bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Extent of Resection Impact Survival in Patients Bearing Glioblastoma?
Authors: Dea Nicolas , Fournier-Gosselin Marie-Pierre , Mathieu David , Goffaux Philippe , Fortin David 
Published: December 2014

Background:The impact of malignant glioma resection on survival is still a matter of controversy. The lack of well-designed prospective studies as well as control of all factors in retrospective studies plays an important role in this debate. Amongst some of these uncontrolled factors, are the inclusion of different histological grades, the lack of objective methods to estimate the extent of resection and unspecified delays in post-operative imaging.Methods:We retrospectively reviewed 126 consecutive patients with glioblastoma, operated on by the senior authors at the Centre Hospitalier Universitaire de Sherbrooke, who met the following criteria: >18 years of age, newly diagnosed glioblastoma, pre-operative magnetic resonance imaging (MRI) within 2 weeks prior to surgery, and a post-operative MRI within 72 hours after surgery. Extent of tumour resection was calculated using pre and post-operative tumour delimitation on gadolinium-enhanced T1 MRI in a volumetric analysis.Results:Applying stringent specific inclusion criteria, 126 patients were retained in the analysis. The median overall survival was 271 days and the median extent of resection was 65%. Patients with more than 90% of tumour resection had a significantly better outcome, improving median survival from 225 to 519 days (P=0.006). Other factors that significantly improved survival were the use of radiotherapy, the number of regimens and type of chemotherapy used.Conclusion:A more aggressive approach combining maximal safe resection and use of salvage chemotherapy seems to confer a survival advantage for glioblastoma patients.
Diagnostic Challenges Revealed from a Neuropsychiatry Movement Disorders Clinic
Authors: Rigby Heather , Roberts-South Angela , Kumar Hrishikesh , Cortese Leonardo , Jog Mandar 
Published: December 2014

Background:Abnormal movements are frequently associated with psychiatric disorders. Optimized management and diagnosis of these movements depends on correct labeling. However, there is evidence of reduced accuracy in the labeling of these movements, which could result in sub-optimal care.Objective:To determine the consensus inter-rater reliability between a movement disorders neurologist and physicians referring from the community for phenomenology and diagnoses of individuals with co-existing psychiatric conditions and movement disorders.Method:Charts of all consecutive patients seen in a combined Movement Disorders and Neuropsychiatry Clinic between 2001-2009 were reviewed retrospectively. Consensus estimates and kappa values for inter-rater reliability were determined for phenomenology and diagnostic terms for the respective referring source and movement disorders neurologist for each patient.Results:A total of 106 charts were reviewed (62 men and 44 women). Agreement for phenomenology terms ranged from 0% (psychogenic) to 73% (tremor). Only 3 terms had kappa values that met or exceeded criteria for moderate inter-rater reliability. Agreement for diagnosis terms was highest for tardive dyskinesia (83%), drug induced tremor (33%), and drug induced parkinsonism (20%). In 18 of the 22 charts (82%), a diagnosis was made of drug induced movement disorder (DIMD) by the referring physician. In contrast, a diagnosis of DIMD was made in only 54 of 106 charts (51%) after the patients were assessed in the clinic.Conclusions:A movement disorders specialist frequently disagreed with referring physicians' identification of patient phenomenology and diagnosis. This suggests that clinicians would benefit from educational resources to assist in characterizing abnormal movements.
Improvement in Thrombolytic Therapy Administration in Acute Stroke with Feedback
Authors: Ghrooda Esseddeeg , Alcock Susan , Jackson Alan C. 
Published: December 2014

Background:The benefits of intravenous recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke is time dependent. Guidelines recommend a door-to-needle (DTN) time of less than 60 minutes.Methods:A retrospective audit of 730 stroke charts from 2008 - 2011 was conducted at Health Sciences Centre. 158 patients treated with IV rt-PA were identified. The time intervals between Emergency Department (ED) arrival, administration of rt-PA and uninfused brain computed axial tomographic scan (CT) were recorded. From this, CT to needle times were calculated. During November 2010 to January 2011 feedback was given to neurologists, ED physicians, ED nurses, and CT technologists. This raised awareness and emphasized the importance of this time driven protocol.Results:The median DTN times for 2008, 2009, and 2010 were 69, 71 and 76 minutes respectively. The median CT-to-needle time for this time period was 47 minutes. In 2011 (n =58) the median DTN time was 49 minutes and the median CT-to-needle was 18 minutes, which were marked improvements (p<0.00005 and p<0.005, respectively). In 2008-2010 only 31% of treated patients (n=100) received rt-PA within 60 minutes, whereas in 2011 this increased to 64%.Conclusions:Dramatic improvements in DTN times and in the percentage of patients receiving rt-PA treatment within 60 minutes were observed in 2011 after feedback was provided regarding the suboptimal performance. Prior to receiving feedback, DTN times were similar to national median DTN times. All centres administering rt-PA for acute ischemic stroke should monitor their clinical performance and give feedback on a regular basis.
The Technique and Cost of Radiosurgery for the Treatment of 1-3 Brain Metastases
Authors: Sharieff Waseem , Whitton Anthony , Chow Tom , Wyman Doug , Wright James , Greenspoon Jeffrey N. 
Published: December 2014

Background:Radiosurgery can be delivered through a variety of modalities including robotic and fixed gantry linacbased systems. They appear equally effective and safe. Thus, community need and costs remain the main determinants for choosing a given modality. We performed an economic evaluation to identify settings in which one modality could be preferred over the other.Methods:Using local estimates of resource volumes and unit prices, we computed the incremental cost/patient of robotic radiosurgery compared to fixed-gantry radiosurgery from a payer's perspective. By varying parameters of resource volumes, we performed a probabilistic analysis stratified by number of brain lesions. in addition, we performed sensitivity analyses to examine the effect of patient volume on cost/patient.Results:The cost of robotic radiosurgery was $4,783/patient, and cost of fixed-gantry radiosurgery was $5,166/patient. The mean incremental cost was $-383 (95% interval: $-670, $110) for all lesions, $78 ($23, $123) for solitary lesions, and $-610 ($-679, $-534) for multiple lesions. The cost/patient of robotic radiosurgery varied from $5,656 (low volume setting) to $4,492 (high volume setting).Conclusion:in settings of moderate to high volume (6-10 hours of daily operation), and in multiple lesions, robotic radiosurgery is more cost effective than fixed-gantry radiosurgery.
Normative Data for the Stroop Color Word Test for a North American Population
Authors: Morrow Sarah A. 
Published: December 2014

Background:Cognitive impairment in multiple sclerosis (MS) often involves attentional deficits. The Stroop colour word test, a measure of attention, lacks current normative data for an english-speaking North american MS population. Further some authors suggest the Stroop actually measures processing speed.Objective:To generate normative data for the Stroop colour word test that can be used for a Canadian or North american MS population and to examine the relationship between processing speed tests - the Paced auditory Serial addition Test (PASAT) and Symbol Digit Modalities Test (SDMT) - and the Stroop.Results:Data from 146 healthy subjects aged 18-56 was collected. age was significantly although weakly correlated with general intelligence (r=0.168, p=0.043) assessed with the North american adult Reading Test (NAART), and education (r=-0.313, p<0.001). No demographic variables were associated with SDMT or PASAT. age had a low-moderate negative correlation (r=-0.403, p<0.001) with Stroop scores. The mean (±standard deviation, SD) Stroop score was 45.4(10.4). The z-score can thus be calculated as [(X-45.4)/10.4]. if adjusted for age, Xadj = [X-(-0.47)(age-37.5)] and is substituted for X. in a comparison MS population consisting of 75 randomly selected patients from the MS Cognitive clinic, Stroop and PASAT performance were not related. a relationship existed between Stroop and SDMT scores but only 12.2% of the Stroop score variance was explained by the SDMT. Therefore, the Stroop measures selective attention independently of processing speed.Conclusion:This data can be used to determine impaired attention in MS patients.
Hydrogen-Rich Saline Attenuated Neuropathic Pain by Reducing Oxidative Stress
Authors: Chen Qianbo , Chen Ping , Zhou Shuangqiong , Yan Xiaodi , Zhang John , Sun Xuejun , Yuan Hongbin , Yu Weifeng 
Published: December 2014

Background:Reactive oxygen species (ROS) are often associated with persistent pains such as neuropathic and inflammatory pain. Hydrogen gas can reduce ROS and alleviate cerebral, myocardial, and hepatic ischemia/reperfusion injuries. In the present study, we aim to investigate whether hydrogen-rich saline can reduce neuropathic pain in a rat model of chronic constriction injury (CCI).Methods:Thirty SD rats were randomly divided into three groups: sham group was administered sodium chloride by intrathecal injection (n=10); control groups underwent CCI surgery and were administered sodium chloride by intrathecal injection (n=10); vehicle group underwent CCI surgery and was administered hydrogen-rich saline by intrathecal injection (n=10). Drugs were administered in the dose of 100ul/kg once a day at 0.5 hours before and 1-7 day after CCI surgery. The mechanical thresholds were tested at one day before and 3-14 day after CCI surgery.Results:We found that hydrogen-rich saline significantly elevated the mechanical thresholds of neuropathic pain compared to vehicle (physiologic saline) control in CCI rats (p<0.05); it also decreased the levels of myeloperoxidase, maleic dialdehyde, and protein carbonyl in spinal cord by 7 days post-chronic constriction injury(p<0.05). In addition, hydrogen-rich saline also suppressed the expression of p38-mitogen-activated protein kinase (p38MAPK) and brain-derived neurotrophic factor (BDNF) in the spinal cord by 7 days post-chronic constriction injury (p<0.01, p<0.01, respectively), but had no effect on P2X4R (p>0.05), an ATP receptor.Conclusion:Intrathecal injection of hydrogen-rich saline can decrease oxidative stress and the expression of p38MAPK and BDNF that may contribute to the elevated threshold of neuropathic pain in rat CCI model.
Multiple Sclerosis in Newfoundland and Labrador - A Model for Disease Prevalence
Authors: Sloka J.S. , Pryse-Phillips W.E.M. , Stefanelli M. 
Published: December 2014

Background:Newfoundland and Labrador, Canada, have been almost exclusively populated by immigrants from southwest England and southeast Ireland. The province’s population grew largely by natural increase from 20,000 people in 1835 to half a million at present. Very little interregional migration occurred within the province. This uniquely-populated region and its subsequent founder effect provide the basis to develop models of disease prevalence.Objectives:To develop a model for the regional prevalence of multiple sclerosis (MS), accounting for settlement patterns and geographic location (latitude).Methods:All living MS patients with confirmed addresses (438 patients) in the province were mailed a survey requesting their place of birth. Regional prevalences were calculated from a 75% rate of return of the survey. Theoretical regional prevalences were proportionally calculated from the source prevalences of southwest England, southeast Ireland, Scotland and the Channel Islands based on settlement patterns. These theoretical regional prevalences were corrected for geographical variations of latitude based on observations in the United Kingdom. Theoretical and actual regional prevalences were compared.Results:When actual regional prevalences were compared with theoretical prevalences, very little variation was noted, especially after correcting for variation in latitude.Conclusion:A regional variation in MS prevalence is noted in the island portion of Newfoundland and Labrador. This regional variation can be modeled by using both migration patterns and latitudinal position. This model demonstrates that the prevalence of MS is influenced by both genetic and environmental contributions.
The BRAINS Study: Safety, Tolerability, and Dose-finding of Repinotan in Acute Stroke
Authors: Teal Philip , Silver Frank L. , Simard Denis 
Published: December 2014

Background and Purpose:Repinotan is a potent, serotonin (5-HT1A) full receptor agonist that interferes with ischemia-mediated neuronal cell death in animal models. This double-blind, placebo-controlled phase II study examined the safety, tolerability, and dose of repinotan in patients with acute ischemic stroke.Methods:Patients with acute hemispheric ischemia and a National Institutes of Health Stroke Scale of 4 to 25 were randomized to placebo or repinotan 0.5, 1.25, or 2.5 mg/day (d) given by continuous intravenous infusion for 72 hours. Treatment was started within six hours of symptom onset. Evaluations were performed at four weeks and three months.Results:Among 240 patients in the safety analysis, repinotan was well-tolerated, with adverse events appearing more frequently in the highest dose group (2.5 mg/d). The most common adverse event was headache (21.3% to 35% with repinotan and 24.1% with placebo). Most (75%) adverse events were of mild or moderate severity. The most common severe adverse events were neurological worsening, cerebral hemorrhage, and brain edema. The number of deaths and serious adverse events were similar among placebo and repinotan groups. Compared to the placebo group, the proportion of patients with good outcomes at three months was greatest in the group receiving repinotan 1.25 mg/d, although the difference was not statistically significant.Conclusion:This study indicates that the incidence of adverse events was comparable with all doses of repinotan and placebo, and no safety issues were observed. A trend toward better tolerability with evidence of efficacy was observed with the repinotan 1.25 mg/d dose.Conclusion:Dans cette Étude, l’incidence des incidents thÉrapeutiques Était comparable quelle que soit la dose de repinotan par rapport au placebo et aucun problème reliÉ à la sÉcuritÉ du produit n’a ÉtÉ observÉ. On a observÉ l’efficacitÉ du repinotan à la dose de 1,25 mg/j. et une tendance à une meilleure tolÉrance du mÉdicament.
Microstent-Assisted Coiling for Wide-Necked Intracranial Aneurysms
Authors: Souza Marlise Peruzzo dos Santos , Agid Ronit , Willinsky Robert A. , Cusimano Michael , Montanera Walter , Wallace M. Christopher , terBrugge Karel G. , Marotta Thomas R. 
Published: December 2014

Objective:To describe the results, technical feasibility, efficacy and challenges encountered in our preliminary experience using a self-expandable microstent, optimized for intracranial use, as an adjunct in the endovascular treatment of wide-necked aneurysms.Methods:Only broad-necked aneurysms (dome-to-neck ratio £2, or an isolated neck size > 4.5 mm) were treated with Neuroform microstent from July 2003 to May 2004. The techniques used for stent deployment were either parallel or sequential. Angiographic results were recorded immediately for all patients and classified as Class 1 (complete occlusion), Class 2 (neck remnant) or Class 3 (sac remnant) by three interventional neuroradiologists not involved in the procedure. Follow-up angiography at six months was obtained for one case. Modified Rankin Score scale was assessed for all patients.Results:Seventeen intracranial aneurysms in a total of 18 patients were treated (mean age, 52.2 yr). Eight patients (44.4%) presented with acute subarachnoid hemorrhage. Eleven aneurysms (61.1%) were in the posterior circulation. Average dome size was 10.2 mm (range, 3.7-19.8 mm) and average neck size was 5.36 mm (range, 3.0-10.0 mm). Six out of seven aneurysms of the anterior circulation were approached with parallel technique. Eight aneurysms of the posterior circulation were approached with sequential technique. Average number of coils deployed was 9.64 (range, 4-23 coils). Eleven aneurysms (64.8%) resulted in Class 1 and/or Class 2. One technical failure was observed. Technical complications were recognized in four patients (23.5%), all of them with unruptured aneurysms in the anterior circulation. Two patients (11.7%) presented transient immediate clinical complications. One patient (5.8%) had minor permanent neurological complication. Neither major clinical complications nor death were encountered. Favorable clinical outcome (Modified Rankin Scale score 0-2) was observed in 88.2% of the patients (average follow-up time, 4.72 months).Conclusion:Absence of major permanent complications and satisfactory immediate obliteration degree in our preliminary experience indicates that microstent-assisted coiling technique is useful for the minimally invasive treatment of broad-necked complex aneurysms that are not ideal for conventional endovascular treatment and are at a high risk for conventional surgical treatment.
Cerebral Small Vessel Disease in Pseudoxanthoma Elasticum: Three Cases
Authors: Pavlovic Aleksandra M. , Zidverc-Trajkovic Jasna , Milovic Marija M. , Pavlovic Dragan M. , Jovanovic Zagorka , Mijajlovic Milija , Petrovic Mirjana , Kostic Vladimir S. , Sternic Nada 
Published: December 2014

Background:Cerebral small vessel disease is rarely described in association with pseudoxanthoma elasticum (PXE), a hereditary connective tissue disorder with skin, eye and vascular manifestations. This autosomally inherited elastic tissue disease has been attributed to mutations in the ABCC6 gene located on chromosome 16p13.1. Different stroke mechanisms are suggested in PXE patients, arterial hypertension and accelerated atherosclerosis being the leading ones.Case Descriptions:Case 1: A 49-year-old man with history of mild hypertension presented with recurrent transient ischemic attacks. At the age of 42, evaluation for progressive visual loss and skin changes led to diagnosis of PXE. Brain magnetic resonance imaging (MRI) disclosed multiple lacunar infarctions and confluent periventricular white matter lesions (WML). Case 2: A 71-year-old woman with history of mild hypertension suffered right-sided stroke. Diagnosis of PXE was made at the age of 48 due to severe visual loss and skin changes. Brain MRI revealed multiple lacunar infarctions and subcortical ischemic leukoencephalopathy. Case 3: A 47-year-old woman with prominent skin changes and bilateral amblyopia developed right-sided weakness. Skin biopsy confirmed PXE. Several lacunar infarcts in deep white matter and pons were revealed on MRI. Discussion: We present three patients with clinical and histopathological features of PXE who presented with multiple lacunar strokes, two with extensive confluent WML. These cases illustrate that PXE is a rare but significant risk factor for small vessel disease and stroke in patients of all age groups. Occlusive small vessel disease and subsequent lacunar infarcts and WML represent important PXE manifestations.
Félix Vicq d'Azyr: Anatomy, Medicine and Revolution
Authors: Parent André 
Published: December 2014

ABSTRACT:Félix Vicq d'Azyr was born in 1748 in the small town of Valognes, Normandy. He studied medicine in Paris but he was particularly impressed by the lectures given at the Jardin du Roi by the comparative anatomist Louis Daubenton and the surgeon Antoine Petit. In 1773, Vicq d'Azyr initiated a series of successful lectures on human and animal anatomy at the Paris Medical School, from which he received his medical degree in 1774. He was elected the same year at the Academy of Sciences at age 26, thanks to his outstanding contributions to comparative anatomy. Vicq d'Azyr became widely known after his successful management of a severe cattle plague that occurred in the southern part of France in 1774, an event that led to the foundation of the Royal Society of Medicine in 1778. As Permanent Secretary of this society, Vicq d'Azyr wrote several eulogies that were models of eloquence and erudition and worth him a seat at the French Academy in 1788. Vicq d'Azyr published in 1786 a remarkable anatomy and physiology treatise: a large in-folio that contained original descriptions illustrated by means of nature-sized, colored, human brain figures of a quality and exactitude never attained before. In 1789, Vicq d'Azyr was appointed physician to the Queen Marie-Antoinette and, in 1790, he presented to the Constituent Assembly a decisive plan to reform the teaching of medicine in France. Unfortunately, Vicq d'Azyr did not survive the turmoil of the French Revolution; he died at age 46 on June 20, 1794.
The “Responsibility to Prevent”: An International Crimes Approach to the Prevention of Mass Atrocities
Authors: Reike Ruben 
Published: December 2014

On September 9, 2013, diplomats and civil society activists gathered in a ballroom in New York to welcome Jennifer Welsh as the UN Secretary-General's new Special Adviser on the Responsibility to Protect (RtoP). In her first public appearance in that role, Special Adviser Welsh explained that one of her top priorities would be “to take prevention seriously and to make it meaningful in practice.” “In the context of RtoP,” Welsh added during the discussion, “we are talking about crimes, and crimes have implications in terms of how we deal with them. You'll hear me say that a lot.” Welsh's approach of treating RtoP as a principle that is primarily concerned with prevention and is firmly linked to international crimes neatly captures the evolution of RtoP since its formal acceptance by states at the 2005 UN World Summit. Paragraphs 138 to 140 of the World Summit's Outcome Document not only elevated the element of prevention to a prominent place within the principle of RtoP but also restricted the scope of RtoP to four specific crimes under international law: genocide, war crimes, ethnic cleansing, and crimes against humanity. The crime and prevention–focused version of RtoP has subsequently been defended and promoted by Secretary-General Ban Ki-moon and by UN member states. This article seeks to systematically explore some of the implications of linking RtoP to the concept of international crimes, with a particular focus on the preventive dimension of RtoP, the so-called responsibility to prevent. What, then, are the consequences of approaching the responsibility to prevent as the prevention of international crimes?In order to systematically examine this question, this article turns to literature from criminology. While the criminological perspective has so far been neglected in debates on RtoP, the prominent criminologists John Hagan and Wenona Rymond-Richmond argue vehemently that “criminology is crucially positioned to contribute understanding and direction to what the United Nations has mandated as the ‘Responsibility to Protect’ groups that are threatened with mass atrocities.” For the purpose of this article, the label “criminology” comprises domestic criminology, supranational criminology, and international criminal law. While insights from supranational criminology and international criminal law are directly applicable to international crimes, translating knowledge generated in relation to crimes at the domestic level to atrocity crimes at the international level is, of course, not without challenges. Reasoning by analogy is an important method in this regard, though given the anarchical nature of international society some analogies will inevitably be imperfect. The benefits of such an approach, if carefully employed, however, outweigh the risks.