bluuebunny/crossref_metadata_2025_split huggingface dataset:
Examination of Needle Surface Corrosion in Electroacupuncture
Authors: Zhang Claire Shuiqing , Zhang George Shengxi , Xu Shanqing , Li Bin , Zhang Anthony Lin , Xue Charlie Changli , Xie Yi Min 
Published: May 2018

Background Electroacupuncture (EA) is a modern form of acupuncture therapy where stainless steel acupuncture needles are used as percutaneous electrodes to apply electrical stimulation. The concern about electrolytic corrosion of needles during EA has not been conclusively addressed. Aim To examine whether corrosion of stainless steel acupuncture needles occurs after EA to establish the safety profile of this therapy. Methods The study comprised four EA sessions on healthy participants mimicking a common clinical practice, with needle surface examinations conducted immediately after each session. Used acupuncture needles that did not undergo electrical stimulation and unused needles taken from the original package were also examined as control comparisons. Two commonly used types of single-use, silicone-coated, stainless steel needles were selected for the experiment. The ES-160 digital acupunctoscope (a charge-balanced electric stimulator) was used to deliver electrical stimulation, and an oscilloscope was used to record the waveforms and electric currents. All needles were sterilised before examination by a scanning electron microscope (SEM), where images of needle tips and shafts were taken for further analysis. Results and conclusions 32 needles were examined under the SEM. As the main findings, the SEM images showed the surface finish, burr attachments and surface characteristics of needle samples. No evidence of electrolytic corrosion was detected on any needle that underwent electrical stimulation for 30 min delivered by a charge-balanced acupunctoscope in healthy participants. The choice of a charge-balanced acupunctoscope is recommended to avoid any potential corrosion of needles in EA clinical practice.
Multimorbidity in children and youth: a scoping review protocol
Authors: Romano Isabella , Buchan M Claire , Ferro Mark A 
Published: May 2018

IntroductionMultimorbidity (co-occurring physical and mental illness) is an important issue for clinicians and researchers with combined efforts aimed at promoting the health and well-being of individuals across the life course. In children and youth, experience of any chronic physical illness leads to a substantial increase in risk for mental illness. As a growing field of interest, research is needed to map the current state of the literature in child and youth multimorbidity in order to identify existing gaps and inform the direction of future investigations.Methods and analysisWe are proposing the conduct of a scoping review to explore the depth and breadth of existing evidence in the field of child and youth multimorbidity. The scoping review will follow the methodological framework developed by Arksey and O’Malley, and will incorporate additional scoping review recommendations made by Levacet al. A systematic search of the following four key databases will be conducted: (1) PubMed; (2) EMBASE; (3) PsycINFO; and (4) Scopus, using combinations of Medical Subject Headings (MeSH) and Emtree terms. We will also consult grey literature sources and hand-search reference lists of included studies to identify additional studies of relevance. For eligible studies that meet all identified inclusion and exclusion criteria, a data extraction tool will be used to collect and store key study characteristics that will be relevant for collating, summarising and reporting the results of the scoping review. This scoping review also presents a novel use of quality index scoring, which we anticipate will contribute to strengthening the rigour of the scoping review methodology.Ethics and disseminationThe proposed scoping review does not require ethical approval. Final study results will be disseminated via conference presentations, publication in a peer-reviewed journal and knowledge translation activities with relevant stakeholders.
Nardilysin inhibits pancreatitis and suppresses pancreatic ductal adenocarcinoma initiation in mice
Authors: Ikuta Kozo , Fukuda Akihisa , Ogawa Satoshi , Masuo Kenji , Goto Norihiro , Hiramatsu Yukiko , Tsuda Motoyuki , Kimura Yoshito , Matsumoto Yoshihide , Kimura Yuto , Maruno Takahisa , Kanda Keitaro , Nishi Kiyoto , Takaori Kyoichi , Uemoto Shinji , Takaishi Shigeo , Chiba Tsutomu , Nishi Eiichiro , Seno Hiroshi 
Published: May 2018

ObjectiveNardilysin (NRDC), a zinc peptidase, exhibits multiple localisation-dependent functions including as an enhancer of ectodomain shedding in the extracellular space and a transcriptional coregulator in the nucleus. In this study, we investigated its functional role in exocrine pancreatic development, homeostasis and the formation of pancreatic ductal adenocarcinoma (PDA).DesignWe analysedPtf1a-Cre; Nrdcflox/floxmice to investigate the impact ofNrdcdeletion. Pancreatic acinar cells were isolated fromNrdcflox/floxmice and infected with adenovirus expressing Cre recombinase to examine the impact ofNrdcinactivation. Global gene expression inNrdc-cKOpancreas was analysed compared with wild-type pancreas by microarray analysis. We also analysedPtf1a-Cre; KrasG12D; Nrdcflox/floxmice to investigate the impact ofNrdcdeletion in the context of oncogenic Kras. A total of 51 human samples of pancreatic intraepithelial lesions (PanIN) and PDA were examined by immunohistochemistry for NRDC.ResultsWe found that pancreatic deletion ofNrdcleads to spontaneous chronic pancreatitis concomitant with acinar-to-ductal conversion, increased apoptosis and atrophic pancreas in mice. Acinar-to-ductal conversion was observed mainly through a non-cell autonomous mechanism, and the expression of several chemokines was significantly increased inNrdc-null pancreatic acinar cells. Furthermore, pancreatic deletion ofNrdcdramatically acceleratedKrasG12D-driven PanIN and subsequent PDA formation in mice. These data demonstrate a previously unappreciated anti-inflammatory and tumour suppressive functions of Nrdc in the pancreas in mice. Finally, absence of NRDC expression was observed in a subset of human PanIN and PDA.ConclusionNrdc inhibits pancreatitis and suppresses PDA initiation in mice.
015 Predicting a diagnosis of pathologically confirmed vasculitic neuropathy
Authors: Nathani Dev , Barnett Michael H , Spies Judith , Pollard John , Kiernan Matthew C 
Published: May 2018

IntroductionNerve biopsy remains the gold standard to diagnose vasculitic neuropathy. Conversely, biopsy has imperfect sensitivity and entails risks associated with an invasive procedure. Methods to improve diagnostic accuracy remain important considerations given the severity of the disease, added with the risks associated with subsequent therapy, particularly in ill-defined cases.MethodsClinical, laboratory and neurophysiological parameters were analysed for all patients who subsequently underwent biopsy. Nerve and muscle biopsy reports were assigned pathologic categories of definite, probable, possible or absent vasculitis using standard guidelines. Correlations were assessed between pre-biopsy parameters and subsequent diagnosis of definite or probable vasculitic neuropathy (pathologically confirmed vasculitis).ResultsFrom a cohort of 207 patients who underwent nerve biopsy over 21 months, 70 were suspected of having vasculitic neuropathy prior to biopsy. Of the 70 patients, vasculitis was confirmed as definite (11.4%), probable (15.7%) or possible (10.0%) on neuropathological assessment. The most sensitive parameters for pathologically confirmed vasculitis were the presence of sensorimotor neuropathy (78%) and axonal neuropathy (67%) on nerve conduction studies (NCS) in the overall cohort. Pathologically absent vasculitis was most prevalent in patients with normal NCS (90%), chronic, symmetric symptoms (86%) and demyelinating findings on NCS (79%). The parameters with the strongest associations with pathologically confirmed vasculitis were positive autoantibody serology (50.0% vs 21.1%, p<0.01), anti-neutrophil cytoplasmic antibody (27.3% vs 6.4%, p<0.01), anti-myeloperoxidase antibody (22.7% vs 1.8%, p<0.005) and rheumatoid factor (22.7% vs 2.8%, p<0.005). In patients suspected to have vasculitis, 83.3% of anti-myeloperoxidase antibody positive patients had pathologically confirmed vasculitis. In patients not suspected to have vasculitis, acute symptoms had the strongest association with pathologically confirmed vasculitis (36.4% vs 10.5%, p<0.05).ConclusionSpecific characteristics of symptoms at the time of presentation, combined with the presence of autoantibodies and neurophysiological abnormalities, were predictive of a tissue diagnosis of vasculitic neuropathy.
017 Paradoxical reaction in tuberculous meningitis: a tertiary referral hospital retrospective experience of concomitant immunosuppression therapy
Authors: Ledingham David , El-Wahsh Shadi , Cappelen-Smith Cecilia , Hodgkinson Suzanne , McDougall Alan , Maley Michael , Cordato Dennis 
Published: May 2018

IntroductionTuberculous meningitis (TBM) accounts for <1% of all tuberculosis (TB) presentations. Paradoxical reactions (PR) in non-HIV patients are a common manifestation of anti-tuberculosis therapy characterised by clinico-radiological deterioration. We report a case series of TBM admissions to our institution, including two cases with corticosteroid-refractory PR who responded to adjuvant cyclosporin.MethodsRetrospective review of 12 HIV-negative patients admitted to Liverpool Hospital, Sydney (2005–2017) with laboratory and/or radiologically confirmed TBM.ResultsMedian age 40 (range 22–81 years), 7 males. Eleven patients were of Asia-Pacific origin. All eleven presented with central nervous system manifestations and 1 had preceding miliary TB. Nine patients had extra-cranial TB involvement, including 8 with past or current pulmonary disease. Cerebrospinal fluid (CSF) TB PCR/culture was positive in 10 patients. One patient had multi-resistant TB. PR of TBM developed in 5 patients despite concomitant corticosteroids in 4. Two cases had refractory PR.Case 1. 22 year old Vietnamese male presented with 6 week history of progressive headache and neck stiffness. CSF demonstrated 61 WCC (75% neutrophils), protein 2.67 g/L (n<0.45), glucose 2.1 mmol/L. Despite concomitant anti-tuberculosis and high-dose corticosteroid treatment, he developed worsening headaches and altered mentation with interval MRI brain increase in size and number of tuberculomas, hydrocephalus, and left thalamic infarction. Cyclosporin was added with gradual improvement and ultimately good outcome.Case 2. 47 year old Filipino male presented with 3 week history of headache and neck stiffness and 3 day history of fever, dysarthria and diplopia. MRI brain showed basal meningitis, hydrocephalus and left putaminal infarction. CSF demonstrated 245 WCC (35% neutrophils), protein 0.68 g/L, glucose 1.8 mmol/L. Despite concomitant anti-tuberculosis and corticosteroid treatment, the patient developed PR-induced worsening hydrocephalus necessitating ventriculo-peritoneal shunting. Cyclosporin was added with gradual PR resolution.ConclusionOur case series highlights the importance of concomitant corticosteroids in TBM and the potential role of cyclosporin in refractory PR.
018 Management of migraine in the australian emergency department
Authors: Gunasekera Lakshini , Sun-Edelstein Christina , Heywood John , Sanders Lauren 
Published: May 2018

IntroductionAcute migraine commonly causes significant personal, economic and work-related disability. Australian guidelines recommend treating mild migraine with aspirin and metoclopramide, and moderate-severe migraine with prochlorperazine, chlorpromazine or sumatriptan. Stratified treatment based on severity is preferred to step-wise treatment. Australian data regarding Emergency Department (ED) migraine treatment are scarce. We evaluated prescribing patterns at a Melbourne hospital against national guidelines.MethodsRetrospective cohort study of migraine (G439 ICD-10-AM) between 2012–2016. Exclusion criteria included migraine without headache, other primary headaches and secondary headaches. Demographic and prescribing data were extracted from medical records. Proportions were calculated with 95% confidence intervals using Wilson’s method. Comparisons were made between groups using Mann-Whitney and Chi-square tests.ResultsOf 214,932 ED presentations, 744 with headache presentation received a G439 diagnosis. Most were female (75%; 558/744), young (mean age 34±13 years) and self-reported migraine history (75%; 558/744). There were 55 different medications prescribed. Paracetamol was more frequently prescribed (52%; 385/744) than aspirin (10.6%; 78/744). Opioid prescription occurred in 46% (345/744), single opioid 36% (267/744),>1 opioid 10% (78/744). Median time-to-discharge was 38 min longer with opioid prescription compared with no opioid (222; IQR 164–309 vs 184; 122–258; p<0.01). Just 6.85% (51/744) received triptans. Other treatments were prochlorperazine (14%; 97/744), metoclopramide (38%; 286/744) and chlorpromazine (44%; 3 25/744). Overall, 25.4% (189/744) received no guideline-recommended medication.ConclusionWe observed considerable polypharmacy in ED migraine management with inconsistent prescribing patterns. Recommended medications are infrequently used. Opioid use is common and associated with increased time-to-discharge. Failure of ED staff to follow guidelines is unexplained, and requires further investigation.
024 Longitudinal diffusion tensor imaging in the primary progressive aphasias
Authors: Mahoney Colin J , Simpson Ivor JA , Nicholas Jennifer M , Rohrer Jonathan D , Warren Jason D 
Published: May 2018

IntroductionPrimary progressive aphasia (PPA) is characterised by progressive erosion of the language network, and is most commonly associated with frontotemporal lobar degeneration. Few biomarkers exist for diagnosis and tracking of disease progression in PPA. Novel techniques such as diffusion tensor imaging (DTI) may allow early disease detection and monitoring, as well as improving our understanding of the trajectory of PPA.MethodsThirty patients with PPA (13 with non-fluent variant, 11 with semantic variant, 6 with logopenic variant), and 20 age-matched healthy participants were assessed using serial DTI at baseline and on average 1.2 years later. Baseline and follow-up DTI scans were registered using a group-wise approach and a region-of-interest analysis performed for individual white matter tracts. Annualised rates of change for DTI metrics were calculated and compared between groups. Changes in neuro-psychometric scores were correlated with white matter structural changes.ResultsIn the non-fluent group, rates of change in fractional anisotropy were most significant within the right and left superior longitudinal fasciculus (right, −5.7%/year, left, −4.3%/year, p<0.001). In the semantic group, change was most significant in right uncinate fasciculus (−14.8%/year, p<0.001). In the logopenic group, change was most significant in only radial diffusivity, within the right inferior longitudinal fasciculus (6.8% per year increase, p<0.05). Using DTI as an outcome measure, sample size estimates for future treatment trials were generally lower across all syndromic groups compared with volumetric MRI.ConclusionThis study demonstrates the feasibility of longitudinal DTI, identifying rates of disease progression across the spectrum of PPA. Syndrome specific trajectories of disease progression emerged. This highlights the potential use of serial DTI as a disease biomarker in PPA, particular in the design of future treatment trials.
027 Lightning injuries: keraunoparalysis and other neurologic manifestations
Authors: Hooi Wai Foong , Tse Gabrielle , Waterston John 
Published: May 2018

IntroductionLightning is one of the most powerful and spectacular natural phenomena. A flash of lightning can heat the air around it to 27 000 degrees Celsius, 6 times hotter than the surface of the sun. Lightning strikes the earth more than 8 million times per day. It was responsible for more than 2 40 000 injuries per year worldwide. Neurologic complications after lightning strikes are not uncommon. They vary from transient benign symptoms to permanent neurological deficits. We present a case of keraunoparalysis and a literature review of neurologic manifestations of lightning strikes.CaseA 23 year old man presented with acute paraplegia with complete sensory loss in the lower limbs after being struck by lightning. He also suffered from other significant injuries including mild sensorineural hearing loss in the left ear, right upper lobe pulmonary contusion, rhabdomyolysis (creatine kinase level peaked at 17 867units/L) and bilateral lower limb compartment syndrome requiring emergency fasciotomy. MRI full spine was normal with no evidence of cord lesion. His lower limb neurology improved significantly over 48 hours.ConclusionKeraunoparalysis is characterised by transient lower limb weakness that usually improves within hours to days. In patients presenting with paraparesis post lightning strike, it is important to consider the diagnosis of keraunoparalysis to avoid unnecessary surgical procedures. Neuroimaging is crucial to exclude other etiologies such as traumatic cord injuries or bleeding.References. Cherington M. Neurologic manifestations of lightning strikes. Neurology2003;60:182–5.. Ritenour AE, Morton MJ, McManus JG, Barillo DJ, Cancio LC. Lightning injury: A review. Burns2008;34:585–94.. Kumar A, Srinivas V, Sahu BP. Keraunoparalysis: What a neurosurgeon should know about it?J Craniovertebr Junction Spine2012Jan;3(1):3–6.
038 Adult-onset leukoencephalopathy with neuroaxonal spheroids and pigmented glia mimicking systemic lupus erythematosus cerebral vasculitis
Authors: Lubomski Michal , Buckland Michael , Sy Joanne , Wei Heng , Tan Irene , Kane Barry , Spring Penelope J 
Published: May 2018

IntroductionWe present an unusual case of adult-onset leukoencephalopathy with neuroaxonal spheroids and pigmented glia (ALSP) mimicking systemic lupus erythematosus (SLE) cerebral vasculitis. ALSP is an autosomal dominant progressive leukodystrophy, associated with mutations in the CSF1R gene, which induce dysregulation of microglia. The case was compiled from records of clinical data, imaging, brain biopsy and genetic studies.CaseA 56 year old previously high functioning man of Southern Chinese origin was hospitalised with recurrent seizures. He had a prior 4 year history of progressive neuropsychiatric features, and 1 year of cognitive decline and occasional falls. Within the year prior, he had positive SLE serology and a renal biopsy consistent with lupus nephritis treated with steroids, mycophenolate, hydroxyl-chloroquine, and later rituximab due to concerns of evolving cerebral vasculitis on cerebral MRI and SPECT scan with MoCA of 20/30. Examination after seizure therapy revealed hyperreflexia, fine tremor, myoclonus, pseudobulbar affect, ideomotor apraxia and slow, independent gait. RUDAS was 6/30 with perseveration. CSF examination and SLE serology were quiescent. Consecutive brain MRIs showed multiple regions of worsening high T2/FLAIR signal in the corpus callosum and supra-tentorial white matter with persistent restricted diffusion. IV steroids and cyclophosphamide were added. Following treatment unresponsiveness, a frontal lobe brain biopsy demonstrated white matter gliosis with prominent axonal spheroids consistent with a primary leukoencephalopathy, with no inflammation, vasculitis nor infection. Immunotherapy was weaned. Genetic testing confirmed a positive CSF1R mutation (c.2329C>T; p. Arg777Trp in Exon 18). A positive family history of dementia in the patient’s elderly mother overseas was identified. The patient remained mobile but mute, and fatally aspirated 8 months after final presentation.ConclusionThis report illustrates an unusual presentation of ALSP, initially misdiagnosed as SLE vasculitis. Clinicians should consider an adult onset leukodystrophy and proceed to biopsy and CSF1R gene testing early in suspected ‘refractory cerebral vasculitis’.
040 An analysis of malignancy risk in the clinical development programme of cladribine tablets in patients with relapsing multiple sclerosis
Authors: Galazka Andrew , Nolting Axel , Cook Stuart , Leist Thomas , Comi Giancarlo , Montalban Xavier , Hicking Christine , King John , Dangond Fernando 
Published: May 2018

IntroductionAn independent meta-analysis; Pakpoor et al. Neurol Neuroimmunol Neuroinflamm 2015;2:e158) in Phase III trials (with a 2 year duration) of disease modifying drugs (DMDs) in patients with relapsing multiple sclerosis found no increased rate of malignancy with cladribine tablets (CT) versus other DMD treatments. Data from additional trials involving CT 3.5 mg/kg (CT3.5) and a safety registry (up to 8 years’ follow-up) allow further insights into malignancy risk. Objective is to assess malignancy risk with CT3.5 monotherapy and placebo (PBO) in data from 3 Phase III trials and a registry, and compare the incidence rate with a global database.MethodsThe CT 3.5 population comprised 923 patients (3433 patient-years’ [PY] total exposure time) and the PBO group comprised 641 patients (2026 PY). Individual case reports of malignancies were reviewed by independent, blinded adjudication committee. Standardised incidence ratios (SIR) were calculated using the GLOBOCAN reference population (excluding non-melanoma skin cancers [NMSCs]) and a Danish reference population for NMSC rates.ResultsThe incidence per 100 PY of confirmed malignancy was CT3.5 0.293 (95%CI 0.158–0.544) and PBO 0.148 (95%CI 0.048–0.460); the risk difference 95% CI included 0 (−0.166–0.414). The CT 3.5 malignancy SIR was almost identical (0.97, 95% CI 0.44–1.85) to the GLOBOCAN matched reference population. The PBO group SIR was numerically lower (0.48, 95% CI 0.14–1.53). There were no cases of haematological, lymphoproliferative or virus-induced cancers. There was no clustering of specific tumour types, and the incidence of skin cancer was not increased after treatment with CT3.5 versus PBO. The incidence of malignancies with CT3.5 was constant and did not increase over time.ConclusionAnalysis of malignancy rates in a cohort that includes patients with up to 8 years’ follow-up confirms the Conclusion of the earlier meta-analysis; the incidence of malignancies with CT3.5 is similar to a matched reference population.