bluuebunny/crossref_metadata_2025 huggingface dataset:
Anticoagulant Therapy In Ischemic Stroke Or TIA
Authors: Mehrvar Kaveh
Published: February 2017

Stroke is the leading cause of disability and the third leading cause of death  . Anticoagulants   have been used to treat patients with acute ischemic stroke for many years. Despite their widespread use, the usefulness of emergency anticoagulation is a subject of debate. Disagreements exist about the best agent to administer, the route of administration, the use of a bolus dose to start treatment, the level of anticoagulation required, and the duration of treatment. There are 2 types of anticoagulants: Parenteral and oral. Heparin is an anticoagulant that used parenteral. Oral anticoagulants are including Warfarin and new anticoagulants such as Dabigatrn,Rivaroxaban ,Apixaban and other newer drugs.In patients with noncardioembolic  ischemic stroke or TIA antiplatelet agents are treatment of choice and preferred to anticoagulants.In cardioembolic  ischemic stroke or TIA with high risk of reembolization  anticoagulants  are considered as preferred treatment.  Warfarin, apixaban10mg/d ,Rivaroxaban20mg/d, and dabigatran 150 mg/d are all indicated for the prevention of recurrent stroke in patients with nonvalvular AF, whether paroxysmal or permanent.Also anticoagulant therapy is recommended for ischemic stroke or TIA patients in the setting of acute MI, atrial or ventricular thrombosis or dilated and restricted cardiomyopathy. Some valvular heart diseases are other indication for anticoagulant therapy in ischemic stroke or TIA patients.Ischemic  Stroke or TIA in patients with Cerebral vein thrombosis and  known hypercoagulable state specially anti phospholipid antibody syndrome are other indications for anticoagulant treatment.
An Overview Of Specialist Nurse Role In Patients With Stroke Caring And Their Care-Givers Support
Authors: Navab Elham , Shali Mehraneh
Published: February 2017

Background: The practical difficulties for patients with stroke include lack of information about their condition, poor knowledge of the services and benefits available. Specialist Stroke nurses provide education and support services for people with Stroke  in many health care systems. A key goal is helping and empowering unable people to self-manage their stroke and supporting caregivers of these valnurable population, too.Objective: The objective of this review was to assess the role of specialist nurse in care for patients following a stroke and their caregivers support.Search methods: The databases CINAHL, PubMed, Science Direct and Synergy were searched from 1988 to 2017 using the keywords Stroke, Specialist Nurse, Care, Caregivers and support. Bibliographies of relevant papers were searched, and hand searching of relevant publications was undertaken to identify additional Studies.Selection criteria: All studies of the effects of a specialist nurse practitioner on short and long term stroke outcomes were included in the review.Data collection and analysis: Three investigators performed data extraction and quality scoring independently; any discrepancies were resolved by consensus.Findings:  Stroke, Specialist Nurse, Care, Caregivers concepts and labels are defined and measured in different and often contradictory ways by using 31 founded study.Conclusions: The findings indicate a dissonance in the views of different stakeholders within the care system. The division of labour associated with nursing care and specialist nurse requires further exploration. The contrasting paradigms of health care professionals and people with stroke regarding models of disability were highlighted.  Stroke, like other chronic illnesses, requires substantial nursing care. There is a growing number of specialist nurses in the workforce, however, little is known how their role interfaces with other nurses.
Cryptogenic Stroke
Authors: Saadatnia Mohammad
Published: February 2017

Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge.The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS) was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.
Carotid Angioplasty In Octogenarians: A Mono-Arm Trial With Clinical And Angiographic Follow Up
Authors: Sharifipour Ehsan , Mohammadian Reza
Published: February 2017

Background: Octogenarians account for a third of ischemic stroke (IS) patients and they have higher morbidity and mortality rate among IS patients. The aim of this study was to evaluate the pri-procedural and long term clinical and angiographic statement of carotid artery angioplasty (CAA) in octogenarians.Methods: In a mono-arm trial 102 patients>80 years old with symptomatic internal carotid artery (ICA) stenosis presented by non-disabling IS or TIA underwent the CAA and were evaluated prospectively from January 2010 to July 2014. All patients had standard stroke care during the study follow up. The peri-procedural complications, cerebrovascular accidents, restenosis in target vessel and mortality rate were recorded to evaluate safety and durability of this secondary stroke prevention method in octogenarians.Results: 48 (47.06%) males and 54 (52.9%) females in a mean period of 24.5±14.1 (6-50 months) were followed. For all patients mean age was 83.39 ±2.53 (range, 80-88) years. The success rate of CAA was 100%, whereas the peri-procedural complication rate was 5.8% (access-site local hematoma and bradycardia during CAA both in 2.94%).There was only one patient who had acute ischemic stroke during the procedure. Restenosis occurred in 3.9% after a mean of 21.5 months. The proportion of recurrent cerebrovascular accident was 9.8% while TIAs occurred in 3.9% and stroke in 1% of patients. Also 4.9% of patients experienced coronary artery disease and the proportion of fatal recurrent cerebrovascular accident was 2.9%.  The median patient event-free survival was 20 months.Conclusion: CAA seems to be a safe and durable IS secondary prevention method in octogenarians with symptomatic carotid artery stenosis.
Diagnosis Of The Risk For Carotid Artery Stenos Based On Thermal Model In Infrared Images
Authors: Valipoori Goodarzi Fatemeh , Habashi Zadeh Tahereh
Published: February 2017

Background and purpose: Ischemic stroke is the third leading cause of death and a common cause of hospitalization in the United States of America and is also an important factor for Inability of patients and carotid stenos is one of the most important factors in creating it. Now, Imaging studies include: Angiography, MRI, CT scan and Doppler ultrasonography , are used to detect carotid artery stenos that is one of the most important causes of ischemic stroke. However, each method has unique advantages and disadvantages, that many of them will have a compromise between performance and accuracy versus easy usage and cost considerations. In contrast, in this paper, thermography is used as a non-invasive and cost effective to detect carotid artery Stenos and thus the risk of stroke.Materials and methods: This study is done on a series of thermal images obtained from the Clinical Center in California. In this imaging, the automatic detection of carotid artery stenos and thus Risk for stroke was done, based on: (1) the difference of average temperature between the right and left carotid arteries in the neck (2) The presence or absence of internal and external carotid arteries.Results: In this study, with the survey conducted by a specialist brain of patients had been previously, the accuracy of this work is confirmed. the techniques and points that are Experimental and  scientifically based  and obtained in this study, can help to doctors for Early detection of Artery disease, based on analysis of thermal images .Conclusion: The method presented in this paper is considered as a non-invasive and cost-effective method that automatically operates to detect the carotid arteries and prevent the Risk for stroke.
Increased Expression Of Toll-Like Receptor 2 Mrna Following Permanent Middle Cerebral Artery Occlusion In Rat: Role Of TRPV1 Receptors
Authors: Moghadam Ahmadi Amir , Allahtavakoli Mohammad , Shamsizadeh Ali , Roohbakhsh Ali , Vakilian Alireza , Hakimizadeh Elham , Rahmani Mohammadreza , Bazmandegan Gholamreza
Published: February 2017

Background: Stroke is a major cause of mortality and long term disability in adults. TRPV1 has a pivotal role in neuroinflammation. Among TLRs, TLR2 significantly participate in induction of inflammation in brain. In this study, the effect of TRPV1 receptor agonist and antagonist on outcome and gene expression of TLR2 in a rat model of permanent middle cerebral artery occlusion (MCAO) was investigated.Methods: Forty male rats were assigned to the following groups: sham, vehicle )stroke), AMG9810 (selective TRPV1 antagonist, 0.5 mg/kg; 3 h after stroke), and capsaicin (1 mg/kg; 3 h after stroke). Stroke was induced by permanent middle cerebral artery occlusion and behavioral functions were assessed 1, 3, and 7 days after stroke. Infarct volume, brain edema and mRNA expression of TLR2 were also evaluated at the end of the study.Results: While stroke animals showed infarctions and behavioral functions, we did not observe any cerebral infarction and behavioral functions in sham-operated animals. AMG9810 decreased neurological deficits 7 days after cerebral ischemia (P<0.01). In the ledged beam-walking test, the slip ratio was increased following ischemia (*P < 0.05). AMG9810 improved this index in animals undergone stroke. However, capsaicin enhanced the slip ratio 3 and 7 days after cerebral ischemia (#P<0.05). TLR2) P<0.05(mRNA expression was elevated in ischemic rats. Conclusion: Our data indicate that pharmacological blockade of TRPV1 by AMG9810 attenuates behavioral function and mRNA expression of TLR2. Therefore, it might be useful as a potential target for the treatment of ischemic stroke.
Correlation Between Lower And Higher Order Sensory Functions And Fine And Gross Motor Function In Dominant And Non-Dominant Hand Of Patients With Choronic Stroke
Authors: Najafabadi Mahbubeh Mandehgary , Akram Azad , Ghorban Taghizadeh
Published: February 2017

Introduction: To investigate the correlation between lower and higher order sensory functions and manual dexterity as well as Identify factors affecting upper extremity motor function(UEMF) in subjects with chronic stroke.Methods: In this correlational study, seventy chronic stroke subjects (48 male and 22 female) by mean age of 56.94 (±12.92) years and mean time after stroke of 3.01 (±2.64) years were selected by simple nonprobability method. Lower order sensory function (i.e., light touch threshold), higher order sensory functions (i.e., tactile acuity, weight and texture discrimination, haptic performance and wrist proprioception) were measured by Weinstein enhanced sensory test, two point discrimination, wrist position sense test, hand active sensation test and haptic object test, respectively. The gross and fine manual dexterity were measured by Wolf Motor Function Test (WMFT), Box and Block Test(BBT) and Purdue Pegboard (PPB) test. The step by step regression model was used to investigate the sensory determinants of motor function.Results: A weak to high significant correlation (r =0.25 to 0.80) was found between sensory predictors and motor outcomes. The regression models explained 19.8%, 30.3% and 52.3% of variancein motor function measures of the PPB, BBT and WMFT, respectively. The tactile threshold (p<0.001) was the most relevant predictor in all stepwise models for all motor outcomes in dominant or non-dominant hand , followed by tactile acuity, haptic performance and wrist proprioception (p< 0.05). The weight and texture discrimination was not included in any outcome models. Conclusion: The results of present study showed that tactile threshold as lowr order sensory function is the most relevant predictor for UEMF in stroke. The results reinforce that rehabilitation interventions focused on tactile threshold may be best able to impact UEMF in stroke subjects.
Impaired Arterial Smooth Muscle Cell Vasodilatory Function In Methamphetamine Users
Authors: Nabaei Ghaemeh , Fatehi Farzad , Ghorbani Askar , Oveisgharan Shahram
Published: February 2017

Objectives: Methamphetamine use is a strong risk factor for stroke. This study was designed to evaluate arterial function and structure in methamphetamine users ultrasonographically.Methods: In a cross-sectional study, 20 methamphetamine users and 21 controls, aged between 20 and 40years, were enrolled. Common carotid artery intima-media thickness (CCA-IMT) marker of early atherogenesis, flow-mediated dilatation (FMD) determinants of endothelium-dependent vasodilation, and nitroglycerine-mediated dilatation (NMD) independent marker of vasodilation were measured in two groups.Results: There were no significant differences between the two groups regarding demographic and metabolic characteristics. The mean (±SD) CCA-IMT in methamphetamine users was 0.58±0.09mm, versus 0.59±0.07mm in the controls (p=0.84). Likewise, FMD% was not significantly different between the two groups [7.6±6.1% in methamphetamine users vs. 8.2±5.1% in the controls; p=0.72], nor were peak flow and shear rate after hyperemia. However, NMD% was considerably decreased in the methamphetamine users [8.5±7.8% in methamphetamine users vs. 13.4±6.2% in controls; p=0.03].Conclusion: According to our results, NMD is reduced among otherwise healthy methamphetamine users, which represents smooth muscle dysfunction in this group. This may contribute to the high risk of stroke among methamphetamine users.
Evaluating Mechanical Thrombectomy Techniques Used For The Patients With Ischemic Stroke In Ghaem Hospital Of Mashhad University Of Medical Science
Authors: Sobhani Mohammadreza , Baharvahdat Humain , Sasannejad Payam , Ghandehari Kavian , Dehghanizadeh Hamzeh
Published: February 2017

Introduction: R tpa injection is a routine and common therapeutic approach in treatment of ischemic stroke patients, but it's use has been limited because of contraindications and limited time span. And because of low success in resolution of thrombus in MCA and ICA arteries. The novel and complementary approach is opening main arteries by mean of mechanical thrombectomy.Methods and material: 27 patients with ischemic stroke underwent mechanical thrombectomy during Jan 2014 to Dec 2016 at Ghaem hospital catheterization lab.Results: Patients including 17 women and 10 gentlemen underwent thrombectomy. We used for our patients these number of techniques, IA rtPA =5, IA integrilin=1, solitaire=21, eric=4, suction=13, balloon and stent=6, IA integrilin=1, Solitaire=21, ERIC=4, Suction=13.Conclusion: We found that the best technique is unique for each patient, but the best outcome obtained from the combination of the above mentioned techniques.
A Case Of Postprtum Rcvs Failed To Respond To Metylprednisolon
Authors: Mehrpour M , Haji Akhoundi F , Afrakhteh M , Raeesmohammadi L , Ashyeri R , Motamed M
Published: February 2017

Introduction:Reversible cerebral vasoconstriction syndrome(RCVS) is a rare condition that occurs as the result of a sudden constriction(tightening) of the vessels that supply blood to the brain. the main symptom of RCVS is thunderclap headaches. stroke or bleeding in to the brain and seizure may or may not be present. the condition is more commonly diagnosed in women between the ages of 20 to 50 and may be associated with changes that happen in the body immediately after giving birth or changing birth control pills. other risk factors associated with RCVS include: use of drugs, alcohol, nicotin patches and certain tumors.Objective:For the first time in our center we diagnose and treat a postpartum RCVS.Case Description:A 37year old lady was referred to our center with GTCS and thunderclap headache. she had an uncomplicated cesarian section last week. she had no significant past medical history and her blood pressure was normal during pregnancy. drug history was negative. in physical exam blood pressure and neurologic exam were normal. in our assessment brain imaging showed cortical SAH, lab data including blood biochemistries and csf were normal, in Angiography vasospasm in left A1 and in carotid duplex MCA velocity was 220 cm/s. Therefore we started nimodipin and metylprednisolon but her symptom aggravated and she showed increased MCA velocity in TCD.SO BRAIN Angiography was done for the second time that show generalized vasospasm in anterior circulation, bilateral v4 and basilar arteries. nimodipin and milrinone were injected slowly and vasospasm become better.TCD monitoring showed decreased MCAs velocities and her symptom did not recur and in TCD MCAs PSVs were below 150 cm/s.Discussion:We presented a case of postpartum RCVS , that aggravated with intra venous metylprednisolon, and resolved with intra arterial milrinone. RCVS is a syndrome of cerebral arterial vasoconstriction, usually presenting with Edit Metadata
Current Canadian And American Experiences In The Treatment Of Acute Ischemic Stroke
Authors: Dolati Parviz
Published: February 2017

Stroke remains one of the main public health issues worldwide. It is the third leading cause of death in the United States, with more than 200,000 people dying from strokes each year. Approximately 80% of all acute ischemic strokes are due to intracranial artery occlusion, most commonly thromboembolic clot occlusion. Revascularization of occluded territories is the cornerstone of acute ischemic stroke and Thrombolysis for ischemic stroke has been systematically studied in large randomized trials only since the 1990s. To date, thrombolytic therapy for ischemic stroke has been investigated in 21 randomized controlled clinical trials enrolling more than 7,000 patients. The advent of modern imaging and endovascular tools and technology has revolutionized treatment of stroke. In this talk, I will review current clinical trials published in The NEJM (ESCAPE, MR Clean, EXTENDED IA, ….) regarding superiority of the endovascular treatments, especially, the stent retrievers, over Iv tPA. I will also go over all endovascular techniques used in the endovascular treatment of acute stroke using my Canadian and American experiences.
Genetic View To Stroke Occurrence
Authors: Yoosefee Sadegh , Amir Hejazi Seyyed , Sharifipour Ehsan , Sabokbar Tayyebeh
Published: February 2017

Stroke is the third leading cause of death. The role of genetics in the etiology and development of this disease is undeniable. As a result of inadequate previous research, more and more studies in the field of genetics are necessary to identify pathways involved in the pathogenesis of stroke, which in turn, may lead to new therapeutic approaches. However, due to the multifactorial nature of stroke and the few studies conducted in this field, genetic diversity is able to predict only a small fraction of the risk of disease. On the other hand, studies have shown genetically different architecture for different types of stroke, and finally pharmacogenomics as an important part of personalized medicine approach, is influenced by genetic studies, all of which confirm the need of addressing the topic by researchers.
Diagnosis Of The Risk For Carotid Artery Stenos Based On Thermal Model In Infrared Images
Authors: Valipoori Goodarzi Fatemeh , Habashizadeh Tahereh
Published: February 2017

Background and purpose: Ischemic stroke is the third leading cause of death and a common cause of hospitalization in the United States of America and is also an important factor for Inability of patients and carotid stenos is one of the most important factors in creating it. Now, Imaging studies include: Angiography, MRI, CT scan and Doppler ultrasonography , are used to detect carotid artery stenos that is one of the most important causes of ischemic stroke. However, each method has unique advantages and disadvantages, that many of them will have a compromise between performance and accuracy versus easy usage and cost considerations. In contrast, in this paper, thermography is used as a non-invasive and cost effective to detect carotid artery Stenos and thus the risk of stroke.Materials and methods: This study is done on a series of thermal images obtained from the Clinical Center in California. In this imaging, the automatic detection of carotid artery stenos and thus Risk for stroke was done, based on: (1) the difference of average temperature between the right and left carotid arteries in the neck (2) The presence or absence of internal and external carotid arteries.Results: In this study, with the survey conducted by a specialist brain of patients had been previously, the accuracy of this work is confirmed. the techniques and points that are Experimental and  scientifically based  and obtained in this study, can help to doctors for Early detection of Artery disease, based on analysis of thermal images .Conclusion: The method presented in this paper is considered as a non-invasive and cost-effective method that automatically operates to detect the carotid arteries and prevent the Risk for stroke.
Correlation Between Lower And Higher Order Sensory Functions And Fine And Gross Motor Function In Dominant And Non-Dominant Hand Of Patients With Choronic Stroke
Authors: Najafabadi Mahbubeh Mandehgary , Akram Azad , Ghorban Taghizadeh
Published: February 2017

Introduction: To investigate the correlation between lower and higher order sensory functions and manual dexterity as well as Identify factors affecting upper extremity motor function(UEMF) in subjects with chronic stroke.Methods: In this correlational study, seventy chronic stroke subjects (48 male and 22 female) by mean age of 56.94 (±12.92) years and mean time after stroke of 3.01 (±2.64) years were selected by simple nonprobability method. Lower order sensory function (i.e., light touch threshold), higher order sensory functions (i.e., tactile acuity, weight and texture discrimination, haptic performance and wrist proprioception) were measured by Weinstein enhanced sensory test, two point discrimination, wrist position sense test, hand active sensation test and haptic object test, respectively. The gross and fine manual dexterity were measured by Wolf Motor Function Test (WMFT), Box and Block Test(BBT) and Purdue Pegboard (PPB) test. The step by step regression model was used to investigate the sensory determinants of motor function.Results: A weak to high significant correlation (r =0.25 to 0.80) was found between sensory predictors and motor outcomes. The regression models explained 19.8%, 30.3% and 52.3% of variancein motor function measures of the PPB, BBT and WMFT, respectively. The tactile threshold (p<0.001) was the most relevant predictor in all stepwise models for all motor outcomes in dominant or non-dominant hand , followed by tactile acuity, haptic performance and wrist proprioception (p< 0.05). The weight and texture discrimination was not included in any outcome models.Conclusion: The results of present study showed that tactile threshold as lowr order sensory function is the most relevant predictor for UEMF in stroke. The results reinforce that rehabilitation interventions focused on tactile threshold may be best able to impact UEMF in stroke subjects.
Reversible Cerebral Vasoconstriction Syndromes
Authors: Karimi Narges
Published: February 2017

Reversible cerebral vasoconstriction syndromes (RCVS) show reversible multifocal narrowing of the cerebral arteries with clinical manifestations that characteristically include thunderclap headache and less commonly focal neurologic deficits related to brain edema, stroke, or seizure. RCVS predominantly affects women (female to male ratio 2:1 to 10:1, depending on the case series). The mean age across published studies is 42 to 44 years. RCVS has been associated with a multiplicity of conditions including pregnancy, migraine ,use of vasoconstrictive drugs and other medications, neurosurgical procedures, hypercalcemia, unruptured saccular aneurysms, cervical artery dissection, cerebral venous thrombosis, and others.  Between 30 and 70 percent of patients with RCVS have no abnormality on initial brain scans, despite having widespread cerebral vasoconstriction. However, approximately 75 percent of admitted patients eventually develop parenchymal lesions. The most frequent lesions are ischemic stroke and cortical surface (nonaneurysmal or convexal) subarachnoid hemorrhage, followed by reversible vasogenic brain edema and parenchymal hemorrhage. Infarcts are often bilateral and symmetrical, located in arterial "watershed" regions of the cerebral hemispheres or in the cortical-subcortical junction. Larger infarcts are often wedge-shaped.  Cerebral angiographic abnormalities are dynamic and progress proximally, resulting in a "sausage on a string" appearance of the circle of Willis arteries and their branches. There is no proven therapy for RCVS. Supportive care is directed towards managing blood pressure, severe headaches, and other complications such as seizures. Oral calcium channel blockers are often administered to treat vasoconstriction but the supporting evidence for this strategy is weak.
A Case Of Postprtum Rcvs Failed To Respond To Metylprednisolon
Authors: Mehrpour M , Haji Akhoundi F , Afrakhteh M , Raeesmohammadi L , Ashyeri R , Motamed M
Published: February 2017

Introduction:Reversible cerebral vasoconstriction syndrome(RCVS) is a rare condition that occurs as the result of a sudden constriction(tightening) of the vessels that supply blood to the brain. the main symptom of RCVS is thunderclap headaches. stroke or bleeding in to the brain and seizure may or may not be present. the condition is more commonly diagnosed in women between the ages of 20 to 50 and may be associated with changes that happen in the body immediately after giving birth or changing birth control pills. other risk factors associated with RCVS include: use of drugs, alcohol, nicotin patches and certain tumors.Objective:For the first time in our center we diagnose and treat a postpartum RCVS.Case Description:A 37year old lady was referred to our center with GTCS and thunderclap headache. she had an uncomplicated cesarian section last week. she had no significant past medical history and her blood pressure was normal during pregnancy. drug history was negative. in physical exam blood pressure and neurologic exam were normal. in our assessment brain imaging showed cortical SAH, lab data including blood biochemistries and csf were normal, in Angiography vasospasm in left A1 and in carotid duplex MCA velocity was 220 cm/s. Therefore we started nimodipin and metylprednisolon but her symptom aggravated and she showed increased MCA velocity in TCD.SO BRAIN Angiography was done for the second time that show generalized vasospasm in anterior circulation, bilateral v4 and basilar arteries. nimodipin and milrinone were injected slowly and vasospasm become better.TCD monitoring showed decreased MCAs velocities and her symptom did not recur and in TCD MCAs PSVs were below 150 cm/s.Discussion:We presented a case of postpartum RCVS , that aggravated with intra venous metylprednisolon, and resolved with intra arterial milrinone. RCVS is a syndrome of cerebral arterial vasoconstriction, usually presenting with recurrent thunderclap headaches, seizures and focal neurologic deficits. our patient s symptoms consist of a thunderclap headache and a GTCS. our patient was not a case of eclampsia and other predisposing factors of RCVS were also absent. she was one of the rare reported cases of RCVS in the postpartum period. treatment of RCVS in usually conservative and symptomatic cases. few existing trapeutic option include: oral or intra arterial of CCBs. Recent studies reported that steroids lack beneficial in RCVS and may even worsen vasoconstriction. this is  what happened in our patient. She finally improved with intra arterial milrinone injection.
Biomarkers As Predicting Models Of Stroke Incidence
Authors: Ghorbani Abbas
Published: February 2017

OBJECTIVES: biomarkers refer to indicators measured by chemical or biologic tests using blood or urine .  The predicts physiologic or disease states, or increased disease risk.Risk stratification of persons at risk of future vascular event can separate subpopulations that would benefit most from established and emerging stoke preventive therapies.METHODS: Biomarkers representing various components of the inflammatory cascade, including:1-systemic inflammation (c-reactive protein{CRP}, interleukin 6, monocyte chemotactic protein1,tumor necrosis factor α1,tumor necrosis factor recepror2{TNFR2}, osteoprotegrin, fibrinogen)2-vascular inflammation/ endothelial dysfunction (intercellular adhesion molecule1,CD40 ligand, P-selectin,lipoprotein associated phospholipaseA  mass and activity,total homocysteine (tHcy),and vascular growth factor(VEGF),oxidative stress(myeloperoxidase)RESULTS: circulating biomarkers of inflammation and endothelial dysfunction are associated with ischemic stroke in stroke free community- dwelling individuals and they can be used to refine stroke prediction models inclusion of 4 biomarkers (CRP-TNFR2-tHcy-VEGF)DISCUSSION: Athough the roles of biomarkers are basically diagnosing the disease and predicting the outcome , biomarkers inpatients with stroke can also provide a large variety of other information about the risk of future stroke, possible stroke mechanisms for biomarker-guided treatment. Among circulating biomarkers  VEGF was the biomarker that had the greatest individual degree of discrimination for future ischemic stroke. Data from studies  have recently demonstrated  the relation between  VEGF and ischemic stroke pathogenesis is, however not well established.total homocysteine and CRP are well established markers of increase stroke risk , the former via its role in accelerated atherosclerotic disease and the latter marking systemic inflammation and plague instability. It has been demonstrated independent association between TNFR2 and ischemic stroke, preliminary data have shown the lower vascular events, in patients with rheumatoid arthritis on TNF inhibitors , particularly in patients with longer duration of use, and characterizing the protective effects Of TNF inhibitors in stroke patientsCONCLUSIONS: recent study reported that multiple microparticle biomarkers in addition to existing protein biomarkes are valuable for predicting future of cerebrovascular events
Obesity-induced diet leads to weight gain, systemic metabolic alterations, adipose tissue inflammation, hepatic steatosis, and oxidative stress in gerbils (Meriones unguiculatus)
Authors: Ventura Luciana L.A. , Fortes Nathália C.L. , Santiago Helton C. , Caliari Marcelo V. , Gomes Maria A. , Oliveira Dirce R.
Published: March 2017

Background

Nowadays, the number of obese people in the world has reached alarming proportions. During the expansion of adipose tissue, a number of functions such as activation and release of cytokines and hormones may be affected. This leads the body to a pro-inflammatory pattern, which may affect the proper functioning of many tissues. Thus, studying the mechanisms by which obesity induces physiological disorders is necessary, and may be facilitated by the use of animal models, in particular rodents. We sought to characterize the metabolic and adipose tissue changes resulting from a diet rich in fats and simple sugars in gerbils.

Methods

We divided 14 gerbils into two experimental groups that received a diet rich in simple carbohydrates and fats with 5,86 kcal/g (OB,n = 7) or a standard diet with 4.15 kcal/g (CT;n = 7) for 11 weeks. The animals had free access to water and food. The animal weight and food consumption were measured weekly. Blood, adipose tissue and liver of each animal were collected at the end of experiment. The following parameters were determined: cholesterol (COL), triglycerides (TGL) and glycemia (GLI) in the plasma; cytokines (IL-6, IL-10 and TNF-α) and hormones (adiponectin and leptin) in adipose tissue; activity of superoxide dismutase (SOD) and catalase (CAT), extraction and differentiation of fat and histology in liver.

Results

The consumption of a diet rich in simple carbohydrates and fats led to increased total body weight and increased relative weights of liver and adipose tissue. In addition, we observed increased fasting glucose levels and circulating triglycerides, along with high TNF-α production in adipose tissue and increased total fat, cholesterol and triglyceride contents in the liver, contributing to higher intensity of hepatic steatosis. On the other hand, the animals of this group showed depletion in the enzyme activity of SOD and CAT in the liver, as well as reduction of IL-10 and adiponectin levels in adipose tissue.

Discussion

High intake of saturated fat and simple carbohydrates establish the gerbil as an experimental model for the study of metabolic and hepatic abnormalities resulting from obesity.
Coat of many colours—DNA reveals polymorphism of mantle patterns and colouration in CaribbeanCyphomaRöding, 1798 (Gastropoda, Ovulidae)
Authors: Reijnen Bastian T. , van der Meij Sancia E.T.
Published: March 2017

The iconic gastropod genusCyphomais commonly observed in the Caribbean, where it lives in association with various octocorallian hosts. Each species in the genusCyphomahas a unique, characteristic mantle pattern and colouration, which separates the valid taxa. Because of its abundance and recognisabilityCyphoma gibbosumhas been used as a model organism in several studies concerning allelochemicals, reef degradation, and physical defence mechanisms. Molecular analyses based on four molecular markers (COI, 16S, H3 and 28S) for threeCyphomaspecies (C. gibbosum,C. mcgintyi,C. signatum) and an unidentified black morph, collected from three localities in the Caribbean, show that they represent morphological varieties of a single, genetically homogeneous species. This outcome is in agreement with previous anatomical studies. As a resultC. mcgintyiandC. signatumare synonymised withC. gibbosum, which is a key result for future work usingC. gibbosumas a model organism. The striking morphological differences in mantle pattern and colouration are hypothesised to be the result of one of three possible scenarios: rapid divergence, supergenes (including balanced polymorphism), or incipient speciation.
Quantifying the trade‐off between carbon sequestration and albedo in midlatitude and high‐latitude North American forests
Authors: Mykleby P. M. , Snyder P. K. , Twine T. E.
Published: March 2017

Afforestation is a viable and widely practiced method of sequestering carbon dioxide from the atmosphere. However, because of a change in surface albedo, placement of less reflective forests can cause an increase in net‐absorbed radiation and localized surface warming. This effect is enhanced in northern high latitudes where the presence of snow cover exacerbates the albedo difference. Regions where afforestation could provide a climate benefit are determined by comparing net ecosystem production and net radiation differences from afforestation in midlatitude and high latitude of North America. Using the dynamic vegetation model Integrated Biosphere Simulator, agricultural version (Agro‐IBIS), we find a boundary through North America where afforestation results in a positive equivalent carbon balance (cooling) to the south, and a negative equivalent carbon balance (warming) to the north. Including the effects of stand age and fraction cover affect whether a site contributes to mitigating global warming.
Paying People to Make Healthy Choices
Authors: English William
Published: March 2017

Paying people to make healthy choices is a promising response to a genuine social problem. Many people engage in behaviours that are not only destructive of their health but also impose significant financial burdens on themselves and their societies. Paying people to make healthy choices can be more effective than the mere provision of information, while also being more efficient and ethical than outright prohibitions of unhealthy behaviour. An enormous range of empirical research confirms this basic insight. However, when it comes to the success of any given programme, the devil is in the details. Health incentive programmes need to be carefully designed and evaluated to ensure that they are indeed effective, efficient and ethical. Moreover, special attention must be paid to concerns about equity, unjustified paternalism, the effects on character and perverse incentives that can generate unintended consequences.

Key Concepts

Unhealthy behaviours impose large costs on healthcare systems, and many people later regret their unhealthy choices.

Policymakers would like to encourage healthier behaviour, but the challenge is to do this in ways that are effective, efficient and ethical.

Paternalists argue that we should encourage people to make healthy choices for their own good, while utilitarians argue that we should encourage people to make healthy choices because of the larger benefits to society.

Both paternalists and utilitarians have argued that extremely unhealthy choices, such the recreational use of narcotic drugs, should be prohibited. However, although effective, prohibitions of unhealthy behaviour are often inefficient and raise ethical challenges.

Concern for individual rights and autonomy has led many to criticise prohibitions on unhealthy behaviour, arguing that it would be better to simply inform people about the costs and harms of unhealthy choices. Unfortunately, information campaigns have had limited success in changing unhealthy behaviour.

Paying people to make healthy choices promises to be more ethical and efficient than prohibitions and more effective than the provision of information.

Paying people to make healthy choices can be more ethical because it still allows people to make a choice; it can be more efficient because rewards and penalties can be adjusted to reflect the social costs of unhealthy behaviours; and it can be more effective because it provides immediate incentives to make a healthy choice.

Health incentive programmes have been successful in many different circumstances. However, programmes need to be carefully designed and evaluated to ensure that they are indeed effective, efficient and ethical.

There are circumstances in which paying people to make healthy choices may not be the best approach. Particular attention must be paid to concerns regarding equity, unjustified paternalism, the effects on character and the creation of incentives that lead to unintended consequences.
Skin Tumours
Authors: Brierley James D. , Gospodarowicz Mary K. , Wittekind Christian
Published: February 2017

The article provides an introduction to various carcinomas of the skin, melanomas, and Merkel cell carcinoma arising from different anatomical sites that will be classified and staged in this section.
Essential
TNM
Authors: Brierley James D. , Gospodarowicz Mary K. , Wittekind Christian
Published: February 2017

Essential TNM facilitates coding the extent of disease when the relevant T, N, and M categories are not recorded or data are not available. The extent can be classified either as Stage I, II, III, or IV or as localized, regional, or distant.
Well‐Differentiated Neuroendocrine Tumours of the Gastrointestinal Tract
Authors: Brierley James D. , Gospodarowicz Mary K. , Wittekind Christian
Published: February 2017

Neuroendocrine carcinomas, nodes, and metastases arising from the gastrointestinal tract have been classified clinically and histologically. High‐grade neuroendocrine carcinomas are however classified according to their respective sites.
Thymic Tumours
Authors: Brierley James D. , Gospodarowicz Mary K. , Wittekind Christian
Published: February 2017

Epithelial tumours of the thymus, nodes, and metastases have been classified clinically and histologically. Clinical assessment is based on physical examination, imaging, endoscopy, and surgical exploration.
Oral Cavity
Authors: Vaish Richa , Dandekar Mitali , Agarwal Jai Prakash , Prabhash Kumar , D'Cruz Anil K.
Published: February 2017

Oral cavity cancer is a global problem with a predominance in South‐East Asia. The majority of patients present with advanced disease. The most important causative agents are tobacco (smoked and smokeless), alcohol and areca nut. Despite well‐recognized premalignant lesions the role of screening for early detection of these cancers has yet to be established. Chemoprevention has not lived up to its initial promise. Histologically, the great majority of tumours are squamous cell carcinoma or its variants. A multidisciplinary approach in diagnosis and management is important for successful outcome. Although both surgery and radiation can be used in a curative setting, surgery is the cornerstone in the treatment of most oral cavity cancer patients with an emphasis on tumour‐negative margins. Increased T stage (T3/T4), poorly differentiated tumours, perineural invasion, lymphovascular invasion, nodal positivity, extracapsular extension and close or positive margins are important prognostic factors warranting adjuvant therapy. Appropriate reconstruction and rehabilitation is an integral part of treatment with free tissue transfer being the best option for restoring function and cosmesis in the majority of patients. Chemotherapy has a limited role in the management of these cancers and is primarily used in the adjuvant setting concurrent with radiotherapy.
Nasal Cavity and Paranasal Sinus
Authors: Pai Prathamesh S. , Ghosh Laskar Sarbani , Kane Shubhada , Robbins K. Thomas , Nicolai Piero , Licitra Lisa
Published: February 2017

Tumours of the nose and paranasal sinuses are unique, rare and often diagnosed in late stages. Unilateral nasal symptoms, such as obstruction, should alert the physician to rule out malignancy. Inflammatory polyps frequently co‐exist with malignant tumours. Endoscopic examination therefore, is strongly recommended to obtain appropriate visualization and to guide biopsy. Sinonasal tumours are unique due to their diverse differentiation, ranging from epithelial and mesenchymal to neuroectodermal and haematolymphoid malignancies. Diagnosis of these tumours is challenging due to many overlapping histopathological features and limited tissue availability in biopsy samples. A systematic approach using ancillary techniques such as immunohistochemistry, cytogenetics and molecular pathology help in differential diagnosis. The sheer number of different pathologies seen in this region makes standardization of guidelines exceedingly difficult. However, the key to a suitable management is to identify the tumour histology and develop an individualized treatment plan based on the biology of the disease.
Fast, Scalable Synthesis of Micronized Ge3N4@C with a High Tap Density for Excellent Lithium Storage
Authors: Kim Chanhoon , Hwang Gaeun , Jung Ji‐Won , Cho Su‐Ho , Cheong Jun Young , Shin Sunghee , Park Soojin , Kim Il‐Doo
Published: March 2017

Nanostructuring has significantly contributed to alleviating the huge volume expansion problem of the Ge anodes. However, the practical use of nanostructured Ge anodes has been hindered due to several problems including a low tap density, poor scalability, and severe side reactions. Therefore, micrometer‐sized Ge is desirable for practical use of Ge‐based anode materials. Here, micronized Ge3N4 with a high tap density of 1.1 mg cm−2 has been successfully developed via a scalable wet oxidation and a subsequent nitridation process of commercially available micrometer‐sized Ge as the starting material. The micronized Ge3N4 shows much‐suppressed volume expansion compared to micrometer‐sized Ge. After the carbon coating process, a thin carbon layer (≈3 nm) is uniformly coated on the micronized Ge3N4, which significantly improves electrical conductivity. As a result, micronized Ge3N4@C shows high reversible capacity of 924 mAh g−1 (2.1 mAh cm−2) with high mass loading of 3.5 mg cm−2 and retains 91% of initial capacity after 300 cycles at a rate of 0.5 C. Additionally, the effectiveness of Ge3N4@C as practical anodes is comprehensively demonstrated for the full cell, showing stable cycle retention and especially excellent rate capability, retaining 47% of its initial capacity at 0.2 C for 12 min discharge/charge condition.
Using labeled choice experiments to analyze demand structure and market position among seafood products
Authors: Thong Nguyen Tien , Solgaard Hans Stubbe , Haider Wolfgang , Roth Eva , Ravn‐Jonsen Lars
Published: February 2017

Understanding market competition and consumer preferences are important first steps in developing a business. In a competitive market, the effectiveness of the various elements of a firm's marketing mix depends not only on the absolute value of each element but also on the relative values of the elements with respect to the firm's position in the market. In this paper, we analyze the demand structure and market positions of a variety of seafood products in the French retail market. We used a labeled choice experiment to analyze 12 seafood species. The choice options were labeled by the names of the seafood, providing researchers the opportunity to analyze the competitive interactions among the species. Competitive clout and vulnerability measures were estimated for each species as summary measures of species competition. These measures were calculated from cross‐ and own‐elasticities and reveal that salmon and cod have the strongest market position, while monkfish and pangasius have the weakest. In general, the demand for seafood is moderately sensitive to price (market elasticity of −1.31). Large size and low‐income households, female consumers, people in the age range 35–44 years, and self‐employed consumers are the most sensitive to price. Four segments were identified and described in terms of both consumer characteristics and preferences. Our results are meaningful for producers and retailers to develop marketing strategies and production plans. [EconLit citations: D12, M21, Q13].
Consumers’ willingness to pay for edamame with a genetically modified label
Authors: Wolfe Elijah , Popp Michael , Bazzani Claudia , Nayga Rodolfo M. , Danforth Diana , Popp Jennie , Chen Pengyin , Seo Han‐Seok
Published: February 2017

Results from a sensory test of edamame, which is soybean (Glycine max (L.) Merr.) harvested near the end of the pod filling stage, followed by a non‐hypothetical auction, and finally a questionnaire were used to determine WTP for GM labeled edamame in comparison to unlabeled and non‐GM labeled edamame. The results showed a significant price premium for non‐GM edamame even though overall sensory impression did not differ between GM and non‐GM edamame. Interestingly unlabeled and GM labeled edamame bids were similar suggesting that consumers wanted to be informed. Preconceived consumer notions appeared to play a role as did knowledge, opinion, income, and consumption frequency in subsamples of respondents. Labeling edamame is in the interest of producers as all edamame produced in the U.S. is non‐GM.