Search

Objective: To develop a novel software method (AR2) for reducing muscle contamination of ictal scalp electroencephalogram (EEG), and validate this method on the basis of its performance in comparison to a commercially available software method (AR1) to accurately depict seizure-onset location. Methods: A blinded investigation used 23 EEG recordings of seizures from 8 patients. Each recording was uninterpretable with digital filtering because of muscle artifact and processed using AR1 and AR2 and reviewed by 26 EEG specialists. EEG readers assessed seizure-onset time, lateralization, and region, and specified confidence for each determination. The two methods were validated on the basis of the number of readers able to render assignments, confidence, the intra-class correlation (ICC), and agreement with other clinical findings. Results: Among the 23 seizures, two-thirds of the readers were able to delineate seizure-onset time in 10 of 23 using AR1, and 15 of 23 using AR2 (p Conclusions: EEG artifact reduction methods for localizing seizure-onset does not result in high rates of interpretability, reader confidence, and inter-reader agreement. However, the assignments by groups of readers are often congruent with other clinical data. Utilization of the AR2 software method may improve the validity of ictal EEG artifact reduction.

Methods A survey of 11 095 urban and rural women attending high school or college, aged 14–24 years, in 6 Chinese provinces was conducted. Ever-smoking (ES), current smoking, established smoking and intention to smoke frequencies were calculated. Bivariate analyses were conducted to identify possible correlates of smoking, and those found to be significant at the p=0.1 level were included in a multivariate logistical regression model to obtain adjusted OR for correlates of ES. Results ES prevalence was 20.1%, with urban female students (UFS) at 22.0% and rural female students (RFS) at 19.0% (p

A 33-year-old man with a history of traumatic brain injury (TBI) from a few years prior, secondary to a high-speed motor vehicle accident, presented with worsening right-sided motor function. Brain MRI showed diffuse axonal injury, punctuate microbleedings, asymmetric Wallerian degeneration along the left corticospinal tract in the brainstem and haemorrhagic left superior cerebellar peduncle, all consistent with his prior TBI. Moreover, the right inferior olivary nucleus was enlarged, which is exemplified in unilateral right hypertrophic olivary degeneration (HOD), likely secondary to the haemorrhagic lesion within …

A 33-year-old homeless woman presented to the emergency room in September, 2012, with 2 days of dry cough, dyspnoea, and fever, and 1 week of pruritic rash. On examination she had a temperature of 41·0°C, blood pressure of 98/65 mm Hg, heart rate of 85 bpm, respiratory rate of 16 bpm, and O2 saturation of 47% on room air. She had a diff use papular rash with vesicles of diff erent ages with haemorrhagic crust aff ecting the trunk, extremities, face, and scalp, but sparing the palms and soles (fi gure). She had normal mental status, cranial nerves, motor, and sensory examination. Chest radiograph showed diff use bilateral airspace opacities. Within a few hours of presentation she suddenly became confused, with fl accid paralysis necessitating intubation and admission to the medical intensive care unit. Electroencephalogram showed non-convulsive status epilepticus. MRI brain showed multiple foci of punctate microhaemorrhages throughout the corpus callosum, both temporal lobes, and left posterior cingulate gyrus, consistent with infectious haemorrhagic encephalitis (fi gure). HIV testing was positive, with CD4 count 4 cells/μL (normal 348–1456 cells/μL), and viral load was 66 000 copies/mL (normal < 50 copies/mL). A skin biopsy sample stained positive for varicella zoster virus (VZV), but negative for herpes simplex virus (HSV). Zoster-associated encephalitis from disseminated VZV can develop within days of the disseminated rash, and should be strongly suspected in immunosuppressed patients. Characteristic signs of zoster-associated encephalitis include acute delirium, typical signs of stroke such as headache with acute hemiplegia, aphasia, ataxia, hemisensory loss, or visual changes, dependent on the predominant location of the VZV vasculitis. Intravenous aciclovir 10 mg/kg every 8 h for 7–10 days should be started early if there is clinical suspicion of encephalitis. Our patient was given intravenous aciclovir and multiple antiepileptic drugs to control her seizures. We treated her for VZV pneumonia, aspergillus pneumonia, propofolinduced pancreatitis, Escherichia coli urinary tract infection, and critical illness myopathy. After stabilisation in hospital she was started on antiretrovirals and pneumocystis pneumonia prophylaxis. After 2 months of rehabilitation she could walk independently and communicate without diffi culty. At last follow-up in March, 2014, she had made a near full recovery in terms of her cognitive and motor function. Lancet 2014; 384: 1698

Pineal gland cysts are typically asymptomatic, benign cysts most commonly found incidentally in adults. In rare cases, a large pineal gland cyst can be complicated by intracystic hemorrhage, which could then manifest with neurological symptoms. We report a new complication of intracystic hemorrhage in a large pineal gland cyst in a 40-year-old man with new onset seizures.

Background Bottle gourd ( Lagenaria siceraria ) is an edible plant in the Cucurbitaceae family. When extremely bitter, ingestion of bottle gourd can cause rapid onset diarrhea, vomiting, gastrointestinal bleeding, and hypotension due to release of a substance named cucurbitacin. Objective Our aim was to increase physician awareness of cucurbitacin poisoning in order to facilitate accurate diagnosis and appropriate management. Case Report Five adult patients presented with nausea, vomiting, and diarrhea within 5 to 25 min of ingesting cooked bitter bottle gourd. One patient developed severe diarrhea, hematemesis, and hypotension requiring hospitalization. All patients improved within a few days with intravenous fluids and proton pump inhibitors. To our knowledge, this is the first reported group of patients with toxicity due to ingestion of bottle gourd in the United States (US). Conclusions Physicians should be suspicious of cucurbitacin toxicity in patients who present with symptoms within minutes of ingestion of a plant in the Cucurbitaceae family. Patients should be asked if the plant tasted unusually bitter. The most common symptoms include diarrhea and hematemesis. More than half of patients develop hypotension. There is no known antidote for bottle gourd poisoning; treatment is supportive. Proton pump inhibitors should be given to patients with gastrointestinal mucosal injury.

Peutz-Jeghers syndrome (PJS) is an autosomal dominantly inherited disease. STK11/LKB1 gene germline mutations have been identified as responsible for PJS. In our study, we investigated the molecular basis of PJS and evaluated correlation between the STK11 mutations and the Chinese population.We collected three pedigrees of PJS and screened the 9 exons and their flanking intronic sequences of STK11/LKB1 gene in the probands and normal individuals in the families using polymerase chain reaction (PCR) and direct sequencing.Sequencing of the STK11 gene in the probands of 3 families revealed two novel mutations (c180C--G and c998-1002delGCAGC) in exon 1 and exon 8, respectively. The mutation of c180C--G resulted in a premature termination codon. The other mutation, a deletion of five nucleotides (998-1002delGCAGC) in exon 8, predicted to generate a translational frameshift and a termination at codon 1070.The growing number of mutations in PJS pedigrees suggests the molecular basis of PJS. STK11 gene mutation can be detected in most patients with PJS.

More than 320 million of China’s 1.3 billion people are smokers (66.9% of all men and 4.2% of all women ⩾15 years old).1 Although Chinese men have been the subject of considerable research,2–4 little is known about smoking initiation among women. Our preliminary tobacco document research suggests significant female market segmentation and brand development by transnational tobacco companies (TTCs) in China. To understand the influence of these factors, we conducted a pilot study on susceptibility among young women in Beijing. We assembled five focus groups of high school girls aged 16–19 years (n = 27) during summer 2006. After obtaining informed consent, a trained, female medical student conducted focus groups to ascertain knowledge, attitudes, behaviours, beliefs and intentions to smoke. Thirteen subjects reported smoking experience (smoked 100 lifetime cigarettes or smoked …