bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of computed tomography of abdomen in difficult to diagnose typhoid fever: a case series
Authors: Hafeez Wajid , Rajalakshmi S , Sripriya S , Madhu Bashini M 
Published: November 2017

Background and Aim Diagnosis of typhoid is challenging when blood cultures fail to isolate Salmonella species. We report our experience with interpreting computed tomography (CT) abdomen findings in a case series of typhoid fever. Methods The case series consisted of patients who had a CT abdomen done as part of their investigations and a final diagnosis of typhoid fever. The CT films were reviewed and findings evaluated for distinctive features. Results During 2011–2017, 11 patients met the inclusion criteria. Indication for CT was pyrexia of unknown origin in the majority of patients. Review of CT films revealed mesenteric lymphadenopathy (100%), terminal ileum thickening (85%), hepatosplenomegaly (45%), retroperitoneal lymphadenopathy (18%) and ascites (9%). Conclusions Enhancing discrete mesenteric lymphadenopathy and terminal ileum thickening are non-specific findings noted in typhoid fever. Absence of matted necrotic nodes and peritoneal thickening rule out tuberculosis and raise suspicion of typhoid fever in endemic regions.
Factors predicting non-alcoholic steatohepatitis (NASH) and advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD)
Authors: Tasneem Abbas Ali , Luck Nasir Hassan , Majid Zain 
Published: November 2017

Introduction To determine the factors predicting non-alcoholic steatohepatitis (NASH) and advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). Methodology All patients aged >18 years and having a fatty liver on abdominal ultrasound (US), presenting from January 2011 to January 2017, were included. A liver biopsy was performed on all the patients. Results Of 96 patients undergoing liver biopsy for non-alcoholic fatty liver disease (NAFLD), 76 (79.2%) were men. On liver US, diffuse fatty liver (DFL) was noted in 68 (70.8%) patients. Liver biopsy showed non-alcoholic steatohepatitis (NASH) in 78 (81.3%) patients. Factors associated with NASH were male gender, body mass index (BMI) > 27 kg/m2, DFL and raised alanine aminotransferase (ALT). A GULAB score (based on gender, US liver findings, lipid (fasting) levels, ALT level and BMI) of ≥5 predicted NASH with 82.05% sensitivity. Factors associated with advanced fibrosis in NAFLD were age >40 years, diabetes mellitus, AST/ALT ratio > 1 and raised GGT. Conclusion NASH is common in patients with male gender, high BMI, DFL on liver US, raised ALT and GULAB score ≥5.
Understanding design scales for a range of potential green infrastructure benefits in a London Garden City
Authors: Pochee Hareth , Johnston Innes 
Published: November 2017

It has been proposed that increasing the amount of foliage, trees and soft landscaping in our cities could prove useful environmentally, economically and socially. Benefits of greener urban environments that have been suggested range from reduction in water pollution to improved mental health. This paper outlines a critical appraisal of the science and reasoning behind several cited benefits of greening cities. The specific potential benefits addressed are urban heat island mitigation, improved insulation, stormwater management, air pollution reduction, energy crop production, acoustic attenuation, food production and community gardening for health and wellbeing. London, UK, has been used as an example case with an aim of estimating the extent, types and distributions of green that would be required to yield meaningful city-scale benefits. The work takes a broad-brush approach, from a designer's perspective, to begin the process of understanding how greenery designs work, to what extent, and how they might be applied in urban environments. The characteristics of some concept design options for a Garden City version of London that illustrate the scale of greening required to realise the benefits are presented. Practical application: This paper outlines a critical appraisal of the science and reasoning behind several cited benefits of greening cities. The specific potential benefits addressed are urban heat island mitigation, improved insulation, stormwater management, air pollution reduction, energy crop production, acoustic attenuation, food production and community gardening for health and wellbeing. A collection of concept designs, for London, UK, has been examined with the aim of estimating the extent, types and distributions of greenery that would be required to yield meaningful city-scale benefits. The work has direct relevance to city planning and the design of green infrastructure in London, UK; however, many of the issues covered are applicable to other cities worldwide.
RNA-Seq investigations of human post-mortem trigeminal ganglia
Authors: LaPaglia Danielle M , Sapio Matthew R , Burbelo Peter D , Thierry-Mieg Jean , Thierry-Mieg Danielle , Raithel Stephen J , Ramsden Christopher E , Iadarola Michael J , Mannes Andrew J 
Published: November 2017

Background The trigeminal ganglion contains neurons that relay sensations of pain, touch, pressure, and many other somatosensory modalities to the central nervous system. The ganglion is also a reservoir for latent herpes virus 1 infection. To gain a better understanding of molecular factors contributing to migraine and headache, transcriptome analyses were performed on postmortem human trigeminal ganglia. Methods RNA-Seq measurements of gene expression were conducted on small sub-regions of 16 human trigeminal ganglia. The samples were also characterized for transcripts derived from viral and microbial genomes. Herpes simplex virus 1 (HSV-1) antibodies in blood were measured using the luciferase immunoprecipitation assay. Results Observed molecular heterogeneity could be explained by sampling of anatomically distinct sub-regions of the excised ganglia consistent with neurally-enriched and non-neural, i.e. Schwann cell, enriched subregions. The levels of HSV-1 transcripts detected in trigeminal ganglia correlated with blood levels of HSV-1 antibodies. Multiple migraine susceptibility genes were strongly expressed in neurally-enriched trigeminal samples, while others were expressed in blood vessels. Conclusions These data provide a comprehensive human trigeminal transcriptome and a framework for evaluation of inhomogeneous post-mortem tissues through extensive quality control and refined downstream analyses for RNA-Seq methodologies. Expression profiling of migraine susceptibility genes identified by genetic association appears to emphasize the blood vessel component of the trigeminovascular system. Other genes displayed enriched expression in the trigeminal compared to dorsal root ganglion, and in-depth transcriptomic analysis of the KCNK18 gene underlying familial migraine shows selective neural expression within two specific populations of ganglionic neurons. These data suggest that expression profiling of migraine-associated genes can extend and amplify the underlying neurobiological insights obtained from genetic association studies.
Excessive daytime sleepiness in chronic migraine and chronic tension-type headache from the general population
Authors: Kristoffersen Espen Saxhaug , Stavem Knut , Lundqvist Christofer , Russell Michael Bjørn 
Published: November 2017

Introduction A relationship between headache and excessive daytime sleepiness (EDS) has been suggested. This study investigated this association in relation to people with chronic migraine or chronic tension-type headaches. Methods A total of 30,000 persons aged 30–44 from the general population were screened for chronic headache. Those eligible were interviewed by a headache specialist. EDS was defined as Epworth sleepiness scale score >10. Logistic regression models were used. Results Among the 323 eligible participants, 21.1% had EDS. In multivariable logistic regression analysis, the odds ratios (OR) of EDS were not significantly different in people with CM and CTTH. However, high headache frequency was associated with EDS (OR 2.03 (95% CI 1.11–3.73, p = 0.022)) for those with ≥ 80 compared to < 80 headache days/3 months, after adjustment for type of headache, age, and gender. Conclusions Increased EDS was associated with higher headache frequency, but not with specific headache diagnoses.
Two novel families with hemiplegic migraine caused by recurrent SCN1A mutation p.F1499L
Authors: Schubert Victoria , Auffenberg Eva , Biskup Saskia , Jurkat-Rott Karin , Freilinger Tobias 
Published: November 2017

Background Familial hemiplegic migraine type 3 is a monogenic subtype of migraine caused by missense mutations in the neuronal voltage-gated sodium channel gene SCN1A, with 10 different mutations reported so far. In two familial hemiplegic migraine type 3 families, partial cosegregation with a rare eye phenotype (elicited repetitive daily blindness) was previously reported. Methods Two novel familial hemiplegic migraine pedigrees were subjected to genetic analysis and detailed work-up of associated clinical features. Results In both pedigrees, we identified SCN1A mutation p.F1499L, which has been previously associated with familial hemiplegic migraine type 3 and elicited repetitive daily blindness. Both families displayed a pure familial hemiplegic migraine phenotype without evidence of an episodic eye phenotype. Conclusion Like a substantial proportion of other familial hemiplegic migraine type 3 mutations, p.F1499L affects the intracellular linker between domains III and IV of SCN1A, which seems to be a mutational hot-spot. Our new data establish p.F1499L as a recurrent familial hemiplegic migraine type 3 mutation. Elicited repetitive daily blindness seems to be a rare phenomenon in familial hemiplegic migraine type 3, even in carriers of the same mutation.
Translation and translingual remixing: A young person developing as a writer
Authors: Dewilde Joke 
Published: November 2017

Aims and Objectives/Purpose/Research Questions: This article aims to understand how a young person develops as a translingual writer and which discursive strategies she identifies as important in this process. Neda (pseudonym) has never learnt to write in Turkmen, which is her home language, but is developing as a confident writer in Norwegian, which is the language of the school. Design/Methodology/Approach: Situated within a linguistic ethnographic framework, in-depth interviews with the young person were conducted as part of a year-long fieldwork. One interview focused on Neda’s writing experiences in general, and the other two examined how she experienced writing selected poems. Data and Analysis: The data for this article are three in-depth interviews with Neda produced over a month’s time, field notes taken in school across that same period, seven poems written at home, and two written in school. The analysis had a joint focus on linguistics and ethnography, identifying core themes. Findings/Conclusions: Neda drew on translation and translingual remixing strategies when writing poetry on her own initiative to develop her voice, which indicates a strong sense of agency. In line with a translingual orientation to communication and literacy, these discursive strategies transcend individual languages and involve diverse semiotic resources in situated meaning construction. Both strategies contribute to creating a deeper understanding of the Norwegian language resources in her repertoire and to finding her voice as a transnational young person. Originality: Few studies have offered detailed insight into how young people reflect upon their development as translingual writers in their spare time and which strategies they identify as important to do so. Significance/Implications: The study contributes to the debate of how teachers can create a space for translingual writing by acknowledging and further developing young people’s own discursive strategies, involving their entire linguistic repertoire.
Helical Therapy is Safe for Lung Stereotactic Body Radiation Therapy Despite Limitations in Achieving Sharp Dose Gradients
Authors: Amin Neha P. , Nalichowski Adrian , Campbell Shauna , Hyder Jal , Spink Robyn , Konski Andre A. , Dominello Michael 
Published: November 2017

Purpose: We observed that many of our helical therapy lung stereotactic body radiation therapy plans did not meet the Radiation Therapy Oncology Group (RTOG) recommended R50% (volume of 50% of the prescription dose/planning target volume), which characterizes the steepness of dose fall off. We hypothesized that despite not meeting R50%, helical therapy lung stereotactic body radiation therapy plans would confer similar local control and minimal side effects as previously reported using nonhelical treatment platforms. Materials and Methods: We report a retrospective review of all consecutive patients treated off-protocol with stereotactic body radiation therapy for peripheral lung lesions from 2008 to 2013 utilizing helical therapy. Seventy-four patients (81 lesions and 79 plans) were treated with doses ranging from 48 to 60 Gy in 3 to 5 fractions prescribed to the edge of the planning target volume. Results: Forty-eight (61%) plans had major deviation from R50%. Only 1 (<1%) plan had a major deviation from the R100%. All plans had > 95% planning target volume coverage by prescription dose, 7(8.6%) plans with 121% to 133% maximum dose, and lung V20 Gy <10% in 70 (89%) plans. With a median follow-up of 4.7 years (95% confidence interval: 4.1-5.3), local control for all patients at 1, 2, and 5 years was 94.6%, 83.4%, and 74%, respectively. For patients with primary stage I-II lung cancer (n = 46), the 1, 2, and 5-year local control: 97.2%, 94.2%, and 86.9%; RC: 97.6%, 82.5%, and 69.5%; and DM: 3%, 16%, and 33.4%, respectively. Patients treated for lung metastases (n = 26) had worse local control at 1, 2, and 5 years: 94.4%, 69.3%, and 55.5%, respectively. Side effects were rare with 2 (3%) patients reporting chest wall pain and 6 (8%) patients experiencing radiation pneumonitis, including 1 patient who had grade 5 radiation pneumonitis. Conclusions: Helical therapy delivers a safe and effective lung stereotactic body radiation therapy plan, despite not being able to meet RTOG’s recommended R50 conformality constraint.
Improving mechanical thrombectomy time metrics in the angiography suite: Stroke cart, parallel workflows, and conscious sedation
Authors: Settecase Fabio , McCoy David B , Darflinger Robert , Alexander Matthew D , Cooke Daniel L , Dowd Christopher F , Hetts Steven W , Higashida Randall T , Halbach Van V , Amans Matthew R 
Published: November 2017

Purpose Earlier reperfusion of large-vessel occlusion (LVO) stroke improves functional outcomes. We hypothesize that use of a stroke cart in the angiography suite, containing all commonly used procedural equipment in a mechanical thrombectomy, combined with parallel staff workflows, and use of conscious sedation when possible, improve mechanical thrombectomy time metrics. Methods We identified 47 consecutive LVO patients who underwent mechanical thrombectomy at our center, retrospectively and prospectively from implementation of these three workflow changes (19 pre- and 28 post-). For each patient, last known normal, NIHSS, angiography suite in-room time, type of anesthesia, groin puncture time, on-clot time, recanalization time, LVO location, number of passes, device(s) used, mTICI score, and outcome (mRS) were recorded. Between-group comparisons of time metrics and multivariate regression were performed. Results Stroke cart, parallel workflows, and primary use of conscious sedation decreased in-room time to groin puncture (−21.3 min, p < 0.0001), in-room to on-clot time (−24.1 min, p = 0.001), and in-room to reperfusion time (−29.5 min, p = 0.01). In a multivariate analysis, endotracheal intubation and general anesthesia were found to significantly increase in-room to on-clot time ( p = 0.01), in-room to reperfusion time ( p = 0.01), and groin puncture to on-clot time ( p = 0.05). The number of patients achieving a good outcome (mRS 0−2), however, did not significantly differ between the two groups (9/18 (47%) vs 14/28 (50%), p = 0.60). Conclusions Use of a stroke cart, parallel workflows by neurointerventionalists, technologists, and nursing staff, and use of conscious sedation may be useful to other institutions in efforts to improve procedural times.
Clinical stroke research in resource limited settings: Tips and hints
Authors: Pandian Jeyaraj D , Liu Hueiming , Gandhi Dorcas BC , Lindley Richard I 
Published: November 2017

Background Most stroke research is conducted in high income countries, yet most stroke occurs in low- and middle-income countries. There is an urgent need to build stroke research capacity in low- and middle-income countries. Aims To review the global health literature on how to improve research capacity in low- and middle-income countries, provide additional data from the recently completed ATTEND Trial and provide examples from our own experience. Summary of review The main themes from our literature review were: manpower and workload, research training, research question and methodology and research funding. The literature and our own experience emphasized the importance of local stakeholders to ensure that the research was appropriate, that there were robust local ethics and regulatory processes, and research was conducted by trained personnel. Research training opportunities can be developed locally, or internationally, with many international schemes available to help support new researchers from low- and middle-income country settings. International collaboration can successfully leverage funding from high income countries that not only generate data for the local country, but also provide new data appropriate to high income countries. Conclusions Building stroke research capacity in low- and middle-income countries will be vital in improving global health given the huge burden of stroke in these countries.
First Experiences With a Wearable Multisensor Device in a Noninvasive Continuous Glucose Monitoring Study at Home, Part II: The Investigators’ View
Authors: Zanon Mattia , Mueller Martin , Zakharov Pavel , Talary Mark S. , Donath Marc , Stahel Werner A. , Caduff Andreas 
Published: November 2017

Background: Extensive past work showed that noninvasive continuous glucose monitoring with a wearable multisensor device worn on the upper arm provides useful information about glucose trends to improve diabetes therapy in controlled and semicontrolled conditions. Method: To test previous findings also in uncontrolled conditions, a long term at home study has been organized to collect multisensor and reference glucose data in a population of 20 type 1 diabetes subjects. A total of 1072 study days were collected and a fully on-line compatible algorithmic routine linking multisensor data to glucose applied to estimate glucose levels noninvasively. Results: The algorithm used here calculates glucose values from sensor data and adds a constant obtained by a daily calibration. It provides point inaccuracy measured by a MARD of 35.4 mg/dL on test data. This is higher than current state-of-the-art minimally invasive devices, but still 86.9% of glucose rate points fall within the zone AR+BR. Conclusions: The multisensor device and the algorithmic routine used earlier in controlled conditions tracks glucose changes also in uncontrolled conditions, although with lower accuracy. The examination of learning curves suggests that obtaining more data would not improve the results. Therefore, further efforts would focus on the development of more complex algorithmic routines able to compensate for environmental and physiological confounders better.
Brainstem glioma: Prediction of histopathologic grade based on conventional MR imaging
Authors: Moharamzad Yashar , Sanei Taheri Morteza , Niaghi Farhad , Shobeiri Elham 
Published: November 2017

Objective The objective of this article is to investigate the association between specific MR imaging findings and histopathologic grading (low-grade vs. high-grade) of brainstem gliomas (BSGs). Methods Sixty-two males and 34 females (mean (standard deviation, SD) age of 24.61 (17.20) years, range = 3 to 70 years) with histologically diagnosed BSG underwent conventional 1.5 T MR imaging, which included T1-weighted (T1W), T2W, and post-contrast T1W sequences. There were 39 children (mean age of 9.38 years) and 57 adults (mean age of 35 years). A binary logistic regression analysis was used to explore associations between MRI features and histopathological grade of the BSG. Results Binary logistic regression revealed that necrosis (adjusted odds ratio (OR) = 16.07; 95% confidence interval (CI) = 3.20 to 80.52; p = 0.001) and inhomogeneous contrast enhancement (adjusted OR = 8.04; 95% CI = 1.73 to 37.41; p = 0.008) as significant predictors of high-grade BSG. The equation (Nagelkerke R2 = 0.575) is Logit ( p high-grade BSG) = (2.77 × necrosis) + (2.08 × heterogeneous contrast enhancement) – 3.13. Sensitivity and specificity values were respectively 66.7% and 96.0% for necrosis and 85.7% and 65.9% for inhomogeneous contrast-enhancing lesions. In the pediatric age group, only inhomogeneous contrast enhancement (adjusted OR = 40; 95% CI = 3.95 to 445.73; p = 0.002) was a significant predictor for high-grade BSG. Conclusion Conventional MR imaging features such as necrosis and inhomogeneous contrast enhancement in adults and heterogeneous contrast enhancement in children suggest high-grade BSG.
Single-centre experience with the Impella CP, 5.0 and RP in 109 consecutive patients with profound cardiogenic shock
Authors: Jensen Peter Blom , Kann Sigrun Høegholm , Veien Karsten Tange , Møller-Helgestad Ole Kristian , Dahl Jordi Sanchez , Rud Charlotte Svejstrup , Jensen Marianne Kjær , Jensen Lisette Okkels , Schmidt Henrik , Møller Jacob Eifer 
Published: November 2017

Rationale: Short-term mechanical circulatory support is increasingly used in the management of cardiogenic shock, but data from controlled studies are sparse. Thus, real-life data on complication rates and predictors of adverse outcome are important. Objective: The objective of this study was to analyse the experience with Impella devices in the management of profound cardiogenic shock. Methods and results: A retrospective study of 109 consecutive patients with severe shock after myocardial infarction, acute heart failure, or cardiac surgery. Possible device-related complications were registered and predictors of death while on Impella support and within 180 days were identified. In 79 patients (72%) cardiogenic shock was caused by myocardial infarction, acute heart failure in 16 (15%) and post-cardiotomy shock in 14 patients (13%). Thirty-five patients (32%) were comatose after cardiac arrest and in seven, the Impella was placed during chest compression. Mean age was 62±12 years, mean arterial pressure was 57±13 mmHg, pH 7.19±0.17 and lactate 7.5±5.7 mmol/l (range 1.8–30.0 mmol/l) at placement. During Impella therapy, 26 patients (28%) died among patients with myocardial infarction or acute heart failure. Of data available prior to placement lactate (hazard ratio 1.14, 95% confidence interval 1.04–1.25, P=0.004) was the only predictor of death on support. During support, five patients (5%) developed leg ischaemia requiring intervention. Bleeding from the Impella insertion site was seen in 14 patients (13%). Conclusion: Impella treatment is feasible in profound cardiogenic shock at an acceptable rate of complications. Despite an aggressive approach to restore cardiac output, mortality was high. Besides the severity of lactic acidosis there were no strong predictors of early death.