bluuebunny/crossref_metadata_2025 huggingface dataset:
Partial Occlusion of the Descending Aorta Increases Cerebral Blood Flow in a Nonstroke Porcine Model
Authors: Hammer Maxim , Jovin Tudor , Wahr Joyce A. , Heiss Wolf-Dieter
Published: August 2009

Background: We studied the effect of partial aortic occlusion on cerebral perfusion and cardiac performance using the intra-aortic NeuroFlo™ catheter. Methods: Adult pigs were instrumented to determine cardiac parameters; unique isotope-labeled microspheres were used to determine cerebral blood flow (CBF) before, during and after sequential partial aortic occlusion. Results: Six pigs were studied; there was no relevant change in cardiac output, and the desired pressure drop of 10–15 mm Hg across the balloons was achieved. CBF increased significantly with inflation of the suprarenal balloon and remained elevated 90 min after deflation. Conclusions:Partial aortic occlusion with the NeuroFlo catheter significantly increased cerebral perfusion without adversely affecting cardiac performance.
Patterns of Acute Cerebral Infarcts in Patients with Active Malignancy Using Diffusion-Weighted Imaging
Authors: Hong Chien-Tai , Tsai Li-Kai , Jeng Jiann-Shing
Published: August 2009

Background and Purpose: It is still controversial whether the nature of cerebral infarcts differs between cancer patients and the general population. The aim of this study is to delineate the characteristics of acute cerebral infarction in patients with active malignancy using diffusion-weighted imaging (DWI). Materials and Methods: Seventy consecutive patients with both active malignancy and acute cerebral infarction (confirmed by DWI) were retrospectively included. These 70 were divided into 3 groups on the basis of infarct pattern: embolic infarction, large artery disease, and lacunar infarction. Medical records were reviewed in detail for demographic data, cancer information, vascular risk factors, and prognosis. Results: Two thirds of cancer patients had multiple infarcts, and 30% of infarcts were located infratentorially. Embolic infarction, large artery disease, and lacunar infarction occurred in 60, 31, and 9% of cancer patients, respectively. Gastrointestinal (GI) cancer was significantly related to embolic infarction (odds ratio 4.64, p = 0.04). The 3-month mortality rates were higher in patients with rather than without cancer metastasis (68 vs. 8%; p < 0.001). Conclusions: Cerebral infarcts in cancer patients tended to be embolic and multiple. Patients with GI cancer were particularly susceptible to embolic infarction.
The Era of Genomic Epidemiology
Authors: Traynor Bryan J.
Published: August 2009

The recent revolution in genomics is already having a profound impact on the practice of epidemiology. The purpose of this commentary is to demonstrate how genomics and epidemiology will continue to rely heavily on each other, now and in the future, by illustrating a number of interaction points between these 2 disciplines: (1) the use of genomics to estimate disease heritability; (2) the impact of genomics on analytical study design; (3) how genome-wide data can be employed to effectively overcome residual population stratification arising from selection bias; (4) the importance of genomics as a tool in epidemiological investigation; (5) the importance of epidemiology in the collection of adequately phenotyped samples for genomics studies, and (6) for unraveling the clinical and therapeutic relevance of genetic variants once they are discovered.
Neurological Emergencies in India – Lessons Learnt and Strategies to Improve Outcomes
Authors: Saddichha Sahoo , Saxena Mukul Kumar , Vibha Pandey , Methuku Mithilesh
Published: August 2009

Background: Neurological emergencies account for between 2.6 and 14% of medical emergencies, a number that can be salvaged, if addressed in time. This study aimed to answer the questions of demand, type and outcome of neurological emergencies by conducting a retrospective analysis of neurological emergencies serviced by 108, the first professional emergency service in India. Method: During the period between January 1, 2007 and December 31, 2008, a total of 24,760 calls were received by 108, of which confirmed neurological emergencies (n = 14,448) were followed up and evaluated. Risk factor analysis and stratification were done with respect to survival outcome at 48/120 h. Results: The subjects had a mean age of 37.4 (±19.5) years, were mainly male (63%) and were victims of seizures (51.5%), stroke (24%) or unconsciousness (21%). Risk stratification observed that rural area (p < 0.001), emergencies of stroke and coma (p < 0.001), age (p < 0.001), lower vital sign measurements (p < 0.001) and time to reach hospital (p = 0.05) were the main risk factors. Conclusion: Emergency medical systems should implement a prehospital stroke protocol including the use of vital sign monitoring, point-of-care clinical diagnostics and advance forewarning systems. Geriatric clinics attending to the elderly age group, especially located in rural areas, with better identification of stroke and coma as medical emergencies, either through neuroimaging or clinical diagnostic facilities, will definitely improve outcomes. As seizures form a large chunk of neurological emergencies, genetic testing and counseling to detect hereditary causes could identify and keep most victims on regulated treatment in order to reduce adverse outcomes.
False Recognition Helps to Distinguish Patients with Alzheimer’s Disease and Amnestic MCI from Patients with Other Kinds of Dementia
Authors: Hildebrandt Helmut , Haldenwanger Andreas , Eling Paul
Published: August 2009

Two recent reviews on neuropsychological assessment argue that Alzheimer’s disease (AD) is characterized by deficits in delayed recall and that this allows differentiating AD from other types of dementia. We attempted to differentiate patients with AD and amnestic mild cognitive impairment (MCI) from patients with fronto-subcortical dementia, normal pressure hydrocephalus and vascular dementia using a simple picture recognition task. We examined 130 patients, 89 with dementia and 41 with MCI. The combination of the CERAD-NP savings score and the number of false recognitions yielded a sensitivity of 100% for identifying AD patients. Moreover, adding the score for false recognitions to that of delayed recall improved the specificity of the diagnosis from 50% to 90%. After matching the groups on memory performance, the AD group still produced more false recognitions. The results suggest that delayed recall impairment and recognition errors stem from different sources. We also found that the number of false recognitions differs between amnestic and non-amnestic MCI patients. The quality of the differential diagnosis may therefore be enhanced significantly by taking into account both delayed recall and false recognitions provoked by a picture recognition task.
Speech with Gaps: Effects of Periodic Interruptions on Speech Intelligibility
Authors: Schnotz Alexander , Digeser Frank , Hoppe Ulrich
Published: August 2009

Objective: This study examined the role of central auditory completion in speech understanding. The perception of periodically interrupted speech was investigated. For this purpose, gaps were inserted into speech signals by silencing out defined intervals. The main hypothesis was that word recognition increases with shorter gaps and is less influenced by the total amount of gaps. Patients and Methods: Seventeen normal-hearing young adults took part in this study. Phrases from the German HSM speech recognition test were used as speech material. The examination comprised 220 modulated sentences presented binaurally at 65 dB. Intervals with durations ranging from 50 to 700 ms were taken to silence out 50, 65 and 80% of each sentence, respectively. Results: Mean speech perception values were in the range of 65–92%, 35–92% and 35–95% correct answers for gap ratios of 50, 65 and 80%, respectively. When comparing the same interval duration, word recognition was better for smaller gap ratios. Both, gap ratio and gap duration had a significant influence on identification performance. Conclusions: Speech can be understood even when very large proportions are blanked out. A significant decrease in perception can be observed when gap duration exceeds more than half of the syllable length.
Developing an Articulation Test for Arabic-Speaking School-Age Children
Authors: Abou-Elsaad Tamer , Baz Hemmat , El-Banna Manal
Published: August 2009

Objective: The aim of this study was to develop an Arabic articulation test using familiar and visually transparent words in order to be used as a criterion for comparing phonemes of both normal and phonologically disordered Arabic-speaking children. Material and Methods: A picture-naming test was designed for the Mansoura Arabic Articulation Test (MAAT) to elicit spontaneous single-word responses representing all possible consonant positions and vowels of Colloquial Egyptian Arabic. Three expert phoniatricians were asked to review MAAT and complete a questionnaire. The MAAT was presented to 100 normal Arabic-speaking Egyptian children randomly selected from the first- and second-grade kindergarten. They were 52 males and 48 females with ages ranging between 42 and 70 months. Children’s responses were converted to a percent correct score for sound utterances and picture identification. Results: Statistically non-significant differences were found among experts’ opinions reflecting approval for the MAAT items. A statistically highly significant adequate correlation was found between correct word utterances and picture identification which proved the content validity of MAAT. Test-retest reliability proved the consistency of MAAT. Conclusion: MAAT is a valid and reliable test that can be applied to collect the phonetic inventory of Arabic-speaking young children.
Influence of Sensory Cues on the Stimulability for Liquid Sounds in Brazilian Portuguese-Speaking Children
Authors: de Castro Márcia Mathias , Wertzner Haydée Fiszbein
Published: August 2009

Objective: Stimulability is the ability to produce an adequate sound under specific conditions. This study aimed to describe the stimulability of Brazilian Portuguese-speaking children with and without phonological disorders for the production of liquid sounds with the aid of visual and tactile cues. Patients and Methods: The study sample included 36 children between 5;0 and 11;6 years of age, 18 with phonological disorder and 18 without any speech-language disorders. Stimulability was measured for syllable imitation. The stimulability test employed includes 63 syllables with the sounds [}], [y], and [2], as well as seven oral vowels. If the subject was unable to imitate a sound, a visual cue was given. When necessary, a tactile cue was also given. Results: The sound [y] required greater use of sensory cues. Children with phonological disorder needed a greater number of cues. Conclusion: The use of sensory cues seemed to facilitate sound stimulability, making it possible for the children with phonological disorder to accurately produce the sounds modeled.
Much Ado about Nothing: Two Millenia of Controversy on Tongue-Tie
Authors: Obladen Michael
Published: August 2009

Tongue-tie, or ankyloglossia, is poorly defined and involves a short, thick, fibrosed, or fixed lingual frenulum. Operative interventions were proposed already in Greek medicine. In the Middle Ages, competition arose between midwives, who used their nails to detach the frenulum, and surgeons, who were allowed to use instruments. During the last century, the justification for frenotomy shifted from improved language to enhanced feeding. Despite the high frequency of the intervention, little research has been performed on its benefit, which remains a controversial topic among different groups of health professionals.
Epidermodysplasia-Verruciformis-Like Eruption Associated with Gamma-Papillomavirus Infection in a Patient with Adult T-Cell Leukemia
Authors: Kawai Kazuhiro , Egawa Nagayasu , Kiyono Tohru , Kanekura Takuro
Published: August 2009

Epidermodysplasia verruciformis (EV) is a genodermatosis characterized by widespread and persistent cutaneous lesions caused by β-papillomaviruses. Rare cases of acquired EV-like eruption associated with β-papillomavirus infection have been reported in immunosuppressed patients. We report a case of acquired EV-like eruption in an immunosuppressed patient with adult T-cell leukemia. The cutaneous lesions clinically resembled pityriasis versicolor and exhibited the typical histological features of EV, but in some areas of the same biopsy specimen characteristic homogeneous intracytoplasmic inclusion bodies were observed. Although β-papillomavirus was not detected by highly sensitive polymerase chain reaction, a putative novel type of γ-papillomavirus was identified. This is the first documentation of an association between EV-like eruption and γ-papillomavirus infection.
Serum Prohepcidin and Hepcidin in Hemodialyzed Patients Undergoing Iron Therapy
Authors: Malyszko Jolanta , Malyszko Jacek S. , Mysliwiec Michal
Published: August 2009

Hepcidin is the predominant negative regulator of iron absorption in the small intestine, iron transport across the placenta, and iron release from the macrophages. Iron supplementation is often introduced in dialyzed patients to replete or to maintain iron stores, particularly in patients treated with erythropoietin-stimulating agents. The aim of this study was to assess hepcidin levels in 12 hemodialyzed (HD) patients (6 females, 6 males, mean age 64 years, mean time on HD 36 months) before and after intravenous iron therapy. Prohepcidin and hepcidin were studied using commercially available kits from DRG Instruments GmbH, Marburg, Germany (ELISA method), and Bachem, St. Helens, UK (RIA method). Soluble receptor of transferrin was studied using a kit from R&D, Abington, UK. We found a significant rise in hemoglobin concentration, hematocrit, ferritin, serum iron, transferrin saturation and a fall in soluble receptor of transferrin. Serum hepcidin and prohepcidin as well as urinary prohepcidin increased significantly after the therapy. In conclusion, hepcidin levels are influenced by iron supplementation in HD patients. Further examinations of hepcidin as a marker of iron deficiency using new validated measurement techniques are required. It remains to be seen if assay of hepcidin will be of help in identifying patients unresponsive to oral iron or requiring intravenous iron supplementation.
Macrophage Diversity and Polarization in Atherosclerosis
Authors: Mantovani Alberto , Garlanda Cecilia , Locati Massimo
Published: August 2009

Diversity and plasticity are hallmarks of mononuclear phagocytes, which are reflected in plaque formation and evolution. Different monocyte subsets, which differentially contribute to plaque infiltration and to atherosclerosis complications, have been identified. Similarly, depending on different environmental signals plaque-associated macrophages can express polarized pro- and antiatherogenic programs by influencing lipid metabolism, inflammatory responses, and plaque stability. Thus, a “macrophage balance” plays a major role in the pathogenesis of atherosclerotic plaques and affects evolution and complications of atherosclerosis.
Protective Role of Clusterin/Apolipoprotein J Against Neointimal Hyperplasia via Antiproliferative Effect on Vascular Smooth Muscle Cells and Cytoprotective Effect on Endothelial Cells
Authors: Kim Han-Jong , Yoo Eun-Kyung , Kim Joon-Young , Choi Young-Keun , Lee Hyo-Jeong , Kim Jeong-Kook , Jeoung Nam Ho , Lee Ki-Up , Park In-Sun , Min Bon-Hong , Park Keun-Gyu , Lee Chul-Ho , Aronow Bruce J. , Sata Masataka , Lee In-Kyu
Published: August 2009

Objective—

Clusterin is induced in vascular smooth muscle cells (VSMCs) during atherosclerosis and injury-induced neointimal hyperplasia. However, its functional roles in VSMCs and endothelial cells remain controversial and elusive. This study was undertaken to clarify the role of clusterin in neointimal hyperplasia and elucidate its mechanism of action.

Methods and Results—

Adenovirus-mediated overexpression of clusterin (Ad-Clu) repressed TNF-α–stimulated expression of MCP-1, fractalkine, ICAM-1, VCAM-1, and MMP-9, leading to inhibition of VSMC migration. Both Ad-Clu and secreted clusterin suppressed VSMC proliferation by inhibiting DNA synthesis, but not by inducing apoptosis. Ad-Clu upregulated p53 and p21
cip1/waf1
but downregulated cyclins D and E, leading to suppression of pRb phosphorylation and subsequent induction of G1 arrest in VSMCs. Clusterin deficiency augmented VSMC proliferation in vitro and accelerated neointimal hyperplasia in vivo, but concomitantly impaired reendothelialization in wire-injured murine femoral arteries. Moreover, Ad-Clu significantly reduced neointimal thickening in balloon-injured rat carotid arteries. Clusterin also diminished TNF-α–induced apoptosis of human umbilical vein endothelial cells and restored endothelial nitric oxide synthase expression suppressed by TNF-α.

Conclusion—

These results suggest that upregulation of clusterin during vascular injury may be a protective response against, rather than a causative response to, the development of neointimal hyperplasia.
Disinhibition of SOD-2 Expression to Compensate for a Genetically Determined NO Deficit in Endothelial Cells–Brief Report
Authors: Asif Abdul R. , Hecker Markus , Cattaruzza Marco
Published: August 2009

Objective—

Homozygosity for the −786C-variant of the human
nos-3
gene is a risk factor for coronary artery disease (CAD). Interestingly, affected individuals develop CAD more frequently but not earlier than the general population.

Methods and Results—

Genotyped primary human umbilical vein endothelial cells (ECs) were exposed to fluid shear stress (FSS) and analyzed for nitric oxide (NO) and superoxide anion (O
2
−
) formation as well as mRNA and protein expression of different antioxidant enzymes. Dysfunctional CC-genotype ECs failed to upregulate NO synthase expression in response to FSS and exhibited a reduced NO synthesis capacity when compared to functionally intact TT-genotype ECs. However, only CC-genotype ECs responded to FSS with an Egr-1–mediated increase in manganese-containing superoxide dismutase (SOD-2) expression, shielding them from endothelin-1–induced oxidative stress in a NO-independent manner.

Conclusions—

This FSS-induced rise in SOD-2 expression in CC-genotype ECs effectively stabilizes their antiatherosclerotic phenotype and may explain not only the comparatively slow onset of CAD in homozygous carriers of the C-allele of the
nos-3
gene but also define a general strategy for preventing endothelial dysfunction at the outset of atherosclerosis.
Rapid Procoagulant Phosphatidylserine Exposure Relies on High Cytosolic Calcium Rather Than on Mitochondrial Depolarization
Authors: Arachiche Amal , Kerbiriou-Nabias Danièle , Garcin Isabelle , Letellier Thierry , Dachary-Prigent Jeanne
Published: August 2009

Objective—

Relationships between intracellular Ca
2+
concentration ([Ca
2+
]
cyt
) and apoptotic events, such as mitochondrial depolarization (ΔΨm loss) and Bcl-2 and Bad phosphorylation, were analyzed in platelets and Jurkat cells in relation to rapid procoagulant phosphatidylserine (PS) exposure.

Methods and Results—

Platelets were stimulated with A23187, thapsigargin (TG) and thrombin plus convulxin (Thr/Cvx), and Jurkat cells with ionomycin, in the presence or absence of cyclosporin A (CsA), a mitochondrial permeability transition pore inhibitor. ΔΨm loss occurred when platelets were stimulated in Ca
2+
medium in conditions exposing PS, but also in EGTA medium. CsA inhibited PS exposure, [Ca
2+
]
cyt
increase, and ΔΨm loss in platelets stimulated with TG and Thr/Cvx, but had no inhibitory effect on A23187 stimulation. CsA reduced TG-induced Ca
2+
release from the endoplasmic reticulum and, consequently, external Ca
2+
influx. In ionomycin-stimulated Jurkat cells, rapid PS exposure was evidenced but not ΔΨm loss, and CsA did not inhibit the process. The status of phosphorylated Bad and Bcl-2 in both cell types remained unchanged on stimulation.

Conclusions—

Whether ΔΨm loss occurs or not, PS exposure is triggered by a high [Ca
2+
]
cyt
increase. Data further demonstrate that CsA prevents membrane scrambling by inhibiting the high [Ca
2+
]
cyt
increase, independently of its effect on mitochondrial permeability transition pore.
FVII, FVIIa, and Downstream Markers of Extrinsic Pathway Activation Differ by EPCR Ser219Gly Variant in Healthy Men
Authors: Ireland Helen A. , Cooper Jackie A. , Drenos Fotios , Acharya Jayshree , Mitchell Jacqueline P. , Bauer Ken A. , Morrissey James H. , Esnouf M. Peter , Humphries Stephen E.
Published: August 2009

Objective—

The purpose of this study was to determine the effect of a variant in EPCR (Ser219Gly), previously shown to affect EPCR shedding, on plasma FVII, FVIIa, and downstream markers of activated coagulation.

Methods and Results—

Statistical analysis was undertaken in ≈2000 healthy middle aged men (NPHSII). Higher soluble EPCR levels were confirmed for Gly allele carriers (
P
<0.0001). Significantly higher levels of FVII, FVIIa, and downstream markers of activated coagulation in the extrinsic pathway (FIX activation pep [FIXpep]; FX activation pep [FXpep]), and prothrombin F1+2 (F1+2) were identified in baseline samples, in Gly carriers compared to Ser/Ser (
P
<=0.04 for trend). In repeat samples collected for up to 5 years, levels of FVII and F1+2 were higher in Gly allele carriers compared to Ser/Ser by (FVII: 6.9% CI 5.5 to 8.4 in Ser/Gly; and 23.4% CI 16.3 to 30.8 in Gly/Gly,
P
<0.0001), (F1+2: 8.1% CI 5.2 to 11.1 in Ser/Gly; 25.2% CI 11.8 to 40.3 in Gly/Gly,
P
<0.04), confirming reproducibility of findings at baseline. Molar ratios for FIXpep, FXpep, and F1+2 to FVIIa were constant in Ser/Ser and Ser/Gly but tended to be higher in Gly/Gly, reaching statistical significance for FIXpep:FVIIa (
P
=0.04).

Conclusions—

These data suggest that higher levels of FVII and FVIIa circulate when EPCR shedding is greatest. Furthermore, these results suggest consequences for activation of extrinsic coagulation.
Flow Activation of AMP-Activated Protein Kinase in Vascular Endothelium Leads to Krüppel-Like Factor 2 Expression
Authors: Young Angela , Wu Wei , Sun Wei , Larman Harry B. , Wang Nanping , Li Yi-Shuan , Shyy John Y. , Chien Shu , García-Cardeña Guillermo
Published: August 2009

Objective—

Vascular endothelial cells (ECs) confer atheroprotection at locations of the arterial tree where pulsatile laminar flow (PS) exists with a high shear stress and a large net forward direction. We investigated whether the PS-induced expression of the transcription factor Krüppel-Like Factor 2 (KLF2) in cultured ECs and its expression in the mouse aorta is regulated by AMP-activated protein kinase (AMPK).

Methods and Results—

AMPK inhibition by Compound C or siRNA had a significant blocking effect on the PS-induced KLF2 expression. The induction of KLF2 by PS led to the increase in eNOS and the suppression of ET-1, which could be reversed by KLF2 siRNA. In addition, PS induced the phosphorylation of ERK5 and MEF2 which are necessary for the KLF2 expression. These mechanotransduction events were abrogated by the blockade of AMPK. Furthermore, the phosphorylation levels of ERK5 and MEF2, as well as the expression of KLF2, were significantly reduced in the aorta of AMPKα2 knockout mice when compared with wild-type control mice.

Conclusion—

The flow-mediated AMPK activation is a newly defined KLF2 regulatory pathway in vascular endothelium that acts via ERK5/MEF2.
Urotensin II Receptor Knockout Mice on an ApoE Knockout Background Fed a High-Fat Diet Exhibit an Enhanced Hyperlipidemic and Atherosclerotic Phenotype
Authors: Bousette Nicolas , D'Orleans-Juste Pedro , Kiss Robert S. , You Zhipeng , Genest Jacques , Al-Ramli Wisam , Qureshi Salman T. , Gramolini Anthony , Behm David , Ohlstein Eliot H. , Harrison Stephen M. , Douglas Stephen A. , Giaid Adel
Published: August 2009

Rationale
:

Expression of the vasoactive peptide Urotensin II (UII) is elevated in a number of cardiovascular diseases.

Objective
:

Here, we sought to determine the effect of UII receptor (UT) gene deletion in a mouse model of atherosclerosis.

Methods and Results
:

UT knockout (KO) mice were crossed with ApoE KO mice to generate UT/ApoE double knockout (DKO) mice. Mice were placed on a high-fat Western-type diet for 12 weeks. We evaluated the degree of atherosclerosis and hepatic steatosis by histology. In addition, serum glucose, insulin, and lipids were determined. DKO mice exhibited significantly increased atherosclerosis compared to ApoE KO mice (
P
<0.05). This was associated with a significant increase in serum insulin and lipids (
P
<0.001) but a decrease in hepatic steatosis (
P
<0.001). UT gene deletion led to a significant increase in systolic pressure and pulse pressure. RT-PCR and immunoblot analyses showed significant reductions in hepatic scavenger receptors, nuclear receptors, and acyl-CoA:cholesterol acyltransferase (ACAT1) expression in DKO mice. UII induced a significant increase in intracellular cholesteryl ester formation in primary mouse hepatocytes, which was blocked by the MEK inhibitor, PD98059. Hepatocytes of UTKO mice showed a significant reduction in lipoprotein uptake compared to wild-type mice.

Conclusions
:

We propose that UT gene deletion in an ApoE-deficient background promotes downregulation of ACAT1, which in turn attenuates hepatic lipoprotein receptor-mediated uptake and lipid transporter expression. As the liver is the main organ for uptake of lipoprotein-derived lipids, DKO leads to an increase in hyperlipidemia, with a concomitant decrease in hepatic steatosis, and consequently increased atherosclerotic lesion formation. Furthermore, the hypertension associated with UT gene deletion is likely to contribute to the increased atherosclerotic burden.
Differential Impact of Lacunes and Microvascular Lesions on Poststroke Depression
Authors: Santos Micaela , Gold Gabriel , Kövari Enikö , Herrmann Francois R. , Bozikas Vasilis P. , Bouras Constantin , Giannakopoulos Panteleimon
Published: August 2009

Background and Purpose—

Previous studies have postulated that poststroke depression (PSD) might be related to cumulative vascular brain pathology rather than to the location and severity of a single macroinfarct. We performed a detailed analysis of all types of microvascular lesions and lacunes in 41 prospectively documented and consecutively autopsied stroke cases.

Methods—

Only cases with first-onset depression <2 years after stroke were considered as PSD in the present series. Diagnosis of depression was established prospectively using DSM-IV criteria for major depression. Neuropathological evaluation included bilateral semiquantitative assessment of microvascular ischemic pathology and lacunes; statistical analysis included Fisher exact test, Mann-Whitney
U
test, and regression models.

Results—

Macroinfarct site was not related to the occurrence of PSD for any of the locations studied. Thalamic and basal ganglia lacunes occurred significantly more often in PSD cases. Higher lacune scores in basal ganglia, thalamus, and deep white matter were associated with an increased PSD risk. In contrast, microinfarct and diffuse or periventricular demyelination scores were not increased in PSD. The combined lacune score (thalamic plus basal ganglia plus deep white matter) explained 25% of the variability of PSD occurrence.

Conclusions—

The cumulative vascular burden resulting from chronic accumulation of lacunar infarcts within the thalamus, basal ganglia, and deep white matter may be more important than single infarcts in the prediction of PSD.
Body Mass Index and Stroke Mortality by Smoking and Age at Menopause Among Korean Postmenopausal Women
Authors: Yi Sang-Wook , Odongua Nemekhee , Nam Chung Mo , Sull Jae Woong , Ohrr Heechoul
Published: August 2009

Background and Purpose—

The association between body mass index and mortality caused by subtypes of stroke among postmenopausal women in terms of smoking status and age at menopause remains controversial.

Methods—

The data were derived from a cohort study of 3321 with 17.8 years of follow-up (1985 to 2002). Hazard ratios (HRs) and 95% CIs for strokes as related to body mass index were estimated by Cox proportional hazard models adjusted for age, hypertension, smoking, drinking, occupation, education, self-reported health, and age at menopause. A stratified analysis was conducted by age at menopause and smoking status.

Results—

The obese group (body mass index ≥27.5 kg/m
2
) had higher risks of total stroke mortality (HR, 1.59; 95% CI, 1.05 to 2.42) and hemorrhagic stroke mortality (HR, 2.91; 95% CI, 1.37 to 6.19) than the normal weight group (18.5≤ body mass index <23.0). Among ever smokers, the obese group showed significantly increased risks of total stroke mortality (HR, 2.33; 95% CI, 1.00 to 5.43) and ischemic stroke mortality (HR, 7.21; 95% CI, 1.18 to 44.3). Obesity had more effect on stroke mortality among women who experienced menopause at age <50 than women with age ≥50. For the obese group of the former, the HR of total stroke was 2.04 (95% CI, 1.25 to 3.34) and that of hemorrhagic stroke 6.46 (95% CI, 2.42 to 17.25).

Conclusions—

In this prospective study, obesity raised the risks of total stroke mortality and hemorrhagic stroke mortality among Korean menopausal women. It was more evident with women who experienced menopause at age <50. The obese group of ever smokers was at an increased risk of ischemic stroke mortality.
Survival, Hazard Function for a New Event, and Healthcare Utilization Among Stroke Patients ≥65 Years
Authors: Olai Lena , Omne-Pontén Marianne , Borgquist Lars , Svärdsudd Kurt
Published: August 2009

Background and Purpose—

The natural history of stroke is still incompletely understood. The aim of this study was to present detailed data on survival, recurrence, and all types of healthcare utilization before and after a stroke event in patients with stroke.

Methods—

Three hundred ninety stroke survivors constituted the study population. Information on survival data during 5 years of follow-up, all hospital admissions since 1971, all outpatient and primary care consultations, and all municipal social service support during the year before and after the index stroke admission and patient interviews 1 week after discharge were obtained.

Results—

The risk of death or a new stroke was high in the early phase after admission but then decreased rapidly during the next few months. Mortality during the first 5 years was influenced by age and functional ability, whereas the risk of stroke recurrence was influenced by number of previous strokes, hypertension diagnosis, and sex. On a day-by-day basis, 35% were dependent on municipal support before and 65% after the stroke. The corresponding proportions in outpatient care were 6% and 10%, and for hospital inpatient care 1% to 2% and 2% to 3%. Of the health care provided, nursing care dominated.

Conclusions—

The risk of dying or having a new stroke event decreased sharply during the early postmorbid phase. Healthcare utilization increased after discharge but was still moderate on a day-by-day basis, except for municipal social service support, which was substantial.
Age Disparities in Stroke Quality of Care and Delivery of Health Services
Authors: Saposnik Gustavo , Black Sandra E. , Hakim Antoine , Fang Jiming , Tu Jack V. , Kapral Moira K.
Published: August 2009

Background and Purpose—

Limited information is available on the effect of age on stroke management and care delivery. Our aim was to determine whether access to stroke care, delivery of health services, and clinical outcomes after stroke are affected by age.

Methods—

This was a prospective cohort study of patients with acute ischemic stroke in the province of Ontario, Canada, admitted to stroke centers participating in the Registry of the Canadian Stroke Network between July 1, 2003 and March 31, 2005. Primary outcomes were the following selected indicators of quality stroke care: (1) use of thrombolysis; (2) dysphagia screening; (3) admission to a stroke unit; (4) carotid imaging; (5) antithrombotic therapy; and (6) warfarin for atrial fibrillation at discharge. Secondary outcomes were risk-adjusted stroke fatality, discharge disposition, pneumonia, and length of hospital stay.

Results—

Among 3631 patients with ischemic stroke, 1219 (33.6%) were older than 80 years. There were no significant differences in stroke care delivery by age group. Stroke fatality increased with age, with a 30-day risk adjusted fatality of 7.1%, 6.5%, 8.8%, and 14.8% for those aged 59 or younger, 60 to 69, 70 to 79, and 80 years or older, respectively. Those aged older than 80 years had a longer length of hospitalization, increased risk of pneumonia, and higher disability at discharge compared to those younger than 80. This group was also less likely to be discharged home.

Conclusions—

In the context of a province-wide coordinated stroke care system, stroke care delivery was similar across all age groups with the exception of slightly lower rates of investigations in the very elderly. Increasing age was associated with stroke severity and stroke case-fatality.
First Food and Drug Administration-Approved Prospective Trial of Primary Intracranial Stenting for Acute Stroke
Authors: Levy Elad I. , Siddiqui Adnan H. , Crumlish Annemarie , Snyder Kenneth V. , Hauck Erik F. , Fiorella David J. , Hopkins L. Nelson , Mocco J
Published: August 2009

Background and Purpose—

Acute revascularization is associated with improved outcomes in ischemic stroke patients. However, it is unclear which method of intraarterial intervention, if any, is ideal. Numerous case series and cardiac literature parallels suggest that acute stenting may yield high revascularization levels with low associated morbidity. We therefore conducted a Food and Drug Administration-approved prospective pilot trial to evaluate the safety of intracranial stenting for acute ischemic stroke.

Methods—

Eligibility criteria included presentation ≤8 hours after stroke onset, age 18 years or older, National Institutes of Health Stroke Scale score ≥8, angiographic demonstration of focal intracerebral artery occlusion ≤14 mm, and either contraindication to intravenous tissue plasminogen activator or failure to improve 1 hour after intravenous tissue plasminogen activator administration. Exclusion criteria included known hemorrhagic diathesis or coagulopathy, platelet count <100 000, intracranial hemorrhage, blood glucose level of <51 mg/100 mL, or CT perfusion imaging demonstrating more than one-third at-risk territory with nonsalvageable brain (low cerebral blood volume). Data are presented as mean±SD.

Results—

Twenty patients were enrolled (mean age, 63±18 years;14 women). Mean presenting National Institutes of Health Stroke Scale was 14±3.8 (median 13). Presenting thrombolysis in myocardial infarction score was 0 (85% of patients) or 1 (15%). Recanalization to thrombolysis in myocardial infarction score of 3 (60% of patients) or 2 (40% of patients;
P
<0.0001) was achieved. One (5%) symptomatic and 2 (10%) asymptomatic intracranial hemorrhages occurred. At 1-month follow-up, a modified Rankin scale score of ≤3 was achieved in 12 of 20(60%) patients and a modified Rankin scale score of ≤1 was achieved in 9 of 20 (45%) patients.

Conclusion—

This Food and Drug Administration-approved prospective study suggests primary intracranial stenting for acute stroke may be a valuable addition to the stroke treatment armamentarium.
Point-of-Care International Normalized Ratio Testing Accelerates Thrombolysis in Patients With Acute Ischemic Stroke Using Oral Anticoagulants
Authors: Rizos Timolaos , Herweh Christian , Jenetzky Ekkehart , Lichy Christoph , Ringleb Peter Arthur , Hacke Werner , Veltkamp Roland
Published: August 2009

Background and Purpose—

Thrombolysis in patients using oral anticoagulants (OAC) and in patients for whom information on OAC status is not available is frequently delayed because the standard coagulation analysis procedure in central laboratories (CL) is time-consuming. By using point-of-care (POC) coagumeters, international normalized ratio (INR) values can be measured immediately at the bedside. The accuracy and effectiveness of POC devices for emergency management in acute ischemic stroke has not been tested.

Methods—

In phase 1, the reliability of emergency INR POC measurements in comparison to CL was determined. In phase 2, patients with ischemic stroke admitted within the time frame for systemic thrombolysis and who were either using OAC or for whom information on OAC status was not available were enrolled. Patients received thrombolysis if POC INR was ≤1.5. Precision and time gain was recorded for INR as measured by POC vs CL.

Results—

In phase 1 (n=113), Bland-Altman analysis showed close agreement between POC and CL, and Pearson correlation was highly significant (
r
=0.98;
P
<0.01). In phase 2, 48 patients were included, of whom 70.8% were using OAC; 23 patients received thrombolysis. After subtracting the time needed for the diagnostic work-up, the net time gain was 28±12 minutes (mean±SD).

Conclusions—

Measuring INR by POC in an emergency setting is sufficiently precise in OAC acute stroke patients and substantially reduces the time interval until INR values are available and therefore may hasten the initiation of thrombolysis.
Effects of Feature-selective and Spatial Attention at Different Stages of Visual Processing
Authors: Andersen Søren K. , Fuchs Sandra , Müller Matthias M.
Published: August 2009

We investigated mechanisms of concurrent attentional selection of location and color using electrophysiological measures in human subjects. Two completely overlapping random dot kinematograms (RDKs) of two different colors were presented on either side of a central fixation cross. On each trial, participants attended one of these four RDKs, defined by its specific combination of color and location, in order to detect coherent motion targets. Sustained attentional selection while monitoring for targets was measured by means of steady-state visual evoked potentials (SSVEPs) elicited by the frequency-tagged RDKs. Attentional selection of transient targets and distractors was assessed by behavioral responses and by recording event-related potentials to these stimuli. Spatial attention and attention to color had independent and largely additive effects on the amplitudes of SSVEPs elicited in early visual areas. In contrast, behavioral false alarms and feature-selective modulation of P3 amplitudes to targets and distractors were limited to the attended location. These results suggest that feature-selective attention produces an early, global facilitation of stimuli having the attended feature throughout the visual field, whereas the discrimination of target events takes place at a later stage of processing that is only applied to stimuli at the attended position.
The Unrested Resting Brain: Sleep Deprivation Alters Activity within the Default-mode Network
Authors: Gujar Ninad , Yoo Seung-Schik , Hu Peter , Walker Matthew P.
Published: August 2009

The sleep-deprived brain has principally been characterized by examining dysfunction during cognitive task performance. However, far less attention has been afforded the possibility that sleep deprivation may be as, if not more, accurately characterized on the basis of abnormal resting-state brain activity. Here we report that one night of sleep deprivation significantly disrupts the canonical signature of task-related deactivation, resulting in a double dissociation within anterior as well as posterior midline regions of the default network. Indeed, deactivation within these regions alone discriminated sleep-deprived from sleep-control subjects with a 93% degree of sensitivity and 92% specificity. In addition, the relative balance of deactivation within these default nodes significantly correlated with the amount of prior sleep in the control group (and not extended time awake in the deprivation group). Therefore, the stability and the balance of task-related deactivation in key default-mode regions may be dependent on prior sleep, such that a lack thereof disrupts this signature pattern of brain activity, findings that may offer explanatory insights into conditions associated with sleep loss at both a clinical as well as societal level.
Processing Expectancy Violations during Music Performance and Perception: An ERP Study
Authors: Maidhof Clemens , Vavatzanidis Niki , Prinz Wolfgang , Rieger Martina , Koelsch Stefan
Published: August 2009

Musicians are highly trained motor experts with pronounced associations between musical actions and the corresponding auditory effects. However, the importance of auditory feedback for music performance is controversial, and it is unknown how feedback during music performance is processed. The present study investigated the neural mechanisms underlying the processing of auditory feedback manipulations in pianists. To disentangle effects of action-based and perception-based expectations, we compared feedback manipulations during performance to the mere perception of the same stimulus material. In two experiments, pianists performed bimanually sequences on a piano, while at random positions, the auditory feedback of single notes was manipulated, thereby creating a mismatch between an expected and actually perceived action effect (action condition). In addition, pianists listened to tone sequences containing the same manipulations (perception condition). The manipulations in the perception condition were either task-relevant (Experiment 1) or task-irrelevant (Experiment 2). In action and perception conditions, event-related potentials elicited by manipulated tones showed an early fronto-central negativity around 200 msec, presumably reflecting a feedback ERN/N200, followed by a positive deflection (P3a). The early negativity was more pronounced during the action compared to the perception condition. This shows that during performance, the intention to produce specific auditory effects leads to stronger expectancies than the expectancies built up during music perception.
Arabinogalactan endo-1,4-β-galactosidase: a putative plant cell wall-degrading enzyme of plant-parasitic nematodes
Authors: Vanholme Bartel , Haegeman Annelies , Jacob Joachim , Cannoot Bernard , Gheysen Godelieve
Published: August 2009

Plant-parasitic nematodes secrete a plethora of enzymes to degrade
polysaccharides of the recalcitrant plant cell wall. Here we report on the
presence of a putative endo-1,4-β-galactosidase (EC 3.2.1.89) in cyst
nematodes of the genus Heterodera. This enzyme hydrolyses β-1,4-galactan in
the hairy regions of pectin and to our knowledge it is the first report of
this class of enzymes in animals. The gene was cloned from H. schachtii and
subjected to a detailed molecular characterisation. The deduced protein
contains a putative signal peptide for secretion, being in agreement with
the presumed extracellular function of the mature protein. It has a
molecular mass of 33.78 kDa and folds into an (α/β)8 barrel structure
typical for glycosyl hydrolases. The two glutamic acids that function as
electron donor and acceptor in the active site are conserved. Whole mount in
situ hybridisation revealed that the gene is expressed in the subventral
pharyngeal glands and the expression was correlated with the onset of
parasitism.
Prolegomena to the Study of the Kurds
Authors: Asatrian Garnik
Published: August 2009

The article presents a thorough review of nearly all relevant aspects of Kurdish Studies concerning the ethnic history, identity, religion, language, and literature of the Kurds. Elaborating upon the respective issues, the author makes extensive use of all available data and materials, including ancient and mediaeval, particularly those never previously examined with regard to related topics. The objective examination of most crucial problems of the field contributes to a better understanding of Kurdish prehistory, expanding, at the same time, the basic methodological concepts upon which further research should be grounded. Due to the politicised nature of Kurdological disciplines, many ideological elements of non-academic provenance, that have found their way into the scholarly milieu in recent decades and have become a constant set of stereotypes and clichés, have been highlighted in the paper.
The Spread and Persistence of Māturīdi Kalām and Underlying Dynamics
Authors: Bruckmayr Philipp
Published: August 2009

The paper is concerned with a long-term perspective on the position of Māturīdi kalām within (mostly) Hanafi Muslim societies from Timurid times to the 19th century. Whereas outright conflict between legal and theological schools was mainly a thing of the past during the time in question with Ash'arism, already fully embraced also by Hanafi constituencies within the ahl al-sunna wa l-jamā'a, a preference for Māturīdi views on specific issues persisted among the majority of Hanafi kalām scholars from Bosnia to South Asia. This state of affairs will be highlighted through recourse to madrasa curricula and theological literature from the era and areas as diverse as Turkey and Southeast Asia. Additionally, it seeks to draw attention to the mechanisms behind the spread and long-term persistence of the school throughout large parts of a Muslim world seemingly dominated by Ash'arism in the sphere of scholastic theology. In this regard, the prevalence of Transoxanian legal tradition within Hanafism and its linkages to Māturīdism, as well as the relationship of Naqshbandi Sufism to the school will be discussed.
Lord of the Auspicious Conjunction: Origins of the Sāhib-Qirān
Authors: Chann Naindeep Singh
Published: August 2009

This paper seeks to look at the origins, employment, and claims associated with the title sāhib-qirān. Occurring throughout the mediaeval to modern period, with special prominence during the early modern, the title underwent various transformations within particular polities and beyond. While any discussion of the sāhib-qirān must give significant place to the life and career of Timur, the title is far older than the Central Asian conqueror. As is shown, roots of the title and its historical background suggest a pre-Islamic Iranian origin, particularly traced in Pahlavi literature.
Sceptre of a Masker (On Some Folk Rituals in Dagestan)
Authors: Seferbekov Ruslan
Published: August 2009

Maskers play a vital role in the ritual and social ceremonies of Dagestan. With sceptre in hand, the maskers' part in folk traditions has preserved this previously sacral iconography in a profane form. This paper seeks to illuminate the role of the maskers and the mythological symbolism of the sceptre through descriptive analysis of festive ceremonies in Dagestan, while comparing its function to other Caucasian communities.
Reincarnation as Perceived by the "People of the Truth"
Authors: Khaksar Mansur
Published: August 2009

Being primarily typical of Hinduism, the belief in reincarnation of souls had penetrated through probably various "heresies"—into the Muslim heterodox milieu and became an organic element of many local doctrines, particularly those of Extreme Shi'ites.This paper focuses on the modern perception of the idea of tanāsux among the Ahl-i Haqq, the "People of the Truth". It is mainly based upon the field materials collected from the Ahl-i Haqq in the Iranian provinces of Kermanshah, Kurdistan, and Eastern Azerbaijan.
Historical Processes of Identity Formation: Displacement, Settlement, and Self-Representations of the Circassians in Jordan
Authors: Shami Seteney
Published: August 2009

This article examines how the historical experience of displacement and resettlement shapes key notions of identity and self-representation among Circassians in Jordan. Circassians, one of the peoples of the North-West Caucasus arrived in the Ottoman Empire in large waves of migration in the late 19th century and were settled as agricultural communities in different provinces of the empire. The experience of settlement, the types of settlements formed, and the relationships with the local inhabitants in the places of settlement—all inform the sense of identity among Circassians. The key images of being displaced, settlers, and Muslims enable Circassians both to maintain a sense of difference but also to integrate into the broader Jordanian society.