bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Endovascular Treatment of Aneurysmal Subarachnoid Hemorrhage Complicated by Neurogenic Pulmonary Edema and Takotsubo-Like Cardiomyopathy
Authors: Manto Andrea , De Gennaro Angela , Manzo Gaetana , Serino Antonietta , Quaranta Gaetano , Cancella Claudia
Published: April 2014

Aneurysmal subarachnoid hemorrhage (SAH) may be associated with acute cardiopulmonary complications, like neurogenic pulmonary edema (NPE) and Takotsubo-like cardiomyopathy (TCM). These dysfunctions seem to result from a neurogenically induced overstimulation of the sympathetic nervous system through the brain-heart connection and often complicate poor grade aneurysmal SAH. The optimal treatment modality and timing of intervention in this clinical setting have not been established yet. Early endovascular therapy seems to be the fitting treatment in this particular group of patients, in which surgical clipping is often contraindicated due to the added risk of craniotomy. Herein we describe the case of a woman admitted to the emergency department with aneurysmal SAH complicated by NPE-TCM, in which early endovascular coiling was successfully performed. Our case, characterized by a favorable outcome, further supports the evidence that early endovascular treatment should be preferred in this peculiar clinical scenario.
Varicella Zoster CNS Vascular Complications
Authors: Chiang Francisco , Panyaping Theeraphol , Tedesqui Gustavo , Sossa Daniel , Leite Claudia Costa , Castillo Mauricio
Published: April 2014

This study explored the neurologic vascular complications of varicella zoster virus (VZV). We describe four patients presenting at our institution with neurologic involvement by VZV. MR and MRA studies of the intracranial arterial circulation in the head were read by board-certified radiologists using standard clinical procedures. On MRI, three patients had acute infarcts and in two instances irregularities and narrowings of vessels were visible. Many of these complications are recognized to be due to a vasculopathy affecting small or large vessels and resulting in cerebral infarctions and rarely hemorrhages. The pattern of cerebral infarction and vascular abnormalities is not specific and resembles those of vasculitis/vasculopathy from other causes. The central nervous system (CNS) vascular complications of VZV should be considered in the patients with simultaneous primary or prior VZV infection whose imaging studies show cerebral infarction and/or vasculitic appearing intracranial arteries.
Histoplasmosis Brain Abscesses in an Immunocompetent Adult
Authors: Andrade Ana Ines , Donato Maren , Previgliano Carlos , Hardjasudarma Mardjohan
Published: April 2014

We describe the case of a 62-year-old man, who presented with a new onset of focal seizures of his right leg. There were no other clinical symptoms, and laboratory results were normal. Brain magnetic resonance imaging revealed multiple lesions, two supratentorial lesions were ring-enhancing. The brain biopsy tissue showed Histoplasma capsulatum abscesses. He improved on treatment with Amphotericin B. This case is reported since cerebral ring-enhancing lesions are rarely associated with histoplasmosis, which is also rare in an immunocompetent individual. We review the literature and discuss the radiologic and pathologic findings of this case compared with previous reports.
Characterization of Intraventricular and Intracerebral Hematomas in Non-Contrast CT
Authors: Nowinski Wieslaw L. , Gomolka Ryszard S. , Qian Guoyu , Gupta Varsha , Ullman Natalie L. , Hanley Daniel F.
Published: April 2014

Characterization of hematomas is essential in scan reading, manual delineation, and designing automatic segmentation algorithms. Our purpose is to characterize the distribution of intraventricular (IVH) and intracerebral hematomas (ICH) in NCCT scans, study their relationship to gray matter (GM), and to introduce a new tool for quantitative hematoma delineation. We used 289 serial retrospective scans of 51 patients. Hematomas were manually delineated in a two-stage process. Hematoma contours generated in the first stage were quantified and enhanced in the second stage. Delineation was based on new quantitative rules and hematoma profiling, and assisted by a dedicated tool superimposing quantitative information on scans with 3D hematoma display. The tool provides: density maps (40–85HU), contrast maps (8/15HU), mean horizontal/vertical contrasts for hematoma contours, and hematoma contours below a specified mean contrast (8HU). White matter (WM) and GM were segmented automatically. IVH/ICH on serial NCCT is characterized by 59.0HU mean, 60.0HU median, 11.6HU standard deviation, 23.9HU mean contrast, 0.99HV/day slope, and 0.24 skewness (changing over time from negative to positive). Its 0.1st −99.9th percentile range corresponds to 25–88HU range. WM and GM are highly correlated (R2=0.88; p<10−10) whereas the GM-GS correlation is weak (R2=0.14; p<10−10). The intersection point of mean GM-hematoma density distributions is at 55.6±5.8HU with the corresponding GM/hematoma percentiles of 88th/40th. Objective characterization of IVH/ICH and stating the rules quantitatively will aid raters to delineate hematomas more robustly and facilitate designing algorithms for automatic hematoma segmentation. Our two-stage process is general and potentially applicable to delineate other pathologies on various modalities more robustly and quantitatively.
Assessment of Cerebrospinal Fluid Flow Patterns Using the Time-Spatial Labeling Inversion Pulse Technique with 3T MRI: Early Clinical Experiences
Authors: Abe Kayoko , Ono Yuko , Yoneyama Hiroko , Nishina Yu , Aihara Yasuo , Okada Yoshikazu , Sakai Shuji
Published: April 2014

CSF imaging using the time-spatial labeling inversion pulse (time-SLIP) technique at 3T magnetic resonance imaging (MRI) was performed to assess cerebrospinal fluid (CSF) dynamics. The study population comprised 15 healthy volunteers and five patients with MR findings showing expansive dilation of the third and lateral ventricles suggesting aqueductal stenosis (AS). Signal intensity changes were evaluated in the tag-labeled CSF, untagged brain parenchyma, and untagged CSF of healthy volunteers by changing of black-blood time-inversion pulse (BBTI). CSF flow from the aqueduct to the third ventricle, the aqueduct to the fourth ventricle, and the foramen of Monro to the lateral ventricle was clearly rendered in all healthy volunteers with suitable BBTI. The travel distance of CSF flow as demonstrated by the time-SLIP technique was compared with the distance between the aqueduct and the fourth ventricle. The distance between the foramen of Monro and the lateral ventricle was used to calculate the CSF flow/distance ratio (CD ratio). The CD ratio at each level was significantly reduced in patients suspected to have AS compared to healthy volunteers. CSF flow was not identified at the aqueductal level in most of the patients. Two patients underwent time-SLIP assessments before and after endoscopic third ventriculostomies (ETVs). CSF flow at the ETV site was confirmed in each patient. With the time-SLIP technique, CSF imaging is sensitive enough to detect kinetic changes in CSF flow due to AS and ETV.
The appraisal of chronic stress and the development of the metabolic syndrome: a systematic review of prospective cohort studies
Authors: Bergmann N , Gyntelberg F , Faber J
Published: April 2014

Chronic psychosocial stress has been proposed as a risk factor for the development of the metabolic syndrome (MES). This review gives a systematic overview of prospective cohort studies investigating chronic psychosocial stress as a risk factor for incident MES and the individual elements of MES. Thirty-nine studies were included. An association between chronic psychosocial stress and the development of MES was generally supported. Regarding the four elements of MES: i) weight gain: the prospective studies supported etiological roles for relationship stress, perceived stress, and distress, while the studies on work-related stress (WS) showed conflicting results; ii) dyslipidemi: too few studies on psychosocial stress as a risk factor for dyslipidemia were available to draw a conclusion; however, a trend toward a positive association was present; iii) type 2 diabetes mellitus (DM2): prospective studies supported perceived stress and distress as risk factors for the development of DM2 among men, but not among women, while WS was generally not supported as a risk factor among neither men nor women; iv) hypertension: marital stress and perceived stress might have an influence on blood pressure (BP), while no association was found regarding distress. Evaluating WS the results were equivocal and indicated that different types of WS affected the BP differently between men and women. In conclusion, a longitudinal association between chronic psychosocial stress and the development of MES seems present. However, the number of studies with sufficient quality is limited and the design of the studies is substantially heterogeneous.
Refractory hypercalcaemia secondary to parathyroid carcinoma: response to high-dose denosumab
Authors: Karuppiah Dharshini , Thanabalasingham Gaya , Shine Brian , Wang Lai Mun , Sadler Gregory P , Karavitaki Niki , Grossman Ashley B
Published: April 2014

Objective

Hypercalcaemia is an important cause of increased morbidity and mortality in patients with parathyroid carcinoma. Surgical resection is the mainstay of treatment but, equally, managing hypercalcaemia is of paramount importance. At present, few therapies have been shown to be effective in the most severe cases. This report describes the efficacy of denosumab in a patient with parathyroid carcinoma when conventional therapies had been shown to be relatively ineffective.

Subject, methods and results

A 50-year-old man presented with symptomatic hypercalcaemia 1 year after the surgery for his parathyroid carcinoma. Investigations revealed raised serum calcium and parathyroid hormone concentrations consistent with the recurrence of the disease. Imaging failed to localise any surgically remediable foci. Medical management with loop diuretics, calcimimetics and bisphosphonates failed to provide a sustained response. Denosumab, as a monthly injection, led to a gradual decrement in his peak calcium concentrations with the values now persistently below 3 mmol/l.

Conclusions

Denosumab, a fully human MAB that binds to the ‘receptor activator of nuclear factor κB ligand (RANKL)’, was shown to have a profound effect in modulating malignant hypercalcaemia. This medication should be considered as an effective option in patients with refractory hypercalcaemia secondary to parathyroid carcinoma.
The economics of counterinsurgency: Some evidence from Andhra Pradesh
Authors: Singhal Saurabh
Published: April 2014

Present in India since the 1960s, the Naxalite insurgency has steadily spread across the country. Counterinsurgency measures lagged behind and did not follow any systematic process till the early 2000s with the exception of Andhra Pradesh, which in 1989 established the Greyhounds, an anti-Naxalite police force. However, under the Congress-led UPA government (in power since 2004), there has been a concerted effort to tackle the insurgency. This article analyzes the centrally funded Security Related Expenditure Scheme in the context of industrial investments in Andhra Pradesh over the period 2005-2009. I find the scheme to have had no effect on industrial credit at the district level. A further disaggregation of the industrial credit data reveals no effects on construction but finds a positive effect on mining and quarrying activity.
A Longitudinal Study of Paternal Mental Health During Transition to Fatherhood as Young Adults
Authors: Garfield Craig F. , Duncan Greg , Rutsohn Joshua , McDade Thomas W. , Adam Emma K. , Coley Rebekah Levine , Chase-Lansdale P. Lindsay
Published: April 2014

BACKGROUND AND OBJECTIVE:

Rates of paternal depression range from 5% to 10% with a growing body of literature describing the harm to fathers, children, and families. Changes in depression symptoms over the life course, and the role of social factors, are not well known. This study examines associations with changes in depression symptoms during the transition to fatherhood for young fathers and whether this association differed by key social factors.

METHODS:

We combined all 4 waves of the National Longitudinal Study of Adolescent Health to support a 23-year longitudinal analysis of 10 623 men and then created a “fatherhood-year” data set, regressing age-adjusted standardized depressive symptoms scores on fatherhood status (nonresidence/residence), fatherhood-years, and covariates to determine associations between Center for Epidemiologic Studies Depression Scale scores and fatherhood life course intervals.

RESULTS:

Depressive symptom scores reported at the entry into fatherhood are higher for nonresident fathers than nonfathers, which in turn are higher than those of resident fathers. Resident fathers have a significant decrease in scores during late adolescence (β = –0.035, P = .023), but a significant increase in scores during early fatherhood (β = 0.023, P = .041). From entrance into fatherhood to the end of early fatherhood (+5 years), the depressive symptoms score for resident fathers increases on average by 68%.

CONCLUSIONS:

In our longitudinal, population-based study, resident fathers show increasing depressive symptom scores during children's key attachment years of 0–5. Identifying at-risk fathers based on social factors and designing effective interventions may ultimately improve health outcomes for the entire family.
Briefing: Effective-stress strength of peat in triaxial compression
Authors: O'Kelly Brendan C. , Orr Trevor L. L.
Published: April 2014

This briefing highlights the difficulties of standard triaxial compression testing of fibrous peat and representing its behaviour in a Mohr–Coulomb framework. Experimental values of effective angle of shearing resistance φ′ and apparent cohesion c′ reported in the literature for fibrous peat are scrutinised, from which the authors conclude that high φ′ values determined from triaxial compression testing can be grossly unconservative. Furthermore, given that shearing in a peat which is not completely humified involves tearing of entangled fibres and cellular connections in addition to shearing at frictional contacts, the authors postulate that the apparent cohesion value of fibrous peat is most likely greater than zero. Hence fundamental research on peat strength and how it is derived needs to be performed; also there needs to be further development of existing and new specific material models to simulate more accurately the soft and viscous nature of peat, and the general cross-anisotropic fabric and reinforcement provided by fibres in peats with low humification.
Effect of Si/Al ratio on engineering properties of alkali-activated GGBS pastes
Authors: Qureshi Mohammed Nadeem , Ghosh Somnath
Published: April 2014

The effect of synthesis parameter, silicon/aluminum molar ratio, on the engineering properties of alkali-activated blast-furnace paste has been investigated. The article presents the study of the compressive strength and microstructure of alkali-activated blast-furnace slag paste specimens prepared using sodium silicate and potassium hydroxide solution as activators. The experimental results have indicated that the compressive strength, bulk density, apparent porosity, water absorption and microstructure of the specimens are significantly affected by the silicon/aluminum molar ratio of alkali-activated ground granulated blast-furnace slag (AAS) paste. The compressive strength at 28 d of 44·90–46·30 MPa was obtained for silicon/aluminum ratios of 2·03–2·26. Increasing silicon/aluminum ratio beyond 2·26 resulted in a decrease in compressive strength of AAS paste due to delayed precipitation of calcium silicate hydrate products. The microstructural changes of hardened AAS paste were studied using scanning electron microscopy/energy-dispersive X-ray spectroscopy, and mineralogical characterization was studied with X-ray diffraction and Fourier transform infrared spectroscopy.
Manufacturing of Manganese-Zinc Soft Ferrite by Powder Metallurgy
Authors: Bhalla Deepak , Aggarwal S. K. , Govil G. P. , Kakkar Ish
Published: April 2014

Objective of this paper is, improvement of quality of Mn-Zn soft ferrites manufactured by powder metallurgy and overall output yield of it's plant. The efforts have been made to synthesize the crucial parameters which are responsible for better material preparation, pressing and sintering. By adopting these recommendations, the rejection rate is substantially reduced and the variation in magnetic properties is less. Data, which give more uniformity in bigger lots and are responsible for more uniform magnetic properties, have been discussed. Simple, quality-control instruments and their measurement methods which can be incorporated for stage inspection have been explained. The additives for better ferrite powder preparation, granules making and to obtain better magnetic have been discussed. Improved pressing, sintering, porosity, density and permeability relationship have been drawn. A sintering method to obtain better sintered density and high permeability in ferrites is also explained.
Photocatalytic and Self-Cleaning Properties of Ag-Doped TiO2
Authors: Tryba B. , Piszcz M. , Morawski A.W.
Published: April 2014

Commercially available TiO2 of anatase structure produced in the Chemical Factory Police S.A. was modified
by doping Ag from AgNO3 solution viaphotodeposition method. The obtained amount of deposited Ag on TiO2 was in
the range of 0.11 to 0.98 mass %. Deposition of Ag on TiO2 resulted in the retarding of the recombination reaction and
formation of the higher amount of OH radicals on the photocatalyst surface during irradiation with UV light. The
photocatalytic activity of samples was tested for the decomposition of phenol and Reactive Black in the water solution
under both, UV and artificial solar light radiation. Deposition of Ag on TiO2surface increased its photocatalytic activity
towards the Reactive Black decomposition but not for phenol. High adsorption of Reactive Black on Ag modified TiO2
photocatalysts, which was higher than on TiO2, could enhance the photocatalytic activity of these samples. The solution
with 1% slurry of TiO2-Ag was sprayed on the surface of concrete. For concrete impregnated with TiO2-Ag slurry the
both, fungicidal and self-cleaning effect for dyes were observed.
Study of the Bandgap of Synthesized Titanium Dioxide Nanoparticules Using the Sol-Gel Method and a Hydrothermal Treatment
Authors: Valencia Sergio , Marín Juan Miguel , Restrepo Gloria
Published: April 2014

In this work optical properties of titanium dioxide nanoparticles were studied. Titanium dioxide nanoparticles
were synthesized by the sol-gel method followed by a hydrothermal treatment using tetraisopropyl orthotitanate (TIOT)
and 2-propanol. The synthesized samples were characterized by X-ray diffraction (XRD), UV-Vis diffuse reflectance
spectroscopy (UV/DRS) and nitrogen adsorption-desorption methods. The bandgap energy was obtained using the
Kubelka-Munk reemission function. The catalyst synthesized with a molar ratio of R1 (water/TIOT) = 3.5 and R2 (2-propanol/TIOT)
= 15 has a predominately anatase phase. It also has a high photo degradation of methyl orange compared to TiO2 Degussa
P-25. A shift band gap energy of 3.27 was observed
Theoretical Verification of Wagner`s Equation Considering Polarization Voltage Losses in SOFCs
Authors: Miyashita T.
Published: April 2014

The necessity for experimental verification of leakage currents using Sm-doped ceria electrolytes (SDC) in solid-oxide fuel cells (SOFCs) has been indicated. This paper describes the theoretical limitations of Wagner's equation and details the analytical work that has been performed to support the experimental results. These limitations cannot be solved, even considering polarization voltage losses. Globally, there are several research groups working on SOFCs to solve the current-voltage relation with mixed ionic electronic solid conductors (MIECs). However, this problem must be solved considering the electric field (E) in MIECs. Thus, even though articles have already been published in similar areas, no approach has been taken within this body of work that considers the E in MIECs. In this report, a new calculation method considering E is expressed only from Wagner's equation, with continuity expressed using the Choudhury and Patterson style. The calculated results match the values from conventional models. The constant field approximation is verified using the conventional definition of E. However, the definition of E should be changed when there is a large voltage drop in the thin area of the electrolyte compared with the lattice constant. In this study, the electric field near the cathode is sufficiently large to cause dielectric breakdown, which has never been reported.
Bone Regenerative Potential of Mesenchymal Stem Cells on a Micro- Structured Titanium Processed by Wire-Type Electric Discharge Machining
Authors: Tamaki Yukimichi , Kataoka Yu , Jang In-Kee , Miyazaki Takashi
Published: April 2014

A new strategy with bone tissue engineering by mesenchymal stem cell transplantation on titanium implant has been drawn attention. The surface scaffold properties of titanium surface play an important role in bone regenerative potential of cells. The surface topography and chemistry are postulated to be two major factors increasing the scaffold properties of titanium implants. This study aimed to evaluate the osteogenic gene expression of mesenchymal stem cells on titanium processed by wire-type electric discharge machining. Some amount of roughness and distinctive irregular features was observed on titanium processed by wire-type electric discharge machining. The thickness of suboxide layer was concomitantly grown during the processing. Since the thickness of oxide film and micro-topography allowed an improvement of mRNA expression of cells, titanium processed by wire-type electric discharge machining is a promising candidate for mesenchymal stem cell based functional restoration of implants.
Changes on Texture and Crystalline Phase of Activated Carbon-Supported Ni-Ca Catalyst During Dry Methane Reforming
Authors: Matos Juan , Rosales Maibelin , González Gema , Urbina de Navarro Caribay
Published: April 2014

Changes on texture and crystalline phase of AC-supported Ni-Ca catalyst during dry methane reforming were
verified. Characterization by N2 adsorption, XPS, XRD, TEM and HR-TEM was performed. XPS and XRD analysis
suggest that the initial activity can be attributed to a nickel reduced phase formed during helium pre-treatment. TEM
showed that a homogeneous distribution of Ni nanoparticles between 10-20nm at the tip of multi-walled carbon nanotubes
is formed during reaction. HR-TEM showed diffusion of Ni nanoparticles and the formation of carbon-like nano onions
with an interlayer separation of 0.5nm suggesting the formation of a ultra-microporous carbon structure. An increase in
surface area from 231m2.g-1 to 2405m2.g-1 after 90min reaction was found and attributed to an in situ activation of carbon deposits by CO2 gasification. The present results suggest that introducing CO2 pulses during reaction carbon-supported
Ni-Ca could be employed as potential catalysts for methane and other hydrocarbon reforming reactions at mild experimental conditions.
Residual Stresses in Case Hardened Materials
Authors: Palaniradja K. , Alagumurthi N. , Soundararajan V.
Published: April 2014

Fatigue behavior of case hardened parts depend to a great extent on the type of residual stresses developed in the components. Topography and metallurgical effects were the two elements which contribute much to surface integrity. Micro hardness of the gas carburized (EN 33 and EN 36) and Induction hardened (AISI 1040 and AISI 6150) specimens obtained during experiments, showed that there was gradual decrease of hardness from surface to sub-surface. Results also showed that more the hardness and case depth, the more was the residual stress. The optimum results gave the maximum compressive residual stress in both the gas carburizing and Induction hardening process irrespective of the mechanisms involved in the process. The X-ray diffraction test showed that the distribution of residual stress was uniform both on the surface and beneath the surface. The magnitude and distribution of residual stress obtained from the experiment agreed with the FEM results found in literatures.
Elevated Serum Free Light Chains Predict Cardiovascular Events in Type 2 Diabetes
Authors: Bellary Srikanth , Faint Jeffrey M. , Assi Lakhvir K. , Hutchison Colin A. , Harding Stephen J. , Raymond Neil T. , Barnett Anthony H.
Published: April 2014

OBJECTIVE

Elevated polyclonal serum immunoglobulin free light chains (FLCs; combined FLCκ+FLCλ [cFLC]) are associated with adverse clinical outcomes and increased mortality; we investigated cFLC and cardiovascular disease (CVD) events in type 2 diabetes.

RESEARCH DESIGN AND METHODS

In a cohort study of 352 south Asian patients with type 2 diabetes, serum cFLC, high-sensitivity C-reactive protein (hsCRP), and standard biochemistry were measured. CVD events over 2 years were recorded and assessed using multiple logistic regression.

RESULTS

cFLC levels were elevated significantly in 29 of 352 (8%) patients with CVD events during 2 years of follow-up (50.7 vs. 42.8 mg/L; P = 0.004). In multivariate analysis, elevated cFLC (>57.2 mg/L) was associated with CVD outcomes (odds ratio 3.3 [95% CI 1.3–8.2]; P = 0.012) and remained significant after adjusting for age, albumin-to-creatinine ratio, diabetes duration, or treatment.

CONCLUSIONS

cFLC elevation is a novel marker for CVD outcomes in type 2 diabetes that warrants further investigation.
Efficacy and Safety of Dulaglutide Versus Sitagliptin After 52 Weeks in Type 2 Diabetes in a Randomized Controlled Trial (AWARD-5)
Authors: Nauck Michael , Weinstock Ruth S. , Umpierrez Guillermo E. , Guerci Bruno , Skrivanek Zachary , Milicevic Zvonko
Published: April 2014

OBJECTIVE

To compare the efficacy and safety of two doses of once-weekly dulaglutide, a glucagon-like peptide 1 receptor agonist, to sitagliptin in uncontrolled, metformin-treated patients with type 2 diabetes. The primary objective was to compare (for noninferiority and then superiority) dulaglutide 1.5 mg versus sitagliptin in change from baseline in glycosylated hemoglobin A1c (HbA1c) at 52 weeks.

RESEARCH DESIGN AND METHODS

This multicenter, adaptive, double-blind, parallel-arm study randomized patients (N = 1,098; mean baseline age 54 years; HbA1c 8.1% [65 mmol/mol]; weight 86.4 kg; diabetes duration 7 years) to dulaglutide 1.5 mg, dulaglutide 0.75 mg, sitagliptin 100 mg, or placebo (placebo-controlled period up to 26 weeks). The treatment period lasted 104 weeks, with 52-week primary end point data presented.

RESULTS

The mean HbA1c changes to 52 weeks were (least squares mean ± SE): −1.10 ± 0.06% (−12.0 ± 0.7 mmol/mol), −0.87 ± 0.06% (9.5 ± 0.7 mmol/mol), and −0.39 ± 0.06% (4.3 ± 0.7 mmol/mol) for dulaglutide 1.5 mg, dulaglutide 0.75 mg, and sitagliptin, respectively. Both dulaglutide doses were superior to sitagliptin (P < 0.001, both comparisons). No events of severe hypoglycemia were reported. Mean weight changes to 52 weeks were greater with dulaglutide 1.5 mg (−3.03 ± 0.22 kg) and dulaglutide 0.75 mg (−2.60 ± 0.23 kg) compared with sitagliptin (−1.53 ± 0.22 kg) (P < 0.001, both comparisons). The most common gastrointestinal treatment-emergent adverse events in dulaglutide 1.5- and 0.75-mg arms were nausea, diarrhea, and vomiting.

CONCLUSIONS

Both dulaglutide doses demonstrated superior glycemic control versus sitagliptin at 52 weeks with an acceptable tolerability and safety profile.
Youth Overweight and Metabolic Disturbances in Predicting Carotid Intima-Media Thickness, Type 2 Diabetes, and Metabolic Syndrome in Adulthood: The Cardiovascular Risk in Young Finns Study
Authors: Koskinen Juha , Magnussen Costan G. , Sabin Matthew A. , Kähönen Mika , Hutri-Kähönen Nina , Laitinen Tomi , Taittonen Leena , Jokinen Eero , Lehtimäki Terho , Viikari Jorma S.A. , Raitakari Olli T. , Juonala Markus
Published: April 2014

OBJECTIVE

Our objective was to assess cardiovascular risk and metabolic complications in adulthood in subjects with or without overweight and metabolic disturbances (i.e., elevated blood pressure, glucose, triglycerides, low HDL cholesterol, and high LDL cholesterol) and their combinations as youth.

RESEARCH DESIGN AND METHODS

Using data from the population-based Cardiovascular Risk in Young Finns study, we examined the utility of four age- and sex-specific youth phenotypes (group I: normal weight, no metabolic disturbances; group II: normal weight, one or more metabolic disturbances; group III: overweight/obese, no metabolic disturbances; group IV: overweight/obese, one or more metabolic disturbances) in predicting adult high carotid intima-media thickness (IMT), type 2 diabetes mellitus (T2DM), and metabolic syndrome (MetS). The study included 1,617 participants 9–24 years of age at baseline who were followed up 21–25 years later.

RESULTS

IMT (mean ± SEM) was higher among participants in groups II (0.627 ± 0.005 mm, P = 0.05), III (0.647 ± 0.010 mm, P = 0.005), and IV (0.670 ± 0.010 mm, P < 0.0001) compared with group I (0.616 ± 0.003 mm). In addition, subjects in group IV had significantly higher IMT compared with those in group II (P = 0.002). Participants in groups II, III, and IV were at increased risk of the development of MetS in adulthood compared with those in the control group. For group II participants, the difference was attenuated after risk factor adjustments. Additionally, participants in group III and IV were at increased risk of the development of T2DM compared with those in groups I and II.

CONCLUSIONS

While metabolic risk factors associated with overweight increase future risk for MetS, T2DM, and increased IMT, overweight in isolation is also a risk factor. Therefore, overweight should be prevented and treated wherever possible.
Validating a Simple Discharge Planning Tool Following Hospital Admission for an Isolated Lower Limb Fracture
Authors: Kimmel Lara A. , Holland Anne E. , Simpson Pam M. , Edwards Elton R. , Gabbe Belinda J.
Published: April 2014

Background

Early, accurate prediction of discharge destination from the acute hospital assists individual patients and the wider hospital system. The Trauma Rehabilitation and Prediction Tool (TRaPT), developed using registry data, determines probability of inpatient rehabilitation discharge for patients with isolated lower limb fractures.

Objective

The aims of this study were: (1) to prospectively validatate the TRaPT, (2) to assess whether its performance could be improved by adding additional demographic data, and (3) to simplify it for use as a bedside tool.

Design

This was a cohort, measurement-focused study.

Methods

Patients with isolated lower limb fractures (N=114) who were admitted to a major trauma center in Melbourne, Australia, were included. The participants' TRaPT scores were calculated from admission data. Performance of the TRaPT score alone, and in combination with frailty, weight-bearing status, and home supports, was assessed using measures of discrimination and calibration. A simplified TRaPT was developed by rounding the coefficients of variables in the original model and grouping age into 8 categories. Simplified TRaPT performance measures, including specificity, sensitivity, and positive and negative predictive values, were evaluated.

Results

Prospective validation of the TRaPT showed excellent discrimination (C-statistic=0.90 [95% confidence interval=0.82, 0.97]), a sensitivity of 80%, and specificity of 94%. All participants able to weight bear were discharged directly home. Simplified TRaPT scores had a sensitivity of 80% and a specificity of 88%.

Limitations

Generalizability may be limited given the compensation system that exists in Australia, but the methods used will assist in designing a similar tool in any population.

Conclusions

The TRaPT accurately predicted discharge destination for 80% of patients and may form a useful aid for discharge decision making, with the simplified version facilitating its use as a bedside tool.
Treadmill Training After Surgical Removal of a Spinal Tumor in Infancy
Authors: Heathcock Jill C. , Christensen Catie , Bush Karah , Butler Marisa , Buehner Jeffrey J. , Basso D. Michele
Published: April 2014

Background and Purpose

Step training on a treadmill is a common intervention for adult and pediatric patients with spinal cord injuries (SCI). Treadmill training has not been used as an intervention for infants and toddlers with SCI before walking onset. This case report describes the intervention and stepping behaviors on a treadmill and overground of a toddler after the surgical removal of a rare spinal tumor resulting in SCI.

Case Description

The toddler presented with an inability to step on the left, rare stepping on the right, and an apparent lack of sensation in the lower extremities. After spinal tumor excision at 5.5 weeks of age, step training on a treadmill and overground occurred once per week from 15 to 35 months of age in addition to traditional physical therapy.

Outcomes

Independent symmetrical stepping emerged both on and off the treadmill over 20 months. Improvements in the number and pattern of steps occurred with training. Walking speed increased, and milestones important to overground walking developed.

Discussion

Independent steps developed during the intervention with little motor development of the lower extremities during the first year of life. Furthermore, improvements in stepping alternation, standing, and walking occurred despite no evidence of sensation in the lower extremities.
The Production of 'Local Culture' in Post-socialist Poland
Authors: Stacul Jaro
Published: April 2014

At a time when European cities redefine themselves through 'culture' in an attempt to attract tourists, investors and potential residents, policymakers have to negotiate different notions of 'local culture' defined by state governments on the one hand and by the EU on the other. Drawing upon research conducted in the Polish city of Gdańsk in the context of the redevelopment of its urban landscape, the article illustrates how 'local culture' is redefined as 'culture of freedom' by municipal and state institutions in order to establish a relationship of historical continuity between the time when Gdańsk was a thriving multicultural city and the post-socialist present. The article puts forward the argument that while the reformulation of local culture as 'culture of freedom' involves reconciling notions of national identity with new norms of local, regional and European integration, it does not necessarily entail the supersession of nationalism.
The Accession Pedagogy
Authors: Firat Bilge
Published: April 2014

From 1989, new plans to enlarge the EU caused growing public disenchantment with the future of European integration as a viable model of cooperation among states and peoples in Europe. To manage disenchantment, EU actors designed various policy tools and techniques in their approaches to European peripheries such as Turkey. Among these, they intensified and perfected processes of pedagogy where EU actors assume that they have unique knowledge of what it means to be 'European' and that they must teach accession candidates how to become true Europeans. Based on accounts of EU politicians and officials, past experiences of government officials from former EU candidate states and Turkish officials' encounters with the EU's accession pedagogy, this article explores the EU's enlargement policy as a pedagogical engagement and the responses it elicits among Turkish governmental representatives, in order to test the reconfigurations of power between Europe and the countries on its margins.
Remembering the Leu
Authors: Grossman Alyssa
Published: April 2014

This article approaches money as the object of a particular type of remembrance work occurring in present-day, post-communist Bucharest. Since the 1989 revolution, the Romanian leu has changed numerous times in appearance and value. Piecing together observations from over a decade of fieldwork in Bucharest, I evaluate everyday behaviours and conversations surrounding these changes, and examine how the leu has been implicated in subjective, highly charged encounters closely bound to the workings of memory. The leu's fluctuating terminology, along with its material and imagerial variations over time have triggered poignant associations and recollections that often remain unspoken, embedded in unseen realms of the mind. By emphasising the leu's role as an everyday artefact and its connections to processes of 'communicative' memory, I point to the present-day climate in Bucharest as one where perceptions of the leu's multiple forms and manifestations reveal strong ambivalences towards current accession-era values, as well as deep uncertainties about Romania's 'European' future.
Altered brain connectivity in sagittal craniosynostosis
Authors: Beckett Joel S. , Brooks Eric D. , Lacadie Cheryl , Wyk Brent Vander , Jou Roger J. , Steinbacher Derek M. , Constable R. Todd , Pelphrey Kevin A. , Persing John A.
Published: April 2014

Object

Sagittal nonsyndromic craniosynostosis (sNSC) is the most common form of NSC. The condition is associated with a high prevalence (> 50%) of deficits in executive function. The authors employed diffusion tensor imaging (DTI) and functional MRI to evaluate whether hypothesized structural and functional connectivity differences underlie the observed neurocognitive morbidity of sNSC.

Methods

Using a 3-T Siemens Trio MRI system, the authors collected DTI and resting-state functional connectivity MRI data in 8 adolescent patients (mean age 12.3 years) with sNSC that had been previously corrected via total vault cranioplasty and 8 control children (mean age 12.3 years) without craniosynostosis. Data were analyzed using the FMRIB Software Library and BioImageSuite.

Results

Analyses of the DTI data revealed white matter alterations approaching statistical significance in all supratentorial lobes. Statistically significant group differences (sNSC < control group) in mean diffusivity were localized to the right supramarginal gyrus. Analysis of the resting-state seed in relation to whole-brain data revealed significant increases in negative connectivity (anticorrelations) of Brodmann area 8 to the prefrontal cortex (Montreal Neurological Institute [MNI] center of mass coordinates [x, y, z]: −6, 53, 6) and anterior cingulate cortex (MNI coordinates 6, 43, 14) in the sNSC group relative to controls. Furthermore, in the sNSC patients versus controls, the Brodmann area 7, 39, and 40 seed had decreased connectivity to left angular gyrus (MNI coordinates −31, −61, 34), posterior cingulate cortex (MNI coordinates 13, −52, 18), precuneus (MNI coordinates 10, −55, 54), left and right parahippocampus (MNI coordinates −13, −52, 2 and MNI coordinates 11, −50, 2, respectively), lingual (MNI coordinates −11, −86, −10), and fusiform gyri (MNI coordinates −30, −79, −18). Intrinsic connectivity analysis also revealed altered connectivity between central nodes in the default mode network in sNSC relative to controls; the left and right posterior cingulate cortices (MNI coordinates −5, −35, 34 and MNI coordinates 6, −42, 39, respectively) were negatively correlated to right hemisphere precuneus (MNI coordinates 6, −71, 46), while the left ventromedial prefrontal cortex (MNI coordinates 6, 34, −8) was negatively correlated to right middle frontal gyrus (MNI coordinates 40, 4, 33). All group comparisons (sNSC vs controls) were conducted at a whole brain–corrected threshold of p < 0.05.

Conclusions

This study demonstrates altered neocortical structural and functional connectivity in sNSC that may, in part or substantially, underlie the neuropsychological deficits commonly reported in this population. Future studies combining analysis of multimodal MRI and clinical characterization data in larger samples of participants are warranted.
Currarino syndrome and spinal dysraphism
Authors: Kole Matthew J. , Fridley Jared S. , Jea Andrew , Bollo Robert J.
Published: April 2014

Currarino syndrome is a rare constellation of congenital anomalies characterized by the triad of sacral dysgenesis, presacral mass, and anorectal malformation. It is frequently associated with other congenital anomalies, often including occult spinal dysraphism. Mutations in the MNX1 gene are identified in the majority of cases. The authors report a rare case of Currarino syndrome in an infant with tethered cord syndrome and a dorsal lipomyelomeningocele continuous with a presacral intradural spinal lipoma, in addition to an imperforate anus and a scimitar sacrum. They review the literature to highlight patterns of occult spinal dysraphism in patients with Currarino syndrome and their relationship to tethered cord syndrome. Approximately 60% of the patients with Currarino syndrome reported in the literature have an occult spinal dysraphism. Published studies suggest that the risk of tethered cord syndrome may be higher among patients with a lipoma and lower among those with a teratoma or anterior meningocele.
Development of a de novo arteriovenous malformation after bilateral revascularization surgery in a child with moyamoya disease
Authors: Fujimura Miki , Kimura Naoto , Ezura Masayuki , Niizuma Kuniyasu , Uenohara Hiroshi , Tominaga Teiji
Published: April 2014

The development of a de novo arteriovenous malformation (AVM) in patients with moyamoya disease is extremely rare. A 14-year-old girl developed an AVM in the right occipital lobe during the 4-year postoperative period following successful bilateral revascularization surgeries. She suffered a transient ischemic attack with hemodynamic compromise of the bilateral hemispheres at the age of 10 years. Results of an initial examination by 1.5-T MRI and MR angiography satisfied the diagnostic criteria of moyamoya disease but failed to detect any vascular malformation. Bilateral direct and indirect revascularization surgeries in the anterior circulation relieved her symptoms, and she underwent MRI and MR angiography follow-up every year after surgery. Serial T2-weighted MRI revealed the gradual appearance of flow voids in the right occipital lobe during the follow-up period. Magnetic resonance angiography ultimately indicated the development of an AVM 4 years after these surgeries when catheter angiography confirmed the diagnosis of an AVM in the right occipital lobe. The AVM remained asymptomatic, and the patient remained free of cerebrovascular events during the time she was observed by the authors. Acquired AVM in moyamoya disease is extremely rare, with only 3 pediatric cases including the present case being reported in the literature. The development of a de novo AVM in a postoperative patient with moyamoya disease appears to be unique, and this case may provide insight into the dynamic pathology of AVMs.
Spinal dural arteriovenous fistula associated with L-4 isthmic spondylolisthesis
Authors: Nishimura Yusuke , Natsume Atsushi , Ginsberg Howard J.
Published: April 2014

The authors describe a case of a 79-year-old man with a lumbar spinal dural arteriovenous fistula (DAVF) and isthmic spondylolisthesis at the same level. The patient's thoracic spine MRI study demonstrated swelling and increased T2 signal in the spinal cord and regional dilated perimedullary vessels. Lumbar spine MRI showed L-4 isthmic spondylolisthesis with severe bilateral L4–5 foraminal stenoses. Spinal angiography revealed a fistulous connection at the left L-4 nerve root sleeve between perimedullary veins and a dural branch of the L-4 radicular artery. Based on previous reports about secondary spinal DAVFs, the abnormal vascular communication likely developed secondary to the microtrauma and inflammation on the left L-4 nerve root sleeve, which was attributable to the isthmic spondylolisthesis. The authors performed disconnection of the arteriovenous shunt as well as an L4–5 decompression and posterior instrumented fusion with pedicle screws. The patient's postoperative course was uneventful, and he improved neurologically. It is important to bear in mind that a spinal DAVF may develop as a consequence of any sort of trauma or inflammation involving nerve roots. One should consider the concomitant treatment of both the spinal DAVF and the underlying pathology that may have given rise to the spinal DAVF.
Direct posterior reduction in a case of posttraumatic irreducible lateral atlantoaxial dislocation
Authors: Salunke Pravin , Sahoo Sushanta K. , Doddamani Ramesh , Ahuja Chirag K. , Mukherjee Kanchan K.
Published: April 2014

Posttraumatic true irreducible C1–2 lateral dislocation is rare. The mechanism of injury is likely to be different for this kind of dislocation. The management of such an injury and the technique for direct posterior reduction remain unclear because of its rarity. The authors describe the case of a 34-year-old man who sustained injury in a vehicular accident, leading to neck pain. Radiological studies revealed fixed right lateral and posterior C1–2 dislocation. Direct posterior open reduction was achieved by distracting the facets and rotating them in a counterclockwise direction. Care was taken to avoid direct or indirect injury to the vertebral arteries. Segmental C1–2 fusion was performed. Distraction with lateral extension injury possibly gives rise to this unique fracture dislocation. Preoperative imaging including angiography for vertebral arteries helps in defining the cause of fixity and in surgical planning. Direct posterior reduction is possible in such fixed C1–2 lateral dislocation, circumventing transoral surgery—provided the facets are preserved.
Pattern of Paediatric Brain Tumours Evaluated in BSMMU, Dhaka, Bangladesh
Authors: Jahan Fauzia , Kamal Mohammed , Sultana Shamsunnahar
Published: April 2014

Background: In children Central Nervous System (CNS) is the second most common site for primary tumours superseded only by leukaemias. Paediatric brain tumours differ from adult one by their type, location and outcome. Objectives: To study the frequency and histomorphological spectrum of CNS tumours in Children and to correlate with age, sex and distribution of tumours. Methodology: This study was carried out at the Department of Pathology, Bangabandhu Shiekh Mujib Medical University (BSMMU) Dhaka during the period of July 2006 to June 2007. Samples from all Paediatric age and both sexes were included in this study. Results: We studied 55 cases of Paediatric CNS tumours. The patients age ranged between 2 months to 15 years. The mean age at diagnosis was 10.12±4.18 years. Regarding location 59% was infratentorial and 41% were supratentorial. Most common tumour was medulloblastoma (23%). Twenty Seven (27%) of the tumours were high grade. DOI: http://dx.doi.org/10.3329/bjch.v37i3.18619 Bangladesh J Child Health 2013; Vol.37(3): 154-157
Junctional Epidermolysis Bullosa: A Case Report
Authors: Nessa Lutfan , Azam Uzere , Mazumder Partho Sharothy , Akhter Shabnam
Published: April 2014

DOI: http://dx.doi.org/10.3329/bjch.v37i3.18622 Bangladesh J Child Health 2013; Vol.37(3): 175-178
Leukoencephalopathy In A Child With Congenital Cytomegalovirus Infection
Authors: Fatema Kanij , Rahman Md Mizanur , Akhter Shaheen
Published: April 2014

DOI: http://dx.doi.org/10.3329/bjch.v37i3.18623 Bangladesh J Child Health 2013; Vol.37(3): 179-182
Abstracts from Current Literature Vol.37(3)
Authors: Editor The
Published: April 2014

DOI: http://dx.doi.org/10.3329/bjch.v37i3.18625 Bangladesh J Child Health 2013; Vol.37(3): 186-187