Conclusions

In this large retrospective population‐based cohort, dual‐chamber ICD showed no benefit in reducing the incidence of death or HF admissions, whereas in a subgroup of patients with IHD, single‐chamber ICD was associated with increased inappropriate therapy. Further prospective studies are necessary to assess the benefit of dual‐chamber ICD in reducing the rate of inappropriate therapy.
Use of outcome measures improved after a tailored implementation in primary care physiotherapy: a prospective, controlled study
Authors: Käll Ingela , Larsson Maria EH , Bernhardsson Susanne
Published: February 2016

Rationale, aims and objectives

It is important that physiotherapists routinely use outcome measures to evaluate treatment results. There is limited knowledge about effective ways to increase use of outcome measures. The objectives were to investigate the effect of a tailored implementation of guidelines for evaluation of physiotherapy treatment and to explore differences in outcome subgrouped by demographic variables.

Methods

A prospective, controlled study was conducted in primary care physiotherapy in western Sweden. 448 publicly employed physiotherapists participated. The intervention comprised a tailored, multi‐component implementation of guidelines for treatment and evaluation of musculoskeletal disorders. The core component was a 3‐hour implementation seminar. The control group received no intervention. Self‐reported attitudes towards, access to and use of outcome measures were assessed with a web‐based questionnaire before and after the implementation.

Results

After the implementation, a significantly higher proportion of physiotherapists in the intervention group than in the control group reported using outcome measures frequently, 54.8% vs. 35.6%, a 19.2% difference. The proportion of physiotherapists who reported that they considered outcome measures important to use and that they had easy access to outcome measures at their workplace, were similar in both groups at follow‐up, 92.8% vs. 93.1%, and 95.2% vs. 90.8%, respectively. At follow‐up, no differences related to demographic variables were found in the subgroup analyses.

Conclusions

The findings suggest that a tailored, multi‐component implementation can be effective in increasing use of outcome measures. Although most physiotherapists considered outcome measures important and reported having easy access to them at their workplace, only a little more than half reported using outcome measures after the intervention.
Development of a cross‐disciplinary continuous insulin infusion protocol for non‐critically ill patients in a French university hospital
Authors: Bernard Lise , Roche Béatrice , Batisse Marie , Maqdasy Salwan , Terral Daniel , Sautou Valérie , Tauveron Igor
Published: February 2016

Rationale, aims and objectives

In non‐critically ill patients, the use of an insulin syringe pump allows the management of temporary situations during which other therapies cannot be used (failure of subcutaneous injections, awaiting advice from the diabetes team, emergency situations, prolonged corticosteroid therapy, initiation of an artificial nutrition, need for a fasting status, etc.). To manage the risks related to this «never event», the use of a standard validated protocol for insulin administration and monitoring is an essential prerequisite. To this end, a multidisciplinary approach is recommended.

Method

With the support of our subcommission «Endocrinology‐Diabetology», we proceeded with a «step‐by‐step process» to create such a standardized protocol: (1) review of all existing protocols in our hospital; (2) overview of the literature data concerning insulin infusion protocols developed by multidisciplinary teams in France and abroad; (3) development of a standardized protocol for non‐intensive care unit patients, respecting the current recommendations and adapting it to the working habits of health teams; and (4) validation of the protocol

Results

Two protocols based on the same structure but adapted to the health status of the patient have been developed. The protocols are divided in to three parts: (1) golden rules to make the use of the protocol appropriate and safe; (2) the algorithm (a double entry table) corresponding to a dynamic adaptation of insulin doses, clearly defining the target and the ‘at risk situations’; and (3) practical aspects of the protocol: preparation of the syringe, treatment initiation and traceability. The protocols have been validated by the institution.

Conclusion

Our standardized insulin infusion protocol is simple, easy to implement, safe and is likely to be applicable in diverse care units. However, the efficiency, safety and the workability of our protocols have to be clinically evaluated.
The Role of TCD in the Evaluation of Acute Stroke
Authors: Brunser Alejandro M. , Mansilla Eloy , Hoppe Arnold , Olavarría Verónica , Sujima Emi , Lavados Pablo M.
Published: February 2016

BACKGROUND

The additional information that transcranial Doppler (TCD) can provide as part of a multimodal imaging stroke protocol in the setting of hyper acute strokes has not been evaluated.

METHODS

Consecutive patients admitted between December 2012 and January 2015 with ischemic stroke of less than 4.5 hours of onset were studied as soon as possible with a protocol consisting of noncontrast brain computed tomography, computed tomography angiography of supra‐aortic vessels, diffusion‐weighted magnetic resonance imaging, and TCD.

RESULTS

Eighty‐six patients were included. The imaging protocol was performed 113.9 (±23) minutes after the stroke symptoms appeared and by TCD after 150.2 (±19) minutes. Sixty‐six (76.7%) patients were treated with revascularization therapies. TCD provided additional information in 49 cases (56.9.4%, 95 CI 46.4‐66.9). More than one piece of additional information was obtained in 17 patients. The most frequent additional information was collateral pathways, information related to patency of vessels, and active microembolization. Multivariate analysis demonstrated that, intracranial vessel occlusion (P <.001) and optimal sonographic windows (P <.004) were the variables associated with additional information. In 15 patients (17.4%; 95 CI 9.4‐25.5) the additional information changed the management. In 8 patients endovascular rescue was applied after the failure of intravenous thrombolysis; in 5 patients angiography was suspended and in 2 other cases aggressive neurocritical care was indicated.

CONCLUSIONS

TCD in the first 4.5 hours of acute ischemia can provide additional information to a multimodal acute ischemic stroke imaging protocol, and can induce changes in the management of a proportion of these patients.
Lateral Sinus Thrombosis: The Importance of the Unaffected Sinus
Authors: Glik Amir , Benkovich Elya , Kesler Anat , Ifergan Gal , Benifla Moni , Shelef Ilan
Published: February 2016

BACKGROUND AND PURPOSE

Intracranial hypertension develops in only some patients with lateral sinus thrombosis (LST), for reasons that are unclear. The purpose of this study was to evaluate a possible association between patency of the unaffected sinus and clinical presentation of unilateral LST.

METHODS

A computerized search identified patients with LST, hospitalized in Soroka Medical Center. Patients with signs of increased intracranial pressure (iICP) and those with normal intracranial pressure (nICP) were compared. CT venography or MR venography confirmed the diagnosis, located the thrombosis, and determined the dominant lateral sinus (LS). Diameters of the right and left LSs (the occluded and unaffected) were compared to the diameter of the distal superior sagittal sinus (SSS).

RESULTS

Of the 50 patients identified, 30 had iICP and 20 nICP. The dominant LS was the right one in 39 (78%) and the left one in 8 (16%); 3 (6%) had equal LS dominance. The dominant sinus was affected in 32 (70%) and the non‐dominant in 15 (30%) patients. iICP was detected in 28/32 (81%) of patients with the dominant side affected, and 3/15 (20%) of those with non‐dominant thrombotic sinus (P = .002). The unaffected sinus was narrower in iICP patients (size relative to SSS diameter = 43% in iICP vs. 86% in nICP [P = .0002]; size grading, according to Farb's method was 1.86 in the iICP vs. 3.57 in the nICP group [P = .0001]).

CONCLUSIONS

Thrombosis was more common in the dominant LS. Unaffected LS patency appears to be associated with the development of increased ICP.
Magnetic Resonance Imaging of the Lumbar Spine In Asymptomatic Adults
Authors: Greenberg Jack O. , Schnell Roger G.
Published: February 2016

We performed magnetic resonance imaging of the lumbar spine on 66 asymptomatic subjects and found that 12 (18%) had either a disc protrusion or herniation. An additional 26 (39%) had a bulge that was associated with degenerative disc disease. We also found examples of spinal stenosis, narrowed nerve root canals, osteophytes, and vertebral body involvement with multiple myeloma. Degenerative disc disease is a common finding in asymptomatic adults that increases in frequency with age. It occurs more frequently in men and usually involves more than one level. The most common location is L5‐S1.
Focal Seizure, White Matter Lesions, and Focal Encephalitis
Authors: Paulson George W. , Liss Leopold
Published: February 2016

Focal seizures became generalized and were associated with intellectual deterioration over a period of at least 4 years. The focal seizures initially appeared to be a tic, and white matter lesions suggested a diagnosis of multiple sclerosis. Examination of a biopsied specimen led to diagnosis.
Single‐Photon Emission Computed Tomography in Distal Field Hypoperfusion
Authors: Pacia Steven V. , Bose Arani , Fayad Pierre , Smith Eileen O. , Hoffer Paul B. , Brass Lawrence M.
Published: February 2016

To assess the ability of technetium‐99m hexamethylpropyleneamineoxime single‐photon emission computed tomography (SPECT) imaging to differentiate distal field hypoperfusion from other stroke mechanisms, 24 patients with acute cerebral ischemia were studied. SPECT scans were read by two physicians according to a preestablished set of criteria for distal field hypoperfusion. SPECT patterns read as “probable” or “definite” for distal field hypoperfusion were found in 42% (1 0/24); of these, 80% (8/1 0) had ipsilateral carotid occlusion or highgrade stenosis. Severe carotid stenosis was found in 43% (6/14) with SPECT scans negative for distal field hypoperfusion (Fisher exact test [1‐tailed] p = 0.0796). The results suggest that a distal field hypoperfusion pattern on SPECT may identify patients with hemodynamically significant large vessel disease.
Magnetic Resonance Angiography of a Posterior Cerebral Artery Occlusion
Authors: Golwyn Daniel H. , Cardenas Carlos A. , Murtagh F. Reed , Sergay Stephen M.
Published: February 2016

A 45‐year‐old woman suddenly had severe pain in the right eye and blurred vision. Physical findings were normal except for left homonymous hemianopia. Laboratory test results were normal. However, magnetic resonance images showed evidence of cerebral infarctions in the right posterior cerebral artery distribution. In addition, magnetic resonance angiography was consistent with absent flow of that vessel.
Anterior Spinal Artery Syndrome in a Heroin Addict
Authors: Gilroy John , Wang Ay-Ming , Lux Jane E.
Published: February 2016

This first known case of heroin injected into the vertebral artery resulted in an acute spinal artery syndrome with quadriplegia, bilateral loss of pain, and temperature sensation to the C3‐C4 dermatome junction and sparing of vibratory sense, proprioception, and mentation. The passage of the heroin bolus to the spinal cord rather than the brainstem was due to occlusion of the distal portion of the right vertebral artery when the head was extended and turned to the left at the time of injection. The spinal cord infarction was demonstrated by magnetic resonance imaging. A hypersensitivity reaction to heroin following a period of abstinence may explain the acute onset of symptoms following injection.
Magnetic Resonance Imaging in a Patient with Wernicke's Encephalopathy Due to Hyperemesis Gravidarum
Authors: Kinkel Peter R. , Schmidt Reinhold , Weymann Catherine , Kinkel William R.
Published: February 2016

Magnetic resonance imaging (MRI) demonstrated acute bilateral hyperintense lesions involving the thalami, hypothalami, quadrigeminal plate, and periaqueductal white matter in a patient with Wernicke's encephalopathy due to hyperemesis gravidarum. This prompted diagnosis despite an initially oligosymptomatic clinical presentation. The reversibility of these changes following treatment was docu.mented.
High‐resolution B‐Mode Ultrasound Scanning Methods in the Atherosclerosis Risk in Communities Study (ARIC)
Authors: Bond M. G. , Barnes R. W. , Riley W. A. , Wilmoth S. K. , Chambless L. E. , Howard G. , Owens B. ,   The ARIC Study Group
Published: February 2016

The Atherosclerosis Risk in Communities study examined popliteal and extracranial carotid arteries in approximately 16,000 randomly selected participants, aged 45 to 64 years. Vessels were studied noninvasively using high‐resolution B‐mode ultrasound imaging at baseline, to be repeated again after 3 years. The ultrasound examinations were performed according to a detailed standardized protocol by trained, certified sonographers subject to semiannual evaluation. Data on intrasonographer reliability from May 15, 1987, to June 30, 1989, showed that sonographers were able to visualize consistently a similar number of points along each of four arterial interfaces. Furthermore, the variability of measured combined intima‐medial thicknesses was low, with 80% or more of duplicate scans differing by less than 0.267 mm. The validity of B‐mode ultrasound imaging to detect asymptomatic carotid and popliteal artery atherosclerosis combined with high measurement reproducibility provides a powerful noninvasive scientific tool to test cross‐sectional and prospective hypotheses related to disease epidemiology.
Magnetic Resonance Imaging Characteristics of Multiple Sclerosis Plaques Imaged with Two‐dimensional and Three‐dimensional Fourier Transform Techniques at Low and Mid Field Strengths
Authors: Rothschild Peter A. , Kramer David M. , Schulz Martin , Kaufman Leon
Published: February 2016

A total of 58 multiple sclerosis lesions from 16 patients were used to characterize the performance of a low field system for the detection of edematous (e.g., water‐elevating) brain lesions. Contrast, signal‐to‐noise, and their product (signal difference to noise) were measured for two‐dimensional and three‐dimensional Fourier transform techniques at low field strength (640 G) and compared to two‐dimensional sequences at mid field strength (3,500 G). The results showed numerically that low field‐strength magnetic resonance imaging can reliably detect multiple sclerosis lesions, and, by extension, other water‐elevating lesions, although with lower confidence levels.
The Cavum Septi Pellucidi; A Magnetic Resonance Imaging Study of Prevalence and Clinical Associations in a Pediatric Population
Authors: Breeding Lisa M. , Bodensteiner John B. , Cowan Linda , Higgins William L.
Published: February 2016

The cavum septi pellucidi is formed when the two leaves of the septum pellucidum fail to fuse as the fetal brain matures. When observed at autopsy or by computed tomography or magnetic resonance imaging (MRI), it is often considered clinically insignificant. Using MRI, this study evaluated the prevalence of cavum septi pellucidi in 445 pediatric patients and correlated the findings to the patients' functional level. A cavum septi pellucidi of 1.3 to 12.0 mm was observed in 64 (14%) of the patients. Of the children with cavum septi pellucidi, 12 (19%) were mentally retarded or severely developmentally delayed and 24 (38%) were less severely handicapped. In a random sample of 64 patients without cavum septi pellucidi from the original population, only 14 (22%) had any functional abnormality. The data suggest that cavum septi pellucidi is clinically significant as a marker for increased risk of disturbed brain function.
Neuroimaging of a New Familial Disorder; Ataxia, Chorea, Seizures, and Dementia
Authors: Farmer Thomas W. , Wingfield Martha S. , Jacobson Peter L. , Katchinoft Barry L. , Lynch Sue A. , Curnes John T.
Published: February 2016

The neuroimaging findings observed in a family with a previously reported syndrome of progressive ataxia, chorea, seizures, and dementia include an unusual combination: (1) bilateral basal ganglia calcification limited to the globus pallidus on brain computed tomography; (2) abnormal focal and diffuse areas of increased signal intensity in the cerebral white matter on brain magnetic resonance imaging; and (3) mild to moderate degrees of atrophy of the cerebrum, cerebellum, and brainstem. These neuroimaging findings define further this new clinical entity.
Effect of Premature Ventricular Contractions on Middle Cerebral Artery Blood Flow Velocity
Authors: Ameriso Sebastian F. , Fisher Mark , Sager Philip
Published: February 2016

The effect of premature ventricular contractions on blood flow velocity in the middle cerebral artery was studied by transcranial Doppler ultrasonography in 1 0 patients. Velocity during three ectopic beats for each patient was lower than that during the preceding and the following beat in every recording. The decrease in peak velocity was 30.7 ± 12.4% and 37.1 ± 13.3% (mean ± standard deviation) compared to the preceding and following beat, respectively. This variation was significantly larger (p < 0.0001) than the spontaneous change observed during sinus rhythm, 2. 7 ± 2.2% in patients with premature ventricular contractions and 3.5 ± 3.2% in control subjects. Similar results were obtained for both mean and diastolic blood flow velocities. Systolic‐diastolic ratios were similar for premature ventricular contractions, beats preceding or following premature ventricular contractions, and sinus rhythm beats. Transcranial Doppler ultrasound appears to be an excellent technique for analyzing the effects of cardiac arrhythmias on the cerebral circulation.
Acute Brown‐Séquard Syndrome in a 25‐Year‐Old Female
Authors: Gzesh Dan , Flanders Adam , Schwartzman Robert J.
Published: February 2016

A 25‐year‐old woman presented with acute, nontraumatic Brown‐Sequard syndrome. Subsequent evaluation disclosed multiple thoracic hemangioblastomas. The neurological differential diagnosis and radiographic evaluation are discussed.
Cavernous and Venous Angiomas of the Central Nervous System, Neuroimaging and Clinical Controversies; Neuroimaging and Clinical Controversies
Authors: Hardjasudarma M.
Published: February 2016

Cavernous and venous angiomas of the brain are often incidental findings on computed tomography (CT) and magnetic resonance imaging (MRI) scans of patients with unrelated signs and symptoms. Cavernous angiomas can cause hemorrhage or seizures. The venous angioma itself is a developmental anomaly and as such has only a slight predisposition to rupture. Cavernous and venous angiomas have distinct CT and MRI characteristics, which facilitate their diagnosis. No therapy is usually indicated for venous angiomas. On the other hand, extirpation of cavernous angiomas is the usual treatment of choice.
Single‐Photon Emission Computed Tomography Findings in Unilateral Parkinsonism
Authors: Masdeu Joseph C. , Van Heertum Ronald L. , Yudd Anthony , Anselmi Gregory
Published: February 2016

Single‐photon emission computed tomography (SPECT) was used to detect basal ganglia hyperperfusion and cortical hypoperfusion contralateral to the affected extremities in a patient with hemiparkinsonism. Computed tomography (CT) and magnetic resonance imaging (MRI) failed to show cerebral asymmetries. The findings on SPECT are compatible with current views on the connectivity of the basal ganglia.
Evaluation of the Transverse Sinus by Magnetic Resonance Venography: Limitations‐An Illustrative Case Report
Authors: Weymann Catherine A. , Schmidt Reinhold , Kinkel Peter R.
Published: February 2016

Many techniques of magnetic resonance angiography depend on flow velocity. The broad normal range of venous flow velocities and preferential patterns of drainage, particularly in the transverse sinuses, may produce images that are diagnostically misleading. This reports such a case, with samples of various flow patterns in the transverse sinuses of other individuals, as demonstrated by one magnetic resonance angiographic technique (time‐of‐flight).
Transverse Myelitis Mimicking Intramedullary Spinal Cord Tumor
Authors: Gieron Maria A. , DiPasquale Karen J. , Martinez Carlos R. , Korthals Jan K.
Published: February 2016

A 14‐year‐old girl presented with a 7‐week history of progressive quadriparesis. Magnetic resonance imaging (MRI) demonstrated cord enlargement with changes in signal intensity on T1‐ and T2‐weighted images, suggesting intramedullary tumor. Subsequently, she improved clinically with resolution of MRI findings.
The Magnetic Resonance Image Appearance of Mycoplasma neumoniae Encephalopathy
Authors: Brillman Jon , Rotheram Edward B. , Valeriano James P. , Scott Thomas F. , Thomas Lisa C.
Published: February 2016

Although the pathogenesis is unknown, the neurological manifestations of Mycoplasma pneumoniae are protean. Direct nervous system invasion by the organism and an autoimmune demyelination have been implicated. The patient reported here developed M. pneumoniae encephalopathy wherein the clinical and imaging data documented the development and resolution of a central nervous system lesion consistent with inflammation. The images and clinical course suggest a delayed hypersensitivity or autoimmune process similar to that of acute disseminated encephalomyelitis.
Transcranial Doppler Assessment of the Cerebral Hemodynamic Effect of Cardiopulmonary Resuscitation in Fatal Cardiac Arrest
Authors: Gomez Camilo R. , Ruoff Brent E. , Lewis Lawrence M. , Gasirowski Ben , Gomez Sandra M. , Hall Irene S.
Published: February 2016

The intracranial circulation of 22 patients who had nontraumatic fatal cardiac arrest was monitored using transcranial Doppler (TCD) ultrasound during cardiopulmonary resuscitation (CPR). The internal carotid artery (ICA) was most easily accessible with the least amount of artifact. The duration of the cardiac arrests varied from 6 to 70 minutes (mean, 63), and the TCD‐monitoring time from 1 to 33 minutes (mean, 9). Maximal ICA mean velocities obtained during CPR ranged between 8 and 66 cmjsec (mean, 38) while minimal mean velocities varied between 2 and 22 cmjsec (mean, 12). Although 3 patients developed spontaneous cardiac rhythm during TCD monitoring, all died. Minute‐to‐minute comparison of ICA mean velocities obtained during the last 1 0 minutes of arrest monitoring showed a statistically significant difference following a deeremental trend (p = 0.05). In patients undergoing CPR, cerebral blood flow velocities as measured by TCD decrease progressively. In addition, changes in Doppler waveform suggest this decrease is secondary to progressively increased flow resistance. The clinical and prognostic significance of these findings awaits definition.
Single‐Photon Emission Computed Tomography Studies of Regional Cerebral Blood Flow in Multiple Infarct Dementia
Authors: Eberling Jamie L. , Jagust William J. , Reed Bruce R. , Kwo‐on‐Yuen P. F. , Martin Eileen M.
Published: February 2016

Multiinfarct dementia (MID) and Alzheimer's disease (AD), both characterized by a decline in cognitive function, are often difficult to differentiate and may coexist. This study reports the findings of single‐photon emission computed tomography (SPECT) using [231]N‐isopropyl‐p‐iodoamphetamine to determine cerebral blood flow patterns in patients with MID (n = 11 ), as compared with patients with AD (n = 22) and nondemented control subjects (n = 12). Data were acquired at two tomographic levels for dorsolateral frontal, parietal, orbitofrontal, and temporal areas of the cortex. Analyses of variance revealed that the blood flow pattern for the MID group was very similar to that in the AD patients, with both groups showing hypoperfusion in the temporal area, although blood flow in the left parietal region was lower for the patients with AD. When normal regional cerebral blood flow (rCBF) was defined as within 2 standard deviations of control values, most of the patients with MID had normal rCBF, while a few patients showed abnormal rCBF in all regions. In contrast, the majority of AD patients showed abnormal rCBF in the temporal part of the cortex. This suggests that while AD is characterized by hypoperfusion in the temporal and parietal areas, there is no characteristic rCBF pattern in MID. These findings emphasize the need to use multiple modalities when clinically evaluating patients with MID.
Monomelic Juvenile Spinal Muscular Atrophy of the Arm
Authors: Kiyoshi Yamamoto , Yoshitaka Takase , Mitsunori Morimatsu
Published: February 2016

In 3 patients with monomelic juvenile spinal muscular atrophy, T2‐weighted and gradient‐echo sagittal magnetic resonance images (MRIs) demonstrated cord atrophy at the C6‐7 level. T1‐weighted and gradient‐echo axial images revealed cord flattening at the C6‐7 level. Gradient‐echo axial images showed high intensity from the anterior horns to the lateral columns bilaterally at C5‐7 in 1 patient and in the right anterior horns at C5‐7 in 2. With the neck flexed, T1‐weighted and gradient‐echo sagittal images of all patients showed narrowing and anterior shifting of the dural sac, corresponding to the localized atrophy, and also congestion of the internal vertebral venous plexus. These findings correlated to clinical features and with necropsy results. The distribution of spinal cord lesions approximates the watershed areas between the central and the peripheral arteries.
Atrial Fibrillation, Congestive Heart Failure, and the Middle Cerebral Artery
Authors: Ameriso Sebastian F. , Sager Philip , Fisher Mark
Published: February 2016

Atrial fibrillation and congestive heart failure are risk factors for ischemic stroke usually attributed to cardiac embolism. To define potential alternative mechanisms, patients with atrial fibrillation and congestive heart failure were investigated by transcranial Doppler. Middle cerebral artery (MCA) blood flow velocities were analyzed in neurologically asymptomatic patients with nonvalvular (n = 10) and valvular (n = 13) atrial fibrillation, patients in normal sinus rhythm with congestive heart failure (n = 13), and control subjects (n = 11). Compared to patients in sinus rhythm with congestive heart failure and to control subjects, patients in both atrial fibrillation groups had significantly greater beat‐to‐beat variation in peak, mean, and diastolic velocities and in pulsatility index. Peak, mean, and diastolic MCA velocities in patients with atrial fibrillation and those with congestive heart failure were significantly less than those in control subjects. Patients with nonvalvular atrial fibrillation had a higher pulsatility index compared to each of the other three groups. These findings demonstrate substantial nonemboligenic alterations of the intracranial circulation associated with atrial fibrillation and congestive heart failure, and also provide an intracranial hemodynamic profile that may distinguish valvular from nonvalvular atrial fibrillation.
Embolic Stroke As a Sequela of Cardiopulmonary Bypass
Authors: Boyajian Robert A , Sobel David F , DeLaria Giacomo A , Otis Shirley M
Published: February 2016

The pathophysiology of brain injury in patients undergoing cardiopulmonary bypass remains unclear despite several decades of inquiry. The advent cit noninvasive high‐resolution brain and cerebrovascular imaging by magnetic resonance, computed tomography, and pulsed Doppler ultrasonography now permits in vivo assessment of pathophysiological mechanisms. Neuroradiographic and carotid duplex studies were performed in patients who developed neurological deficits following cardiopulmonary bypass. Among 30 symptomatic patients undergoing magnetic resonance or computed tomography brain scans, 18 (60%) had findings of acute ischemic injury. Embolic infarction was evident in 14 (78%) of these 18 patients. Watershed injury was the predominant finding in a single patient, while findings consistent with global anoxia were present in another patient. Carotid atheroemboli were excluded as a possible source of embolism in 11 patients whose carotid duplex studies were unremarkable preoperatively as well as in 3 further patients whose neuroradiographic findings did not correspond with their moderate carotid disease. It is concluded that infarction due to noncarotid embolism is the primary pathophysiology of neurological deterioration following cardiopulmonary bypass.
Hyperperfusion after Carotid Endarterectomy Managed by a Removable Clamp
Authors: R. Smith Robert , Burt Travis
Published: February 2016

Post‐carotid endarterectomy seizures have been previously described. They may be secondary to increased blood flow in the territory supplied by the carotid vessel. This paper reports a patient with post‐carotid endarterectomy in status epilepticus with abnormally high cerebral blood flow velocities as measured by transcranial Doppler criteria. She was treated successfully with a removable, adjustable carotid clamp until cerebral blood flow velocities were maintained in the normal range independent of the clamp.
Diagnosis by Electroencephalographic Topography
Authors: Johnson Stephen F
Published: February 2016

In 5 patients, electroencephalographic (EEG) topography (Fourier analysis and topographic display of EEG data) demonstrated clinically significant acute brain lesions not seen by magnetic resonance imaging or computed tomography. EEG topography contributed to patient management more than standard EEG. Additional, carefully designed, prospective studies may indicate how frequently and in which settings EEG topography is a valuable diagnostic test.
Subcortical Magnetic Resonance Imaging Changes in a Healthy Elderly Population; Stroke Risk Factors, Ultrasound, and Hemostasis Findings
Authors: Fisher Mark , Zawadzki Michael Brant , Ameriso Sebastian , Quismorio Francisco , Wong Vicky , Bernard Jacqueline , Zee Chi-Shing , Paganini‐Hill Annlia
Published: February 2016

Magnetic resonance imaging (MRI) findings in a group of 60 ambulatory elderly individuals (average age, 75.8 yr) were characterized as normal (grade 0), periventricular changes only (grade 1 ). small punctate lesions (grade 2), and confluent or large (> 2 mm) punctate lesions (grade 3). Patients were characterized by stroke risk factors, cardiolipin antibodies, coagulation factors (fibrinogen and plasminogen activator inhibitor‐1 ). and Doppler ultrasound findings in the carotid and middle cerebral arteries. Subcortical signal abnormalities were present in 62% (37 /60), relatively evenly distributed between grade 1 (18%), grade 2 (25%), and grade 3 (18%). There was no significant association between variables and MRI grade. These findings suggest that ischemia is not a major cause of MRI signal abnormalities in neurologically asymptomatic elderly individuals.
Reports Arachnoiditis in the Cauda Equina Syndrome of Longstanding Ankylosing Spondylitis
Authors: Bruining Kersti , Weiss Kenneth , Zeifer Barbara , Comfort Christopher , Kaplan Jerry G.
Published: February 2016

A patient with cauda equina syndrome from long‐standing ankylosing spondylitis exhibited erosive cystic defects of the thecal sac on lumbosacral magnetic resonance imaging. This report confirms the presence of nerve root clumping described previously, documents contrast enhancement of the leptomeninges for the first time, and suggests that arachnoiditis has a role in the evolution of this disorder.
Partial Resolution of Calcifications in Cerebral Infarcts in a Patient with Lupus
Authors: Futrell Nancy
Published: February 2016

A patient with lupus had calcified cerebral infarcts, with partial resolution of the calcification over time. Such reductions in the number and size of calcifications may contribute to an underestimation of the frequency of calcium deposition in cerebral infarcts.