Cerebral Venous Sinus Thrombosis (CVST): Long-Term Single-Center Experience

CVST is a rare location of thrombosis involving Dural/ cerebral venous sinuses. It affects around 5-10 people per million population annually. It is an uncommon but life-threatening form of stroke affecting younger individuals. Therefore, identifying and treating in a timely manner is critical. Rarer thrombotic disorders like paroxysmal nocturnal hemoglobinuria (PNH) or Janus Kinase 2 (JAK2) mutation positive myeloproliferative neoplasms (MPN) can rarely present with CVST. It can also present during pregnancy for the first time. Diagnosis is often established by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). Infections, certain medication use (asparaginase or birth control pills) could lead to CVST. Patients often present with headaches, seizures or neurological deficits. Management is often with systemic anticoagulation despite intraparenchymal hemorrhage. Reducing intracranial pressure by invasive approaches is sometimes needed.https://digitalcommons.unmc.edu/surp2022/1024/thumbnail.jp

Highly Aggressive and Radiation-Resistant, “Atypical” and Silent Pituitary Corticotrophic Carcinoma: A Case Report and Review of the Literature

Background: Pituitary tumors typically remain silent unless interaction with nearby structures occurs. Rare subsets of pituitary tumors display aggressive phenotypes: highly mitotic, locally invasive, metastatic, chemotherapy and radiation resistant, etc. Disease progression and response to therapy is ill-defined in these subtypes, and their true prognostic potential is debated. Thus, identifying tumor characteristics with prognostic value and efficacious treatment options remains a challenge in aggressive pituitary tumors. Case Presentation: A 45-year-old female presented with a nonfunctioning corticotropic pituitary macroadenoma with biomarkers suggestive of an “atypical” subtype: Ki-67 of 8–12%, increased mitosis, and locally invasive. Despite resections and radiation, growth continued, eventually affecting her vision. Although histologically ACTH positive, the patient remained clinically asymptomatic. Twelve months later, an episode of Cushing’s disease-induced psychosis prompted a PET-CT scan, identifying sites of metastasis. Temozolomide was added to her medical regimen, and her metastatic liver lesions and boney metastases were treated with radiofrequency ablation and stereotactic body radiation therapy, respectively. Systemic treatment resulted in a drop in her ACTH levels, with her most recent scans/labs at 12 months following RFA suggesting remission. Conclusions: This is a unique presentation of a pituitary tumor, displaying characteristics of both clinically silent corticotropic and “atypical” macroadenoma subtypes. Although initially ACTH positive while clinically silent, the patient’s disease ultimately recurred metastatically with manifestations of Cushing’s disease and psychosis. With the addition of temozolomide to her treatment plan, her primary and metastatic sites have responded favorably to radiation therapy. Thus, the addition of temozolomide may be beneficial in the treatment of aggressive pituitary tumors

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

The Helicobacter pylori Genome Project : insights into H. pylori population structure from analysis of a worldwide collection of complete genomes

Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics

Utvärdering av programvara/molntjänst för framställning av ortofoton med UAS-data

Unmanned Aerial Vehicle (UAV) är en benämning på en obemannad flygande farkost. UAV är en benämning för själva farkosten och därför har Unmanned Aircraft System (UAS) tagit över eftersom det är ett begrepp som rör hela systemet som förutom flygfarkost innefattar start, landning, markstation och kommunikationslänk. Inom mätningsteknik är UAS ett relativt nytt begrepp och tekniken har sin historia mestadels inom det militära området. Syftet med denna studie är att analysera samt utvärdera två programvaror och en molntjänst för bearbetning och framtagning av ortofoto från UAS-data. De frågor som ställts inför arbetet är: kan en molntjänst ersätta ett avancerat datorprogram vid generering av ortofoton? Kan dessa datorprogram ge ett bra resultat utan hjälp av andra GIS-program? Vilket program är enklast att förstå och använda samt vilka är skillnaderna mellan programmen? Dessa frågor har besvarats genom användning av insamlat data och för att få utvärderingen rättvis har därför tre olika dataset skapats. Programtjänsterna som har utvärderats är Agisoft PhotoScan 0.9.0 och Pix4UAV Desktop/Cloud 2.1.2. Insamling av data har skett genom en flygning med en oktokopter över Fågelmyratippen i Dalarna. Resultaten visar att priset snabbt blir högt om endast Pix4UAV Cloud används och att överlag är PhotoScan billigare än Pix4UAV Desktop. Kvalitetsrapporten som följer med varje projekt är överskådlig i PhotoScan och mer ingående i Pix4UAV Desktop/Cloud. Trots samma indata blir utdatat olika vid bearbetning av de olika programmen, till exempel skiljer sig markupplösningen åt mellan programmen. Generellt är PhotoScan tydligare på att visa hur arbetsprocessen går till. Supporten hos båda företagen är bra, tips och tricks finns på respektive hemsida. Till PhotoScan finns även en manual för nedladdning samt en YouTube-kanal med instruktionsvideor. De enda slutsatserna vi drar är att Pix4UAV Cloud inte klarar av att ersätta ett avancerat bildbehandlingsprogram och att för tillfället bör ytterligare ett GIS-program användas som komplement för att få bästa resultat. I övrigt har vi endast skrapat på ytan av programmen och rekommenderar att läsaren tar till sig det vi skrivit under resultat och diskussion för att sedan bilda sig en egen uppfattning med hjälp av respektive programs prövotid. Till sist presenteras förslag på vidare studier inom ämnet.Unmanned Aerial Vehicle (UAV) is a term for a remote controlled airbornevehicle. Since UAV is an acronym for the vehicle itself, Unmanned Aircraft Systems(UAS) has therefore replaced UAV, as it is a concept related to the wholesystem, beside the vehicle it also includes landing, ground station andcommunications link. Within land surveying UAS is a relatively new concept asthe technology has its history mainly associated to the military. The purposeof this study is to analyze and evaluate two software and a cloud service for processingand preparation of orthophotos from data collected with a UAS. The questions tobe answered in this thesis are: Can a cloud service replace an advancedcomputer software for generating orthophotos? Can these produce good resultswithout the help of other GIS software? Which software is the easiest tounderstand and to use and what are the main differences. These questions wereanswered by using collected data, and to get the evaluation fair three datasetshave been created. The software being evaluated are Agisoft PhotoScan andPix4UAV desktop/cloud. The data collection was done by a flight with an octokopterover Fågelmyratippen in Dalarna. The results show that the price quicklybecomes high if only Pix4UAV Cloud is used and that generally PhotoScan ischeaper than Pix4UAV Desktop. The quality report that comes with each projectis easy to understand in PhotoScan but more detailed in Pix4UAV Desktop/Cloud. Despitethe use of same data the results vary when processed, for example the groundresolution. Generally PhotoScan is better at showing the work process. Eachcompany’s support is good and they both have tips and tricks at their websites.On the Agisoft webpage there is a manual available for download and they alsohave a YouTube-channel with instruction videos. The conclusion is that thecloud service is not capable of replacing an advance image processing software.Another conclusion is that for the moment another GIS-program should be used toget the best results. We like to point out that we only scratched the surfaceof the software and we recommend that the reader embrace what we write inresults and discussion to then form their own opinion by using the softwareevaluation period. I the last part we present subjects of further study

A Basic List-oriented Information Structures System (BLISS)

http://archive.org/details/basiclistoriente00tho

Occipital Bony Abnormality and Multiple Strokes in a Pediatric Patient

This study presents a case of a 15-year-old boy who had a right vertebral artery dissection with distal embolization from repeated trauma from an occipital bony spicule. The authors hypothesize that this bony spicule was contacting the left vertebral artery during head rotation, resulting in trauma to the vessel and formation of emboli which then showered distally, causing strokes in the posterior circulation of the brain. This specific phenomenon has previously been reported three times, only one of which was in pediatric literature. It is important for individuals to be aware of this rare anatomic cause of vertebral artery dissection in patients presenting with an odd constellation of symptoms related to strokes from vertebro-basilar system. Treatment options including early intervention with intravascular coil embolization are also discussed

En studie om utvecklingen av webbapplikationen AnteckningsBlocket

Denna rapport beskriver projektprocessen och resultatet av utvecklingsarbetet med webbapplikationen AnteckningsBlocket. AnteckningsBlocket är en e-butik och en plattform där studenter kan köpa, sälja och dela med sig av studiehjälpmedel som de själva har skrivit. Arbetet har utgått från att, baserat på gjord marknadsundersökning, utveckla en användbar webbutik för att därmed besvara frågeställningen ”Hur kan en e-butik för studiehjälpmedel kopplat till kurser vid Linköpings universitet utformas för att skapa en användbar samlingsplats för relevant studiehjälpmedel?” Rapporten syftar till att redogöra för implementationen av den funktionalitet som en sådan applikation kräver. Den ämnar beskriva systemets uppbyggnad och diskutera utfallet av de tekniska val som gjorts under utvecklingsprocessen. Rapporten beskriver även arbetsförloppet av arbetsmetoden Scrum som använts med syfte att kontinuerligt lyfta fram och prioritera önskad funktionalitet i olika utvecklingsfaser. Med stark grundfunktionalitet, ett tydligt fokus på användbarhet och en attraktiv webbdesign har teamet lyckats skapa en webbapplikation där studenter kan mötas och dela med sig av sina kunskaper.This report describes the work and result of developing the web application AnteckningsBlocket. AnteckningsBlocket is an e-shop and a platform where students can buy, sell and share self-written study aids. Based on a market survey, the work has focused on developing a usable online shop to help answer the question “How can an e-shop for study aids connected to courses at Linköping university be formed to create a usable gathering point for relevant study aids?” The report aims to account for the implementation of the functionality that such an application requires. It also aims to explain the structure of the system and to discuss the result of the technical choices that have been made during the development. The report describes the work process of the Scrum method, which has been used to continuously emphasize and prioritize functions in the different phases of the development. With a strong fundamental functionality, a clear focus on usability and an attractive design the team has succeeded in creating a web application where students can meet and share their knowledge