bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors associated with premature myocardial infarction: a systematic review protocol
Authors: Dugani Sagar B , Ayala Melendez Ana Patricia , Reka Roger , Hydoub Yousif M , McCafferty Shannon N , Murad M Hassan , Alsheikh-Ali Alawi A , Mora Samia 
Published: February 2019

IntroductionPremature myocardial infarction (MI) generally refers to MI in men ≤55 years or women ≤65 years. Premature MI is a major contributor to cardiovascular disease (CVD), which claimed 17.6 million lives globally in 2016. Reducing premature MI and CVD is a key priority for all nations; however, there is sparse synthesis of information on risk factors associated with premature MI. To address this knowledge gap, we are conducting a systematic review to describe the association between risk factors (demographics, lifestyle factors and biomarkers) and premature MI.Methods and analysisThe following databases were searched from inception to June 2018: CENTRAL, CINAHL, Clinical Trials, EMBASE and MEDLINE. We will include original research articles (case–control, cohort and cross-sectional studies) that report a quantitative relationship between at least one risk factor and premature MI. Two investigators will use predetermined selection criteria and independently screen articles based on title and abstract (primary screening). Articles that meet selection criteria will undergo full-text screening based on criteria used for primary screening (secondary screening). Data will be extracted using predetermined data extraction forms. The Newcastle-Ottawa Scale for case–control and cohort studies will be used to evaluate the risk of bias and will be adapted for cross-sectional studies. Whenever feasible, data will be summarised into a random-effects meta-analysis.Ethics and disseminationTo our knowledge, this will be the first study to synthesise results on the relationship between risk factors and premature MI. These findings will inform healthcare providers on factors associated with risk of premature MI and potentially improve primary prevention efforts by guiding development of interventions. These findings will be summarised and presented at conferences and through publication in a peer-reviewed journal.PROSPERO registration numberCRD42018076862.
T cell clonal expansions in ileal Crohn’s disease are associated with smoking behaviour and postoperative recurrence
Authors: Allez Matthieu , Auzolle Claire , Ngollo Marjolaine , Bottois Hugo , Chardiny Victor , Corraliza Ana Maria , Salas Azucena , Perez Kevin , Stefanescu Carmen , Nancey Stéphane , Buisson Anthony , Pariente Benjamin , Fumery Mathurin , Sokol Harry , Tréton Xavier , Barnich Nicolas , Seksik Philippe , Le Bourhis Lionel 
Published: February 2019

T cell clonal expansions are present in the inflamed mucosa of patients with Crohn’s disease (CD) and may be implicated in postoperative recurrence after ileocolonic resection.MethodsT cell receptor (TCR) analysis was performed in 57 patients included in a prospective multicentre cohort. Endoscopic recurrence was defined by a Rutgeerts score >i0. DNA and mRNA were extracted from biopsies collected from the surgical specimen and endoscopy, and analysed by high throughput sequencing and microarray, respectively.ResultsTCR repertoire in the mucosa of patients with CD displayed diverse clonal expansions. Active smokers at time of surgery had a significantly increased proportion of clonal expansions as compared with non-smokers (25.9%vs17.9%, p=0.02). The percentage of high frequency clones in the surgical specimen was significantly higher in patients with recurrence and correlated with postoperative endoscopic recurrence (area under the curve (AUC) 0.69, 95% CI 0.54 to 0.83). All patients with clonality above 26.8% (18/57) had an endoscopic recurrence. These patients with a high clonality were more frequently smokers than patients with a low clonality (61% vs 23%, p=0.005). The persistence of a similar TCR repertoire at postoperative endoscopy was associated with smoking and disease recurrence. Patients with high clonality showed increased expression of genes associated with CD8 T cells and reduced expression of inflammation-related genes. Expanded clones were found predominantly in the CD8 T cell compartment.ConclusionClonal T cell expansions are implicated in postoperative endoscopic recurrence. CD patients with increased proportion of clonal T cell expansions in the ileal mucosa represent a subgroup associated with smoking and where pathogenesis appears as T cell driven.Trial registration numberNCT03458195.
Clinical presentation, natural history and outcomes of intramedullary spinal cord cavernous malformations
Authors: Goyal Anshit , Rinaldo Lorenzo , Alkhataybeh Redab , Kerezoudis Panagiotis , Alvi Mohammed Ali , Flemming Kelly D , Williams Lindsy , Diehn Felix , Bydon Mohamad 
Published: February 2019

ObjectiveThere is a paucity of literature investigating the clinical course of patients with spinal intramedullary cavernous malformations (ISCMs). We present a large case series of ISCMs to describe clinical presentation, natural history and outcomes of both surgical and conservative management.MethodsWe retrospectively reviewed the clinical course of patients diagnosed with ISCMs at our institution between 1995 and 2016. Haemorrhage was defined as clinical worsening in tandem with imaging changes visualised on follow-up MRI. Outcomes assessed included neurological status and annual haemorrhage rates.ResultsA total of 107 patients met inclusion criteria. Follow-up data were available for 85 patients. While 21 (24.7%) patients underwent immediate surgical resection, 64 (75.3%) were initially managed conservatively. Among this latter group, 16 (25.0%) suffered a haemorrhage during follow-up and 11 (17.2%) required surgical resection due to interval bleeding or neurological worsening. The overall annual risk of haemorrhage was 5.5% per person year. The rate among patients who were symptomatic and asymptomatic on presentation was 9.5% and 0.8%, respectively. Median time to haemorrhage was 2.3 years (0.1–12.3). Univariate analysis identified higher ISCM size (p=0.024), history of prior haemorrhage (p=0.013) and presence of symptoms (p=0.003) as risk factors for subsequent haemorrhage. Multivariable proportional hazards analysis revealed presence of symptoms to be independently associated with haemorrhage during follow-up (HR 9.39, CI 1.86 to 170.8, p=0.013).ConclusionLarge, symptomatic ISCMs appear to be at increased risk for subsequent haemorrhage. Surgery may be considered in such lesions to prevent rebleeding and subsequent neurological worsening.
WM1-2 SFX-01 after subarachnoid haemorrhage: protocol of a multi-centre, phase II, double-blinded, randomised controlled trial
Authors: Zolnourian A , Holton P , Galea I , Bulters D 
Published: February 2019

ObjectivesTo assess the safety and efficacy of SFX-01 after subarachnoid haemorrhage.DesignSFX-01 is a synthetic agent that contains sulforaphane that has been shown to be neuroprotective in animal models of subarachnoid haemorrhage. This is a phase II double-bilinded, placebo-controlled randomised clinical trial.SubjectsTarget of 90 patients with fisher 3 or 4 subarachnoid haemorrhage.MethodsPatients admitted to the three recruiting centres within 48 hours of ictus will be randomly allocated to placebo or SFX-01. The randomisation is stratified into WFNS 1–3 or 4–5. Participants will receive the trial medication in a capsule format twice-daily for 28 days. Patients will have transcranial dopplers (TCD) on alternate daily basis for at least 7 days. The maximum mean MCA flow velocity as well as safety are the two primary end-points. All patients will have paired blood and CSF taken at day 7 either through an LP or via EVD sampling. Follow-ups are performed at day 28, 3 months and 6 months which include safety bloods, functional questionnaires, mRS, GOSE and MRI.Results64 (71% of the target) patients have been enrolled. 35 patients have completed the study. Statistical analysis of the TCD data will be performed at the end of the trial. The mortality is at 9.5% (6). DSMB have met twice since the start of the trial and there have been no safety concerns.ConclusionsThe trial is recruiting on the planned trajectory and at this rate we are projected to complete the trial by the end of the year.
P35 Ability to quantify stereoelectroencephalography (SEEG) electrode trajectory proximity to vessels across imaging protocols
Authors: Sparks R , Vakharia V , Rodionov R , Vos S , McEvoy A , Miserocchi A , Duncan J , Ourselin S 
Published: February 2019

ObjectivesAutomated planning of stereoelectroencephalography (SEEG) electrode trajectories is dependent on vessel segmentation.1We quantify imaging protocols ability to measure trajectory-to-vessel distance.DesignRetrospective analysis.SubjectsTen consecutive patients were selected whom had SEEG implantation (95 electrodes) and Digital Catheter Subtraction Angiography (DSA) with catheterization of carotid or vertebral arteries, post-gadolinium T1-weighted (GAD), phase-contrast MR angiography and MR venography (MR) acquired.MethodsSEEG trajectories were planned manually with DSA. Minimum distance to vessels and risk1were computed for each trajectory using vessel segmentation from GAD, MR, or DSA. Vessel size was considered by including DSA vessels diameters above 1, 2, 3, or 4 mm.ResultsMinimum distance to a vessel was 6.2±3.9 mm (GAD), 2.5±1.6 mm (MR), and 1.5±1.2 mm (DSA). Based on DSA vessel size minimum distances were 2.0±1.5 mm (DSA >1 mm), 3.4±2.6 (DSA >2 mm), 6.6±4.6 mm (DSA >3 mm), and 11.8±7.9 mm (DSA >4 mm). Risk was 0.4±0.4 (GAD), 0.8±0.4 (MR), and 1.1±0.2 (all DSA), 1.0±0.2 (DSA >1 mm), 0.7±0.4 (DSA >2 mm), 0.4±0.5 (DSA >3 mm), and 0.2±0.3 (DSA >4 mm).ConclusionsDSA is best able to segment vessels. MR has metrics similar to DSA vessels above 2 mm. GAD has metrics similar to DSA vessels above 3 mm.
P37 Do all notochordal lesions require proton beam radiotherapy? A case series of ecchordosis physaliphora
Authors: Sooltangos A , Giamouriadis A , Barazi S , Barkas K , Thomas N , Bodi I , Ghimire P , Maratos E 
Published: February 2019

ObjectivesEcchordosis physaliphora (EP) is a benign, usually asymptomatic, notochord tumour but may also present with a spontaneous CSF fistula. Differentiating EP from its more aggressive counterpart, chordoma is challenging but important as the clinical course and management differ significantly, with the latter requiring proton beam radiotherapy. This case series aims to further inform this discussion.DesignCase series.SubjectsPatients with suspected EP from 2015–2018.MethodsRetrospective analysis.ResultsSix patients were identified. Four presented with suspected CSF leak. MRI revealed a T1-hypointense and T2-hyperintense clival lesion without enhancement. CT showed pneumocephalus, a clival defect and no mass lesion. All underwent endoscopic endonasal repair of CSF fistula with biopsy. Histology revealed physaliphorous cells with no mitoses; immunohistochemistry confirmed notochord origin (EMA, S100, CD10 and/or MNF116) and low proliferation index. In 2 patients, EP was found incidentally on imaging and these lesions have remained static on follow-up.ConclusionsIn the absence of a clival mass, notochord remnant lesions with benign histopathology can be treated as EP and patients can avoid radiotherapy. The diagnosis of EP, however, remains challenging as no distinctive histopathological marker exists to differentiate it from chordoma and until a genetic or immunohistochemical marker is identified, the diagnosis rests solely on the presence or absence of a mass on imaging.
WP1-9 Treatment implications of parkinson’s disease in normal pressure hydrocephalus
Authors: Funnell JP , Craven CL , D’Antona L , Thorne L , Watkins LD , Toma AK 
Published: February 2019

ObjectivesPatients with Parkinson’s disease (PD) presenting with worsening gait and ventriculomegaly could have underlying normal pressure hydrocephalus (NPH). We aim to identify features of concurrent PD and NPH, assess investigations and benefits of intervention.DesignSingle-centre retrospective cohort study of patients diagnosed with PD and NPH, presenting to neurosurgery between April 2004 – April 2018.Subjects24 patients (20M: 4F) with concurrent PD and NPH, mean age 74.5±6.49 years (mean ±SD). 22 patients were diagnosed with PD prior to NPH diagnosis.MethodsMedical records were studied for demographics, symptoms, and response to ventriculoperitoneal (VP) shunting. Chi-square test was used to compare frequency of post-operative symptoms against a local database of NPH patients.ResultsAll patients presented to neurosurgery with gait disturbances, 21/24 with cognitive impairment, and 18/24 with urinary incontinence. 19 patients underwent VP shunt insertion; 5 patients were not suitable having failed a lumbar drain trial. Patients with PD and NPH improved in walking test outcomes and in urinary continence similarly to other NPH patients. Cognitive impairment did not respond well to VP shunting in patients with concurrent PD, significantly less than NPH patients without PD (p<0.01).ConclusionsDiagnosis of NPH in patients with PD is a complex clinical problem due to frequent overlap of symptoms. Benefits may be gained if this subset of patients do reach neurosurgical services and receive intervention.
P43 Parasellar capillary haemangioma with intrasellar extension
Authors: Low J , Maratos E , Kumar A , King A , Al-Sarraj S , Barazi S 
Published: February 2019

ObjectivesCapillary haemangioma is a benign vascular tumour that typically arises from skin and mucosal surfaces at birth and in infants. Central nervous system (CNS) capillary haemangioma in adults is extremely rare. We describe a case of capillary haemangioma located within the parasellar region extending into the sella.DesignCase report.ResultsWe report a 64-year-old patient who presented with a short history of ptosis and left sided headaches. CT showed a 3 cm by 2.5 cm para-sellar lesion extending into the sella. MRI showed a homogenously hyperintense lesion on T2-weighted MRI and FLAIR, which was isointense with adjacent brain parenchyma on T1-weighted MRI. This lesion also demonstrated contrast enhancement. The patient underwent an initial endoscopic transsphenoidal biopsy, which was inconclusive, followed by a craniotomy and debulking. Histological examination revealed fibrous tissue containing numerous thin walled and irregular vascular channels of varying sizes. There was a mild associated inflammatory infiltrate, mainly formed of small mononuclear chronic inflammatory cells, and occasional histiocytes. The histological appearances were in keeping capillary haemangioma.ConclusionsThe present case describes a capillary haemangioma located in the sella. The rarity of this vascular entity and the absence of any pathognomonic imaging features make it difficult to diagnose based on radiological appearances alone. Although rare, CH should be a differential when considering a sella or parasellar lesion.
P47 30 day readmission is not an accurate measure of morbidity in cranial meningioma surgery
Authors: James Z , Leach P , Hayhurst C 
Published: February 2019

Objectives30 day readmission rate is a widely adopted marker of quality and performance of acute care, but validity is not well demonstrated. We analysed readmission data following cranial meningioma surgery to assess risk factors for readmission.DesignRetrospective cohort study.SubjectsAll adult patients who underwent cranial meningioma resection from January 2015 to December 2017 in a single institution.MethodsUsing Welsh Clinical Portal electronic data to identify readmission within and beyond 30 days to both the index hospital and regional hospitals. Causes of readmission were recorded.Results160 patients were included (76% female, median age 58). 28 cases were emergency admissions, median length of initial admission 7 days. 26% had seizures at presentation. Total readmission rate was 13.5% (median age 54.5, pre-operative seizure rate 40.1%, median length of readmission 9 days). 13 (59%) patients presented within 30 days and 9 (41%)>30 days. Readmission causes were seizure, neurological deficit, thromboembolic, infection, CSF, bleeding and social. Causes after 30 days were the same except social or neurological deficit.ConclusionsReadmission rates are not associated with age, admission route or initial length of stay. Those who have had seizures are more likely to be readmitted. 41% of readmissions presented outside of the 30 day post-operative time. 30 day readmission rates may not be the most suitable method to demonstrate neurosurgical unit performance in meningioma surgery.
P52 Prescription of patient’s regular medications on admission to neurosurgical unit
Authors: Su Z , Khan R , Toma A 
Published: February 2019

ObjectivesTimely and correct prescription of patients’ regular medications on admission to neurosurgical unit is noticed not to be fully compliant with set standards. This audit aims to review the practice of medication prescription by junior doctors during patient admission to a national neurosurgical unit, and to identify areas of improvement for prompt and accurate prescription.DesignProspective clinical audit.Subjects130 patients admitted to the neurosurgical unit in 2 weeks.MethodsPrescription of patient’s regular medications on admission was audited. The prescription practice was compared against the set standards, and between different settings (in-hour vs. out-of-hour, emergency vs. elective, experienced vs. new SHOs).Results18% of patients had no regular medications prescribed by clerking doctors, the majority of which were elective admissions during in-hour clerking and performed by experienced SHOs. Of the patients who had their regular medications prescribed on admission, 29% were prescribed inaccurately, and 16% in wrong doses. Total percentage of missed and error prescription was 46%, in which only 18% were corrected within 24 hours and 21% corrected up to 48 hours after admission.ConclusionsAreas of improvement identified: prescription practice of experienced SHOs during elective admissions, medication and dose check on prescription in both elective and emergency settings, medication reconciliation within 24 hours and thereafter. Changes (e.g. an alert system) are being implemented and re-audit is in plan.
WP1-10 Prevalence of normal pressure hydrocephalus in falls clinic patients
Authors: Sennik S , Craven C , D’Antona L , Asif H , Dawes W , Thorne L , Toma A , Watkins L 
Published: February 2019

ObjectivesPatients with idiopathic Normal Pressure Hydrocephalus (iNPH) present with Hakim Adams triad and radiological findings suggestive of iNPH. We compare the presence of clinical and radiological signs of iNPH present in patients presenting to falls clinic at a District General Hospital with the general population.DesignRetrospective analysis of patients referred to falls clinic (January 2017 to December 2017) and interpretation of CT or MRI head imaging with Evans index.SubjectsFalls clinic patients presenting to a District General Hospital outpatient clinic.MethodsRetrospective cohort of patients admitted to a single District General Hospital with falls and recent CT or MRI head. An Evans Index above 0.35 was used as an indicator of hydrocephalic ventricular enlargement.Results371 patients were seen in one year. 216 had previous CT or MRI head. 6.75% of all patients seen in falls clinic (11.6% who have had brain imaging) have hydrocephalic ventricular enlargement. This is compared to 4.5% in a study of patients aged 70 and over in a normal population.1ConclusionsPatients seen in Falls clinic have an increased probability of having radiological signs consistent with idiopathic normal pressure hydrocephalus.ReferenceJaraj D, Marlow T, Jensen C, Skoog I, Wikkelso C. Prevalence of idiopathic normal-pressure hydrocephalus. Neurology2014April 22;82(16):1449–1454.
P58 Setting up an encephalitis multidisciplinary meeting in a tertiary neurology centre
Authors: Bharucha T , Brown R , Bamford A , Kaliakatsos M , Hoskote C , Breuer J , Manji H , Zandi M 
Published: February 2019

ObjectivesTo improve the outcome of encephalitis in the region.DesignService evaluation of the introduction of monthly encephalitis meetings attended by specialist neuroradiologists, neurologists and infection doctors.SubjectsPatient referred at the discretion of the clinician from local hospitals and the tertiary referral centre.MethodsDiagnosis confirmed at the MDT or as a direct result of the MDT discussion.ResultsTo be presented.ConclusionsEncephalitis is a rare and complex clinical syndrome that requires close communication between neurologists and infection doctors. Setting up an MDT established this interaction, and streamlines patient care. Further, it provides access to novel technologies such as metagenomic diagnostic approaches.
P59 Acute varicella zoster encephalitis? Don’t forget the treatment!
Authors: Sun B , Singh N , Wroe S 
Published: February 2019

ObjectivesEducate physicians on the need for monitoring of Aciclivir levels in renal failure.DesignRetrospective case report.Subjects59 year old woman presented with acute psychosis following recent herpes zoster treated with oral Aciclovir.MethodsData collection from; original casenotes, electronic laboratory records, electronic picture archiving and communication system (PACS).ResultsLumbar puncture showed raised protein (0.92 g/L), CSF:serum glucose ratio(0.9), 36 WBCs/cmm(72% polymorphs) and detection of VZV DNA. MRI brain only revealed intracranial-hypotension secondary to lumbar puncture. Despite absence of VZV DNA on surveillance lumbar puncture, she remained minimally responsive. Aciclovir levels were significantly elevated post-dose at 32.7 mg/L (cutoff 10.8 mg/L) and a sedation hold revealed temporal correlation of pre-dose levels (6.4 mg/L) with improvement of GCS, strongly implicating Aciclovir as causative agent. Rapid resolution of encephalopathy occurred upon cessation with no residual neurological compromise.ConclusionsAciclovir neurotoxicity mimics zoster-related encephalitis and VZV DNA is commonly detected in cerebrospinal fluid of patient’s with herpes zoster (Rudzeket al. 2007). Our case highlights the need for vigilance of Aciclovir-neurotoxicity in renal failure patients.ReferenceRudzek D, Piskunova N, Zampachova E. High variability in viral load in cerebrospinal fluid from patients with herpes simplex and varicella-zoster infections of the central nervous system. Clinical Microbiology and Infection2007;13(12):1217–1219.
P65 Implementing a pain scale to improve botulinum toxin practice for cervical dystonia
Authors: Jesuthasan Aaron , Batla Amit , Bhatia Kailash 
Published: February 2019

ObjectivesTo evaluate the effectiveness of introducing a pain scale to improve cervical dystonia (CD) patient satisfaction rates in the National Hospital for Neurology and Neurosurgery (NHNN) Botox clinic.DesignCase control study.SubjectsSubjects included CD patients attending the NHNN Botox clinic to receive injections.MethodsInjectors were educated about the Toronto Western Spasmodic Torticollis Rating pain subscale (TWSTRS) and subsequently incorporated it into their standard assessment of CD patients prior to injections. Surveys were created and disseminated to patients immediately following their appointment to assess their opinions of the clinical team. Information was entered into Microsoft Excel and analysed using appropriate statistical methods. Results were compared with a previous NHNN Botox clinic audit.Results42 surveys were collected in total from CD patients over a 4 week period. 36 patients (85.7%) reported pain associated with the condition. In comparison to an audit conducted in 2016, involving a similar sample size (n=40, with 28 reporting pain), a higher proportion of CD patients felt their pain was well understood by the clinical team (89.3% vs 94.4%). Furthermore, a higher proportion felt the team were competent in managing their pain (67.9% vs 94.4%).ConclusionsOur study supports the use of a TWSTRS pain subscale to improve CD patient satisfaction rates in the Botox clinic. Further studies are encouraged to validate these findings and determine other suitable pain scales for implementation.