bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variations of celiac axis, common hepatic artery and its branches in 600 patients
Authors: Sureka Binit , Mittal Mahesh Kumar , Mittal Aliza , Sinha Mukul , Bhambri Narendra Kumar , Thukral Brij Bhushan 
Published: October 2013

Abstract
Purpose: To evaluate the spectrum of celiac axis, common hepatic artery (CHA), right, left, middle hepatic artery and gastroduodenal artery variations by using spiral computed tomography (CT). Materials and Methods: A retrospective review of Multidetector CT (MDCT) abdominal angiography scans was performed in patients sent for various liver and other abdominal pathologies between January 2012 and February 2013. A total of 600 patients were evaluated. Definitions of CHA, ambiguous celiac axis, course and division patterns of CHA, replaced hepatic artery, accessory hepatic artery and middle hepatic artery were used as proposed by Song et al., Covey et al., and Wang et al. The pattern of the aortic origin of branches of celiac axis, common hepatic artery and its branches was analyzed. Results: Six types of celiac axis anatomic variations were identified in our study. A total of 546 of the 600 patients had a normal celiac axis anatomy. Anatomic variations were seen in 5.5% of patients. Ambiguous anatomy was seen in 3.5% of the patients. CHA originated from celiac axis in 95.83% of the patients. Variations in anatomic origin of CHA were seen in 8 patients. Ambiguous dual pathway was seen in 4 patients. Normal Sp-preportal course of CHA was identified in 97.78% of cases, Sp-retroportal course in 7 patients, Tp-preportal course in 2, Tp-retroportal in 1, Ip-preportal in 1 and through Ligamentum venosum in 2 patients. Normal origin of RHA from HAP was seen in 79.6% patients. Replaced origin of RHA was seen in 15.16% cases and Accessory origin of RHA was seen in 5.16% cases. LHA originated from HAP in 81.5% patients. Replaced LHA origin was seen in 10.8% cases and Accessory LHA origin seen in 7.6% cases. MHA originated from RHA in 41.3% patients, LHA in 27.83% and from CHA in 4.5% cases. Origin of MHA could not be defined in 26.3% of patients. GDA originated from CHA in 97.6% of patients, from celiac axis in 1.6%, from RHA in 0.33% in patients. Trifurcation of CHA was seen in 7.16% and quadrifurcation of CHA in 2.16%. Conclusion: CT Angiography is a safe and highly sensitive and accurate modality for evaluation of arterial anatomy and its variants.
CT imaging findings and endovascular management of isolated spontaneous dissecting aneurysm of celiac artery
Authors: Rama Krishnan RS , Murali K , Madan R , Francis G 
Published: October 2013

AbstractIsolated spontaneous dissecting aneurysm of celiac artery without concomitant involvement of aorta is a rare entity and only a few cases are reported in the literature. More cases are being detected recently with greater advancements in CT technology. Clinicians and emergency physicians should be aware of this condition and should include it in the differential diagnosis of patients who present with refractory postprandial epigastric pain, particularly in middle-aged men. We present a case of a 45-year-old male with isolated spontaneous dissecting celiac artery aneurysm, with special emphasis on CT findings and the role of endovascular management.
Depression and sleep disturbances in patients with multiple sclerosis and correlation with associated fatigue
Authors: Nagaraj Karthik , Taly Arun B. , Gupta Anupama , Prasad Chandrajit , Christopher Rita 
Published: October 2013

ABSTRACT
Objective: To observe prevalence of depression and sleep disturbances in multiple sclerosis (MS) patients and their correlation with associated fatigue. Study Design and Setting: Prospective observation study in a university tertiary research hospital in India. Materials and Methods: Thirty‑one patients (6 male and 25 female) with definite MS (McDonald’s criteria) presented in out‑patient/admitted in the department of neurology (between February 2010 and December 2011) were included in the study. Depression was assessed using Beck’s Depression Inventory (BDI). Sleep quality was assessed using Pittsburg Sleep Quality Index (PSQI). Disease severity was evaluated using the Kurtzke’s expanded disability status scale (EDSS). Fatigue was assessed using Krupp’s fatigue severity scale (FSS). We tried to observe correlation of depression and sleep disturbance with associated fatigue in MS patients. Results: The age of patients varied between 16 and 50 years (30.1 ± 9.1). The mean age at first symptom was 25.2 ± 6.4 years (range 14-39 years). The prevalence of sleep disturbance and depression was 51.6% (16/31) each and fatigue 58.1% (18/31) in the study group. The PSQI scores were significantly greater in the patients with fatigue as compared with those without fatigue indicating poorer sleep quality is associated with fatigue in MS (P = 0.005). The BDI scores were also significantly higher in the fatigue group showing that severity of depression also strongly correlated with fatigue (P = 0.001). Conclusions: Depression and sleep disturbance in patients with MS is significantly correlated with associated fatigue
Disseminated neurocysticercosis presenting as affective mood disorder with chronic tension type headache
Authors: Chatterjee Krishnarpan , Ghosh Gopal Chandra 
Published: October 2013

ABSTRACTNeurocysticercosis is a common parasitic infection in India presenting usually with seizues, headache, focal neurological deficits. Neurocysticercosis presenting as a psychiatric illness is rare. Disseminated cysticercosis with involvement of central nervous system and head and neck muscles is rare even in endemic areas. We present a case of disseminated cysticercosis, which presented with chronic tension type headache and affective mood disorder. Treatment with cysticidal drugs led to complete remission of psychiatric complaints. In endemic areas history suggestive of mood disorder should not be used as supportive evidence of a primary headache syndome like tension type headche without ruling out secondary causes. Making an early diagnosis can prevent morbidity.
Giant cystic intradural extramedullary pilocytic astrocytoma of Cauda equina
Authors: Kumar Amandeep , Sharma Bhawani S. , Kale Shashank S. , Garg Ajay , Sharma M. C. 
Published: October 2013

ABSTRACTAstrocytomas of Conus‑Cauda equina region are rare. Astrocytomas, which are intramedullary tumors, may rarely have an extramedullary component. However, primary intradural extramedullary astrocytomas are extremely rare, with very few cases reported in the literature. We describe a giant extramedullary pilocytic astrocytoma of Cauda equina in a 20‑year‑old male. To the best of our knowledge, this is the first report of such a case in the available literature. This case highlights the fact that astrocytomas can be primarily extramedullary and emphasizes the need to consider pilocytic astrocytoma in the differential diagnosis of cystic Cauda equina tumors.
A case of multiple myeloma presenting as scalp swelling with intracranial extension
Authors: Senapati Satya Bhusan , Mishra Sudhansu Sekhar , Dhir Manmath Kumar , Das Srikanta , Tripathy Kalpalata 
Published: October 2013

ABSTRACTMultiple myeloma is a malignant neoplasm of bone marrow affecting plasma cells. It is usually detected in skull bone with characteristic features of multiple punched-out lesions. Its presentation as a solitary scalp swelling with underlying skull bone erosion and intracranial extension is very rare. A 35-year-old female presented to us with complains of rapidly growing left-side scalp swelling with right-side paresis and simple partial seizure of right upper limb. Local examination, X-ray skull, CT scan, and MRI of brain were suggestive of a malignant lesion. Near total excision of lesion was done. Histopathological study was suggestive of plasmacytoma of skull. Bone marrow study further confirmed it as a case of multiple myeloma. Cases presenting with solitary osteolytic skull lesions, possibility of plasmacytoma, or multiple myeloma should be kept in mind.
Reliability of motor parameters for follow.up after local steroid injection in carpal tunnel syndrome
Authors: Gupta Salil , Tewari A. K. , Gupta Aditya , Nair Velu 
Published: October 2013

ABSTRACT
Background: Local steroid injection is one of the treatment modalities for carpal tunnel syndrome (CTS). Symptomatic and electrophysiological improvement has been previously documented. The electrophysiological parameter, which represents the most consistent change after local steroid injection, is not well‑known. Objective: The objective of this study was to evaluate the changes in electrophysiological parameters 1 month after local steroid injection and to determine the parameter that is able to depict improvement across the severity spectrum of CTS. Materials and Methods: Forty‑seven patients (27 with bilateral disease, 74 hands totally) were included. The electrophysiological parameters studied at baseline included sensory onset latency, sensory nerve action potential amplitude, sensory conduction velocity (CV), distal motor latency, compound muscle action potential amplitude and motor CV. All patients were injected with 40 mg triamcinalone at the wrist. After 1 month, symptomatic improvement from baseline was documented using visual analog score of 100. Electrophysiology was repeated. Paired t tests were done between baseline electrophysiology parameters and those obtained 1 month after steroid injection for significant improvement. Subgroup analyses were performed in hands with mild to moderate (Grade 3 or less by Bland’s classification) and severe disease (Grades 4 and 5). Results: All patients showed a symptomatic improvement. Distal motor latency showed most consistent improvement irrespective of the severity of CTS. In mild to moderate CTS (Grade 3 or less of the classification given by Bland) sensory parameters were recordable and showed significant improvement in addition to distal motor latency. In the subcategory of severe CTS (Grades 4 and 5 of Bland) where sensory parameters are not recordable distal motor latency and the motor CV showed a significant improvement. Conclusion: One month after local steroid injection among the electrophysiological parameters studied distal motor latencies showed most consistent and recordable improvement across the severity spectrum of CTS. This can be used as a single objective parameter to follow‑up patients after a local steroid injection to document improvement or relapse. They can also be considered as objective parameter to follow‑up patients after surgery.
Patient-centered care at Joslin: Reflections of a mirror
Authors: Madden Paul 
Published: October 2013

AbstractThis personal communication describes the practical aspects of patient-centered care (PCC), as viewed by a person with diabetes, who is also a diabetes educator. He describes his encounters with two leading diabetologists, who practiced the real essence of PCC. The author also explains the impact these patient-centered doctors had on him, and how it has shaped his personal as well as professional life, over the past half century.
Information Technology Improves Emergency Department Patient Discharge Instructions Completeness and Performance on a National Quality Measure
Authors: Bell E.J. , Takhar S.S. , Beloff J.R. , Schuur J.D. , Landman A.B. 
Published: October 2013

SummaryObjectives: To compare the completeness of Emergency Department (ED) discharge instructions before and after introduction of an electronic discharge instructions module by scoring compliance with the Centers for Medicare and Medicaid Services (CMS) Outpatient Measure 19 (OP-19).Methods: We performed a quasi-experimental study examining the impact of an electronic discharge instructions module in an academic ED. Three hundred patients discharged home from the ED were randomly selected from two time intervals: 150 patients three months before and 150 patients three to five months after implementation of the new electronic module. The discharge instructions for each patient were reviewed, and compliance for each individual OP-19 element as well as overall OP-19 compliance was scored per CMS specifications. Compliance rates as well as risk ratios (RR) and risk differences (RD) with 95% confidence intervals (CI) comparing the overall OP-19 scores and individual OP-19 element scores of the electronic and paper-based discharge instructions were calculated.Results: The electronic discharge instructions had 97.3% (146/150) overall OP-19 compliance, while the paper-based discharge instructions had overall compliance of 46.7% (70/150). Electronic discharge instructions were twice as likely to achieve overall OP-19 compliance compared to the paper-based format (RR: 2.09, 95% CI: 1.75 – 2.48). The largest improvement was in documentation of major procedures and tests performed: only 60% of the paper-based discharge instructions satisfied this criterion, compared to 100% of the electronic discharge instructions (RD: 40.0%, 95% CI: 32.2% – 47.8%). There was a modest difference in medication documentation with 92.7% for paper-based and 100% for electronic formats (RD: 7.3%, 95% CI: 3.2% – 11.5%). There were no statistically significant differences in documentation of patient care instructions and diagnosis between paper-based and electronic formats.Conclusions: With careful design, information technology can improve the completeness of ED patient discharge instructions and performance on the OP-19 quality measure.Citation: Bell EJ, Takhar SS, Beloff JR, Schuur JD, Landman AB. Information technology improves emergency department patient discharge instructions completeness and performance on a national quality measure: A quasi-experimental study. Appl Clin Inf 2013; 4: 499–514 http://dx.doi.org/10.4338/ACI-07-RA-0046
A Discriminative Analysis of Fine-Grained Semantic Relations including Presupposition: Annotation and Classification
Authors: Tremper Galina , Frank Anette 
Published: October 2013

In contrast to classical lexical semantic relations between verbs, such as antonymy, synonymy or hypernymy, presupposition is a lexically triggered semantic relation that is not well covered in existing lexical resources. It is also understudied in the field of corpus-based methods of learning semantic relations. Yet, presupposition is very important for semantic and discourse analysis tasks, given the implicit information that it conveys. In this paper we present a corpus-based method for acquiring presupposition-triggering verbs along with verbal relata that express their presupposed meaning. We approach this difficult task using a discriminative classification method that jointly determines and distinguishes a broader set of inferential semantic relations between verbs.
The present paper focuses on important methodological aspects of our work: (i) a discriminative analysis of the semantic properties of the chosen set of relations, (ii) the selection of features for corpus-based classification and (iii) design decisions for the manual annotation of fine-grained semantic relations between verbs. (iv) We present the results of a practical annotation effort leading to a gold standard resource for our relation inventory, and (v) we report results for automatic classification of our target set of fine-grained semantic relations, including presupposition. We achieve a classification performance of 55% F1-score, a 100% improvement over a best-feature baseline.
Clinical Outcomes of Mild Isolated Cerebral Ventriculomegaly in the Presence of Other Neurodevelopmental Risk Factors
Authors: Ball John D. , Abuhamad Alfred Z. , Mason Janelle L. , Burket Jessica , Katz Elionora , Deutsch Stephen I. 
Published: October 2013

ObjectivesThe purpose of this study was to evaluate neuropsychological test data in school‐aged children whose fetal sonograms revealed mild isolated cerebral ventriculomegaly without asymmetry of the lateral ventricles.MethodsNine of 52 children 6 years and older with sonographic evidence of mild isolated cerebral ventriculomegaly without asymmetry of the lateral ventricles were able to be recruited for follow‐up school‐aged neuropsychological testing. The children received a half‐day battery of neuropsychological tests, including the Wechsler Abbreviated Scales of Intelligence; Beery‐Buktenica Developmental Test of Visual Motor Integration, Fifth Edition; Wide Range Achievement Test, Fourth Edition; and Integrated Visual and Auditory Continuous Performance Test. Parents completed the Conners 3 Parent Short Form and the Personality Inventory for Children, Second Edition.ResultsIn this small group, other risk factors for neurodevelopmental disorders were often present, including preterm birth, perinatal hypoxia, and a family history of psychiatric disease or substance abuse. Within this sample, the proportion of children with a pattern of test results showing poorer nonverbal intelligence than verbal intelligence scores and poorer math than reading performance, as well as meeting criteria for a diagnosis of attention deficit/hyperactivity disorder, was higher than the basal rates of these problems among children in general.ConclusionsParticularly given the complexity of various factors affecting neurodevelopment, follow‐up neuropsychological evaluation is warranted in children with sonographic evidence of mild isolated cerebral ventriculomegaly without asymmetry of the lateral ventricle (eg, in the context of poor school performance).
Diagnostic Utility of Sonography and Correlation Between Sonographic and Clinical Findings in Patients With Carpal Tunnel Syndrome
Authors: Tajika Tsuyoshi , Kobayashi Tsutomu , Yamamoto Atsushi , Kaneko Tetsuya , Takagishi Kenji 
Published: October 2013

ObjectivesFirst, we investigated the accuracy of carpal tunnel syndrome diagnosis by comparing the cross‐sectional area of the median nerve measured at the level of proximal inlet of the carpal tunnel with that measured at the level of the distal radioulnar joint on sonography. Second, we evaluated the correlation between sonographic and neurophysiologic findings and clinical findings assessed by the Carpal Tunnel Syndrome Instrument of the Japanese Society for Surgery of the Hand (JSSH).MethodsFifty wrists in 34 patients and 81 wrists in 45 healthy volunteers were examined. The proximal cross‐sectional area and the difference (Δ) between the proximal and distal cross‐sectional areas were calculated for each wrist. Nerve conduction velocity tests were performed for all patients with carpal tunnel syndrome. The proximal, distal, and Δ cross‐sectional areas were compared for the two groups. We examined the correlation between the proximal, distal, and Δ areas, nerve conduction velocity findings, and JSSH scores in the patients.ResultsThe diagnosis of carpal tunnel syndrome determined by the Δ cross‐sectional area was more accurate than the diagnosis determined by the proximal area on receiver operating characteristic curve analysis (P = .006). Statistically significant correlations were found between proximal area, Δ area, and nerve conduction velocity findings (proximal, r = 0.45; P = .0013; Δ, r = 0.44; P = .001). The proximal and distal areas were positively correlated with the JSSH symptom severity score (proximal, r= 0.39; P= .005; distal, r = 0.35; P = .014).ConclusionsThe cross‐sectional area method using sonography has excellent performance for diagnosing carpal tunnel syndrome. It was useful for measuring the proximal and distal cross‐sectional areas to evaluated the symptom severity and for calculating the Δ cross‐sectional area to assess motor nerve damage in patients with carpal tunnel syndrome.
Focused Renal Sonography Performed and Interpreted by Internal Medicine Residents
Authors: Caronia Jonathan , Panagopoulos Georgia , Devita Maria , Tofighi Babak , Mahdavi Ramyar , Levin Benjamin , Carrera Louis , Mina Bushra 
Published: October 2013

ObjectivesIntensivist‐performed focused sonography, including renal sonography, is becoming accepted practice. Whether internal medicine residents can be trained to accurately rule out renal obstruction and identify sonographic findings of chronic kidney disease is unknown. The purpose of this study was to test the ability of residents to evaluate for this specific constellation of findings.MethodsInternal medicine residents were trained in a 5‐hour module on focused renal sonography evaluating renal length, echogenicity, hydronephrosis, and cysts on a convenience sample of medical ward, intermediate care, and medical intensive care unit patients. All patients underwent comprehensive sonography within 24 hours. The primary outcome was represented by the Fleiss κ statistic, which indicated the degree of interobserver agreement between residents and radiologists. Sensitivity, specificity, and positive and negative predictive values were calculated using the comprehensive radiologist‐read examination as the reference.ResultsSeventeen internal medicine residents imaged 125 kidneys on 66 patients. The average number of studies performed was 7.3 (SD, 6.6). Residents demonstrated excellent agreement with radiologists for hydronephrosis (κ = 0.73; P < .001; SE, 0.15; sensitivity, 94%; specificity, 93%), moderate agreement for echogenic kidneys (κ = 0.43; P < .001; SE, 0.13; sensitivity, 40%; specificity, 98%), and substantial agreement for renal cysts (κ = 0.61; P < .001; SE, 0.12; sensitivity, 60%; specificity, 96%). Residents showed sensitivity of 100% and specificity of 88% for identification of atrophic kidneys, defined as length less than 8 cm.ConclusionsAfter a 5‐hour training course, medical residents accurately identified hydronephrosis and key sonographic findings of chronic kidney disease in a cohort of medical patients. Screening for hydronephrosis and renal atrophy can be performed by medical residents after adequate training.
Single‐Molecule Tracking Photoactivated Localization Microscopy to Map Nano‐Scale Structure and Dynamics in Living Spines
Authors: MacGillavry Harold D. , Blanpied Thomas A. 
Published: October 2013

AbstractSuper‐resolution microscopy has rapidly become an indispensable tool in cell biology and neuroscience by enabling measurement in live cells of structures smaller than the classical limit imposed by diffraction. The most widely applied super‐resolution method currently is localization microscopy, which takes advantage of the ability to determine the position of individual fluorescent molecules with nanometer accuracy even in cells. By iteratively measuring sparse subsets of photoactivatable fluorescent proteins, protein distribution in macromolecular structures can be accurately reconstructed. Moreover, the motion trajectories of individual molecules within cells can be measured, providing a unique ability to measure transport kinetics, exchange rates, and binding affinities of even small subsets of molecules with high temporal resolution and great spatial specificity. This unit describes protocols to measure and quantify the distribution of scaffold proteins within single synapses of cultured hippocampal neurons, and to track and measure the diffusion of intracellular constituents of the neuronal plasma membrane. Curr. Protoc. Neurosci. 65:2.20.1‐2.20.19. © 2013 by John Wiley & Sons, Inc.