bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum Levels of 25‐Hydroxy‐Vitamin D3 Among Sun‐protected Outdoor Workers in Israel
Authors: Azizi Esther , Pavlotsky Felix , Kudish Avraham , Flint Pazit , Solomon Arie , Lerman Yehuda , Oberman Bernice , Sadetzki Siegal
Published: July 2012

The objective of this study was to evaluate the effect of reduced sun exposure of outdoor workers on vitamin D status using different modalities of sun protection, for primary prevention of skin cancer. 25‐OH‐D3 measurements were performed in two successive winters, 8 (interim) and 20 months after initiation of the study, in three groups of male outdoor workers, enrolled in either a complete, partial or minimal sun protection program. Ambient solar UVB radiation was monitored simultaneously. No intragroup or intergroup differences were observed between the interim‐ and postintervention measurements of mean 25‐OH‐D3, which were close to 30 ng mL−1. Significant risk factors for postintervention 25‐OH‐D3 levels >33.8 ng mL−1 (a surrogate for reduced sun protection) were: previous sunburn episodes (OR 2.5; 95% CI 1.01–6.3; P = 0.05) and younger age (OR 0.92; 95 CI 0.86–0.98; P = 0.009). Outdoor workers of Western, compared with those of Eastern paternal origin had a borderline significant risk (OR 2.4; 95% CI 0.9–6.3; P = 0.07). A borderline significant effect (OR 2.9; 95% CI 0.97–10.1; P = 0.085) was also noted for those in the minimal intervention group. In conclusion, sun protection among outdoor workers following a successful intervention did not suppress mean winter 25‐OH‐D3.
Amino‐Terminal Pro‐B‐Type Natriuretic Peptide for Risk Prediction in Acute Decompensated Heart Failure
Authors: Scrutinio Domenico , Guida Pietro , Passantino Andrea , Lagioia Rocco , Pepe Silvana , Catanzaro Raffaella , Santoro Daniela
Published: July 2012

©2012 Wiley Periodicals Inc.

Amino‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) has been associated with prognosis in heart failure. The aim of this study was to assess whether NT‐proBNP enhances risk prediction in acute decompensated heart failure (ADHF). The authors enrolled 453 patients hospitalized for ADHF. The primary outcome was 12‐month mortality. Two separate multivariable predictive models were built by using standard variables–only and NT‐proBNP concentrations. The models were internally validated using the bootstrapping method. Twelve‐month mortality was 28.3%. There was no statistical evidence of overfit. Compared with the standard variables–only model, the NT‐proBNP model had a better predictive performance as judged by the Nagelkerke R2 (0.410 vs 0.374) and the Brier score (0.136 vs 0.141), which are measures of overall performance; the Akaike Information Criterion (399.2 vs 415.0), which is a tool for model selection; and the C index (0.844 vs 0.831), which is a measure of the discriminative ability. Both models were well calibrated, as judged by the Hosmer‐Lemeshow chi‐square test. Both models predicted 12‐month mortality significantly better than the Enhanced Feedback for Effective Cardiology Treatment risk score. In conclusion, the NT‐proBNP model improved risk prediction compared with the standard variables–only model.
Mental disorders diagnosed in childhood and at‐risk mental state in a help‐seeking population
Authors: Comparelli Anna , Pucci Daniela , Savoja Valeria , Kotzalidis Giorgio D. , Falcone Ilaria , Angelone Massimiliano , Comazzetto Claudia , Emili Emanuele , Rigucci Silvia , Tatarelli Roberto , Girardi Paolo
Published: July 2012

Aim

Disorders usually first diagnosed in infancy, childhood or adolescence (DUFD‐ICA) may have preceded the onset of psychosis by several years and share some co‐morbidity with psychotic disorders, but only a few studies have investigated this aspect. We looked for past or current DUFD‐ICA in a sample of first adult psychiatric service users assessed for the presence of an at‐risk mental state with the Structured Interview for Psychosis‐risk Syndromes (SIPS).

Methods

We interviewed with the SIPS 159 first‐time help seekers (age range 13–30 years) at adult psychiatric services who volunteered to participate in the study. For psychiatric diagnoses, we used the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition‐Text Revision. We also assessed retrospectively the presence of DUFD‐ICA and administered the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning. The sample has been subdivided diagnostically into first‐episode psychosis, multiple episode psychosis, ultra‐high risk (UHR) and other diagnoses.

Results

The risk for having one of first‐episode psychosis, multiple episode psychosis or UHR was over 3.45 higher in the DUFD‐ICA‐positive history group than in the non‐DUFD‐ICA. Grouping the UHR with the not full‐blown psychosis cases resulted in a further increase of the risk to 4.71. DUFD‐ICA‐positive participants scored higher than non‐DUFD‐ICA on the Positive, Negative and Disorganization scales of the SIPS and on several core‐psychotic BPRS items.

Conclusions

A positive history of DUFD‐ICA increases the risk of a diagnosis of prodromal or current psychosis at help seeking. Impaired neurodevelopment may be shared among the psychoses and DUFD‐ICA.
Amniotic band syndrome associated with orofacial clefts: a report of two cases
Authors: Adeosun O.O. , James O. , Akinmoladun V.I. , Owobu T.
Published: July 2012

This article presents two cases of amniotic band syndrome associated with orofacial deformities. There was an uncommon presentation in one of them as Tessier nos. 5, 7 and 30 with irregularly distributed amniotic facial band. The surgical repair of the facial clefts and difficulties in overall management in our environment are further discussed.
Uranium Metallogenic Regionalization and Resource Potential in China
Authors: Ziying LI , Jindai ZHANG , Xiaofei JIAN , Yuqi CAI , Qingyin GUO , Pengfei ZHU
Published: July 2012

This paper is comprehensively involved in main types of uranium deposits and their general metallogenic characteristics, metallogenic fields, provinces, regions and belts, and uranium resources potential evaluation. Generally speaking, there are favorable conditions and good uranium resources potential for uranium mineralization in China.
The Genesis Mechanism of the Mantle Fluid Action and Evolution in the Ore‐Forming Process: A Case Study of the Laowangzhai Gold Deposit in Yunnan, China
Authors: Xianfan LIU , Chunhui LI , Qiuxia LU , Biping DENG , Xiangfeng SONG , Fufeng ZHAO , Yating CHU , Jixiong XIAO , Liwen YI , Yupeng HUANG
Published: July 2012

Based on petrological studies of the wall rocks, mineralizing rocks, ores and veins from the Laowangzhai gold deposit, it is discovered that along with the development of silication, carbonation and sulfidation, a kind of black opaque ultra‐microlite material runs through the spaces between grains, fissures and cleavages. Under observations of the electron microprobe, scanning electronic microscopy and energy spectrum, this kind of ultra‐microlite material is confirmed to consist of ultra microcrystalline quartz, silicate, sulfides and carbonates, as well as rutile, scheelite and specularite (magnetite), showing characters of liquation by the analyses of SEM and energy spectrum. The coexistence of immiscibility and precipitating co‐crystallization strongly suggests that the mineralizing fluid changed from the melt to the hydrothermal fluid. Combined with the element geochemical researches, it is realized that the ultra‐microlite aggregate is the direct relics of the mantle fluid behaving like a melt and supercritical fluid, which goes along with the mantle‐derived magma and will escape from the magma body at a proper time. During the alteration process, the nature of the mantle fluid changed and it is mixed with the crustal fluid, which are favorable for mineralization in the Loawangzhai gold deposit.
Emplacement Ages and Petrogenesis of the Molybdenum–bearing Granites in the Jinduicheng Area of East Qinling, China: Constraints from Zircon U–Pb Ages and Hf Isotopes
Authors: Hongying LI , Xiaoxia WANG , Huishou YE , Lei YANG
Published: July 2012

The Mesozoic porphyry assemblage in the Jinduicheng area is a special molybdenum area in China, the Mo deposits, including the Jinduicheng, Balipo, Shijiawan, Huanglongpu, are distributed. The emplacement age and geochemical features of the granites in the Jinduicheng area can provide essential information for the exploration and development of the porphyry molybdenum deposit. In this study, we report LA–ICP–MS zircon U–Pb age and zircon Hf isotopic compositions of granite porphyries from the Jinduicheng area, and provide insights on the petrogensis and source characteristics of the granites. The results show that the zircon U–Pb ages of the Jinduicheng granite porphyry (143±1 Ma) and the Balipo granite (154±1 Ma), agree well with the Re–Os ages of molybdenite in the Jinduicheng molybdenum polymetallic deposit (139±3 Ma) and the Balipo molybdenum polymetallic deposit (156±2 Ma), indicating that the emplacement of granite porphyries occurred between Late Jurassic and Early Cretaceous. Zircons granite from the Jinduicheng area give the εHf(t) values mainly ranging from –10 to –16, and –20 to –24, respectively, corresponding to two–stage model ages (tDM2: mainly focused on 1.86–2.0 Ga, and 2.2–2.6 Ga, respectively) of zircons of the granite from the Jinduicheng values. The ore–forming materials are mainly derived from crust, with minor mantle substances. Zircons of the granite from the Balipo area give εHf(t) values ranging from –18 to –20, –28 to –38, and –42 to –44, respectively, corresponding to two–stage model ages (tDM2: mainly focused on 1.88–3.0 Ga, and 3.2–3.90 Ga, respectively), the εHf(t) values of the Jinduicheng porphyry more than that of the Balipo porphyry, and two–stage model ages (tDM2) less than that of the Balipo porphyry, shows that he source of the porphyries originated from ancient lower crustal materials in the Jinduicheng area, and mixed younger components, more younger components contributed for the source of the Jinduicheng porphyry.
The Grade‐Tonnage Model for China's Molybdenum Deposits
Authors: Zhong WANG , Keyan XIAO , Chuanzhong SONG
Published: July 2012

The authors have studied the statistical characteristics of China's molybdenum deposits to establish the grade‐tonnage model based on the data updated to the end of 2010. The results showed that each type of China's molybdenum deposits complied with Lasky's law approximately and the characteristics of grade‐tonnage model obey the lognormal distribution. However, there are poor correlations between grade and tonnage respectively. Ultimately, we aimed to fit the grade‐tonnage model through the known distribution function, draw the cumulative probability curves, and evaluated undiscovered mineral resources of China's molybdenum deposits by means of Monte Carlo simulation integrated in MRAS.
Geological Characteristics and Zircon U‐Pb Dating of Volcanic Rocks from the Beizhan Iron Deposit in Western Tianshan Mountains, Xinjiang, NW China
Authors: Zuoheng ZHANG , Wei HONG , Zongsheng JIANG , Shigang DUAN , Lingang XU , Fengming LI , Xincheng GUO , Zhengang ZHAO
Published: July 2012

The Beizhan large iron deposit located in the east part of the Awulale metallogenic belt in the western Tianshan Mountains is hosted in the Unit 2 of the Dahalajunshan Formation as lens, veinlets and stratoid, and both of the hanging wall and footwall are quartz‐monzonite; the dip is to the north with thick and high‐grade ore bodies downwards. Ore minerals are mainly magnetite with minor sulfides, such as pyrite, pyrrhotite, chalcopyrite and sphalerite. Skarnization is widespread around the ore bodies, and garnet, diopside, wollastonite, actinolite, epidote, uralite, tourmaline sericite and calcite are ubiquitous as gangues. Radiating outwards from the center of the ore body the deposit can be classified into skarn, calcite, serpentinite and marble zones. LA‐ICP‐MS zircon U‐Pb dating of the rhyolite and dacite from the Dahalajunshan Formation indicates that they were formed at 301.3±0.8 Ma and 303.7±0.9 Ma, respectively, which might have been related to the continental arc magmatism during the late stage of subduction in the western Tianshan Mountains. Iron formation is genetically related with volcanic eruption during this interval. The Dahalajunshan Formation and the quartz‐monzonite intrusion jointly control the distribution of ore bodies. Both ore textures and wall rock alteration indicate that the Beizhan iron deposit is probably skarn type.
Sequence Stratigraphy of the Jurassic Coal Measures in Northwestern China
Authors: Tong WANG , Longyi SHAO , Ye TIAN , Jing LU , Wenlong WANG
Published: July 2012

The sequence stratigraphy of the Jurassic coal measures of northwestern China has been studied based on data from outcrop and borehole sections. Because of the geological background and the diversity of basin types, such as isochronisms of coal seams and recognition of key sequence boundaries, it is rare to summarize and correlate sequence structure and framework. The types and recognition characteristics of the sequence boundaries of the Jurassic coal measures are revealed by comparing climatic characteristics, structural styles and the base level cycle. A total of five third‐order sequences and 15 systems tracts have been subdivided and the sequence stratigraphic framework has been reconstructed confirming that the thick coals accumulated in the late stage of transgression system tracts of sequence I (SQ I) and sequence III (SQ III). This idea is of important academic significance for instructing coal resources exploration, and enhancing geological effects of prospecting engineering. It is also of practical significance for guaranteeing construction of the large‐scale coal production base in northwestern China, accelerating the westward development of the coal industry stratagem.
Lung cancer incidence and mortality in China, 2008
Authors: Zeng Hongmei , Zheng Rongshou , Zhang Siwei , He Jie , Chen Wanqing
Published: July 2012

Background:  To provide cancer statistics to health planners, researchers, and the public, we reported the incidence and mortality data of lung cancer in 2008 in Chinese registration areas by age, sex, and geographic area.

Methods:  In 2011, 56 population‐based cancer registries reported the lung cancer incidence and mortality data of 2008 to the Chinese National Central Cancer Registry. Forty‐one registries' data met the national criteria. The crude incidence and mortality rates of lung cancer were calculated by age, gender, and area. Age‐standardized rates were calculated using the Chinese and World populations.

Results:  The crude incidence rate for lung cancer was 54.75/100 000 (73.12/100 000 for male and 36.08/100 000 for female; 57.96/100 000 in urban and 42.80/100 000 in rural). Age‐standardized rates by China population (CASR) and World population (WASR) for incidence were 24.98/100 000 and 34.07/100 000, respectively. The crude mortality rate for lung cancer was 46.07/100 000 (62.47/100 000 for male and 29.39/100 000 for female; 48.76/100 000 in urban and 36.03/100 000 in rural). The CASR and WASR for mortality were 20.09/100 000 and 27.68/100 000, respectively. Both for incidence and mortality, the rates for lung cancer were higher in males than in females, and in urban areas than in rural areas. The overall age‐specific incidence and mortality rates showed that both rates were relatively low up to 35 years of age, but dramatically increased from such age, reaching a peak with subjects of 80–84 years old.

Conclusion:  The burden of lung cancer remains high in China, especially for males in urban areas. Effective intervention, such as smoking control, should be enhanced in the future.
Discordance of epidermal growth factor receptor mutations between primary tumors and corresponding mediastinal nodal metastases in patients operated on for stage N2 non‐small cell lung cancer
Authors: Fang Qin , Yang Hua , Ou Wei , Ye Xiong , Zhang Bin‐bin , Sun Hai‐bo , Zhang Liang , Cao Xun , Wang Si‐yu
Published: July 2012

The discordance of epidermal growth factor receptor (EGFR) mutations between primary lung tumors and the corresponding mediastinal nodal metastases has not yet been well elucidated. We investigate the discordance of EGFR mutations between primary tumors and the corresponding mediastinal nodal metastases, and the discordance of EGFR mutations between different mediastinal lymph node stations in patients operated on for stage N2 non‐small cell lung cancer (NSCLC). Two hundred and nineteen surgically resected primary tumors and their 553 corresponding mediastinal nodal metastases were evaluated for EGFR mutations in exon 19 or 21 by TaqMan real‐time polymerase chain reaction (PCR) analysis. EGFR mutation was detected in 26.0% (57/219) of the primary tumors and 14.8% (82/553) of the corresponding mediastinal nodal metastases. In 162 cases with EGFR wild‐type in primary tumors, none of their 402 corresponding mediastinal nodal metastases had EGFR mutation. In 57 cases with EGFR mutations in primary tumors, EGFR mutations were detected in 82 of all 151 metastatic lymph node stations (54.3%), 34 cases had EGFR mutations in mediastinal nodal metastases, and 23 cases had lost the mutations in mediastinal nodal metastases. Among the 219 cases, 196 cases had at least two metastatic lymph node stations, 9.0% (18/196) of cases with multiple metastatic nodal stations exhibited discordance in EGFR mutations between different lymph node stations. The possibility of discordance in EGFR mutations between primary tumors and corresponding mediastinal nodal metastases, and between different mediastinal lymph node stations should be considered whenever these mutations are used for the selection of patients for EGFR‐directed tyrosine kinase inhibitor therapy.
A Single Promoter Inversion Switches
Photorhabdus
Between Pathogenic and Mutualistic States
Authors: Somvanshi Vishal S. , Sloup Rudolph E. , Crawford Jason M. , Martin Alexander R. , Heidt Anthony J. , Kim Kwi-suk , Clardy Jon , Ciche Todd A.
Published: July 2012

Twin Tales of Two Toxins

The luminescent bacterium,
Photorhabdus luminescens
, is carried in the gut of an insect-parasitic nematode as a stealth weapon. By using an allele swapping technique,

Somvanshi
et al.

(p.
88
) investigated the promoter-switching mechanism that flips the bacterium from the almost dormant M forms, which stick to the adult nematode's posterior gut, into the motile, luminous P forms, which are armed with the toxic virulence factors needed to overcome the insect prey of the nematode. Similar switches may operate in bacteria that flip between harmless commensals and lethal pathogens. The bio-control agent
Bacillus thuringiensis
also kills insects by means of a crystal toxin, which allows the bacteria to penetrate the host gut and access nutrients. Release of nutrients also allows bacterial cheats that do not make toxin, to grow and outcompete the toxin-producing colonizers. In field experiments,

Raymond
et al.

(p.
85
) found that, consequently, the bacterial population becomes less virulent. Because these type of virulence factors are secreted from the cell and are widespread in pathogens, such social interactions may affect the fitness and constrain the virulence of many toxin-producing bacteria.
The Dynamics of Cooperative Bacterial Virulence in the Field
Authors: Raymond Ben , West Stuart A. , Griffin Ashleigh S. , Bonsall Michael B.
Published: July 2012

Twin Tales of Two Toxins

The luminescent bacterium,
Photorhabdus luminescens
, is carried in the gut of an insect-parasitic nematode as a stealth weapon. By using an allele swapping technique,

Somvanshi
et al.

(p.
88
) investigated the promoter-switching mechanism that flips the bacterium from the almost dormant M forms, which stick to the adult nematode's posterior gut, into the motile, luminous P forms, which are armed with the toxic virulence factors needed to overcome the insect prey of the nematode. Similar switches may operate in bacteria that flip between harmless commensals and lethal pathogens. The bio-control agent
Bacillus thuringiensis
also kills insects by means of a crystal toxin, which allows the bacteria to penetrate the host gut and access nutrients. Release of nutrients also allows bacterial cheats that do not make toxin, to grow and outcompete the toxin-producing colonizers. In field experiments,

Raymond
et al.

(p.
85
) found that, consequently, the bacterial population becomes less virulent. Because these type of virulence factors are secreted from the cell and are widespread in pathogens, such social interactions may affect the fitness and constrain the virulence of many toxin-producing bacteria.
Fraud-Detection Tool Could Shake Up Psychology
Authors: Enserink Martin
Published: July 2012

An unpublished statistical method to detect data fraud has led psychologist Dirk Smeesters of Erasmus University Rotterdam to resign and his school to request the retraction of two of his papers.
Researchers Hail New Restoration Program Funds
Authors: Malakoff David
Published: July 2012

Researchers must figure out how best to use the fines from the 2010
Deepwater Horizon
oil spill in the Gulf of Mexico to repair wetlands and marine ecosystems battered by more than a century of abuse.
Supreme Court Cites Science in Limiting Punishments for Juveniles
Authors: Miller Greg
Published: July 2012

Laurence Steinberg, a child psychologist at Temple University, was the chief scientific consultant on amicus curiae briefs submitted to the Supreme Court in the course of last week's ruling banning life imprisonment for juveniles.
Turning Over a New Leaf in China's Forests
Authors: Hvistendahl Mara
Published: July 2012

A massive redistribution of land-use rights aims to boost afforestation and sustainable forestry.
LOL and a Touch of Science, Too
Authors: Pennisi Elizabeth
Published: July 2012

Cartoonist Jim Toomey finds ways to sneak marine conservation and science into his popular comic strip.
Investigating the Ills Of Long-Dead Celebrities
Authors: Kean Sam
Published: July 2012

Vladimir Lenin's death was examined recently by a medical group that tries to decide how historical figures died; some historians disapprove of the practice.
Acupuncture Combined with Curcumin Disrupts Platelet-Derived Growth Factor β Receptor/Extracellular Signal-Regulated Kinase Signalling and Stimulates Extracellular Matrix Degradation in Carbon Tetrachloride-Induced Hepatic Fibrosis in Rats
Authors: Zhang Xiao-Ping , Zhang Feng , Zhang Zi-Li , Ma Jin , Kong De-Song , Ni Guang-Xia , Wang Ai-Yun , Chen Wen-Xing , Lu Yin , Zheng Shi-Zhong
Published: July 2012

Background

Acupuncture treatment has been increasingly used to treat chronic liver diseases. We previously reported that acupuncture combined with curcumin, a natural antifibrotic compound, could remarkably attenuate liver fibrosis in chemically intoxicated rats, but the underlying molecular mechanisms are poorly understood. The present study was aimed at investigating the effects of acupuncture combined with curcumin on platelet-derived growth factor (PDGF) signalling and extracellular matrix (ECM) regulation in the fibrotic liver.

Methods

A total of 60 Sprague-Dawley male rats were randomly divided into control, model, sham, acupuncture, curcumin and combination treatment groups. During the establishment of fibrosis using carbon tetrachloride (CCl4), acupuncture at LR3, LR14, BL18 and ST36 and/or curcumin treatment by mouth were performed simultaneously. After treatment, serum PDGF levels were measured. Protein and mRNA expression of key effectors in PDGF pathway and fibrinolysis in the liver was determined.

Results

Acupuncture combined with curcumin potently reduced serum PDGF levels and selectively disrupted the PDGF-βR/extracellular signal-regulated kinase (ERK) cascade. Combination treatment also significantly repressed expression of connective tissue growth factor and upregulated expression of matrix metalloproteinase-9, promoting fibrinolysis in the fibrotic liver.

Conclusions

The beneficial effects of acupuncture and its combination with curcumin could be attributed to the disruption of PDGF-βR/ERK pathway and stimulated ECM degradation in the fibrotic liver. Acupuncture treatment significantly enhanced curcumin effects at the molecular level. These findings may provide molecular insights into the potential of acupuncture combined with curcumin for prevention of hepatic fibrosis.
Effect of exercise-induced dehydration on endurance performance: evaluating the impact of exercise protocols on outcomes using a meta-analytic procedure
Authors: Goulet Eric D B
Published: July 2012

Objective

It is purported that exercise-induced dehydration (EID), especially if ≥ 2% bodyweight, impairs endurance performance (EP). Field research shows that athletes can achieve outstanding EP while dehydrated > 2% bodyweight. Using the meta-analytic procedure, this study compared the findings of laboratory-based studies that examined the impact of EID upon EP using either ecologically valid (EV) (time-trial exercise) or non-ecologically valid (NEV) (clamped-intensity exercise) exercise protocols.

Methods

EP outcomes were put on the same scale and represent % changes in power output between euhydrated and dehydrated exercise tests. Random-effects model meta-regressions and weighted mean effect summaries, mixed-effects model analogue to the ANOVAs and magnitude-based effect statistics were used to delineate treatment effects.

Main results

Fifteen research articles were included, producing 28 effect estimates, representing 122 subjects. Compared with euhydration, EID increased (0.09±2.60%, (p=0.9)) EP under time-trial exercise conditions, whereas it reduced it (1.91±1.53%, (p<0.05)) with NEV exercise protocols. Only with NEV exercise protocols did EID ≥ 2% body weight impair EP (p=0.03).

Conclusions

Evidence indicates that (1) EID ≤ 4% bodyweight is very unlikely to impair EP under real-world exercise conditions (time-trial type exercise) and; (2) under situations of fixed-exercise intensity, which may have some relevance for military and occupational settings, EID ≥ 2% bodyweight is associated with a reduction in endurance capacity. The 2% bodyweight loss rule has been established from findings of studies using NEV exercise protocols and does not apply to out-of-doors exercise conditions. Athletes are therefore encouraged to drink according to thirst during exercise.
Functional outcomes and quality of life of young adults who survive out-of-hospital cardiac arrest
Authors: Deasy Conor , Bray Janet , Smith Karen , Harriss Linton , Bernard Stephen , Cameron Peter ,   on behalf of the VACAR Steering Committee
Published: July 2012

Background

Evaluating the quality of life of young adult survivors of out-of-hospital cardiac arrest (OHCA) is important as they are likely to have a longer life expectancy than older patients. The aim of this study was to assess their functional and quality of life outcomes.

Methodology

The Victorian Ambulance Cardiac Arrest Registry records were used to identify survivors of OHCA that occurred between 2003 and 2008 in the 18-39 year-old age group. Survivors were administered a telephone questionnaire using Short Form (SF-12), EQ-5D and Glasgow Outcome Scale-Extended. Cerebral Performance Category (CPC) ascertained at hospital discharge from the medical record was recorded for the uncontactable survivors.

Results

Of the 106 young adult survivors, five died in the intervening years and 45 were not contactable or refused. CPC scores were obtained for 37 (74%) of those who did not take part in telephone follow-up, and 7 (19%) of these had a CPC ≥3 indicating severe cerebral disability. The median follow-up time was 5 years (range 2.7- 8.6 years) for the 56 (53%) patients included. Of these, 84% were living at home independently, 68% had returned to work, and only 11% reported marked or severe disability. The majority of patients had no problems with mobility (75%), personal care (75%), usual activities (66%) or pain/discomfort (71%). However, 61% of respondents reported either moderate (48%) or severe (13%) anxiety.

Conclusions

The majority of survivors have good functional and quality of life outcomes. Telephone follow-up is feasible in the young adult survivors of cardiac arrest; loss to follow-up is common.
The face arm speech test: does it encourage rapid recognition of important stroke warning symptoms?
Authors: Robinson Thompson G , Reid Ann , Haunton Victoria Joanna , Wilson Andrew , Naylor A Ross
Published: July 2012

Objectives

To assess public knowledge of stroke and transient ischaemic attack symptoms, and awareness of the content of a recent national health campaign.

Design

Interviewer-administered questionnaire.

Setting

Leicester, UK.

Participants

1300 members of a mixed urban/rural, multiethnic population that was sampled in public areas, places of work and schools.

Main outcome measures

Knowledge of the terms ‘stroke’, ‘stroke risk factors’ and the ‘FAST campaign’. Awareness of stroke symptoms, and ability to distinguish from non-stroke symptoms.

Results

70% of the public surveyed were aware of the FAST campaign, with highest penetration in the female, older and white population. Overall, high levels of awareness of FAST symptoms (facial weakness 89%, arm weakness 83%, speech problems 91%) as warning signs of stroke were observed, though significantly lower levels were reported in the black and minority ethnic population. However, poor recognition of other important signs, including leg weakness (57%) and visual loss (44%) were seen, and significantly more men were likely to report non-specific symptoms as being associated with stroke.

Conclusions

The survey has confirmed the effectiveness of the recent FAST campaign in raising public awareness of stroke and stroke warning signs, though poorest penetration was seen in the black and minority ethnic population. However, important stroke symptoms, including leg weakness and visual loss, were poorly recognised. This may lead to delays in presentation, specialist assessment and secondary prevention, and such stroke warning signs should be included in future public health campaigns.
O-011 Rate of ischemic events detected by MRI following balloon remodeling for the treatment of aneurysms in the ruptured and unruptured setting
Authors: Spiotta A , Wu O , Bhalla T , Hui F , Moskowitz S
Published: July 2012

Introduction

The introduction of balloon remodeling has revolutionized the approach to coiling of wide-necked aneurysms. We compared rates of ischemic events as detected by postprocedure MRI following balloon remodeling for the treatment of aneurysms in the unruptured vs ruptured setting.

Methods

A retrospective review was undertaken of 159 patients undergoing balloon remodeling for intracranial aneurysm coil embolization at a single institution (81 unruptured, 78 ruptured). Patients underwent postprocedural MRI. The rates of ischemic events were compared to a control group consisting of an additional 66 unruptured aneurysms treated by unassisted coiling.

Results

Patients in the ruptured and unruptured groups were closely matched for age and risk factors for stroke including incidence of hypertension, diabetes and smoking. Patients with unruptured aneurysms were, however, more likely to have a prior history of an ischemic stroke (18.5%) than those in the ruptured group (1.3%). Patients in both groups underwent full intraprocedural anticoagulation with heparin and none received pharmacologic protection during balloon inflation. The two groups did differ in the distribution of aneurysm locations treated. Among the patients with ruptured aneurysms, clinical Hunt and Hess (HH) grade was as follows: HH1=12.8%, HH2=39.7%, HH3=25.6%, HH4=15.4%, HH5=6.4%. DWI abnormalities were detected on postprocedural MRI in 24.7% (20/81) of patients with unruptured aneurysms treated with balloon assistance. Similarly, unruptured aneurysms treated with unassisted coiling were found to have a 22.7% (15/61) rate of DWI lesions on MRI. By comparison, patients with ruptured aneurysms treated with balloon remodeling had a significantly higher rate of DWI lesions on MRI at 88.9%.

Conclusions

Balloon remodeling for aneurysm embolization in the setting of subarachnoid hemorrhage is associated with a significantly higher rate of ischemic events on MRI than those treated in the elective setting.

Competing interests

A Spiotta: Integra, Hemedex. O Wu: None. T Bhalla: None. F Hui: None. S Moskowitz: None.
O-022 Pre-radiosurgical embolization of arteriovenous malformations: a single institution review
Authors: Santarelli J , Steinberg G , Do H , Dodd R , McTaggart R , Marcellus M , Adler J , Chang S , Marks M
Published: July 2012

Background

Multimodality therapy for brain AVMs utilizing embolization followed by radiosurgery is controversial. We present the results of the largest case series to date of patients who have undergone AVM embolization followed by radiosurgery, in order to evaluate cure rates and complications using this modality of therapy.

Methods

A retrospective review of our institutional AVM database was performed, identifying 95 patients over an 11-year period (1997–2008) who underwent dual modality treatment. Patients previously treated with either surgery or radiosurgery prior to embolization were excluded, as were patients who underwent scheduled surgical treatment following embolization. Pre- and post-treatment AVM volumes were assessed using angiography. Post-radiosurgical treatment volumes were assessed using angiography (41%) or MRI (59%). Only those patients with >3-year post-radiosurgical follow-up were included in this analysis.

Results

Mean AVM volume pre-embolization was 26 ml and declined to 15 ml post-embolization. Mean modified Pollock-Flickinger score pre-embolization was 3.4 and post-embolization was 2.2. 59 patients had adequate follow-up for inclusion in our study. 34 patients (58%) achieved AVM obliteration within 3 years of treatment, without neurological decline. 23 patients had residual at 3 years. Two patients died in the follow-up period. Excellent outcome was accomplished in 100% of patients with modified Pollock-Flickinger score 2.

Conclusion

Pre-radiosurgical embolization of brain AVMs in our series appears to improve the rate of excellent outcome (obliteration following radiosurgery, without change in modified Rankin score).

Competing interests

None.
O-024 Cost comparison of endovascular treatment of anterior circulation aneurysms with the pipeline embolization device vs stent-assisted coiling
Authors: Colby G , Lin L , Paul A , Huang J , Tamargo R , Coon A
Published: July 2012

Introduction

The Pipeline embolization device (PED) is an efficacious endovascular option for anterior circulation aneurysms with broad-based, fusiform involvement of the parent vessel. Endovascular treatment of such aneurysms has classically involved coil embolization with adjunctive use of a stent. However, stent-coiling can incur significant equipment and implant costs, particularly if the aneurysm is large and numerous coils are used. The authors hypothesized that PED embolization is a cost effective alternative to stent-assisted coiling.

Methods

A prospective single-center aneurysm database was retrospectively reviewed to identify consecutive patients with anterior circulation aneurysms who underwent aneurysm treatment with the PED or by single-staged stent-assisted coiling. Thirty consecutive patients were selected in each group, for a total of 60 patients. The hospital cost of equipment and implants were analyzed and compared for each group.

Results

Hospital equipment and implant costs were analyzed for 30 consecutive aneurysm treatments with the PED (mean aneurysm size 9.8 mm) vs 30 consecutive cases of stent-assisted coiling (mean aneurysm size 7.3 mm). The total combined cost of proximal access/guide catheters, microcatheters, and microwires were equivalent between the two groups (PED $3057±$102 vs stent-coiling $3199±$126, p=0.3927). The cost of implants, however, was significantly lower in the PED group ($13 175±$726 vs $19 069±$2015, p=0.0126), despite this group having a larger mean aneurysm size. Furthermore, the total cost (equipment, implants, and adjunctive devices) was significantly lower for the PED group vs the stent-coiling group ($16 445±$735 vs $22 145±$2022, p=0.0181), representing a 25.7% cost reduction. This represents a 27.1% reduction in the cost per millimeter of aneurysm treated in the PED group ($2261±$299) vs the stent-coiling group ($3102±$193, p=0.0202).

Conclusion

Treatment of anterior circulation aneurysms by flow diversion with the PED is a cost effective alternative to traditional stent-assisted coiling.

Competing interests

G Colby: None. L Lin: None. A Paul: None. J Huang: None. R Tamargo: None. A Coon: Covidien.
O-026 Coil costs and aneurysm size: 2 years of data
Authors: Hui F , Wang C , Spiotta A
Published: July 2012

The material costs associated with endovascular treatment of cerebral aneurysms include access catheters, equipment utilization, personnel costs, and embolization materials. The costs of coiling aneurysms in general has been discussed, however, detailed analysis of aneurysm embolization costs as a function of aneurysm size is lacking.

Methods

We reviewed the material logs and aneurysm descriptions for a total of 221 aneurysms spanning January 30, 2009 to June 2, 2011, excluding aneurysms that had incomplete chart data, coil costs, ethyl vinyl alcohol embolization and spurious size measurements. We tabulated the total embolisate costs at prices available to the institution as of September 2011, and analyzed the costs of coiling as a function of calculated volume, the variance of costs as a function of volume, and performed a regression analysis in order to model projected costs for a given aneurysm size.

Findings

Curves modeled are presented in graph form. As expected, there is a strong correlation of aneurysm size by estimated volume to cost with a p<0.000001. A plot of the residuals is also given, showing from projected cost for a given volume. Given the apparent increase in variance as a function of volume, a log-log transform was applied to the data with regression analysis performed. For every doubling in aneurysm volume, there is a projected 36% increase in cost.

Conclusion

Neurointerventions are reimbursed at a flat per-aneurysm basis, irrespective of embolysate costs. The variance in coiling costs shown, indicates that aneurysm embolization costs vary according to volume in a relatively predictable fashion. This understanding may be useful in modifying future coding. Additionally, there is a degree of variance in costs for a given estimated volume, which may indicate material choice and strategy may affect embolization as well. Further analysis of this observation may be helpful in optimizing coil selection for therapies.

Competing interests

F Hui: None. C Wang: T32 Training Grant NIH A Spiotta: None.

Abstract O-026 Figure 1Abstract O-026 Figure 2
O-003 Temporal distribution of stroke volumes and clinical-diffusion mismatch in patients with proximal arterial occlusions: Abstract O-003 Figure 1
Authors: Nogueira R , Liebeskind D , Souza L , Hao Q , Furie K , Yoo A , Saver J , Lev M , Gupta R
Published: July 2012

Background and Purpose

Previous studies have demonstrated that the benefit of reperfusion therapy declines over time. The Clinical-Diffusion Mismatch (CDM) model has been suggested as surrogate for salvable tissue in acute ischemic stroke (AIS) patients. We sought to describe the temporal behavior profile of infarct volumes and CDM in patients suffering AIS due to proximal arterial occlusion (PAO).

Methods

We performed a retrospective analysis of consecutive AIS patients admitted to two large academic institutions fulfilling the following criteria: (1) Baseline NIHSS ≥8; (2) PAO defined as MCA-M1, intracranial ICA, or tandem cervical + ICA/MCA-M1 occlusion on admission CTA/MRA; and (3) MRI-DWI performed ≤8 h from time of stroke onset/last seen well (TSO). CDM was defined as baseline NIHSS ≥8 and DWI volume ≤25cc (as proposed by Davaloset al). Linear regression analysis was performed to define the changes on DWI lesion volume on presentation over time. The observed TSO to MRI were broken down into quartiles to look for any differences in the distribution of the baseline variables over time.

Results

A total of 132 consecutive patients were identified (mean age, 66±16.8 years; 57% females; mean baseline NIHSS 17.5±5.3; occlusion site: MCA-M1, 64%; intracranial-ICA, 29%; tandem, 5%, mean TSO to DWI, 269.5±105.48 min). The mean DWI stroke volume on presentation was 46.7±54.8 cc (range, 0.19–436.1) and 63 (46.7%) patients had CDM. There was no significant changes in age, gender, baseline NIHSS, or occlusion site among the different time quartiles. Median infarct volume (cc) increased (quartile #1=8.5; #2=30.1; #3=38.5; #4=29.4) and the chances of having a CDM decreased (p<0.0001) across the different time quartiles. However, there was an overall poor correlation between DWI lesion volume on presentation and TSO to MRI (R2=0.031, Abstract O-003 figure 1) and a significant proportion of the patients still had a CDM at later time epochs (#1=91.1% (20/22); #2=47.8% (11/23); #3=34.4% (21/61); #4=42.3% (11/26)).

Abstract O-003 Figure 1

Relationship between Baseline DWI Volume (cc) and Time (minutes). Line is best fitted linear regression model.

Conclusions

Although infarct volume increases and the amount of penumbral tissue decreases over time, many patients with PAO will still have salvable penumbra at the later time epochs. This reflects individual differences in anatomic and physiological characteristics including the strength of collateral flow and highlights that selected patients may benefit from reperfusion therapy even at the later time windows.

Competing interests

R Nogueira: Concentric Medical; ev3 Neurovascular; Coaxia. D Liebeskind: Concentric Medical; Neurovascular; Coaxia. L Souza: None. Q Hao: None. K Furie: NIH. A Yoo: Penumbra. J Saver: ev3 Neurovascular; NIH. M Lev: Coaxia. R Gupta: Concentric Medical; Codman; Coaxia.
O-034 Mobile phone-based remote patient information system for management and therapy in acute stroke patients: The i-stroke system
Authors: Takao H , Murayama Y , Ishibashi T , Yuki I , Karagiozov K , Abe T
Published: July 2012

Purpose

Physicians must quickly evaluate stroke patients to determine if they're eligible for time-sensitive treatment and prompt diagnosis and treatment of cerebral stroke patients are essential to their recovery. With the increasing demand for such management of stroke, telemedicine's role of coordinating timely the efforts of a stroke team became important. We developed “i-Stroke” system in Japan to access rapidly diagnostic images and clinical information.

Methods

This system was made on the basis of transferring patient data, images and movie (Angio and/or Operating room) between hospital systems and participating medical staffs in and out of the hospital, through their standard, currently utilized mobile devices (iPhone, Andorid). The system is able to transfer clinical data, CT, MR, echo, angiographic and intraoperative images and expert opinion in real time. It provides also tools for management of diagnostic and treatment information, even such as simple calculation of appropriate drug dosage, modified Rankin Scale and perfusion diffusion mismatch.

Results

A pilot application of the system in our hospital showed adequate performance and proper information transfer, resulting in proper diagnosis and management of all stroke patients. The i-Stroke system was introduced at our institution in August 2010, for communication with our affiliated hospitals and over 100 “i-stroke” call were initiated until the end of February 2012.

Conclusions

The “i-stroke” system proved to be efficient for appropriate standard management in most time demanding treatments of stroke. It is our belief that adoption of this software with handheld terminals will make it possible to help and save the lives of more patients who suffer cerebral stroke.

Competing interests

H Takao: FUJIFILM Co. Ltd. Y Murayama: FUJIFILM Co. Ltd. T Ishibashi: None. I Yuki: None. K Karagiozov: None. T Abe: None.

Abstract O-034 Figure 1Abstract O-034 Figure 2
P-013 Treatment of ruptured basilar artery pontine perforator aneurysm with neuroform stent monotherapy: a report of two cases: Abstract P-013 Figure 1
Authors: Turner R , Turk A , Chaudry I , Nyberg E , Spiotta A , Fiorella D
Published: July 2012

Introduction

Subarachnoid hemorrhages (SAH) are most commonly caused by trauma, ruptured cerebral aneurysm, and benign perimesencephalic hemorrhage. We report two cases of basal cistern SAH that were initially angiographically negative, however follow-up delayed angiography demonstrated an 2 mm aneurysm arising from a sub-millimeter pontine artery perforator, distinct from the basilar artery. In each case, treatment was placement of two overlapping Neuroform stents in the basilar artery.

Case presentation

A 46-year-old man presents with SAH centered in the pre-pontine cistern. Initial angiography was negative and the patient clinically did well, however subsequent angiography at 6 weeks demonstrated a 2 mm aneurysm arising from a pontine artery perforator. A 61-year-old female presented to with a SAH. Similarly, the initial angiography was negative, however subsequent angiography demonstrated a 2 mm aneurysm arising from a pontine artery perforator.

Discussion

In both cases, the patients' aneurysm originated from a small pontine artery perforator and the basilar artery was clearly distinct. In the first case (in 2006) had treatment options of observation, surgical exploration, or stenting of the basilar artery. The perforator was too small to catheterize with a microcatheter. Placement of overlapping Neuroform stents did not change aneurysm opacification initially, however at follow-up angiography, the aneurysm no longer opacified despite the artery being patent (Abstract P-013 figure 1A). The second case occurred in 2011, and therefore flow diversion with Pipeline was possible, however we chose to place overlapping Neuroform stents, which resulted aneurysm occlusion while maintaining vessel potency (Abstract P-013 figure 1B).

Abstract P-013 Figure 1

Conclusion

Aneurysms arising from a basilar artery perforator are extremely rare, however successful treatment is possible. Although we treated with conventional microstents, newer flow diversion devices also offer a reasonable treatment option.

Competing interests

R Turner: Microvention, Codman. ev3, Penumbra, Mindframe. A Turk: None. I Chaudry: None. E Nyberg: None. A Spiotta: None. D Fiorella: None.