"The Red Flags" in Clinical Approach to Acute Ataxia-the Experience in Cohort of 76 Children.

The aim of our study is to define the most frequent etiology, clinical presentation, and predictive factors of outcome in children with acute ataxia (AA) and to determine "the red flags" in the diagnostic approach to children with AA. The retrospective study included the patients with AA treated in the institute from 2015 to 2021. The inclusion criteria were children aged 1-18 years, evolution time of ataxia within 72 h, and diagnosis made by a physician. The exclusion criteria were anamnestic data about ataxia without confirmation by any physician, chronic/persistent ataxia, and psychogenic or postictal ataxia. Clinical presentation was divided into two categories: (1) isolated cerebellar signs (CS): ataxic gait, dysmetria, dysdiadochokinesia, intention tremor, dysarthria, and nystagmus; (2) CS-plus symptoms which included CS associated with any of other symptoms such as encephalopathy (GCS < 15), awareness disturbances, vomiting, headache, a new onset limb or facial paresis, torticollis, hypotonia, and opsoclonus. The outcome was assessed at the end of hospitalization and was defined as complete or incomplete recovery. The study included 76 children, with a mean age of 5.7 years (IQR 2.1-8.3). The most frequent causes of AA were immune-mediated/infective cerebellar ataxia in 27 (35.5%), and intoxication in 24 (31.6%) cases, followed by vestibular ataxia, opsoclonus-myoclonus-ataxia syndrome, and intracranial expansive process. Forty-two (56%) cases experienced isolated CS, and 35 (46%) cases had CS-plus. Complete recovery was experienced by 62 (81.6%) patients. Analysis of some risk factors (sex, age, presence of previous infection, "cerebellar plus symptoms," and structural abnormalities/neuroimaging abnormalities) and their relation to outcome was performed. Analysis showed that presence of additional symptoms to ataxia, so called "cerebellar plus symptoms" (p = 0.002) and structural abnormalities (p < 0.001), had statistically higher frequency of poor outcome. Statistical significance remained in the univariate analysis. Significant data was included in multivariate logistic regression analysis which also showed that presence of "cerebellar plus symptoms" (p = 0.021) and structural abnormalities (p = 0.002) is related to a poor outcome. Most of the children with AA have "benign" etiology such as intoxication and post/parainfectious cerebellar ataxia with favorable outcomes. On the other hand, AA might be the first manifestation of CNS neoplasm or paraneoplastic phenomena. "The red flags" associated with cerebellar signs are limbs or facial palsy, hypotonia, GCS < 15, vomiting, opsoclonus, headache, myoclonus, visual impairment, torticollis, and vertigo. The presence of those signs and/or structural brain abnormalities was related to poor outcomes in children with AA.

Diagnostic challenge and surgical management of multiple pancreatic neuroendocrine tumors - A case report.

Insulinoma is the most common functional solitary, benign pancreatic neuroendocrine tumor. In this paper, we share our experience of triple pancreatic insulinomas, with an idea to highlight the fact that despite the high frequency of solitary insulinoma, there is the possibility of multiple lesions and point out the need for a systematic and detailed radiographic and clinical examination. A 33-year-old woman was admitted to our clinic due to chronic fatigue, sweating, sporadic episodes of palpitations, unsteady hands, and blurred images, which resolve spontaneously after a few minutes. A comprehensive radiological examination revealed two lesions in the pancreatic tail, highly indicative of neuroendocrine tumor - insulinoma, so we elected for surgical treatment. Intraoperative exploration by manual palpation and ultrasonography revealed two more lesions. In the case of sporadically distributed lesions in the pancreas and if it is not possible to accurately differentiate those that represent the insulinoma for sure, the surgical procedure should be delayed. Additionally, tests such as selective arterial calcium stimulation testing should be carried out, and then, with more information in hands, make a re-plan of the potential surgical treatment which should be made.

Critical exponents at the ferromagnetic transition in tetrakis(dimethylamino)ethylene-C(60) (TDAE- C(60)).

Critical exponents at the ferromagnetic transition were measured for the first time in an organic ferromagnetic material tetrakis(dimethylamino)ethylene fullerene[60] (TDAE- C(60)). From a complete magnetization-temperature-field data set near T(c) = 16.1+/-0.05, we determine the susceptibility and magnetization critical exponents gamma = 1.22+/-0.02 and beta = 0.75+/-0.03, respectively, and the field vs magnetization exponent at T(c) of delta = 2.28+/-0.14. Hyperscaling is found to be violated by Omega identical with d(')-d approximately -1/4, suggesting that the onset of ferromagnetism can be related to percolation of a particular contact configuration of C(60) molecular orientations.

Barkhausen avalanches in anisotropic ferromagnets with 180 degrees domain walls

We show that Barkhausen noise in two-dimensional disordered ferromagnets with extended domain walls is characterized by the avalanche size exponent tau(s)=1.54 at low disorder. With increasing disorder the characteristic domain size is reduced relative to the system size due to nucleation of new domains and a dynamic phase transition occurs to the scaling behavior with tau(s)=1.30. The exponents decrease at finite driving rate. The results agree with recently observed behavior in amorphous Metglas and Fe-Co-B ribbons when the applied anisotropic stress is varied.

Scaling of avalanche queues in directed dissipative sandpiles

Using numerical simulations and analytical methods we study a two-dimensional directed sandpile automaton with nonconservative random defects (concentration c) and varying driving rate r. The automaton is driven only at the top row and driving rate is measured by the number of added particles per time step of avalanche evolution. The probability distribution of duration of elementary avalanches at zero driving rate is exactly given by P1(t,c)=t(-3/2) exp[t ln(1-c)]. For driving rates in the interval 0 server queue in the queue theory. We study scaling properties of the busy period and dissipated energy of sequences of noninterrupted activity. In the limit c-->0 and varying linear system size L<<1/c we find that at driving rates r>1/c increasing the driving rate somewhat compensates for the energy losses at defects above the line r approximately sqrt[c]. The scaling exponents of the distributions in this region of phase diagram vary approximately linearly with the driving rate. Using properties of recurrent states and the probability theory we determine analytically the exact upper bound of the probability distribution of busy periods. In the case of conservative dynamics c=0 the probability of a continuous flow increases as F(infinity) approximately r(2) for small driving rates.

Allozyme marker loci associated with favorable alleles for grain yield in maize.

The evaluation of germplasm to identify its potential as a source of new favorable alleles is a time-consuming phase of maize hybrid breeding programs. The objective of this paper was to study the relationship between allozyme diversity and quantitative estimators of the relative number of new favorable alleles for grain yield, present in donor lines but not present in the elite hybrid. Twenty-two maize inbred lines representing heterotic groups from the United States (US) and Yugoslavia (YU) were used as donors to estimate the presence of new favorable alleles for grain yield improvement for the hybrid B73 x Mo17. In a second experiment, a 15-line diallel was grown, and 13 single crosses differing in allozyme relatedness measure (ARM) and heterotic grouping were considered as targets to be improved by the remaining 13 lines. Minimally biased estimates of new favorable alleles for grain yield (µG) and ARM values were made for all donor lines within each target hybrid. Donor lines were grouped in four allozyme-pedigree classes for each target hybrid to compare the effect of allozyme diversity with pedigree diversity. Pedigree dissimilarities had significant effects on µG estimates. Dissimilar pedigree classes had higher µG estimates than similar pedigree classes. Allozyme differences between donor inbred lines and target hybrids had inconsistent effects on µG estimates. Significant differences in µG estimates among allozyme classes were found for 31% of the target hybrids. Classes with similar allozymes had higher µG estimates more frequently than classes with disimilar allozymes. Correlation coefficients between µG estimates and ARM values were low and not significant for 12 of the 14 target hybrids.