Search

Background/aims Data are limited on the frequency of ‘consensus decisions’ between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses and post-MDM ‘adherence’ to such advice. Methods This prospective audit/quality improvement project collated prospectively-recorded data from a weekly Neurovascular/Stroke Centre MDM documenting the proportion of extracranial carotid/vertebral stenosis patients in whom ‘consensus management decisions’ were reached by neurologists, vascular surgeons, stroke physicians-geriatricians and neuroradiologists. Adherence to MDM advice was analysed in asymptomatic carotid stenosis (ACS), symptomatic carotid stenosis (SCS), ‘indeterminate symptomatic status stenosis’ (ISS) and vertebral artery stenosis (VAS) patients, including intervals between index event to MDM + / − intervention. Results One hundred fifteen patients were discussed: 108 with carotid stenosis and 7 with VAS. Consensus regarding management was noted in 96.5% (111/115): 100% with ACS and VAS, 96.2% with SCS and 92.9% with ISS. Adherence to MDM management advice was 96.4% (107/111): 100% in ACS, ISS and VAS patients; 92% (46/50) in SCS patients. The median interval from index symptoms to revascularisation in 50–99% SCS patients was 12.5 days (IQR: 9–18.3 days; N = 26), with a median interval from MDM to revascularisation of 5.5 days (IQR: 1–7 days). Thirty patients underwent revascularisation. Two out of twenty-nine patients (6.9%) with either SCS or ISS had a peri-procedural ipsilateral ischaemic stroke, with no further strokes/deaths during 3-months follow-up. Conclusions The high frequency of inter-specialty consensus regarding management and adherence to proposed treatment supports a collaborative/multidisciplinary model of care in patients with extracranial arterial stenoses. Service development should aim to shorten times between MDM discussion-intervention and optimise prevention of stroke/death.

Background Diagnostic uncertainty in ALS has serious management implications and delays recruitment into clinical trials. Emerging evidence of presymptomatic disease-burden provides the rationale to develop diagnostic applications based on the evaluation of in-vivo pathological patterns early in the disease. Objectives To outline and test a diagnostic classification approach based on an array of complementary imaging metrics in key disease-associated anatomical structures. Methods Data from 75 ALS patients and 75 healthy controls were randomly allocated in a ‘training’ and ‘validation’ cohort. Spatial masks were created for anatomical foci which best discriminate patients from controls in the ‘training sample’. In a virtual ‘brain biopsy’, data was then retrieved from these key disease-associated brain regions. White matter diffusivity indices, grey matter T1-signal intensity values and basal ganglia volumes were evaluated as predictor variables in a canonical discriminant function. Results Following predictor variable selection, a classification specificity of 85.5% and sensitivity of 89.1% was achieved in the training sample and 90% specificity and 90% sensitivity in the validation sample. Discussion This study evaluates disease-associated imaging measures in a dummy diagnostic application. Although larger samples will be required for robust validation, the study confirms the potential of multimodal quantitative imaging in future clinical applications., Graphical abstract Image 1, Highlights • Reliable diagnostic, monitoring and prognostic biomarkers are urgently in ALS. • Accurate diagnostic classification may be achieved based on MRI metrics. • Basal ganglia, grey and white matter indices were integrated in a diagnostic model. • 85.5% specificity and 89.1% sensitivity were achieved in the training sample. • 90% specificity and 90% sensitivity were achieved in the validation sample.

Background\ud Motor Unit Number Index (MUNIX) is a neurophysiological measure that provides an index\ud of the number of lower motor neurons in a muscle. Its performance across centres in healthy\ud subjects and patients with Amyotrophic Lateral Sclerosis (ALS) has been established, but\ud inter-rater variability between multiple raters in one single subject has not been\ud investigated.\ud Objective\ud To assess reliability in a set of 6 muscles in a single subject among 12 examiners (6 experienced\ud with MUNIX, 6 less experienced) and to determine variables associated with variability\ud of measurements.\ud Methods\ud Twelve raters applied MUNIX in six different muscles (abductor pollicis brevis (APB),\ud abductor digiti minimi (ADM), biceps brachii (BB), tibialis anterior (TA), extensor dig. brevis\ud (EDB), abductor hallucis (AH)) twice in one single volunteer on consecutive days. All raters\ud visited at least one training course prior to measurements. Intra- and inter-rater variability as\ud determined by the coefficient of variation (COV) between different raters and their levels of\ud experience with MUNIX were compared.\ud Results\ud Mean intra-rater COV of MUNIX was 14.0% (±6.4) ranging from 5.8 (APB) to 30.3% (EDB).\ud Mean inter-rater COV was 18.1 (±5.4) ranging from 8.0 (BB) to 31.7 (AH). No significant differences\ud of variability between experienced and less experienced raters were detected.\ud Conclusion\ud We provide evidence that quality control for neurophysiological methods can be performed\ud with similar standards as in laboratory medicine. Intra- and inter-rater variability of MUNIX is\ud muscle-dependent and mainly below 20%. Experienced neurophysiologists can easily\ud adopt MUNIX and adequate teaching ensures reliable utilization of this method.

Bu çalışmada Dohuk Kentindeki hava kirliliği problemi ele alınmış ve kirliliği etkileyen değişkenler belirlenerek kirliliğin nasıl kontrol edilebileceği incelenmiştir. Çalışmayı gerçekleştirmek için ihtiyaç duyulan veri toplama süreci iki ayrı bölümden oluşmaktadır. İlk bölüm, 43 trafik bölgesine ayrılan Dohuk kentine yaşayan toplulukların sosyo-ekonomik yapısına ilişkin veri çalışmasını içermektedir. Veriler bu amaçla hazırlanan özel bir anket formu yardımıyla toplanmıştır. İkinci bölümde, WSAP-D4 gaz analiz cihazı kullanarak hava kirliliği ölçümleri gerçekleştirilmiştir. Bu ölçümlerde zararlı olduğu bilinen, Karbon-monoksit (CO), Nitrojen-monoksit (NO), Nitrojen-dioksit (NO2), ve Sülfur-dioksit (SO2) yoğunlukları ölçülmüştür. Özel otomobille ve taksi ile yapılan yolculuklar, toplu taşıma ve minibus ile yapılan yolculuklar ve dörtten fazla olan araba sahiplikleri gibi farklı sosyo ekonomik değişkenler modele sokulmamıştır. Ancak bir, iki ve daha fazla olan araba sahiplikleri çözümlemeye katılmıştır. Sosyo ekonomik değişkenlerle, kirlilik değerlerini ilişkilendirmek için adımsal regresyon tekniği kullanılmıştır. Dört farklı gaz yoğunluğunun farklı sosyo-ekonomik değişkenlerle ilişkilendirmek için 20 farklı model üretilmiştir. Bu modellemeler sonucunda toplu taşımanın hava kirliliğini azaltmasına karşın, özel otomobil ve taksi kullanımının, araba sahipliği sayısının, gelir seviyesindeki yükselmenin ve yolculuk sayısının kirliliği arttırdığı sonucuna varılmıştır. Ayrıca çalışma sonucunda zararlı dört gazın yoğunluğunun en yüksek olduğu öğlen ile geceyarısı arasında standarlarda belirlenen maksimum yoğunlukları geçmediği görülmüştür. In this study, air pollution problem in Dohuk City is discussed in detail in order to evaluate the main factors concerning the problem, and how to control them. Data required implementing this study including two main parts. The first part of the data collected is concerning the socio-economic characteristics of the Dohuk City Society living within a geographical area including 43 traffic analysis zones. Travel data was collected using a special questionnaire form. The second part of the data compile by the author of this study is air pollution measurements using a special instrument called WSAP-D4 Gas Analyzer. Four types of hazardous gases were collected, which are Carbon Monoxide CO, Nitrogen Monoxide NO, Nitrogen Dioxide NO2, and Sulphur Dioxide SO2. Different socio-economic parameters such as, trips by private cars and taxi, trips by public transit and min bus, car-ownership four levels are considered in this study as zero, one car, two cars, and more than two cars owned levels are considered in the analysis. Step-wise Multiple Linear Regression Technique is followed in this study to correlate the socio-economic parameters with air pollution measured data as dependent parameters. Correlation of the four classes of toxic gases with the different social-economic parameters produced twenty step-wise type empirical models. It is concluded that, air pollution concentrations with the different four gases introduced in this study are going to reduce with using public transit as a cheap mode of transport, but increase with using private cars and taxi, car ownership, income level increase, and total trips number. Results for this topic revealed that, all the four gases are going to be less in concentration than average values from mid-day up to mid-night time without passing the maximum recommended levels. 138

Introduction The incidence of neurosyphilis has declined markedly since the introduction of penicillin therapy. While there are a number of case reports in the literature of neurosyphilis causing focal decreased 18F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography scans, to the best of our knowledge this is the first published report of neurosyphilis presenting with intensely increased 18F-fluorodeoxyglucose uptake in the hippocampus. Case presentation A 55-year-old Caucasian man presented to our facility with acute collapse against a background of memory difficulties over the previous six months. The results of his initial physical examination were normal. He scored 24 out of 30 on the Montreal Cognitive Assessment test. A magnetic resonance imaging scan of his brain revealed high T2 signal intensity and atrophy within the right frontal area in addition to high T2 signal intensity in the bilateral mesial temporal areas. Blood and cerebrospinal fluid analysis revealed an active syphilis infection. An 18F-fluorodeoxyglucose positron emission tomography brain scan showed intensely increased 18F-fluorodeoxyglucose uptake limited to the head of the right hippocampus. He responded to penicillin treatment with an improvement in his cognition, which was further reflected in a complete resolution of the findings previously seen on magnetic resonance imaging and 18F-fluorodeoxyglucose positron emission tomography scans. Conclusions Diagnosis of neurosyphilis can be difficult, as many patients are either asymptomatic or present with non-specific symptoms such as memory disturbance or seizures. This report highlights the importance of considering neurosyphilis in the differential diagnosis when mesiotemporal changes are seen on magnetic resonance imaging or 18F-fluorodeoxyglucose positron emission tomography scans.

Multiple-Input-Multiple-Output (MIMO) communication techniques have been an important area of focus for 4th generation wireless systems. This is mainly because of their potentials for high capacity, increased diversity, and interference suppression. The cooperative communication techniques can avoid the difficulties of implementing actual antenna arrays and convert the single-input single-output (SISO) system into a virtual MIMO system. In this scheme, the user explores its other neighbor users to act as relaying nodes and forming virtual MIMO system. Space-Time Block Coding (STBC) is used to improve the transmission reliably and spectral efficiency of MIMO systems. When STBC is applied to a cooperative diversity, the system termed as Distributed Space Time Block Code (D-STBC). Most of the existing research assumes perfect synchronization among cooperative users in D-STBC. This means that they have identical timing, carrier frequency, and propagation delay, which is almost impossible to be achieved. The lack of common timing reference can badly influence the performance of the D-STBC system. There are different research efforts to overcome this problem; most of which have high decoding complexity. In this research, two low decoding complexity detection schemes of D-STBC have been proposed and they have proven their efficiency in mitigation the impact of imperfect synchronization between the relay nodes. The first one is based on Parallel Interference Cancellation (PIC) method and the other is based on Successive Interference Cancellation (SIC) method.

The authors report a 19-year-old woman who developed convulsions preceded by nasal ingestion of a cocaine mimic named 'the bubble' or mephedrone, obtained legally from a 'headshop' in Dublin. Characteristic posterior white matter oedema on brain imaging after the seizure suggested a diagnosis of posterior reversible encephalopathy syndrome (PRES). While PRES has been rarely associated with cocaine ingestion, this is the first report of an association with mephedrone.