Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy / Pronóstico en pacientes con trombosis venosa cerebral severa tratada con craniectomía descompresiva

Introduction: Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. Materials and methods: Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. Results: Twenty-six patients were included (20 female, age 35.4 ± 12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction ± hemorrhagic lesion) > 6 cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. Conclusion: In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.(AU)

Introducción: A pesar del pronóstico favorable en pacientes con trombosis venosa cerebral (TVC), cerca de un 2% de estos pacientes fallecen, para los cuales la craniectomía descompresiva (CD) puede ser una opción terapéutica. El objetivo de este artículo es describir los factores de riesgo, las características de las neuroimágenes, complicaciones hospitalarias y evolución funcional, de pacientes con TVC severa tratados con CD. Materiales y métodos: Se analizaron características demográficas, clínicas y funcionales de casos consecutivos de TVC severa tratados con CD, a partir de una base de datos retrospectiva de un hospital de tercer nivel. Resultados: Veintiséis pacientes fueron incluidos (20 mujeres, media de edad 35,4 ±12,1 años); un 53,8% de los pacientes presentaron una TVC aguda, con manifestaciones neurológicas focales como el síntoma más frecuente en el 92,3% de los casos. La trombosis del seno sagital superior estuvo presente en el 84,6% y se presentaron lesiones bilaterales parenquimatosas en 10 pacientes (38,5%). La imagen al ingreso demostró lesiones parenquimatosas (infarto venoso ± lesión hemorrágica) > 6 cm (medida en el mayor diámetro de la misma), en 25 pacientes (96,2%). La duración media del deterioro neurológico fue de 3,5 días; 11 pacientes (42,3%) murieron durante la hospitalización. Conclusión: En pacientes con formas severas de TVC encontramos una mayor mortalidad que la publicada previamente; la CD podría ser una opción terapéutica en ese grupo de pacientes.(AU)

Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy.

INTRODUCTION: Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. MATERIALS AND METHODS: Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. RESULTS: Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. CONCLUSION: In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.

Anorexia in Medicare Fee-for-Service Beneficiaries: A Claims-Based Analysis of Epidemiology and Mortality.

OBJECTIVES: Loss of appetite in older adults can lead to malnutrition, weight loss, frailty, and death, but little is known about its epidemiology in the United States (US). The objective of this study was to estimate the annual prevalence and incidence of anorexia in older adults with Medicare fee-for-service (FFS) health insurance. DESIGN: Retrospective and observational analysis of administrative health insurance claims data. SETTING: This study included Medicare FFS claims from all settings (eg, hospital inpatient/outpatient, office, assisted living facility, skilled nursing facility, hospice, rehabilitation facility, home). PARTICIPANTS: This study included all individuals aged 65 to 115 years old with continuous Medicare FFS medical coverage (Parts A and/or B) for at least one 12-month period from October 1, 2015, to September 30, 2021 (ie, approximately 30 million individuals each year). INTERVENTION: Not applicable. MEASUREMENTS: Anorexia was identified using medical claims with the ICD-10 diagnosis code "R63.0: Anorexia". This study compared individuals with anorexia to a control group without anorexia with respect to demographics, comorbidities using the Charlson Comorbidity Index (CCI), Claims-based Frailty Index (CFI), and annual mortality. The annual prevalence and incidence of anorexia were estimated for each 12-month period from October 1, 2015, to September 30, 2021. RESULTS: The number of individuals with anorexia ranged from 317,964 to 328,977 per year, a mean annual prevalence rate of 1.1%. The number of individuals newly diagnosed with anorexia ranged from 243,391 to 281,071 per year, a mean annual incidence rate of 0.9%. Individuals with anorexia had a mean (±standard deviation) age of 80.5±8.7 years (vs 74.9±7.5 years without anorexia; p<.001), 64.4% were female (vs 53.8%; p<.001), and 78.4% were White (vs 83.2%; p<.001). The most common CCI comorbidities for those with anorexia were chronic pulmonary disease (39.4%), dementia (38.3%), and peripheral vascular disease (38.0%). Median (interquartile range [IQR]) CCI with anorexia was 4 [5] (vs 1 [3] without anorexia; p<.001). The annual mortality rate among those with anorexia was 22.3% (vs 4.1% without anorexia; relative risk 5.49 [95% confidence interval, 5.45-5.53]). CONCLUSION: Approximately 1% of all adults aged 65-115 years old with Medicare FFS insurance are diagnosed with anorexia each year based on ICD-10 codes reported in claims. These individuals have a higher comorbidity burden and an increased risk of annual mortality compared to those without a diagnosis of anorexia. Further analyses are needed to better understand the relationship between anorexia, comorbidities, frailty, mortality, and other health outcomes.

Quiste epidermoide en conducto auditivo externo: reporte de caso / Epidermoid cysts of the external auditory canal: case report

Resumen El quiste epidérmico es una lesión benigna y común de la piel. Se desarrolla por un bloqueo de la unidad pilosebácea, con la consecuente proliferación de células epiteliales y secuestro de queratina. El 7% se desarrollan en cabeza y cuello, sin embargo, son infrecuentes en canal auditivo externo. Su patrón de crecimiento es lento y progresivo durante años, siendo asintomáticos. Al aumentar de tamaño causan sintomatología variable, acorde a su localización; en el canal auditivo tienen un comportamiento obstructivo que genera síntomas como otalgia e hipoacusia. Se presenta caso de una paciente de 69 años, con acúfeno e hipoacusia progresiva derecha. Durante la otoscopia se observó una neoformación obstructiva del 100% de la luz del conducto. Se realizaron estudios de imagen que reportaron tumoración de características quísticas de conducto auditivo derecho, bien circunscrita, sin erosión ósea. Para el diagnóstico definitivo, se realizó resección quirúrgica y biopsia reportando quiste epidérmico. Durante el seguimiento posoperatorio sin hallazgos de recidiva.

Abstract The epidermal cyst is a common and benign lesion of the skin. It develops due to a blockage of the pilosebaceous unit, with the consequent proliferation of epithelial cells and keratin sequestration. Seven percent develop in the head and neck; however, they are infrequent in the external auditory canal. Its growth pattern is slow and progressive over the years, being asymptomatic. As they increase in size, they cause variable symptoms, according to their location. In the ear canal they have an obstructive behavior that generates symptoms such as earache and hearing loss. A case of a 69-year-old female with tinnitus and progressive right hearing loss is presented. At otoscopy, a 100% obstructive neoformation of the canal lumen was observed. Imaging studies showed a well circumscribed, cystic tumor of the right ear canal, without bone erosion. For the definitive diagnosis, a resection and biopsy were performed, reporting an epidermal cyst. During follow up there was no recurrence of tumor.

Prognosis of patients with severe cerebral venous thrombosis treated with decompressive craniectomy.

INTRODUCTION: Despite the highly favorable prognosis, mortality occurs in nearly 2% of patients with cerebral venous thrombosis (CVT), in which decompressive craniectomy (DC) may be the only way to save the patient's life. The aim of this report is to describe the risk factors, neuroimaging features, in-hospital complications and functional outcome of severe CVT in patients treated with DC. MATERIALS AND METHODS: Consecutive malignant CVT cases treated with DC from a retrospective third-level hospital database were analyzed. Demographic, clinical, and functional outcomes were analyzed. RESULTS: Twenty-six patients were included (20 female, age 35.4±12.1 years); 53.8% of the patients had acute CVT, with neurological focalization as the most common symptom in 92.3% of the patients. Superior sagittal sinus thromboses were found in 84.6% of cases. Bilateral lesions were present in 10 patients (38.5%). Imaging on admission showed a parenchymal lesion (venous infarction±hemorrhagic lesion)>6cm measured along the longest diameter in 25 patients (96.2%). Mean duration of clinical neurological deterioration was 3.5 days; eleven patients (42.3%) died during hospitalization. CONCLUSION: In patients with severe forms of CVT, we found higher mortality than previously reported. DC is an effective life-saving treatment with acceptable functional prognosis for survivors.

The added value of musculoskeletal ultrasound to clinical evaluation in the treatment decision of rheumatoid arthritis outpatients: physician experience matters.

BACKGROUND: Musculoskeletal ultrasound improves the accuracy of detecting the level of disease activity (DA) in RA patients, although its impact on the final treatment decision in a real clinical setting is uncertain. The objectives were to define the percentage of clinical scenarios from an ongoing cohort of RA outpatients in which the German Ultrasound Score on 7 joints (GUS-7) impacted the treatment and to explore if the impact differed between a senior rheumatologist (SR) vs. a trainee (TR). METHODS: Eighty-five consecutive and randomly selected RA outpatients underwent 170 assessments, 85 each by the SR and the TR. Initially, both physicians (blinded to each other) performed a rheumatic assessment and recommended a preliminary treatment. Then, the patients underwent the GUS-7 evaluation by an experienced rheumatologist blinded to clinical evaluations; selected joints of the clinically dominant hand were assessed by gray-scale and power Doppler (PD). In the final step, the TR and the SR integrated the GUS-7 findings with their previous evaluation and reviewed their recommendations. The patients received the final recommendation from the SR to avoid patient confusion. The study was approved by the Internal Review Board and all the patients signed informed consent. GUS-7 usefulness was separately evaluated by the SR and the TR according to a visual analogue scale (0 = not useful at all, 10 = very useful). Descriptive statistics were used. RESULTS: The patients were primarily middle-aged females (91.4%) with (mean ± SD) disease duration of 7.5 ± 3.9 years. The majority of them (69.2% according to TR and 71.8% to SR) were in DAS28-ESR-remission. In 34 of 170 clinical scenarios (20%), the GUS-7 findings modified the final treatment proposal; 24 of these scenarios were determined by the TR vs. 10 by the SR: 70.5% vs. 29.5%, p = 0.01. Treatment changes (increase, decrease and joint injection) were similar between both specialists. As expected, the TR rated the GUS-7 usefulness higher than the SR, particularly in the clinical scenarios where the GUS-7 findings impacted treatment. CONCLUSIONS: Musculoskeletal ultrasound added to standard rheumatic assessments impacted the treatment proposal in a limited number of patients; the impact was greater in the TR.

Simulating the activation, contraction and movement of skeletal muscles using the bidomain model.

A simulation of the muscle activation, contraction and movement is here presented. This system was developed based on the Bidomain mathematical model of the electrical propagation in muscles. This study shows an electrical stimuli input to a muscle and how this behave. The comparison between healthy subject and patient with muscle activation impairment is depicted, depending on whether the signal reaches a threshold. A 3D model of a bicep muscle and a forearm bone connected was constructed using OpenGL. This platform could be used for development of controllers for biomechatronic systems in future works. This kind of bioinspired model could be used for a better understanding of the neuromotor system.

Novel compliant actuator for wearable robotics applications.

In the growing fields of wearable robotics, rehabilitation robotics, prosthetics, and walking robots, variable impedance and force actuators are being designed and implemented because of their ability to dynamically modulate the intrinsic viscoelastic properties such as stiffness and damping. This modulation is crucial to achieve an efficient and safe human-robot interaction that could lead to electronically generate useful emergent dynamical behaviors. In this work we propose a novel actuation system in which is implemented a control scheme based on equilibrium forces for an active joint capable to provide assistance/resistance as needed and also achieve minimal mechanical impedance when tracking the movement of the user limbs. The actuation system comprises a DC motor with a built in speed reducer, two force-sensing resistors (FSR), a mechanism which transmits to the FSRs the torque developed in the joint and a controller which regulate the amount of energy that is delivered to the DC motor. The proposed system showed more impedance reduction, by the effect of the controlled contact forces, compared with the ones in the reviewed literature.

Aspirin versus anticoagulation in intra- and extracranial vertebral artery dissection.

BACKGROUND AND PURPOSE: To evaluate the incidence and predictors of ischaemic recurrent stroke and the adverse events of antithrombotic therapy in patients with first intra- or extracranial vertebral artery dissection (VAD) who were treated with aspirin or oral anticoagulation (OA). METHODS: A 21-year database of consecutive patients with confirmed diagnoses of VAD (n = 110, 63% men; mean age 37.9 ± 8.5 years) without intracerebral hemorrhage and who were treated with aspirin or OA were analyzed retrospectively. In all cases, the admission diagnosis was ischaemic stroke. Three groups were defined according to the site of the dissection: (i) extracranial, (ii) intracranial, and (iii) intra-/extracranial. Clinical follow-up was obtained by neurologic examination. Outcome measures were (i) recurrent ischaemic events (ischaemic stroke or transient ischaemic attack) and (ii) intra- and extracranial major bleeding. RESULTS: No difference in age, smoking, or hypertension was found between patients treated with OA (n = 49) and those treated with aspirin (n = 50). Extracranial artery dissection (49%) had preponderance over intracranial (27%) or intra-/extracranial (23%) location. During the follow-up, recurrent ischaemic events were rare (one case). There were no bleeding complications. The treatment that was used did not influence the functional outcome or recanalization. A good functional outcome (modified Rankin score ≤ 2) was observed in 82 patients. CONCLUSIONS: Although this was a non-randomized study, our data suggest that the frequency of recurrent ischaemic stroke in patients with intra- or extracranial VAD is low and most likely independent of the type of antithrombotic treatment.

Infarto cerebral criptogénico en pacientes jóvenes. Pronóstico y recurrencia a largo plazo / Cryptogenic stroke in young patients: Long-term prognosis and recurrence

Antecedentes: En menores de 45 años, el infarto cerebral (IC) criptogénico representa hasta el 40% de los casos. El objetivo de la presente serie es determinar la tasa de recurrencia, la evolución clínica funcional a largo plazo y las características de imagen de pacientes menores de 45 años, con IC criptogénico. Métodos: 98 pacientes con diagnóstico confirmado de IC criptogénico fueron seguidos durante una mediana de 54 meses (rango de 12 a 238). Registramos los datos demográficos, factores de riesgo, hallazgos clínicos, de laboratorio y de imagen, así como las complicaciones y la evolución funcional. La evaluación de los casos incluyó estudios de imagen vascular intra y extracraneal, ecocardiograma y dos determinaciones de estudios protrombóticos. Resultados: Esta serie representa el 11% de los casos de IC en jóvenes en nuestro hospital. La edad promedio de los casos fue de 39,5±5, 48 (49%) fueron mujeres, 6 (6%) tenían hipertensión arterial, 11 (11%) hipercolesterolemia, 7 (7%) antecedente de migraña, 32 (33%) de tabaquismo activo y 11 (11%) de alcoholismo. Todos los casos fueron manejados con aspirina. Se observó buen pronóstico funcional (Rankin 0 a 2) en 65 (66%) casos y recurrencia en 4 (4%). La circulación anterior (parcial en 56%, total 12%) fue la más afectada y en 87 (88%) casos el infarto fue único. Conclusiones: En esta serie, los IC criptogénicos fueron mayoritariamente únicos, con baja recurrencia y buen pronóstico funcional a largo plazo. Los infartos totales de circulación anterior se correlacionaron con mal pronóstico (AU)

Background: Around 40% of strokes in young people are labelled as infarcts of undeterminedcause. The aim of this study was to determine the image haracteristics, the long-term functional outcome and recurrence after cryptogenic ischaemic stroke. Methods: We studied ninety-eight patients under 45 years of age during a median follow up of 54 months (range 12-238), with ischaemic stroke of undetermined cause. We registered vascular risk factors, clinical syndrome, laboratory and imaging results. We used Rankin disability score to assess functional outcome. The cases were evaluated with intracranial and extracranialvascular imaging studies, echocardiogram, and at least two determinations of prothromboticstates. Results: In our hospital 11% of the patients with cerebral infarction under 45 years of age were labelled as cryptogenic. The mean age of the cases was 39.5±5, 48 (49%) were women, 6(6%) had arterial hypertension, 7 (7%) prior history of migraine, 32 (33%) were active smokers,11 (11%) had ypercholesterolemia, and 11 (11%) had alcoholism. All cases were treated withaspirin. We observed good functional outcome (Rankin 0-2) in 65 (65%) cases. The anteriorcirculation was the most affected (partial in 56%, total in 12%). Infarction was unique in 87(88%) cases. Recurrence was observed in 4 (4%) cases.Conclusions: In this study cryptogenic cerebral infarctions were mostly single, had lowrecurrence and good functional outcome in the long-term follow-up. Total anterior circulationinfarctions correlated with poor outcome (AU)

Cryptogenic stroke in young patients: long-term prognosis and recurrence.

BACKGROUND: Around 40% of strokes in young people are labelled as infarcts of undetermined cause. The aim of this study was to determine the image characteristics, the long-term functional outcome and recurrence after cryptogenic ischaemic stroke. METHODS: We studied ninety-eight patients under 45 years of age during a median follow up of 54 months (range 12-238), with ischaemic stroke of undetermined cause. We registered vascular risk factors, clinical syndrome, laboratory and imaging results. We used Rankin disability score to assess functional outcome. The cases were evaluated with intracranial and extracranial vascular imaging studies, echocardiogram, and at least two determinations of prothrombotic states. RESULTS: In our hospital 11% of the patients with cerebral infarction under 45 years of age were labelled as cryptogenic. The mean age of the cases was 39.5 ± 5, 48 (49%) were women, 6 (6%) had arterial hypertension, 7 (7%) prior history of migraine, 32 (33%) were active smokers, 11 (11%) had hypercholesterolemia, and 11 (11%) had alcoholism. All cases were treated with aspirin. We observed good functional outcome (Rankin 0-2) in 65 (65%) cases. The anterior circulation was the most affected (partial in 56%, total in 12%). Infarction was unique in 87 (88%) cases. Recurrence was observed in 4 (4%) cases. CONCLUSIONS: In this study cryptogenic cerebral infarctions were mostly single, had low recurrence and good functional outcome in the long-term follow-up. Total anterior circulation infarctions correlated with poor outcome.

Citicoline for acute ischemic stroke in Mexican hospitals: a retrospective postmarketing analysis.

Some neuroprotective agents have shown benefits in animal models, but disappointing results in humans. Citicoline is used in several countries as coadjuvant treatment in acute ischemic stroke (AIS) patients; however, there are no retrospective postmarketing surveillances on the experience of citicoline in Mexico. The aim of this study was to evaluate the correlation between citicoline exposure and functional outcome at discharge and at 30 and 90 days post-stroke, in a retrospective case-control design on systematic descriptive databases from three referral hospitals. Clinical records of 173 consecutively registered patients were analyzed, 86 of whom were treated with citicoline within the first 48 h after AIS and the remaining 87 were untreated, randomly selected controls matched for age (+/- 5 years), gender and NIHSS (+/- 1 point) at hospital admission. Pretreatment conditions were similar between groups. Compared with controls, exposure to citicoline was associated with a significantly lower 30-day mean and median modified Rankin score (in both, P < 0.05). After paired multivariate analyses (controlled for NIHSS, age, gender, hospital arrival in < 24 h, thrombolysis and comorbidities) citicoline was independently associated with a lower 90-day mortality risk (P = 0.047) and with fewer in-hospital complications (mainly infections and sepsis, P = 0.001). In this observational study, citicoline use was associated with a better functional status and lower rates of short-term mortality, possibly due to fewer in-hospital systemic complications. The putative benefits should be interpreted as clinical associations, since this is not a randomized, controlled clinical trial.

Nicotine increases the expression of neurotrophin receptor tyrosine kinase receptor A in basal forebrain cholinergic neurons.

In this study, we investigated whether the potential positive effects of nicotine in Alzheimer's disease (AD) may involve neurotrophic factors, such as nerve growth factor (NGF), closely associated with basal forebrain (BF) cholinergic function and survival. To this aim, we studied the effects of prolonged nicotine treatment on neurotrophin receptors expression and on NGF protein levels in the rat BF cholinergic circuitry. Both in vivo and in vitro experiments were conducted. We found that s.c. nicotine infusion (1.2 mg free base/kg/d delivered by mini-pumps for 7 days) induced in vivo an increase in tyrosine kinase receptor A (TrkA)-but not TrkB, TrkC or low affinity neurotrophin receptor p75 (p75)-expression in BF cholinergic neurons targeting the cerebral cortex. Nicotine did not produce statistically significant long-lasting effects on NGF levels in the cerebral cortex, or in the BF. In vitro experiments performed on primary BF neuronal cultures, showed that 72 h exposure to nicotine increased both TrkA expression, and NGF release in culture medium. Neutralization experiments with an anti-NGF antibody showed that NGF presence was not necessary for nicotine-induced increase of TrkA levels in cultured cholinergic neurons, suggesting that nicotine may act through NGF-independent mechanisms. This study shows that nicotine, independently of its action on NGF levels, may contribute to the restoration of the trophic support to BF cholinergic neurons by increasing TrkA levels.

Epizootiology of Babesia bovis and Babesia bigemina in free-ranging white-tailed deer in northeastern Mexico.

Species of Rhipicephalus (Boophilus) ticks are the vectors of babesiosis (cattle fever tick), which are distributed worldwide. White-tailed deer (Odocoileus virginianus) are important secondary hosts for the cattle fever ticks, Rhipicephalus (B.) annulatus and Rhipicephalus (B.) microplus. White-tailed deer are capable of sustaining Boophilus spp. tick populations in the presence or absence of cattle. The objectives of this study were to determine the frequency of Babesia bovis and Babesia bigemina and the prevalence of antibodies to them and identify possible risk factors for bovine babesiosis in white-tailed deer in 3 northeastern states of México. Whole blood and serum samples (n = 457) were collected from white-tailed deer in the states of Coahuila, Nuevo Leon, and Tamaulipas during the spring of 2004. Samples were tested for B. bovis and B. bigemina by nested polymerase chain reaction (n-PCR) (the primers for B. bovis identified the gene Rap-1 and B. bigemina were specific primers) and by an indirect immunofluorescence antibody test (IFAT). A questionnaire was given to each ranch to obtain information about management practices. Logistic regression methods were used to test the association between management factors and the dependent variable of positive n-PCR or IFAT. Nineteen (4.2%) samples were positive to B. bigemina and 6 (1.7%) were positive to B. bovis by n-PCR. Serological testing showed 59.9% (n = 274) of deer sampled were positive to B. bovis and 5.4% (n = 25) were positive to B. bigemina antibodies. The logistic model varied with different dependent variables. With positive n-PCR and B. bigemina as the dependent variable, 3 factors were associated: habitat (presence of brush and exotic grasses; odds ratio (OR), 3.3; 95% confidence interval (CI), 1.3-8.5), grazing system (continuous grazing OR 4.0; CI, 1.3-12.2), and tick treatment frequency (3-4 mo; OR 7.0, CI 1.4-34.3; 5-6 mo; OR, 11.0; CI, 1.9-62.7; > 6 mo; OR, 4.6; CI, 0.9-23.3). These findings suggest that white-tailed deer may act as a reservoir for the 2 bovine Babesia spp. and that white-tailed deer may be important in the epidemiology of babesiosis. However, evidence is not available to support whether white-tailed deer are, or are not, likely to be a host that could complete the transmission cycle of Babesia spp. These results suggest that additional research is needed to demonstrate the importance of white-tailed deer as a Babesia spp. infection source for ticks.

Near-wake structure behind two circular cylinders in a side-by-side configuration with heat release.

Flow around two circular cylinders in a side-by-side arrangement normal to the free stream with heat release from one of the cylinders is studied experimentally. This flow, with no heat release, is known to exhibit a range of flow regimes at different cylinder spacings. In particular, the wake exhibits well-known intermittently bistable behavior in the center-to-center spacing (normalized by cylinder diameter) range of 1.2-2.0. We present, for the first time, the effect of heat release from one of the cylinders on the near-wake structure of the two cylinder configuration. The experiments are performed at spacing ratios of 1.1, 1.7, and 3.0, Reynolds numbers of 250, 350, and 450 and Richardson number less than 0.14. The investigations are carried out in a water tunnel using hydrogen bubble technique for flow visualization and particle-image-velocimetry for quantitative measurements. The bistability of the wake at a spacing ratio of 1.7 is controlled with a threshold heat release from one of the cylinders resulting in a stable narrow wake behind the heated cylinder and a wider wake behind the unheated cylinder. The heat release resulted in deflection of the gap-bleeding flow toward the heated cylinder at spacing ratio of S/D=1.1 and did not produce any visual changes in the near-wake structure at spacing ratio of 3.0.

Release of butylated hydroxytoluene from an active film packaging to Asadero cheese and its effect on oxidation and odor stability.

Antioxidant active packaging consisting of coextruded films made of low density polyethylene (LDPE) added with 0, 8, and 14 mg/g of butylated hydroxytoluene (BHT) and polyamide 6/66 were fabricated. The release of BHT from the films to Asadero cheese was determined. Most of the BHT was diffused from the LDPE layer to the cheese during the first 20 d of storage at 5 degrees C. Diffusion coefficient for the diffusion of BHT from the films 8 and 14 to the cheese was calculated as 6.24E-12 and 6.26E-12 cm2/s, respectively. The release of BHT from the film added with 8 mg/g of the antioxidant in the LDPE layer complied with the legal limit established for food products. However, the film added with 14 mg/g of the antioxidant exceeded that limit. The film added with 8 mg/g of BHT maintained the same levels of oxidized odor from 20 to 100 d of storage.

[Nonaneurysmal subarachnoid hemorrhage. Study of long-term follow-up]. / Hemorragia subaracnoidea no aneurismática. Estudio de seguimiento a largo plazo.

INTRODUCTION: Nonaneurysmal subarachnoid hemorrhage (SAH) accounts for 15% to 20% of all the cases of SAH. Its prognosis may vary from complete recovery to different and serious complications. We describe a series of cases with nonaneurysmal SAHs, their clinical and tomographic characteristics and causes as well as long term prognosis. PATIENTS AND METHODS: 50 patients diagnosed of SAH and two negative brain angiographies for aneurysm were followed-up for an average period of 62 months. The demographic data of importance, vascular risk factors, were recorded. They were evaluated during the acute phase with the Hunt and Hess clinical scale and Fisher topographic scale. The distribution of the hemorrhage was listed as absent, perimesencephalic, focal, ventricular or diffuse. Presence of rebleeding, death and the functional course, measured by the Rankin modified scale, were recorded during the follow-up. According to this scale, Rankin of 0 to 2 was considered as a favorable prognosis. RESULTS: This series represents 8.6 of all the SAH cases in our hospital. In 6 cases (12%), there was a causal relationship between the use of sympathicomimetic drugs and the development of SAH. In 80% of them, it was not possible to document the cause of the hemorrhage, while difference causes )cerebral venous thrombosis in 4 [8%], spontaneous dissection of the vertebral artery in 2 [4%], vasculitis secondary to neurocystecerosis in 2 [4%], cavernous angioma in 1 [2%] and spinal arteriovenous malformation in 1) were found. Rebleeding did not occur in any of the cases and only one patient died. In 45 patients (90%), the final functional prognosis was good (Rankin 0-2). We found no significant differences between the tomographic pattern of the hemorrhage, initial clinical condition and long term prognosis. CONCLUSIONS: Our findings show a low frequency of nonaneurysmal SAH in our population and a diversity of causes greater than those reported by other series. The good functional prognosis in these cases was confirmed.

Prevalence and factors associated with headache in patients with systemic lupus erythematosus.

Headache is common in systemic lupus erythematosus with reported prevalence as high as 70%. The aims of this study were: to estimate the prevalence and types of headache in a sample of patients with systemic lupus erythematosus comparing it with rheumatoid arthritis, to determine clinical and serological associations. Eighty-one systemic lupus erythematosus and 29 rheumatoid arthritis consecutive patients seen in our outpatient clinic were interviewed. Headache was evaluated using the diagnostic criteria proposed by the International Headache Society. Additional evaluations were carried out in the 81 systemic lupus erythematosus patients including depression, disease activity, lupus damage, function disability, quality of life, and severity degree using a validated scales. We analysed the following autoantibodies: anti-double stranded DNA, anti-nucleosomes, anti-histones, anti-ribosomal P, anti-cardiolipin antibodies, anti-beta2-glycoprotein-I (GPI), and antinuclear antibodies. Forty-one per cent of systemic lupus erythematosus and 17% of rheumatoid arthritis patients suffered from headache (P = 0.02). No significant difference for any primary headache type between the two groups was found. Frequency of headache types in systemic lupus erythematosus patients was: migraine 24%, tensional-type headache 11%, and mixed headache 5%. In systemic lupus erythematosus patients the risk factors associated with headaches were Raynaud's phenomenon (OR 3.6; 95% CI 1.3-9.5; P = 0.009) and beta2GPI antibody positivity (OR 4.5; 95% CI 1.2-16.2; p = 0.016). We conclude that headache is more common in systemic lupus erythematosus than in rheumatoid arthritis patients and was independently associated with Raynaud's phenomenon and beta2GP-I antibodies.

Internuclear ophthalmoplegia: causes and long-term follow-up in 65 patients.

OBJECTIVES: To analyze the causes and long-term clinical outcome of internuclear ophthalmoplegia (INO) in a consecutive series of 65 patients. PATIENTS AND METHODS: From a clinical registry of a neuroophthalmological department, patients with diagnosis of INO were retrospectively identified. Patients were classified into three groups: unilateral INO, bilateral INO, and one-and-a-half syndrome. RESULTS AND CONCLUSIONS: Thirty-three men (50.8%) and 32 women (49.2%), with a mean age of 38.4 years were included in the study. INO was unilateral in 36 patients (55.4%), bilateral in 22 (33.8%) and one-and-a-half syndrome in seven (10.8%). The most common causes were vascular (36.9%), multiple sclerosis (32.3%), and infectious diseases (13.8%). Resolution of INO was documented in 32 patients (49.2%): 15 patients showed INO resolution during the first 3 months and 17 patients in 3-9 months. INO persisted in 33 patients (50.8%) even after a follow-up longer than 12 months.