Aseptic meningoencephalitis mimicking transient ischaemic attacks

Purpose: To highlight meningoencephalitis as a transient ischaemic attack (TIA) mimic and suggest clinical clues for differential diagnosis. Methods: This was an observational study of consecutively admitted patients over a 9.75-year period presenting as TIAs at a stroke unit. Results: A total of 790 patients with TIAs and seven with TIA-like symptoms but a final diagnosis of viral meningoencephalitis were recognised. The most frequent presentations of meningoencephalitis patients were acute sensory hemisyndrome (6) and cognitive deficits (5). Signs of meningeal irritation were minor or absent on presentation. Predominantly lymphocytic pleocytosis, hyperproteinorachia and a normal cerebrospinal fluid (CSF)/serum glucose index (in 5 out of 6 documented patients) were present. Meningeal thickening on a brain magnetic resonance imaging (MRI) scan was the only abnormal imaging finding. Six patients received initial vascular treatment; one thrombolysed. Finally, six patients were treated with antivirals and/or antibiotics. Although neither bacterial nor viral agents were identified on extensive testing, viral meningoencephalitis was the best explanation for all clinical and laboratory findings. Conclusions: Aseptic meningoencephalitis should be part of the differential diagnosis in patients presenting as TIA. The threshold for a lumbar puncture in such patients should be set individually and take into account the presence of mild meningeal symptoms, age and other risk factors for vascular disease, the results of brain imaging and the basic diagnostic work-up for a stroke sourc

Fragility curves for mixed concrete/steel frames subjected to seismic excitation

Use of appropriate fragility curves for structures is an essential and basic tool for earthquake loss estimation. Fragility curves for frames made only of concrete or only of steel members are already available in the literature. In this paper, fragility curves for plane mixed concrete/steel moment resisting framed structures are developed. Parametric numerical results for these mixed structures are presented and discussed

How does cloud-radiative heating over the North Atlantic change with grid spacing, convective parameterization, and microphysics scheme in ICON version 2.1.00?

Cloud-radiative heating (CRH) within the atmosphere and its changes with warming affect the large-scale atmospheric winds in a myriad of ways, such that reliable predictions and projections of circulation require reliable calculations of CRH. In order to assess the sensitivities of upper-tropospheric midlatitude CRH to model settings, we perform a series of simulations with the ICOsahedral Nonhydrostatic Model (ICON) over the North Atlantic using six different grid spacings, parameterized and explicit convection, and one- versus two-moment cloud microphysics. While sensitivity to grid spacing is limited, CRH profiles change dramatically with microphysics and convection schemes. These dependencies are interpreted via decomposition into cloud classes and examination of cloud properties and cloud-controlling factors within these different classes. We trace the model dependencies back to differences in the mass mixing ratios and number concentrations of cloud ice and snow, as well as vertical velocities. Which frozen species are radiatively active and the broadening of the vertical velocity distribution with explicit convection turn out to be crucial factors in altering the modeled CRH profiles.</p

Concentration of apricot juice using complex membrane technology

In this study, pressed apricot (Prunus armeniaca L.) juice was concentrated using complex membrane technology with different module combinations: UF-RO-OD, UF-RO-MD, UF-NF-OD and UF-NF-MD. In case of the best combination a cross-flow polyethylene ultrafiltration membrane (UF) was applied for clarification, after which preconcentration was done using reverse osmosis (RO) with a polyamide membrane, and the final concentration was completed by osmotic distillation (OD) using a polypropylene module. The UF-RO-OD procedure resulted in a final concentrate with a 65-70 °Brix dry solid content and an excellent quality juice with high polyphenol content and high antioxidant capacity.Nanofiltration (NF) and membrane distillation (MD) were not proper economic solutions.The influence of certain operation parameters was examined experimentally. Temperatures of UF and RO were: 25, 30, and 35 °C, and of OD 25 °C. Recycle flow rates were: UF: 1, 1.5, and 2 m3 h−1; RO: 200, 400, and 600 l h−1; OD: 20, 30 and 40 l h−1. The flow rates in the module were expressed by the Reynolds number, as well. Based on preliminary experiments, the transmembrane pressures of UF and RO filtration were 4 bar and 50 bar, respectively. Each experimental run was performed three times. The following optimal operation parameters provided the lowest total cost: UF: 35 °C, 2 m3 h−1, 4 bar; RO: 35 °C, 600 l h−1, 50 bar; OD: 20, 30 and 40 l h−1; temperature 25 °C.In addition, experiments were performed for apricot juice concentration by evaporation, which technique is widely applied in the industry using vacuum and low temperature.For description the UF filtration, a dynamic model and regression by SPSS 14.0 statistics software were applied

Tear fluid biomarkers in ocular and systemic disease: potential use for predictive, preventive and personalised medicine

In the field of predictive, preventive and personalised medicine, researchers are keen to identify novel and reliable ways to predict and diagnose disease, as well as to monitor patient response to therapeutic agents. In the last decade alone, the sensitivity of profiling technologies has undergone huge improvements in detection sensitivity, thus allowing quantification of minute samples, for example body fluids that were previously difficult to assay. As a consequence, there has been a huge increase in tear fluid investigation, predominantly in the field of ocular surface disease. As tears are a more accessible and less complex body fluid (than serum or plasma) and sampling is much less invasive, research is starting to focus on how disease processes affect the proteomic, lipidomic and metabolomic composition of the tear film. By determining compositional changes to tear profiles, crucial pathways in disease progression may be identified, allowing for more predictive and personalised therapy of the individual. This article will provide an overview of the various putative tear fluid biomarkers that have been identified to date, ranging from ocular surface disease and retinopathies to cancer and multiple sclerosis. Putative tear fluid biomarkers of ocular disorders, as well as the more recent field of systemic disease biomarkers, will be shown

Advantages of the Ilizarov external fixation in the management of intra-articular fractures of the distal tibia

<p>Abstract</p> <p>Background</p> <p>Treatment of distal tibial intra-articular fractures is challenging due to the difficulties in achieving anatomical reduction of the articular surface and the instability which may occur due to ligamentous and soft tissue injury. The purpose of this study is to present an algorithm in the application of external fixation in the management of intra-articular fractures of the distal tibia either from axial compression or from torsional forces.</p> <p>Materials and methods</p> <p>Thirty two patients with intra-articular fractures of the distal tibia have been studied. Based on the mechanism of injury they were divided into two groups. Group I includes 17 fractures due to axial compression and group II 15 fractures due to torsional force. An Ilizarov external fixation was used in 15 patients (11 of group I and 4 of group II). In 17 cases (6 of group I and 11 of group II) a unilateral hinged external fixator was used. In 7 out of 17 fractures of group I an additional fixation of the fibula was performed.</p> <p>Results</p> <p>All fractures were healed. The mean time of removal of the external fixator was 11 weeks for group I and 10 weeks for group II. In group I, 5 patients had radiological osteoarthritic lesions (grade III and IV) but only 2 were symptomatic. Delayed union occurred in 3 patients of group I with fixed fibula. Other complications included one patient of group II with subluxation of the ankle joint after removal of the hinged external fixator, in 2 patients reduction found to be insufficient during the postoperative follow up and were revised and 6 patients had a residual pain. The range of ankle joint motion was larger in group II.</p> <p>Conclusion</p> <p>Intra-articular fractures of the distal tibia due to axial compression are usually complicated with cartilaginous problems and are requiring anatomical reduction of the articular surface. Fractures due to torsional forces are complicated with ankle instability and reduction should be augmented with ligament repair, in order to restore normal movement of talus against the mortise. Both Ilizarov and hinged external fixators are unable to restore ligamentous stability. External fixation is recommended only for fractures of the ankle joint caused by axial compression because it is biomechanically superior and has a lower complication rate.</p

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

MDR/XDR-TB management of patients and contacts: Challenges facing the new decade. The 2020 clinical update by the Global Tuberculosis Network.

The continuous flow of new research articles on MDR-TB diagnosis, treatment, prevention and rehabilitation requires frequent update of existing guidelines. This review is aimed at providing clinicians and public health staff with an updated and easy-to-consult document arising from consensus of Global Tuberculosis Network (GTN) experts. The core published documents and guidelines have been reviewed, including the recently published MDR-TB WHO rapid advice and ATS/CDC/ERS/IDSA guidelines. After a rapid review of epidemiology and risk factors, the clinical priorities on MDR-TB diagnosis (including whole genome sequencing and drug-susceptibility testing interpretations) and treatment (treatment design and management, TB in children) are discussed. Furthermore, the review comprehensively describes the latest information on contact tracing and LTBI management in MDR-TB contacts, while providing guidance on post-treatment functional evaluation and rehabilitation of TB sequelae, infection control and other public health priorities

Validation, comparison, and combination of algorithms for automatic detection of pulmonary nodules in computed tomography images: The LUNA16 challenge

Automatic detection of pulmonary nodules in thoracic computed tomography (CT) scans has been an active area of research for the last two decades. However, there have only been few studies that provide a comparative performance evaluation of different systems on a common database. We have therefore set up the LUNA16 challenge, an objective evaluation framework for automatic nodule detection algorithms using the largest publicly available reference database of chest CT scans, the LIDC-IDRI data set. In LUNA16, participants develop their algorithm and upload their predictions on 888 CT scans in one of the two tracks: 1) the complete nodule detection track where a complete CAD system should be developed, or 2) the false positive reduction track where a provided set of nodule candidates should be classified. This paper describes the setup of LUNA16 and presents the results of the challenge so far. Moreover, the impact of combining individual systems on the detection performance was also investigated. It was observed that the leading solutions employed convolutional networks and used the provided set of nodule candidates. The combination of these solutions achieved an excellent sensitivity of over 95% at fewer than 1.0 false positives per scan. This highlights the potential of combining algorithms to improve the detection performance. Our observer study with four expert readers has shown that the best system detects nodules that were missed by expert readers who originally annotated the LIDC-IDRI data. We released this set of additional nodules for further development of CAD systems

Mutations disrupting neuritogenesis genes confer risk for cerebral palsy

In addition to commonly associated environmental factors, genomic factors may cause cerebral palsy. We performed whole-exome sequencing of 250 parent-offspring trios, and observed enrichment of damaging de novo mutations in cerebral palsy cases. Eight genes had multiple damaging de novo mutations; of these, two (TUBA1A and CTNNB1) met genome-wide significance. We identified two novel monogenic etiologies, FBXO31 and RHOB, and showed that the RHOB mutation enhances active-state Rho effector binding while the FBXO31 mutation diminishes cyclin D levels. Candidate cerebral palsy risk genes overlapped with neurodevelopmental disorder genes. Network analyses identified enrichment of Rho GTPase, extracellular matrix, focal adhesion and cytoskeleton pathways. Cerebral palsy risk genes in enriched pathways were shown to regulate neuromotor function in a Drosophila reverse genetics screen. We estimate that 14% of cases could be attributed to an excess of damaging de novo or recessive variants. These findings provide evidence for genetically mediated dysregulation of early neuronal connectivity in cerebral palsy