Πέμπτη 19 Νοεμβρίου 2020

What are the symptoms of idiopathic intracranial hypertension? Changes in eyesight such as blurry vision or double vision. Vision loss, especially in the peripheral vision. Feeling dizzy or nauseated. Vomiting. Neck stiffness. Trouble walking. Frequent headaches, often along with nausea or vomiting.

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Abstract

Background

Isolated onset of intracranial hypertension due to spinal cord tumor is rare, thus, easily leading to misdiagnosis and delay in effective treatment.

Case presentation

Herein, we describe a 45-year-old female patient who manifested isolated symptoms and signs of intracranial hypertension and whose condition was initially diagnosed as idiopathic intracranial hypertension and transverse sinus stenosis. The patient received a stent implantation; however, no improvements were observed. One year later her symptoms exacerbated, and during rehospitalization a spinal imaging examination revealed a lumbar tumor. Pathologic evaluation confirmed schwannoma, and tumor resection significantly improved her symptoms, except for poor vision.

Conclusions

Space-occupying lesions of the spine should be considered in the differential diagnosis of idiopathic intracranial hypertension, even in the absence of spine-localized signs or symptoms.

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Intracranial hypertension due to spinal cord tumor misdiagnosed as pseudotumor cerebri syndrome: case report

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Abstract

Background

Isolated onset of intracranial hypertension due to spinal cord tumor is rare, thus, easily leading to misdiagnosis and delay in effective treatment.

Case presentation

Herein, we describe a 45-year-old female patient who manifested isolated symptoms and signs of intracranial hypertension and whose condition was initially diagnosed as idiopathic intracranial hypertension and transverse sinus stenosis. The patient received a stent implantation; however, no improvements were observed. One year later her symptoms exacerbated, and during rehospitalization a spinal imaging examination revealed a lumbar tumor. Pathologic evaluation confirmed schwannoma, and tumor resection significantly improved her symptoms, except for poor vision.

Conclusions

Space-occupying lesions of the spine should be considered in the differential diagnosis of idiopathic intracranial hypertension, even in the absence of spine-localized signs or symptoms.

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Validity of the Japanese core outcome measures index (COMI)-neck for cervical spine surgery: a prospective cohort study

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Abstract

Purpose

To investigate the psychometric properties of the Japanese version of the Core Outcome Measures Index-Neck (COMI-Neck) in patients undergoing cervical spine surgery.

Methods

A total of 177 patients undergoing cervical spine surgery for spinal disorders from April to December 2017 were enrolled. Patient-reported outcomes (PROs) included EuroQOL, Neck Disability Index, and treatment satisfaction. To address whether the questionnaire's scores relate to other outcomes based on a predefined hypothesis, the correlations between the COMI-Neck and the other PROs were measured (Spearman's rank correlation coefficients). The minimum clinically important difference (MCID) of the COMI summary score was calculated using the receiver operating characteristic (ROC) curve with a 7-point Likert scale of satisfaction with the treatment results. To assess reproducibility, another group of 59 volunteers with chronic neck pain were asked to reply to the COMI-Neck twice with an interval of 7–14 days.

Results

The COMI summary score showed no floor or ceiling effects preoperatively or postoperatively. Each of the COMI domains and the COMI summary score correlated to the hypothesized extent with the scores of the reference questionnaires (ρ = 0.40–0.79). According to the ROC curve with satisfaction (including "very satisfied" and "satisfied"), the area under the curve and MCID of the COMI summary score were 0.78 and 2.1. The intraclass correlation coefficient and the minimum detectable change (MDC 95%) of the COMI summary score were 0.97 and 0.77.

Conclusion

The Japanese version of the COMI-Neck is valid and reliable for Japanese-speaking patients with cervical spinal disorders.

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Analytical solitary wave solution of dust ion acoustic waves in nonextensive plasma in the framework of damped forced Korteweg–de Vries–Burgers equation

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Abstract

Dust ion acoustic waves (DIAWs) are investigated analytically in the framework of damped forced Korteweg–de Vries–Burgers (DFKdVB) equation in an unmagnetized collisional dusty plasma consisting of negatively charged stationary dust grains, positively charged ions and q-nonextensive distributed electrons. Reductive perturbation technique is used to obtain the DFKdVB equation for DIAWs. The effects of different physical parameters such as the entropic index (q), ratio of unperturbed number densities of electrons and ions \((\mu )\) , dust ion collision frequency \((\nu _{\mathrm{id}0})\) , kinematic viscosity ( \(\eta _0\) ), the speed of the traveling wave \((M_0)\) , strength \((f_0)\) and frequency \((\omega )\) of the external periodic force on the analytical DIAWs are shown. The results of the present paper will be useful in laboratory and space plasmas.

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Investigation of the relationship of the number, localization, and displacement of rib fractures with intrathoracic structures and abdominal solid organ complications using computed tomography

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Abstract

Purpose

This study aimed at evaluating the fracture properties, intrathoracic structures, and abdominal solid organ complications in patients with traumatic rib fractures.

Methods

Chest CT images of 305 patients were retrospectively evaluated to determine the number and level of rib fractures and measure the magnitude of displacement. The relationship of rib fractures and displacement patterns with intrathoracic structures and abdominal solid organ complications was investigated.

Results

The fractures were most located in the fifth, sixth, and seventh ribs. The mean age of the patients with displaced fractures was statistically significantly higher than the non-displaced fracture group with pneumothorax, hemothorax or lung injury. RibScore was statistically significantly higher in patients with pneumothorax, hemothorax, and lung parenchyma injury, as well as those with liver, spleen, and kidney injury. Hepatic, splenic, and renal injuries were markedly higher in patients with displaced fractures, but this was not statistically significant. Spleen and kidney injuries were statistically significantly more frequent among the patients with the fractures of the 10th to 12th ribs. The rib fracture displacement cut-off values for pneumothorax, hemothorax, and lung injury were found to be 2.18 mm, 2.32 mm, and 2.82 mm, respectively.

Conclusion

The presence of a displaced rib fracture is a strong predictor of intrathoracic complications. A more careful intrathoracic evaluation of rib fractures with more than 2 mm displacement will contribute to patient management.

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Treatment Pattern and Outcomes in Newly Diagnosed Multiple Myeloma Patients Who Did Not Receive Autologous Stem Cell Transplantation: A Real-World Observational Study

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Abstract

Introduction

The objective of this study was to describe the treatment patterns among patients with newly diagnosed multiple myeloma (MM) who had not received autologous stem cell transplantation (ASCT). It further compares the safety and clinical outcomes across different frontline regimens as well as explores whether treatment duration predicts outcomes.

Methods

Patients with MM (> 45 years) who had not received ASCT were retrospectively identified from the US SEER-Medicare (Jan 2007–Dec 2016) and Optum (Jan 2007–Sep 2018) databases. Cox proportional hazard models were used to compare overall survival (OS) among bortezomib + lenalidomide + dexamethasone regimen (VRd), lenalidomide + dexamethasone regimen (Rd), cyclophosphamide + bortezomib + dexamethasone regimen (CyBorD), bortezomib + dexamethasone regimen (Vd), and other bortezomib-containing therapies based on propensity score matching. To address immortal time bias, time-fixed and time-dependent Cox models were employed to estimate the association of longer frontline treatment exposure with outcomes.

Results

Mean (standard deviation; SD) age was 71 (9.8) years; and 49.51% were women. Bortezomib and lenalidomide-based combinations were the most common treatment modalities. After matching, the HR (95% CI) of OS by frontline therapies comparing VRd with Vd was 0.76 (0.66, 0.86), CyBorD was 0.87 (0.75, 1.05), for other bortezomib-based therapies was 0.56 (0.49, 0.64), Rd was 0.83 (0.73, 0.95), and for other therapies was 0.70 (0.61, 0.80). Longer frontline treatment duration was associated with better OS for overall frontline [HR (95% CI) 0.86 (0.82, 0.90)]; Vd [0.81 (0.74, 0.89)]; CyBorD [0.79 (0.64, 0.98)] and Rd [0.86 (0.78, 0.95)].

Conclusion

Results demonstrated that the frontline therapies prescribed to most patients who did not receive ASCT for MM in the United States were consistent with the NCCN guideline recommendations. Longer frontline treatment duration was associated with improved OS.

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Preparation of melamine–formaldehyde resin-microencapsulated ammonium polyphosphate and its application in flame retardant rigid polyurethane foam composites

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Abstract

Melamine–formaldehyde resin-microencapsulated ammonium polyphosphate (MFAPP) was prepared by in situ polymerization using melamine–formaldehyde (MF) resin as the shell material. MFAPP was characterized by X-ray photoelectron spectroscopy (XPS), Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), and scanning electron microscopy (SEM), which confirmed its successful fabrication. MFAPP was further introduced to prepare rigid polyurethane foam/microencapsulated ammonium polyphosphate composites (RPUF/MFAPP). The flame retardancy, water resistance, physical properties, and thermal stability of RPUF/MFAPP were compared with virgin RPUF and RPUF/APP composite. RPUF/MFAPP30 possessed excellent flame retardancy. Even after immersion in water for 15 days, RPUF/MFAPP30 achieved V-1 rating in UL-94 test with limiting oxygen index (LOI) of 21.3 vol%, which was better than that of RPUF/APP30 with equivalent APP loading. The compressive strength of RPUF/MFAPP30 was 0.295 MPa, which was 13.5% higher than that of RPUF/APP30. Thermogravimetric analysis-Fourier transform infrared spectroscopy (TGA-FTIR) was applied to investigate gaseous products of the decomposition process for RPUF/APP and RPUF/MFAPP. It was found that the intensities of CO2, isocyanate compounds, and CO for RPUF/MFAPP were lower than the values for RPUF/APP, indicating superior fire safety of RPUF/MFAPP. SEM and Raman spectra confirmed that RPUF/MFAPP30 possessed more compact char residue with higher thermal resistance, which was thus better able to inhibit mass and heat transmission in combustion. Consequently, a possible gas–solid flame-retardant mechanism of the RPUF/MFAPP composite was proposed.

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Preparation and characterization of PSF-TiO 2 hybrid hollow fiber UF membrane by sol–gel method

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Abstract

Organic–inorganic hybrid polysulfone (PSF)-titanium dioxide (TiO2) hollow fiber ultrafiltration (UF) membranes were prepared by sol–gel process and dry–wet spinning method. The effects of added TiO2 nanoparticles on membranes properties and morphologies were investigated by SEM, FT-IR, DSC, contact angle goniometer, UF experiments and so on. The results show that the membrane is a double-row finger-like pore structure, and with the increase of TiO2 content, the volume of finger-like pores increases first and then decreases. The organic–inorganic network structure forms between the TiO2 nanoparticles and the PSF chain introduced by the sol–gel method leads to an increase in the porosity, mechanical strength and thermal stability of the membrane. The addition of TiO2 improves the hydrophilicity, permeability and anti-fouling properties of the membrane. However, high TiO2 concentratio n induces nanoparticles aggregate, resulting in the decline of hydrophilicity, permeability and anti-fouling properties. So added the right amount of TiO2 nanoparticles can give the membrane better UF performance, mechanical properties and antifouling properties as well as longer service life.

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Effects of socioeconomic status on cancer patient survival: counterfactual event-based mediation analysis

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Abstract

Purpose

This study investigated the direct and indirect effects of socioeconomic status (SES) on the survival time of cancer patients by using cancer stage to create a pathway from SES to health outcomes and facilitate a mechanistic inference.

Methods

Both a traditional mediation analysis and a counterfactual event-based mediation analysis were applied to SEER (The Surveillance, Epidemiology, and End Results) data from the National Cancer Institute of the United States. A Cox proportional hazards model for survival analysis was performed in the mediation analysis.

Results

The counterfactual event-based mediation analysis showed that the effect of SES on survival time was partially mediated by stage at diagnosis in lung (12%), liver (14.33%), and colorectal (9%) cancers. Investigation of the fundamental mechanism involved thus established the direct effect of SES on survival time and the indirect effect of SES on survival time through stage at diagnosis. Moreover, the mediation analysis also revealed that the disparity in timely diagnosis (i.e., stage at diagnosis) caused by SES was slightly significant.

Conclusions

SES can either affect cancer survival directly or indirectly through stage at diagnosis. Opportunities to reduce cancer disparity exist in the design of early detection policies or mechanisms for patients with varying resources.

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Functional genomic analyses uncover APOE -mediated regulation of brain and cerebrospinal fluid beta-amyloid levels in Parkinson disease

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Abstract

Alpha-synuclein is the main protein component of Lewy bodies, the pathological hallmark of Parkinson's disease. However, genetic modifiers of cerebrospinal fluid (CSF) alpha-synuclein levels remain unknown. The use of CSF levels of amyloid beta1–42, total tau, and phosphorylated tau181 as quantitative traits in genetic studies have provided novel insights into Alzheimer's disease pathophysiology. A systematic study of the genomic architecture of CSF biomarkers in Parkinson's disease has not yet been conducted. Here, genome-wide association studies of CSF biomarker levels in a cohort of individuals with Parkinson's disease and controls (N = 1960) were performed. PD cases exhibited significantly lower CSF biomarker levels compared to controls. A SNP, proxy for APOE ε4, was associated with CSF amyloid beta1–42 levels (effect = − 0.5, p = 9.2 × 10−19). No genome-wide loci assoc iated with CSF alpha-synuclein, total tau, or phosphorylated tau181 levels were identified in PD cohorts. Polygenic risk score constructed using the latest Parkinson's disease risk meta-analysis were associated with Parkinson's disease status (p = 0.035) and the genomic architecture of CSF amyloid beta1–42 (R2 = 2.29%; p = 2.5 × 10−11). Individuals with higher polygenic risk scores for PD risk presented with lower CSF amyloid beta1–42 levels (p = 7.3 × 10−04). Two-sample Mendelian Randomization revealed that CSF amyloid beta1–42 plays a role in Parkinson's disease (p = 1.4 × 10−05) and age at onset (p = 7.6 × 10−06), an effect mainly mediated by variants in the APOE locus. In a subset of PD samples, the APOE ε4 allele was associated with significantly lower levels of CSF amyloid beta1–42 (p� ��= 3.8 × 10−06), higher mean cortical binding potentials (p = 5.8 × 10−08), and higher Braak amyloid beta score (p = 4.4 × 10−04). Together these results from high-throughput and hypothesis-free approaches converge on a genetic link between Parkinson's disease, CSF amyloid beta1–42, and APOE.

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Right ventricular outflow tract obstruction caused by sinus of Valsalva aneurysm

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Abstract

Right ventricular outflow tract (RVOT) obstruction caused by sinus of Valsalva aneurysm is a rare observation. We describe a successful case of valve-sparing root replacement using reimplantation technique for RVOT obstruction by a large right coronary sinus of Valsalva aneurysm in a 76-year-old man. In the pathological examination, the elastic fibers of the medial layer were defective not only in the wall of the aneurysmal Valsalva sinus but also in the remaining two sinus walls. Our experience illustrated that valve-sparing root replacement can be an effective procedure in such a case.

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Perfusion in hand arthritis on dynamic contrast-enhanced computed tomography: a randomized prospective study using MRI as a standard of reference

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Abstract

Objective

To evaluate the performance of dynamic contrast-enhanced CT (DCE-CT) in detecting and quantitatively assessing perfusion parameters in patients with arthritis of the hand compared with dynamic contrast-enhanced MRI (DCE-MRI) as a standard of reference.

Materials and methods

In this IRB-approved randomized prospective single-centre study, 36 consecutive patients with suspected rheumatoid arthritis underwent DCE-CT (320-row, tube voltage 80 kVp, tube current 8.25 mAs) and DCE-MRI (1.5 T) of the hand. Perfusion maps were calculated separately for mean transit time (MTT), time to peak (TTP), relative blood volume (rBV), and relative blood flow (rBF) using four different decomposition techniques. Region of interest (ROI) analysis was performed in metacarpophalangeal joints II–V and in the wrist. Pairs of perfusion parameters in DCE-CT and DCE-MRI were compared using a two-tailed t test for paired samples and interpreted for effect size (Cohen's d). According to the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) scoring results, differentiation of synovitis-positive and synovitis-negative joints with both modalities was assessed with the independent t test.

Results

The two modalities yielded similar perfusion parameters. Identified differences had small effects (d 0.01–0.4). DCE-CT additionally differentiates inflamed and noninflamed joints based on rBF and rBV but tends to underestimate these parameters in severe inflammation. The total dose-length product (DLP) was 48 mGy*cm with an estimated effective dose of 0.038 mSv.

Conclusion

DCE-CT is a promising imaging technique in arthritis. In patients with a contraindication to MRI or when MRI is not available, DCE-CT is a suitable alternative to detect and assess arthritis.

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