bluuebunny/crossref_metadata_2025 huggingface dataset:
A Strain Feedback Compensation Method during Cell Tensile Experiments
Authors: Zhou Rong , Yang Yunshu , Zhang Wenzhuo , Zou Yuanwen
Published: June 2017

Cell tensile technique is an important and widely used tool in cell mechanical research. However, the strain control condition in traditional tensile experiments is not satisfied and would result in big errors. These strain errors will seriously impact the experimental accuracy and decrease the reliability and comparability of experimental results. In order to achieve the accurate strain control of the membrane during stretching, a strain feedback compensation method based on the digital image correlation is proposed in this paper. To evaluate the effect of the proposed compensation method, a series of stretching experiments in different strains ranging from 5% to 20% were performed. The results showed that our proposed method significantly decreased the errors of strain control. These results indicate that the strain feedback compensation method is very effective in controlling strain and can greatly improve the experimental accuracy.
The Effect of Osteopontin on Microglia
Authors: Yu Huan , Liu Xiaohong , Zhong Yisheng
Published: June 2017

Osteopontin (OPN) is a proinflammatory cytokine that can be secreted from many cells, including activated macrophages and T-lymphocytes, and is widely distributed in many tissues and cells. OPN, a key factor in tissue repairing and extracellular matrix remodeling after injury, is a constituent of the extracellular matrix of the central nervous system (CNS). Recently, the role of OPN in neurodegenerative diseases has gradually caused widespread concern. Microglia are resident macrophage-like immune cells in CNS and play a vital role in both physiological and pathological conditions, including restoring the integrity of the CNS and promoting the progression of neurodegenerative disorders. Microglia’s major function is to maintain homeostasis and the normal function of the CNS, both during development and in response to CNS injury. Although the functional mechanism of OPN in CNS neurodegenerative diseases has yet to be fully elucidated, most studies suggest that OPN play a role in pathogenesis of neurodegenerative diseases or in neuroprotection by regulating the activation and function of microglia. Here, we summarize the functions of OPN on microglia in response to various stimulations in vitro and in vivo.
The Holy Grail of Orthopedic Surgery: Mesenchymal Stem Cells—Their Current Uses and Potential Applications
Authors: Berebichez-Fridman Roberto , Gómez-García Ricardo , Granados-Montiel Julio , Berebichez-Fastlicht Enrique , Olivos-Meza Anell , Granados Julio , Velasquillo Cristina , Ibarra Clemente
Published: June 2017

Only select tissues and organs are able to spontaneously regenerate after disease or trauma, and this regenerative capacity diminishes over time. Human stem cell research explores therapeutic regenerative approaches to treat various conditions. Mesenchymal stem cells (MSCs) are derived from adult stem cells; they are multipotent and exert anti-inflammatory and immunomodulatory effects. They can differentiate into multiple cell types of the mesenchyme, for example, endothelial cells, osteoblasts, chondrocytes, fibroblasts, tenocytes, vascular smooth muscle cells, and sarcomere muscular cells. MSCs are easily obtained and can be cultivated and expanded in vitro; thus, they represent a promising and encouraging treatment approach in orthopedic surgery. Here, we review the application of MSCs to various orthopedic conditions, namely, orthopedic trauma; muscle injury; articular cartilage defects and osteoarthritis; meniscal injuries; bone disease; nerve, tendon, and ligament injuries; spinal cord injuries; intervertebral disc problems; pediatrics; and rotator cuff repair. The use of MSCs in orthopedics may transition the practice in the field from predominately surgical replacement and reconstruction to bioregeneration and prevention. However, additional research is necessary to explore the safety and effectiveness of MSC treatment in orthopedics, as well as applications in other medical specialties.
Noradrenaline, Serotonin, GABA, and Glycine in Cerebrospinal Fluid during Labor Pain: A Cross-Sectional Prospective Study
Authors: Chalermkitpanit Pornpan , Thonnagith Atikun , Engsusophon Phatthanaphol , Charuluxananan Somrat , Honsawek Sittisak
Published: June 2017

Background and Aims. The inhibitory pathways that play a role in spinal modulation include local interneurons and descending control. Clinical data regarding the role of these pathways in acute pain is lacking. Accordingly, the aim of this study was to evaluate cerebrospinal fluid (CSF) levels of noradrenaline, serotonin, gamma-aminobutyric acid (GABA), and glycine in parturients with labor pain compared to those without labor pain.Methods. One hundred term uncomplicated pregnant women receiving spinal anesthesia for cesarean section were enrolled in this prospective cross-sectional study. CSF noradrenaline, serotonin, GABA, and glycine levels were analyzed by enzyme-linked immunosorbent assay. Labor pain score was assessed by numerical rating scale.Results. Median CSF serotonin concentration in parturients with labor pain was significantly lower than in those without pain (p<0.001). Median CSF glycine level in the labor pain group was significantly higher than in the control group (p<0.001). There were no significant differences in median CSF level of noradrenaline or GABA between parturients with and without labor pain. Subsequent analysis showed labor pain scores to be negatively correlated with CSF serotonin (r=-0.217,p=0.04) but positively correlated with CSF glycine (r=0.415,p<0.001).Conclusion. CSF serotonin and glycine were significantly correlated with labor pain scores. These findings suggest that the serotonergic and glycinergic systems may play a role in spinal modulation of visceral pain.
Proliferation of Interstitial Cells in the Cyclophosphamide-Induced Cystitis and the Preventive Effect of Imatinib
Authors: Sancho Maria , Triguero Domingo , Lafuente-Sanchis Aranzazu , Garcia-Pascual Angeles
Published: June 2017

Cyclophosphamide- (CYP-) induced cystitis in the rat is a well-known model of bladder inflammation that leads to an overactive bladder, a process that appears to involve enhanced nitric oxide (NO) production. We investigated the changes in the number and distribution of interstitial cells (ICs) and in the expression of endothelial NO synthase (eNOS) in the bladder and urethra of rats subjected to either intermediate or chronic CYP treatment. Pronounced hyperplasia and hypertrophy of ICs were evident within the lamina propria and in the muscle layer. IC immunolabeling with CD34, PDGFRα, and vimentin was enhanced, as reflected by higher colocalization indexes of the distinct pairs of markers. Moreover, de novo expression of eNOS was evident in vimentin and CD34 positive ICs. Pretreatment with the receptor tyrosine kinase inhibitor Imatinib prevented eNOS expression and ICs proliferation, as well as the increased voiding frequency and urinary tract weight provoked by CYP. As similar results were obtained in the urethra, urethritis may contribute to the uropathology of CYP-induced cystitis.
Circadian Rhythms in Fear Conditioning: An Overview of Behavioral, Brain System, and Molecular Interactions
Authors: Albrecht Anne , Stork Oliver
Published: June 2017

The formation of fear memories is a powerful and highly evolutionary conserved mechanism that serves the behavioral adaptation to environmental threats. Accordingly, classical fear conditioning paradigms have been employed to investigate fundamental molecular processes of memory formation. Evidence suggests that a circadian regulation mechanism allows for a timestamping of such fear memories and controlling memory salience during both their acquisition and their modification after retrieval. These mechanisms include an expression of molecular clocks in neurons of the amygdala, hippocampus, and medial prefrontal cortex and their tight interaction with the intracellular signaling pathways that mediate neural plasticity and information storage. The cellular activities are coordinated across different brain regions and neural circuits through the release of glucocorticoids and neuromodulators such as acetylcholine, which integrate circadian and memory-related activation. Disturbance of this interplay by circadian phase shifts or traumatic experience appears to be an important factor in the development of stress-related psychopathology, considering these circadian components are of critical importance for optimizing therapeutic approaches to these disorders.
Total Parenteral Nutrition Successfully Treating Black Esophagus Secondary to Hypovolemic Shock
Authors: Brar Tony S. , Helton Richard , Zaidi Zareen
Published: June 2017

We present a patient who developed black esophagus secondary to hypovolemic shock and was placed on total parenteral nutrition for three weeks after hospital discharge. The area of interest is the multimodal approach used in treatment of this noncompliant patient. Even with a high mortality rate, this case illustrates a successful outcome of a patient who responded to appropriate immediate therapy resulting in complete resolution of the necrosis with no further development of complications.
Risk Factors and Etiology of Young Ischemic Stroke Patients in Estonia
Authors: Schneider Siim , Kornejeva Alina , Vibo Riina , Kõrv Janika
Published: June 2017

Objectives. Reports on young patients with ischemic stroke from Eastern Europe have been scarce. This study aimed to assess risk factors and etiology of first-ever and recurrent stroke among young Estonian patients. Methods. We performed a retrospective study of consecutive ischemic stroke patients aged 18–54 years who were treated in our two hospitals from 2003 to 2012. Results. We identified 741 patients with first-ever stroke and 96 patients with recurrent stroke. Among first-time patients, men predominated in all age groups. The prevalence of well-documented risk factors in first-time stroke patients was 83% and in the recurrent group 91%. The most frequent risk factors were hypertension (53%), dyslipidemia (46%), and smoking (35%). Recurrent stroke patients had fewer less well-documented risk factors compared to first-time stroke patients (19.8 versus 30.0%, P=0.036). Atrial fibrillation was the most common cause of cardioembolic strokes (48%) and large-artery atherosclerosis (LAA) was the cause in 8% among those aged <35 years. Compared to first-time strokes, recurrent ones were more frequently caused by LAA (14.3 versus 24.0%, P=0.01) and less often by other definite etiology (8.5 versus 1.0%, P=0.01). Conclusions. The prevalence of vascular risk factors among Estonian young stroke patients is high. Premature atherosclerosis is a cause in a substantial part of very young stroke patients.
Complete Chloroplast Genome Sequence of Coptis chinensis Franch. and Its Evolutionary History
Authors: He Yang , Xiao Hongtao , Deng Cao , Fan Gang , Qin Shishang , Peng Cheng
Published: June 2017

The Coptis chinensis Franch. is an important medicinal plant from the Ranunculales. We used next generation sequencing technology to determine the complete chloroplast genome of C. chinensis. This genome is 155,484 bp long with 38.17% GC content. Two 26,758 bp long inverted repeats separated the genome into a typical quadripartite structure. The C. chinensis chloroplast genome consists of 128 gene loci, including eight rRNA gene loci, 28 tRNA gene loci, and 92 protein-coding gene loci. Most of the SSRs in C. chinensis are poly-A/T. The numbers of mononucleotide SSRs in C. chinensis and other Ranunculaceae species are fewer than those in Berberidaceae species, while the number of dinucleotide SSRs is greater than that in the Berberidaceae. C. chinensis diverged from other Ranunculaceae species an estimated 81 million years ago (Mya). The divergence between Ranunculaceae and Berberidaceae was ~111 Mya, while the Ranunculales and Magnoliaceae shared a common ancestor during the Jurassic, ~153 Mya. Position 104 of the C. chinensis ndhG protein was identified as a positively selected site, indicating possible selection for the photosystem-chlororespiration system in C. chinensis. In summary, the complete sequencing and annotation of the C. chinensis chloroplast genome will facilitate future studies on this important medicinal species.
ExCNVSS: A Noise-Robust Method for Copy Number Variation Detection in Whole Exome Sequencing Data
Authors: Kong Jinhwa , Shin Jaemoon , Won Jungim , Lee Keonbae , Lee Unjoo , Yoon Jeehee
Published: June 2017

Copy number variations (CNVs) are structural variants associated with human diseases. Recent studies verified that disease-related genes are based on the extraction of rare de novo and transmitted CNVs from exome sequencing data. The need for more efficient and accurate methods has increased, which still remains a challenging problem due to coverage biases, as well as the sparse, small-sized, and noncontinuous nature of exome sequencing. In this study, we developed a new CNV detection method, ExCNVSS, based on read coverage depth evaluation and scale-space filtering to resolve these problems. We also developed the method ExCNVSS_noRatio, which is a version of ExCNVSS, for applying to cases with an input of test data only without the need to consider the availability of a matched control. To evaluate the performance of our method, we tested it with 11 different simulated data sets and 10 real HapMap samples’ data. The results demonstrated that ExCNVSS outperformed three other state-of-the-art methods and that our method corrected for coverage biases and detected all-sized CNVs even without matched control data.
Macroscopic Hematuria due to Placenta Percreta: Report of Two Cases and Short Review
Authors: Koukoura Ourania , Lialios George , Garas Antonios , Sveronis George , Nidimos Asterios , Gkorezi Irondiana , Alevra Zoi , Tzortzis Vassilios , Oeconomou Athanasios , Zachos Ioannis , Daponte Alexandros
Published: June 2017

Herein we present two cases of pregnant women with placenta percreta and severe hematuria during the 24th and 35th weeks of pregnancy, respectively. A timely sonographic diagnosis was feasible in the first case and cesarean section was performed during the 29th week. During the operation, the placenta was invading the bladder wall and concomitant hysterectomy with cystotomy and bladder wall reconstruction was performed. The second case presented in our emergency department with vaginal bleeding during the 35th weeks of pregnancy. She underwent an emergency cesarean section with uterine preservation, cystotomy, and bladder reconstruction.
The Alkylating Chemotherapeutic Temozolomide Induces Metabolic Stress in IDH1-Mutant Cancers and Potentiates NAD+ Depletion–Mediated Cytotoxicity
Authors: Tateishi Kensuke , Higuchi Fumi , Miller Julie J. , Koerner Mara V.A. , Lelic Nina , Shankar Ganesh M. , Tanaka Shota , Fisher David E. , Batchelor Tracy T. , Iafrate A. John , Wakimoto Hiroaki , Chi Andrew S. , Cahill Daniel P.
Published: June 2017

IDH1-mutant gliomas are dependent upon the canonical coenzyme NAD+ for survival. It is known that PARP activation consumes NAD+ during base excision repair (BER) of chemotherapy-induced DNA damage. We therefore hypothesized that a strategy combining NAD+ biosynthesis inhibitors with the alkylating chemotherapeutic agent temozolomide could potentiate NAD+ depletion–mediated cytotoxicity in mutant IDH1 cancer cells. To investigate the impact of temozolomide on NAD+ metabolism, patient-derived xenografts and engineered mutant IDH1-expressing cell lines were exposed to temozolomide, in vitro and in vivo, both alone and in combination with nicotinamide phosphoribosyltransferase (NAMPT) inhibitors, which block NAD+ biosynthesis. The acute time period (<3 hours) after temozolomide treatment displayed a burst of NAD+ consumption driven by PARP activation. In IDH1-mutant–expressing cells, this consumption reduced further the abnormally lowered basal steady-state levels of NAD+, introducing a window of hypervulnerability to NAD+ biosynthesis inhibitors. This effect was selective for IDH1-mutant cells and independent of methylguanine methyltransferase or mismatch repair status, which are known rate-limiting mediators of adjuvant temozolomide genotoxic sensitivity. Combined temozolomide and NAMPT inhibition in an in vivo IDH1-mutant cancer model exhibited enhanced efficacy compared with each agent alone. Thus, we find IDH1-mutant cancers have distinct metabolic stress responses to chemotherapy-induced DNA damage and that combination regimens targeting nonredundant NAD+ pathways yield potent anticancer efficacy in vivo. Such targeting of convergent metabolic pathways in genetically selected cancers could minimize treatment toxicity and improve durability of response to therapy. Cancer Res; 77(15); 4102–15. ©2017 AACR.
Colorectal Cancer Screening: How Health Gains and Cost-Effectiveness Vary by Ethnic Group, the Impact on Health Inequalities, and the Optimal Age Range to Screen
Authors: McLeod Melissa , Kvizhinadze Giorgi , Boyd Matt , Barendregt Jan , Sarfati Diana , Wilson Nick , Blakely Tony
Published: June 2017

Background: Screening programs consistently underserve indigenous populations despite a higher overall burden of cancer. In this study, we explore the likely health gains and cost-effectiveness of a national colorectal cancer screening program for the indigenous Māori population of New Zealand (NZ).

Methods: A Markov model estimated: health benefits (quality-adjusted life-year; QALY), costs, and cost-effectiveness of biennial immunochemical fecal occult blood testing (FOBTi) of 50- to 74-year-olds from 2011. Input parameters came from literature reviews, the NZ Bowel Screening Programme Pilot, and NZ linked health datasets. Equity analyses substituted non-Māori values for Māori values of background (noncolorectal cancer) morbidity and mortality, colorectal cancer survival and incidence, screening coverage, and stage-specific survival. We measured the change in “quality-adjusted life expectancy” (QALE) as a result of the intervention.

Results: Based upon a threshold of GDP per capita (NZ$45,000), colorectal cancer screening in NZ using FOBTi is cost-effective: NZ$2,930 (US$1,970) per QALY gained [95% uncertainty interval: cost saving to $6,850 (US$4,610)]. Modeled health gains per capita for Māori were less than for non-Māori: half for 50- to 54-year-olds (0.031 QALYs per person for Māori vs. 0.058 for non-Māori), and a fifth (0.003 c.f. 0.016) for 70- to 74-year-olds and ethnic inequalities in QALE increased with colorectal cancer screening.

Conclusions: Colorectal cancer screening in NZ using FOBTi is likely to be cost-effective but risks increasing inequalities in health for Māori.

Impact: To avoid or mitigate the generation of further health inequalities, attention should be given to underserved population groups when planning and implementing screening programs. Cancer Epidemiol Biomarkers Prev; 26(9); 1391–400. ©2017 AACR.
How Many Deaths from Colorectal Cancer Can Be Prevented by 2030? A Scenario-Based Quantification of Risk Factor Modification, Screening, and Treatment in Norway
Authors: Skyrud Katrine Damgaard , Myklebust Tor Åge , Bray Freddie , Eriksen Morten Tandberg , de Lange Thomas , Larsen Inger Kristin , Møller Bjørn
Published: June 2017

Background: Colorectal cancer mortality can be reduced through risk factor modification (adherence to lifestyle recommendations), screening, and improved treatment. This study estimated the potential of these three strategies to modify colorectal cancer mortality rates in Norway.

Methods: The potential reduction in colorectal cancer mortality due to risk factor modification was estimated using the software Prevent, assuming that 50% of the population in Norway—who do not adhere to the various recommendations concerning prevention of smoking, physical activity, body weight, and intake of alcohol, red/processed meat, and fiber—started to follow the recommendations. The impact of screening was quantified assuming implementation of national flexible sigmoidoscopy screening with 50% attendance. The reduction in colorectal cancer mortality due to improved treatment was calculated assuming that 50% of the linear (positive) trend in colorectal cancer survival would continue to persist in future years.

Results: Risk factor modification would decrease colorectal cancer mortality by 11% (corresponding to 227 prevented deaths: 142 men, 85 women) by 2030. Screening and improved treatment in Norway would reduce colorectal cancer mortality by 7% (149 prevented deaths) and 12% (268 prevented deaths), respectively, by 2030. Overall, the combined effect of all three strategies would reduce colorectal cancer mortality by 27% (604 prevented deaths) by 2030.

Conclusions: Risk factor modification, screening, and treatment all have considerable potential to reduce colorectal cancer mortality by 2030, with the largest potential reduction observed for improved treatment and risk factor modification.

Impact: The estimation of these health impact measures provides useful information that can be applied in public health decision-making. Cancer Epidemiol Biomarkers Prev; 26(9); 1420–6. ©2017 AACR.
Optimization of RAS/BRAF Mutational Analysis Confirms Improvement in Patient Selection for Clinical Benefit to Anti-EGFR Treatment in Metastatic Colorectal Cancer
Authors: Santos Cristina , Azuara Daniel , Garcia-Carbonero Rocio , Alfonso Pilar Garcia , Carrato Alfredo , Elez Mª Elena , Gomez Auxiliadora , Losa Ferran , Montagut Clara , Massuti Bartomeu , Navarro Valenti , Varela Mar , Lopez-Doriga Adriana , Moreno Victor , Valladares Manuel , Manzano Jose Luis , Vieitez Jose Maria , Aranda Enrique , Sanjuan Xavier , Tabernero Josep , Capella Gabriel , Salazar Ramon
Published: June 2017

In metastatic colorectal cancer (mCRC), recent studies have shown the importance to accurately quantify low-abundance mutations of the RAS pathway because anti-EGFR therapy may depend on certain mutation thresholds. We aimed to evaluate the added predictive value of an extended RAS panel testing using two commercial assays and a highly sensitive and quantitative digital PCR (dPCR). Tumor samples from 583 mCRC patients treated with anti–EGFR- (n = 255) or bevacizumab- (n = 328) based therapies from several clinical trials and retrospective series from the TTD/RTICC Spanish network were analyzed by cobas, therascreen, and dPCR. We evaluated concordance between techniques using the Cohen kappa index. Response rate, progression-free survival (PFS), and overall survival (OS) were correlated to the mutational status and the mutant allele fraction (MAF). Concordance between techniques was high when analyzing RAS and BRAF (Cohen kappa index around 0.75). We observed an inverse correlation between MAF and response in the anti-EGFR cohort (P < 0.001). Likelihood ratio analysis showed that a fraction of 1% or higher of any mutated alleles offered the best predictive value. PFS and OS were significantly longer in RAS/BRAF wild-type patients, independently of the technique. However, the predictability of both PFS and OS were higher when we considered a threshold of 1% in the RAS scenario (HR = 1.53; CI 95%, 1.12–2.09 for PFS, and HR = 1.9; CI 95%, 1.33–2.72 for OS). Although the rate of mutations observed among techniques is different, RAS and BRAF mutational analysis improved prediction of response to anti-EGFR therapy. Additionally, dPCR with a threshold of 1% outperformed the other platforms. Mol Cancer Ther; 16(9); 1999–2007. ©2017 AACR.
Antegrade Dissection and Reentry as Part of the Hybrid Chronic Total Occlusion Revascularization Strategy
Authors: Maeremans Joren , Dens Jo , Spratt James C. , Bagnall Alan J. , Stuijfzand Wynand , Nap Alexander , Agostoni Pierfrancesco , Wilson William , Hanratty Colm G. , Wilson Simon , Faurie Benjamin , Avran Alexandre , Bressollette Erwan , Egred Mohaned , Knaapen Paul , Walsh Simon , Smith Dave , Chase Alexander , Smith William H.T. , Harcombe Alun , Kayaert Peter , Smith Elliot J. , Kelly Paul , Irving John , McEntegart Margaret B. , Strange Julian W
Published: June 2017

Background—

Development of the CrossBoss and Stingray devices for antegrade dissection and reentry (ADR) of chronic total occlusions has improved historically suboptimal outcomes. However, the outcomes, safety, and failure modes of the technique have to be studied in a larger patient cohort. This preplanned substudy of the RECHARGE registry (Registry of CrossBoss and Hybrid Procedures in France, the Netherlands, Belgium and United Kingdom) aims to evaluate the value and use of ADR and determine its future position in contemporary chronic total occlusion intervention.

Methods and Results—

Patients were selected if an ADR strategy was applied. Outcomes, safety, and failure modes of the technique were assessed. The ADR technique was used in 23% (n=292/1253) of the RECHARGE registry and was mainly applied for complex lesions (Japanese chronic total occlusion score=2.7±1.1). ADR was the primary strategy in 30% (n=88/292), of which 67% were successful. Bail-out ADR strategies were successful in 63% (n=133/210). The Controlled ADR (ie, combined CrossBoss-Stingray) subtype was applied most frequently (32%; n=93/292) and successfully (81%; n=75/93). Overall per-lesion success rate was 78% (n=229/292), after use of additional bail-out strategies. The inability to reach the distal target zone (n=48/100) or to reenter (n=43/100) most commonly led to failure. ADR-associated major events occurred in 3.4% (n=10/292).

Conclusions—

Although mostly applied as a bail-out strategy for complex lesions, the frequency, outcomes, and low complication rate of the ADR technique and its subtypes confirm the benefit and value of the technique in hybrid chronic total occlusion percutaneous coronary intervention, especially when antegrade wiring or retrograde approaches are not feasible.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT02075372.
Effect of Obesity and Underweight Status on Perioperative Outcomes of Congenital Heart Operations in Children, Adolescents, and Young Adults
Authors: O’Byrne Michael L. , Kim Sunghee , Hornik Christoph P. , Yerokun Babatunde A. , Matsouaka Roland A. , Jacobs Jeffrey P. , Jacobs Marshall L. , Jonas Richard A.
Published: June 2017

Background:

Extreme body mass index (BMI; either very high or very low) has been associated with increased risk of adverse perioperative outcome in adults undergoing cardiac surgery. The effect of BMI on perioperative outcomes in congenital heart disease patients has not been evaluated.

Methods:

A multicenter retrospective cohort study was performed studying patients 10 to 35 years of age undergoing a congenital heart disease operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database between January 1, 2010, and December 31, 2015. The primary outcomes were operative mortality and a composite outcome (1 or more of operative mortality, major adverse event, prolonged hospital length of stay, and wound infection/dehiscence). The associations between age- and sex-adjusted BMI percentiles and these outcomes were assessed, with adjustment for patient-level risk factors, with multivariate logistic regression.

Results:

Of 18 337 patients (118 centers), 16% were obese, 15% were overweight, 53% were normal weight, 7% were underweight, and 9% were severely underweight. Observed risks of operative mortality (
P
=0.04) and composite outcome (
P
<0.0001) were higher in severely underweight and obese subjects. Severely underweight BMI was associated with increased unplanned cardiac operation and reoperation for bleeding. Obesity was associated with increased risk of wound infection. In multivariable analysis, the association between BMI and operative mortality was no longer significant. Obese (odds ratio, 1.28;
P
=0.008), severely underweight (odds ratio, 1.29;
P
<0.0001), and underweight (odds ratio, 1.39;
P
=0.002) subjects were associated with increased risk of composite outcome.

Conclusions:

Obesity and underweight BMI were associated with increased risk of composite adverse outcome independently of other risk factors. Further research is necessary to determine whether BMI represents a modifiable risk factor for perioperative outcome.
Secondary Prevention of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus
Authors: Pagidipati Neha J. , Navar Ann Marie , Pieper Karen S. , Green Jennifer B. , Bethel M. Angelyn , Armstrong Paul W. , Josse Robert G. , McGuire Darren K. , Lokhnygina Yuliya , Cornel Jan H. , Halvorsen Sigrun , Strandberg Timo E. , Delibasi Tuncay , Holman Rury R. , Peterson Eric D.
Published: June 2017

Background:

Intensive risk factor modification significantly improves outcomes for patients with diabetes mellitus and cardiovascular disease. However, the degree to which secondary prevention treatment goals are achieved in international clinical practice is unknown.

Methods:

Attainment of 5 secondary prevention parameters—aspirin use, lipid control (low-density lipoprotein cholesterol <70 mg/dL or statin therapy), blood pressure control (<140 mm Hg systolic, <90 mm Hg diastolic), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and nonsmoking status—was evaluated among 13 616 patients from 38 countries with diabetes mellitus and known cardiovascular disease at entry into TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin). Logistic regression was used to evaluate the association between individual and regional factors and secondary prevention achievement at baseline. Cox proportional hazards regression analysis was used to determine the association between baseline secondary prevention achievement and cardiovascular death, myocardial infarction, or stroke.

Results:

Overall, 29.9% of patients with diabetes mellitus and cardiovascular disease achieved all 5 secondary prevention parameters at baseline, although 71.8% achieved at least 4 parameters. North America had the highest proportion (41.2%), whereas Western Europe, Eastern Europe, and Latin America had proportions of ≈25%. Individually, blood pressure control (57.9%) had the lowest overall attainment, whereas nonsmoking status had the highest (89%). Over a median 3.0 years of follow-up, a higher baseline secondary prevention score was associated with improved outcomes in a step-wise graded relationship (adjusted hazard ratio, 0.60; 95% confidence interval, 0.47–0.77 for those patients achieving all 5 measures versus those achieving ≤2).

Conclusions:

In an international trial population, significant opportunities exist to improve the quality of cardiovascular secondary prevention care among patients with diabetes mellitus and cardiovascular disease, which in turn could lead to reduced risk of downstream cardiovascular events.

Clinical Trial Registration:

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00790205.
Prediction of Recurrent Stroke or Transient Ischemic Attack After Noncardiogenic Posterior Circulation Ischemic Stroke
Authors: Zhang Changqing , Wang Yilong , Zhao Xingquan , Liu Liping , Wang ChunXue , Pu Yuehua , Zou Xinying , Pan Yuesong , Wong Ka Sing , Wang Yongjun
Published: June 2017

Background and Purpose—

Posterior circulation ischemic stroke (IS) is generally considered an illness with a poor prognosis. However, there are no effective rating scales to predict recurrent stroke following it. Therefore, our aim was to identify clinical or radiological measures that could assist in predicting recurrent cerebral ischemic episodes.

Methods—

We prospectively enrolled 723 noncardiogenic posterior circulation IS patients with onset of symptoms <7 days. Stroke risk factors, admission symptoms and signs, topographical distribution and responsible cerebral artery of acute infarcts, and any recurrent IS or transient ischemic attack (TIA) within 1 year were assessed. Cox regression was used to identify risk factors associated with recurrent IS or TIA within the year after posterior circulation IS.

Results—

A total of 40 patients (5.5%) had recurrent IS or TIA within 1 year of posterior circulation IS. Multivariate Cox regression identified chief complaint with dysphagia (hazard ratio [HR], 4.16; 95% confidence interval [CI], 1.69–10.2;
P
=0.002), repeated TIAs within 3 months before the stroke (HR, 15.4; 95% CI, 5.55–42.5;
P
<0.0001), responsible artery stenosis ≥70% (HR, 7.91; 95% CI, 1.00–62.6;
P
=0.05), multisector infarcts (HR, 5.38; 95% CI, 1.25–23.3;
P
=0.02), and not on antithrombotics treatment at discharge (HR, 3.06; 95% CI, 1.09–8.58;
P
=0.03) as independent predictors of recurrent IS or TIA.

Conclusions—

Some posterior circulation IS patients are at higher risk for recurrent IS or TIA. Urgent assessment and preventive treatment should be offered to these patients as soon as possible.
Contributors to the Excess Stroke Mortality in Rural Areas in the United States
Authors: Howard George , Kleindorfer Dawn O. , Cushman Mary , Long D. Leann , Jasne Adam , Judd Suzanne E. , Higginbotham John C. , Howard Virginia J.
Published: June 2017

Background and Purpose—

Stroke mortality is 30% higher in the rural United States. This could be because of either higher incidence or higher case fatality from stroke in rural areas.

Methods—

The urban–rural status of 23 280 stroke-free participants recruited between 2003 and 2007 in the REGARDS study (Reasons for Geographic and Racial Differences in Stroke) was classified using the Rural–Urban Commuting Area scheme as residing in urban, large rural town/city, or small rural town or isolated areas. The risk of incident stroke was assessed using proportional hazards analysis, and case fatality (death within 30 days of stroke) was assessed using logistic regression. Models were adjusted for demographics, traditional stroke risk factors, and measures of socioeconomic status.

Results—

After adjustment for demographic factors and relative to urban areas, stroke incidence was 1.23-times higher (95% confidence intervals, 1.01–1.51) in large rural town/cities and 1.30-times higher (95% confidence intervals, 1.03–1.62) in small rural towns or isolated areas. Adjustment for risk factors and socioeconomic status only modestly attenuated this association, and the association became marginally nonsignificant (
P
=0.071). There was no association of rural–urban status with case fatality (
P
>0.47).

Conclusions—

The higher stroke mortality in rural regions seemed to be attributable to higher stroke incidence rather than case fatality. A higher prevalence of risk factors and lower socioeconomic status only modestly contributed to the increased risk of incident stroke risk in rural areas. There was no evidence of higher case fatality in rural areas.
Risk of Stroke With Various Types of Menopausal Hormone Therapies
Authors: Løkkegaard Ellen , Nielsen Lars Hougaard , Keiding Niels
Published: June 2017

Background and Purpose—

Double-blind randomized studies on the effects of oral postmenopausal hormone therapies were stopped mainly because of increased risk of stroke. We aimed to assess the risk of all strokes and various subtypes associated with hormone therapy and explore the influence of regimens and routes of administration.

Methods—

A national historical cohort of women aged 51 to 70 years from 1995 to 2010 was established by linking 5 Danish registries. The National Registry of Medicinal Product Statistics provided information on hormone therapy exposure and the National Patient or Cause of Death Registries supplied data regarding stroke diagnoses (ischemic/hemorrhagic/subarachnoid hemorrhage). Multiply adjusted rate ratios with time-varying covariates were fitted in Poisson regression models.

Results—

Of the 980 003 included women, 20 199 suffered a stroke (78% ischemic, 12% hemorrhagic, and 10% subarachnoid hemorrhage). In total, 36% of women used hormone therapy. Current use conferred a relative rate of 1.16 (95% confidence interval, 1.12–1.22). Compared with never users, the increased rate ratio of all stroke with continuous, cyclic combined estrogen/progestin, and estrogen only oral therapies were 1.29 (95% confidence interval, 1.21–1.37), 1.11 (95% confidence interval, 1.04–1.20), and 1.18 (95% confidence interval, 1.10–1.26), respectively. The increased risk was because of ischemic stroke, but not hemorrhagic stroke. Transdermal application of hormone therapy was not associated with risk of stroke. Vaginal estrogen was associated with a decreased risk of stroke.

Conclusions—

In a national setting, we found an increased risk of stroke, based on ischemic stroke, with oral hormone therapies that was comparable to findings from randomized studies. We found no risk of stroke with transdermal application and a reduced risk with vaginal estrogen.
Abnormal P-Wave Axis and Ischemic Stroke
Authors: Maheshwari Ankit , Norby Faye L. , Soliman Elsayed Z. , Koene Ryan J. , Rooney Mary R. , O’Neal Wesley T. , Alonso Alvaro , Chen Lin Y.
Published: June 2017

Background and Purpose—

Abnormal P-wave axis (aPWA) has been linked to incident atrial fibrillation and mortality; however, the relationship between aPWA and stroke has not been reported. We hypothesized that aPWA is associated with ischemic stroke independent of atrial fibrillation and other stroke risk factors and tested our hypothesis in the ARIC study (Atherosclerosis Risk In Communities), a community-based prospective cohort study.

Methods—

We included 15 102 participants (aged 54.2±5.7 years; 55.2% women; 26.5% blacks) who attended the baseline examination (1987–1989) and without prevalent stroke. We defined aPWA as any value outside 0 to 75° using 12-lead ECGs obtained during study visits. Each case of incident ischemic stroke was classified in accordance with criteria from the National Survey of Stroke by a computer algorithm and adjudicated by physician review. Multivariable Cox regression was used to estimate hazard ratios and 95% confidence intervals for the association of aPWA with stroke.

Results—

During a mean follow-up of 20.2 years, there were 657 incident ischemic stroke cases. aPWA was independently associated with a 1.50-fold (95% confidence interval, 1.22–1.85) increased risk of ischemic stroke in the multivariable model that included atrial fibrillation. When subtyped, aPWA was associated with a 2.04-fold (95% confidence interval, 1.42–2.95) increased risk of cardioembolic stroke and a 1.32-fold (95% confidence interval, 1.03–1.71) increased risk of thrombotic stroke.

Conclusions—

aPWA is independently associated with ischemic stroke. This association seems to be stronger for cardioembolic strokes. Collectively, our findings suggest that alterations in atrial electric activation may predispose to cardiac thromboembolism independent of atrial fibrillation.
Admission Brain Cortical Volume
Authors: Sagnier Sharmila , Catheline Gwenaëlle , Dilharreguy Bixente , Munsch Fanny , Bigourdan Antoine , Poli Mathilde , Debruxelles Sabrina , Olindo Stéphane , Renou Pauline , Rouanet François , Dousset Vincent , Tourdias Thomas , Sibon Igor
Published: June 2017

Background and Purpose—

Several markers of poststroke cognitive impairment have been reported. The role of brain cortical volume remains uncertain. The aim of this study was to evaluate the influence of brain cortical volume on cognitive outcomes using a voxel-based morphometry approach in subjects without prestroke dementia.

Methods—

Ischemic stroke patients were prospectively recruited 24 to 72 hours post stroke (M0). Cognition was evaluated at M0, 3 months, and 1 year (M12) using the Montreal Cognitive Assessment, the Isaacs set test, and the Zazzo’s cancellation task. A 3-T brain magnetic resonance imaging was performed at M0. Grey matter (GM) was segmented using Statistical Parametric Mapping 12 software. Association between global GM volume and cognitive score slopes between M0 and M12 was evaluated using a linear mixed model. Correlations between focal GM volumes and changes in cognitive performance were evaluated using Statistical Parametric Mapping 12.

Results—

Two-hundred forty-eight patients were included (mean age 65±SD 14 years old, 66% men). Global GM volume was significantly associated with changes in Montreal Cognitive Assessment scores (β=0.01;
P
=0.04) and in the number of errors on the Zazzo’s cancellation task (β=−0.02;
P
=0.04) independently of other clinical/radiological confounders. Subjects with lower GM volumes in the left fronto-temporo-insular cortex were more vulnerable to transient Montreal Cognitive Assessment and Isaacs set test impairment. Subjects with lower GM volumes in right temporo-insular cortex, together with basal ganglia, were more vulnerable to transient cognitive impairment on the Zazzo’s cancellation task.

Conclusions—

Smaller cortical volumes in fronto-temporo-insular areas measured 24 to 72 hours post stroke are associated with cognitive vulnerability in the subacute stroke phase.
Helping patients reduce anxiety and choose new physicians through improved provider biographies
Authors: Perrault Evan K
Published: June 2017

Objective:

Not being able to effectively communicate with a new physician because of high anxiety associated with the interaction could lead to issues not being addressed, or even inaccurate diagnoses. Using uncertainty reduction and media richness theories as guidance, this study sought to find ways health educators within healthcare organisations could help prospective patients reduce their communication apprehension (CA) prior to a consultation.

Methods:

A total of 90 participants with high Communication Apprehension (CA) with respect to physicians were randomly exposed to two biographies of two different physicians in counterbalanced order that varied in the kind of information provided about the physician (primarily professional or personal), and the media through which the information was presented (text or video).

Setting:

An online experiment surrounding primary care provider selection.

Results:

Repeated measures analyses revealed that CA was reduced the greatest when participants viewed video biographies and biographies containing personal information about the physicians. Participants indicated they would want to visit the physician with whom they had the lowest level of CA.

Conclusion:

This research highlights improvements health educators or service provider managers could make to their physicians’ online biographies to help high-CA patients reduce their apprehension, and make the choice of the next physician much easier. Notably, including personal information about providers, and providing video introductions, reduces CA most significantly.
Avoiding Being a Crushed Prawn and Becoming a Dolphin Swimming between the Two Fighting Whales? South Korea’s Strategic Choice in the Face of the Intensifying Sino–US Competition
Authors: Kim Min-hyung
Published: June 2017

This article presents an analysis of South Korea’s strategic choices over the Asian Infrastructure Investment Bank (AIIB), the Trans-Pacific Partnership (TPP), and the Terminal High Altitude Area Defense (THAAD) in light of the Sino–US competition in post-Cold War East Asia. South Korea’s puzzling behavior here represents Seoul’s hedging strategy against the uncertain future of the Sino–US competition in East Asia. The driving force of South Korea’s hedging behavior is Seoul’s dual concerns about being excessively dependent on the USA for its security at the time of China’s rapid rise on the one hand and being pulled into a growing China’s sphere of influence at the expense of traditional US–ROK security ties on the other. Reflecting Seoul’s prudent balancing acts between the two superpowers, South Korea’s hedging often results in apparently indecisive and underdetermined strategic choices in the face of the intensifying Sino–US competition. Nevertheless, South Korea’s hedging strategy allows Seoul to deepen extensive economic ties with Beijing while maintaining a traditional security alliance with Washington. The hedging behavior of South Korea, which is uniquely positioned as a strategic partner of rapidly rising China as well as a key security ally of the rebalancing USA, sheds important light on the behavior of middle powers in alliance politics, which has largely been neglected in the current literature.
Suicide Trends According to Age, Gender, and Marital Status in South Korea
Authors: Kim Jung Woo , Jung Hee Young , Won Do Yeon , Noh Jae Hyun , Shin Yong Seok , Kang Tae In
Published: June 2017

The purpose of this study is to examine suicide trends in South Korea, which has one of the highest suicide rates in the world. The results show that the male suicide rate outweighs that of females, the likelihood of committing suicide increases with age, and that, in regard to marital status, nonmarried people are the most at risk. In addition, several methods of reducing suicide rates are identified: the wider use of social networks to reduce social burden, the development of a social atmosphere where aging is accepted as a natural process, and the development of protection factors within families.
Simulation of the effects of structural parameters of glass fiber fabric on the thermal insulation property
Authors: Zheng Zhenrong , Wang Hongmei , Zhao Xiaoming , Zhang Nannan
Published: June 2017

The impact of different structural parameters on the thermal insulation of glass fiber fabrics, by using numerical simulation, was investigated. The structural parameters investigated were the weave structure, warp density and yarn fineness. A series of structure models were calculated under the same boundary and initial conditions, which combine thermal radiation, conduction and convection. The simulation results have been validated by experiments. The experimental results and the predictions from numerical simulations were in good agreement. The results show that thermal insulation for the samples is in the order plain < 2/1 twill < 2/2 twill < 2/3 twill < 3/3 twill fabric, when using constant structure density and yarn fineness. Increasing the warp density, from 110 to 160 ends/10 cm, leads to a significant decrease in heat transfer performance. When the warp density increases to more than 160 ends/10 cm, the thermal insulation property shows a decreasing trend with an increase in warp density. Furthermore, thermal insulation performance of the samples dramatically increases as yarn fineness goes from 129 to 280 tex, and then decreases for yarn fineness greater than 280 tex. This study will provide the theoretical basis for the thermal design and application of fibrous materials.
Fiber-based structures for electromagnetic shielding – comparison of different materials and textile structures
Authors: Palanisamy Sundaramoorthy , Tunakova Veronika , Militky Jiri
Published: June 2017

In this study, 32 different electro-conductive fabrics and seven different non-conductive fabrics were taken for an analysis of their electromagnetic shielding ability, electrical resistivity and air permeability. According to the present state of development of electromagnetic shielding textile structures, a diverse set of samples was selected, including stainless steel, copper, silver, aluminum, carbon and polypyrrole as a conductive component. The ASTM D4935 coaxial transmission line method was used to study the electromagnetic shielding and the ASTM D257 ring electrode method was used to evaluate the surface and volume electrical resistivity of all the samples. Air permeability was considered as an additional important parameter for the production of electromagnetic radiation protective fabrics designed for technical or clothing applications. It was confirmed that textile structures made of conventional textile fibers are transparent to an electromagnetic field. The electromagnetic shielding effectiveness of non-conductive samples is less than 0.2 dB regardless of material composition. On the other hand, the electromagnetic shielding effectiveness of electro-conductive samples containing different content and types of conductive component ranges from 1 to 79 dB at the high-frequency range, whereas the woven sample containing 75 wt% of staple metal fiber provides excellent shielding ability together with high air permeability. It was confirmed that, in particular, the surface resistivity can be used to predict the electromagnetic shielding ability of fabric samples due to a strong inverse relationship between these two parameters.