bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neuropsychological impairment in severe acute viral hepatitis is due to minimal hepatic encephalopathy
Authors: Sharma Praveen , Sharma Barjesh Chander , Tyagi Pankaj , Kumar Manoj , Sarin Shiv Kumar 
Published: March 2010

AbstractBackground and Aims: Minimal hepatic encephalopathy (MHE) in patients with liver cirrhosis may have prognostic significance with regard to the development of clinical hepatic encephalopathy (HE) and deterioration in patient quality of life. Its prevalence in acute viral hepatitis (AVH) is not known.Patients and Methods: Consecutive 20 AVH patients (age, 29.9±7.9 years; M:F 18:2, hepatitis A:B:E: 2:16:2) without overt encephalopathy were evaluated for MHE and followed up. All patients underwent number connection tests – A and B, figure connection tests – A and B, digit symbol test and object assembly test and critical flicker frequency (CFF) at baseline and after the resolution of icterus. MHE was diagnosed if two or more psychometric tests were abnormal.Results: Prevalence of MHE (n=5) was 25%, which resolved on follow‐up during the anicteric resolution phase. Five (25%) patients had greater than two abnormal psychometry tests and four (20%) had CFF <38 Hz. CFF alone had sensitivity and specificity of 80 and 100%, respectively, in the diagnosis of MHE. There was significant difference in the performance of CFF during the icteric and resolution phase of AVH (40.6±3.4 vs 41.8±2.1 Hz, P=0.04). Arterial ammonia level were higher in patients with MHE compared with patients without MHE (88.2±23.5 vs 53.8±10.9 μmol/L, P=0.001). On univariate analysis fasting ammonia level at baseline was significantly associated with all the psychometric tests (P=0.001). None of the patients developed HE either in MHE group or in those who did not had MHE at baseline.Conclusions: MHE occurs in 25% of patients with AVH and resolves on follow up with recovery of AVH. Raised arterial ammonia during the icteric phase is associated with development of MHE.
Immunoregulatory effects of liver ablation therapies for the treatment of primary and metastatic liver malignancies
Authors: Gravante Gianpiero , Sconocchia Giuseppe , Ong Seok Ling , Dennison Ashley R. , Lloyd David M. 
Published: March 2010

AbstractAblation of liver tissue produces in situ tumoural antigens and elicits specific immune responses. The aim of this review is to examine the available data about the local and systemic responses produced and to compare differences between the methods available. A literature search was undertaken for all papers focusing on immune responses following ablative therapy of the liver, including experimental and clinical studies. Following ablative procedures, the cellular response is elicited by the presentation of antigens by dendritic cells to specific CD4+ T cells, which in turn stimulate natural killer or CD8+ cytotoxic cells. The local release of intracellular debris activates Kupffer cells to produce cytokines, which, in the immediate vicinity, activate monocytes/macrophages or specific T cells that respond and produce systemic reactions such as fever, thrombocytopaenia or shock. The immune responses elicited by cryotherapy, both cellular and cytokine, seem far greater than those produced by radiofrequency or microwave ablation, probably as a consequence of the peculiar mechanism of cell death of the former (disruptive necrosis). This mechanism is considered central to the pathogenesis of cryoshock. Ablative techniques stimulate the immune system and provide an easy way to achieve in vivo vaccination against tumoural antigens. Immunomodulatory approaches have the potential to augment the initial immune stimulation and this combined approach could pave the way to a more selective and specific method of treating liver tumours.
Nutritional Status and Cognitive Function in Community‐Living Rural Bangladeshi Older Adults: Data from the Poverty and Health in Ageing Project
Authors: Ferdous Tamanna , Cederholm Tommy , Kabir Zarina Nahar , Hamadani Jena Derakhshani , Wahlin Åke 
Published: March 2010

OBJECTIVES: To investigate the association between nutritional status and general and specific (fluid and crystallized) cognitive functioning in a group of older people living in a rural area in Bangladesh.DESIGN: Cross‐sectional study.SETTING: Matlab, Bangladesh.PARTICIPANTS: Four hundred fifty‐seven randomly selected persons aged 60 and older (mean age 69.5 ± 6.8), 55% female.MEASUREMENTS: Nutritional status was evaluated using a modified form of the Mini Nutritional Assessment (MNA). General cognitive function was assessed using the Bangla Adaptation of the Mini‐Mental State Examination, and a word synonym test was used to test semantic memory function (a crystallized ability). To assess cognitive processing speed (a fluid ability), “cross balls” and “complete boxes” tests (scores/time unit) were used. Clinical diagnoses were registered. Structured questionnaires were used to assess demographic and socioeconomic status of the participants.RESULTS: Twenty‐six percent of the participants were undernourished, and 62% were at risk of malnutrition according to the MNA. The MNA scores were significantly lower in women than in men (P=.01). Women performed worse than men in all three cognitive tasks (P<.001). Poorer cognitive performance was independently associated with older age, female sex, illiteracy, visual impairment, severity of disease, and depressive symptoms. There were significant associations between better nutritional status and better cognitive performance tests of general ability and processing speed, whereas semantic memory appeared to be less affected.CONCLUSION: The association between nutritional status and cognitive function involves general and specific cognitive abilities, with fluid ability seeming to be affected but crystalized functions being relatively spared.
Evaluation of the Potential for Bloodborne Pathogen Transmission Associated with Diabetes Care Practices in Nursing Homes and Assisted Living Facilities, Pinellas County
Authors: Thompson Nicola D. , Barry Vaughn , Alelis Karen , Cui Dongming , Perz Joseph F. 
Published: March 2010

OBJECTIVES: To evaluate and characterize routine blood glucose monitoring practices in nursing homes and assisted living facilities (ALFs).DESIGN: Cross‐sectional, self administered survey and facility site visit.SETTING: Two hundred eighty‐nine licensed long‐term care facilities in Pinellas County, Florida.PARTICIPANTS: Stratified random sample of 48 long‐term care facilities (17% overall sample).MEASUREMENTS: Data on facility characteristics, infection control policies, staff practices, and equipment used for blood glucose monitoring. Differences between facilities in each stratum were compared and evaluated using the Pearson chi‐square or Fisher exact test.RESULTS: Fifteen nursing homes and 17 small and 16 large ALFs participated; 53 declined (48% participation rate). Bloodborne pathogen training (P=.02), hepatitis B vaccination (P=.003), and blood glucose monitoring (P<.001) policies were reported less often at ALFs. Staff glove use during blood glucose monitoring was lowest (50%) at small ALFs (P=.02). Reusable fingerstick devices intended for personal use were most often in use at ALFs (P<.001); four of 18 facilities (including 1 nursing home) were inappropriately using them for multiple residents. At 22 facilities (including all nursing homes), multiple residents shared blood glucose meters; only six (27%) reported cleaning them after each use.CONCLUSION: Despite existing recommendations, practices that facilitate bloodborne pathogen transmission during blood glucose monitoring were identified at nursing homes and ALFs. Infection control practices and polices were most often lacking at ALFs. Better training and oversight of blood glucose monitoring in long‐term care is needed to prevent transmission of bloodborne pathogens.
Rheumatoid Leptomeningitis: Magnetic Resonance Imaging and Pathologic Findings—A Case Report
Authors: Cianfoni Alessandro , Falcone Carlo , Faustini Francesca , Lauriola Libero , Imbesi Steven , Marca Giacomo Della , Zoli Angelo , Colosimo Cesare 
Published: March 2010

ABSTRACTBACKGROUND AND PURPOSE Rheumatoid arthritis (RA) is a chronic inflammatory multisystem disease with articular and extra‐articular manifestations. Intracranial manifestations of RA are rare. Purpose of this article is to report on a rarely described leptomeningeal involvement in RA, and on its neuroimaging features, including diffusion‐weighted imaging (DWI). METHODS The authors describe the case of a 74‐year‐old woman with a 5‐year history of RA presenting with progressive left‐side weakness and hypoesthesia. The patient underwent laboratory investigation and brain contrast‐enhanced MRI, also with DWI, before undergoing brain biopsy. RESULTS Neuroimaging revealed abnormal high T2‐signal in right frontal and parietal lobes, restricted diffusion in the subarachnoid space, and diffuse thick linear leptomeningeal contrast‐enhancement. These findings were interpreted as rheumatoid leptomeningitis, and brain biopsy confirmed this diagnosis. CONCLUSIONS In summary, rheumatoid meningitis is a rare neurological complication of RA, but it should be considered in the proper clinical setting when patient presentation and laboratory results fail to support the other differential diagnostic possibilities proposed by the MR imaging findings.
Extravasating Contrast Material on Angiography Following Carotid Angioplasty and Stenting: Not Necessarily Subarachnoid Hemorrhage
Authors: Sharma Pranshu , Poppe Alexandre Y. , Eesa Muneer , Steffanhagan Nikolai , Hudon Mark , Morrish William 
Published: March 2010

ABSTRACT We describe a case of asymptomatic extravasation of iodinated contrast material into the sulci on digital subtraction angiography following carotid angioplasty and stenting resulting in sulcal hyperdensity on computed tomography (CT). We believe the mechanism for this observation is hyperperfusion injury and that in the absence of any associated clinical signs, it should not be considered alarming for subarachnoid hemorrhage.
Treatment of Vertebral Artery Origin Stenosis with Anti‐Proliferative Drug‐Eluting Stents
Authors: Edgell Randall C. , Yavagal Dileep R. , Drazin Doniel , Olivera Raul , Boulos Alan S. 
Published: March 2010

ABSTRACTBACKGROUND Vertebral artery origin stenosis is a known cause of stroke that is treatable with angioplasty and stenting. Previous studies have demonstrated that this technique is safe but is limited by high rates of in‐stent stenosis. Anti‐proliferative drug‐eluting stents are an alternative for reducing in‐stent stenosis at the vertebral artery origin. METHODS This retrospective study included five consecutive patients treated with anti‐proliferative drug‐eluting stents. The patients' demographics, indications for treatment, procedural technique, and clinical and radiographic follow‐up are presented along with a review of the literature. RESULTS No peri‐procedural complications occurred. One patient had a transient ischemic attack (TIA) during the follow‐up period. No patients had hemodynamically significant (>50%) in‐stent stenosis at follow‐up. Among the 287 cases reported in the literature, there were two strokes (.7%), four TIAs (1.4%), and no procedurally related deaths. Among patients undergoing angiographic follow‐up, 26% were found to have >50% in‐stent stenosis. CONCLUSIONS Anti‐proliferative drug‐eluting stents hold promise for reducing in‐stent stenosis at the vertebral artery origin.
Pathophysiology and Long‐Term Outcome of Reversible Tumor‐Like Lesions Induced by Presenting Status Epilepticus
Authors: Canas Nuno , Soares Pedro , Calado Sofia , Pestana Ricardo , Ribeiro Constança , Vale José 
Published: March 2010

ABSTRACTBACKGROUND AND PURPOSE Within the spectrum of reversible neuroimaging abnormalities induced by status epilepticus (SE) tumor‐like lesions (TLL) have been rarely described. Their etiology, pathophysiology, and long‐term outcome remain uncertain. These issues could be clarified by long‐term magnetic resonance imaging (MRI) studies in TLL induced by presenting SE. METHODS Prospective multi‐sequence MRI and clinical and electroencephalographic long‐term (18 to 60 months) follow‐up studies were performed in 3 patients with reversible TLL induced by presenting SE. RESULTS In the peri‐ictal MRI, TLL are hypointense in T1‐weighted, hyperintense in T2‐weighted, and fluid‐attenuated inversion recovery images with a marked subcortical component and sulci effacement. The diffusion and MR‐spectroscopy studies disclosed intermixed areas of increased/decreased diffusivity associated with a lactate peak and a decreased N‐acetylaspartate. At long‐term follow‐up, none of the patients had seizure recurrence or electroencephalographic epileptiform abnormalities; MRI showed residual focal atrophy and gliosis associated with neuronal loss/dysfunction. CONCLUSIONS SE per se may induce TLL. MRI multi‐sequence studies disclosed that they are mainly formed by focal vasogenic and cytotoxic edema resulting from the hypermetabolism associated with seizure activity. In spite of a clinical favorable long‐term outcome, the demonstration of irreversible brain damage argues in favor of immediate treatment of SE.
Pilot Study of New Diagnostic Criteria for Middle Cerebral Artery Stenosis by Transcranial Doppler
Authors: Hao Qing , Gao Shan , Leung Thomas Wai Hong , Guo Ming Hui , You Yong , Wong Ka Sing 
Published: March 2010

ABSTRACTBACKGROUND AND PURPOSE Current criteria for middle cerebral artery (MCA) stenosis by transcranial Doppler were mainly based on the flow velocity acceleration, ignoring other useful parameters. We tested the accuracy of new criteria using magnetic resonance angiography (MRA) as the confirmative method. METHODS A compositive score for each MCA was calculated according to following parameters: Velocity Scale (score 0‐6 for peak systolic velocity <140 to ≥300 cm/second), Hemodynamic Scale (score 0‐5 for diffuse or focal velocity increase; score 0‐6 for differences between bilateral MCA; score 17 for damping velocity), and Spectrum Scale (score 0‐2 for normal spectrum, turbulence, and musical murmurs). RESULTS The median scores in normal‐mild, moderate, and severe groups on MRA differed significantly (P < .001). The optimal cutoff score for <50% and ≥50% stenosis was 3 with the PPV of 72.3% (95% confidence interval [CI]: 65.3% to 78.5%) and negative predictive value (NPV) of 89.5% (95% CI: 85.9% to 92.3%), for moderate and severe stenosis was 6 with the PPV of 85.9% (95% CI: 76.7% to 92.0%) and NPV of 61.9% (95% CI: 50.6% to 72.1%). Both scores performed better than peak systolic or mean velocity. CONCLUSIONS This new method was feasible and reliable and showed some advantages over the velocity‐only method. Further studies using digital subtraction angiography as the gold standard are needed to ameliorate the new criteria.
High‐Resolution Phased‐Array MRI of the Human Brain at 7 Tesla: Initial Experience in Multiple Sclerosis Patients
Authors: Metcalf Meredith , Xu Duan , Okuda Darin T. , Carvajal Lucas , Srinivasan Radhika , Kelley Douglas A.C. , Mukherjee Pratik , Nelson Sarah J. , Vigneron Daniel B. , Pelletier Daniel 
Published: March 2010

ABSTRACT Recent advancement for magnetic resonance imaging (MRI) involves the incorporation of higher‐field strengths. Although imagers with higher magnetic field strengths were developed and tested in research labs, the direct application to patient MR studies have been extremely limited. Imaging at 7 Tesla (7T) affords advantages in signal‐to‐noise ratio and image contrast and resolution; however, these benefits can only be realized if the correct coils exist to capture the images. The objective of this study was to develop optimized high‐resolution 7T MRI techniques using high sensitivity, specialized phased‐array coils, for improved gray matter (GM) and white matter differentiation, in an effort to improve visualization of multiple sclerosis (MS) lesions in vivo. Twenty‐three subjects were enrolled in this preliminary study, 17 with clinically definite MS (11 females, 6 males; mean age 43.4 years; range 22‐64 years) and 6 healthy controls (2 females, 4 males; mean age 39.0 years; range 27‐67 years). MR imaging of MS patients at 7T was demonstrated to be safe, well tolerated, and provided high‐resolution anatomical images allowing visualization of structural abnormalities localized near or within the cortical layers. Clear involvement of the GM was observed with improved morphological detail in comparison to imaging at lower‐field strength.
Frequency of Microemboli Signal in Stroke Patients Treated with Low Molecular Weight Heparin or Aspirin
Authors: Hao Qing , Chang Hui Meng , Wong Meng Cheong , Wong Ka Sing , Chen Christopher 
Published: March 2010

ABSTRACTBACKGROUND AND PURPOSE Microemboli signal (MES) detected by transcranial Doppler (TCD) may represent ongoing embolic phenomenon and is a predictor of recurrent stroke or transient ischemic attack. We sought to study the frequency of MES in stroke patients with large artery occlusive diseases treated with low molecular weight heparin (LMWH) or aspirin. METHODS Patients participating in the Fraxiparine in Ischemic Stroke (FISS)‐tris study were recruited. MES detection was performed from middle cerebral artery on the 1st, 3rd, and 7th days after randomization. The correlation between the presence of MES and the treatment was determined by the χ2 test. RESULTS Among 47 patients, 26 were randomized to LMWH and 21 to aspirin. On day 1, MES were detected in 10 patients (7/26 on LMWH, 3/21 on aspirin; P= .475). On day 3, 12 patients had MES (7/25 on LMWH, 5/20 on aspirin; P= .821). On day 7, 11 patients had MES (6/25 on LMWH, 5/20 on aspirin; P= .938). The median of the number of MES on days 1, 3, and 7 was 4 (range 1‐10), 5 (range 1‐42), and 3 (range 1‐33) for the LMWH group and 1 (range 1‐15), 4 (range 1‐10), and 2 (range 1‐4) for the aspirin group. CONCLUSIONS There were no significant differences in the frequency of MES between patients with large artery occlusive disease treated with LMWH and aspirin.
Iron Foreign Body in the Optic Nerve without Ocular Siderosis
Authors: Hwang Yih‐Shiou , Lin Ken‐Kuo , Chen Kuan‐Jen , Lai Chi‐Chun 
Published: March 2010

ABSTRACTBACKGROUND AND PURPOSE An intraocular iron foreign body may cause many ocular complications, sometimes even blindness. Therefore, if possible, it should be removed to avoid ocular siderosis. We report a case in which a foreign body was trapped in the optic nerve and could not be removed. After a 2‐year follow‐up, no ocular siderosis or progressive deterioration in vision was found. This is the first case report of a foreign body in the optic nerve behind the eyeball in the PubMed literature. METHODS The authors describe the case of a 33‐year‐old man with an ocular trauma history at work. A metal iron foreign body was trapped in the optic nerve behind the eyeball, which was demonstrated by computed tomography. RESULTS There was no significant vision change and ocular siderosis by electroretinogram after 2 years of follow‐up. CONCLUSIONS Intra‐optic‐nerve foreign body may have a better ocular prognosis. Siderosis may not be seen in patients with optic nerve iron foreign body. Intraocular foreign body should be accurately studied before surgical procedures.
Reversed Flow in the External Carotid Artery Despite a Patent but Stenosed Common Carotid Artery
Authors: Savva Elena , Sztajzel Roman , Landis Theodor , Perren Fabienne 
Published: March 2010

ABSTRACTBACKGROUND AND PURPOSE Occlusion of the common carotid artery (CCA) is generally associated with an occlusion of the ipsilateral internal carotid artery (ICA) or of the external carotid artery (ECA) or of both. Sometimes, collateral circulation to the ECA may preserve patency of the ICA via retrograde perfusion through the bulb. We herewith report a case of reversed flow in the ECA in the presence of a patent but stenosed CCA as diagnosed with color‐coded duplex flow imaging (CDFI). CASE REPORT This 85‐year‐old right‐handed man was admitted for rapidly regressive acute dysarthria associated with left hemiparesis. Diffusion‐weighted magnetic resonance (MR) imaging showed an acute ischemic lesion in the territory of the right middle cerebral artery. MR angiography showed patency of the right ICA and ECA but an occlusion of the CCA was suspected. CDFI demonstrated patency of the right CCA with a high‐resistance pattern due to a large, partially calcified, stenosing atheromatous plaque. Surprisingly, reversed flow was observed in the right ECA of which signal was dampened. CONCLUSION Collateralization with reversed flow in the ECA may occur in a patent but stenosed CCA associated with a high‐grade stenosis of the carotid bifurcation. CDFI is a very useful tool to detect such hemodynamic conditions.
MR Atypical Wernicke Encephalopathy Showing Extensive Brain Stem and Diencephalic Involvement
Authors: Nardone Raffaele , Venturi Alessandro , Golaszewski Stefan , Caleri Francesca , Tezzon Frediano , Ladurner Gunther 
Published: March 2010

ABSTRACT Wernicke encephalopathy (WE) is a serious neurological disorder caused by thiamine (vitamin B1) deficiency. We report a case of atypical and extensive location of abnormal signal lesions on magnetic resonance imaging (MRI) in a man with alcohol abuse with WE. MRI performed on the first hospital day showed signal intensity alterations extending in the whole brain stem and diencephalon; the mismatch between diffusion‐weighted images and apparent diffusion coefficient map was highly suggestive of vasogenic edema. This report further supports the view that WE may represent a spectrum of radiological entities and can have a wide spectrum of manifestations on MRI; thus, clinical features are essential to diagnose it.
Prefrontal Compensatory Mechanism May Enable Normal Semantic Memory Performance in Mild Cognitive Impairment (MCI)
Authors: Gigi Ariela , Babai Reuven , Penker Avichen , Hendler Talma , Korczyn Amos D. 
Published: March 2010

ABSTRACT Mild cognitive impairment (MCI) is considered as a potential transitional state between normal aging and dementia. Studies addressing semantic memory in patients with incipient dementia and MCI show inconsistent results. In the current report we focused on MCI and examined memory performance (semantic, episodic, and working memory) in addition to structural and functional magnetic resonance imaging (fMRI) measurements. We studied 6 MCI, 6 normal controls, and 4 Alzheimer disease (AD) patients. MCI participants demonstrated normal semantic memory performance while fMRI examination revealed distinct patterns of activations between MCI and normal aged subjects. According to our previous study, time courses were taken from parietal, dorsolateral‐prefrontal‐cortex (DLPFC), hippocampal formation, and fusiform gyri. A small number of activated voxels in parietal regions were depicted in MCI participants and were correlated with structural changes in this region. In contrast, significantly higher activation (intensity and number of voxels) was observed in DLPFC of MCI subjects. The overactivity seen in DLPFC of MCI may represent a compensatory mechanism that enables them to perform normally. These preliminary results suggest that functional imaging may be useful for early diagnosis of dementia and call to develop reliable tests and criteria that will enable using such methods clinically.