bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Distal Embolization From tPA (Tissue-Type Plasminogen Activator) Administration Prior to Endovascular Stroke Treatment
Authors: Flint Alexander C. , Avins Andrew L. , Eaton Abigail , Uong Stephen , Cullen Sean P. , Hsu Daniel P. , Edwards Nancy J. , Reddy Prasad A. , Klingman Jeffrey G. , Rao Vivek A. , Chan Sheila L. , Hartman Jonathan , Zrelak Patricia A. , Nguyen-Huynh Mai N. 
Published: August 2020

Background and Purpose:
In large artery occlusion stroke, both intravenous (IV) tPA (tissue-type plasminogen activator) and endovascular stroke treatment (EST) are standard-of-care. It is unknown how often tPA causes distal embolization, in which a procedurally accessible large artery occlusion is converted to a more distal and potentially inaccessible occlusion.

Methods:
We analyzed data from a decentralized stroke telemedicine program in an integrated healthcare delivery system covering 21 hospitals, with 2 high-volume EST centers. We captured all cases sent for EST and examined the relationship between IV tPA administration and the rate of distal embolization, the rate of target recanalization (modified Treatment in Cerebral Infarction scale 2b/3), clinical improvement before EST, and short-term and long-term clinical outcomes.

Results:

Distal embolization before EST was quite common (63/314 [20.1%]) and occurred more often after IV tPA before EST (57/229 [24.9%]) than among those not receiving IV tPA (6/85 [7.1%];
P
<0.001). Distal embolization was associated with an inability to attempt EST: after distal embolization, 26/63 (41.3%) could not have attempted EST because of the new clot location, while in cases without distal embolization, only 8/249 (3.2%) were unable to have attempted EST (
P
<0.001). Among patients who received IV tPA, 13/242 (5.4%) had sufficient symptom improvement that a catheter angiogram was not performed; 6/342 (2.5%) had improvement to within 2 points of their baseline NIHSS. At catheter angiogram, 2/229 (0.9%) of patients who had received tPA had complete recanalization without distal embolization. Both IV tPA and EST recanalization were associated with improved long-term outcome.

Conclusions:
IV tPA administration before EST for large artery occlusion is associated with distal embolization, which in turn may reduce the chance that EST can be attempted and recanalization achieved. At the same time, some IV tPA-treated patients show symptomatic improvement and complete recanalization. Because IV tPA is associated with both distal embolization and improved long-term clinical outcome, there is a need for prospective clinical trials testing the net benefit or harm of IV tPA before EST.
Plaque Distribution Correlates With Morphology of Lenticulostriate Arteries in Single Subcortical Infarctions
Authors: Jiang Shuai , Yan Yuying , Yang Tang , Zhu Qiange , Wang Changyi , Bai Xueling , Hao Zilong , Zhang Shihong , Yang Qi , Fan Zhaoyang , Sun Jiayu , Wu Bo 
Published: August 2020

Background and Purpose:
We aimed to use novel whole-brain vessel-wall magnetic resonance imaging (WB-VWI) to investigate the association between plaque distribution of middle cerebral artery (MCA) and morphological changes of the lenticulostriate arteries (LSAs) in single subcortical infarctions.

Methods:
Forty single subcortical infarction patients with no relevant MCA disease on magnetic resonance angiography were prospectively enrolled. Plaque location in the MCA was dichotomized as proximal (located adjacent to the LSA origin) or distal (located distal to the LSA origin) on whole-brain vessel-wall magnetic resonance imaging. The MCAs with proximal plaques were divided into the symptomatic and asymptomatic side, and asymptomatic side MCAs without proximal plaques were the control group. The morphological characteristics of the LSAs and features of proximal plaques were analyzed.

Results:

A total of 71 MCAs in 40 patients were analyzed (31 on the symptomatic side, 22 on the asymptomatic side, and 18 in the control group). Superior-wall plaques of MCAs were observed more frequently on the symptomatic side than the asymptomatic side (45.2% versus 9.1%,
P
=0.005). The wall area index, plaque burden, and remodeling index did not differ significantly between the symptomatic and asymptomatic side. The number of LSA branches was smaller (
P
=0.011) in the symptomatic side (5.48±1.88) compared with the control group (6.83±1.92). The symptomatic side exhibited shorter average length of the LSAs (23.23±3.44 versus 25.75±3.76 mm,
P
=0.025) and shorter average distance of the LSAs (16.47±3.11 versus 21.53±4.76 mm,
P
<0.001) compared with the asymptomatic side.

Conclusions:
Superiorly distributed MCA plaques at the LSA origin are closely associated with morphological changes of the LSA in symptomatic MCAs, suggesting that the distribution, rather than the inherent features of plaques, determines the occurrence of single subcortical infarctions. Our findings provide insight into the etiologic mechanism of branch atheromatous disease in single subcortical infarctions.
Systematic Differences in Bucket Sea Surface Temperatures Caused by Misclassification of Engine Room Intake Measurements
Authors: Chan Duo , Huybers Peter 
Published: August 2020

AbstractDifferences in sea surface temperature (SST) biases among groups of bucket measurements in the International Comprehensive Ocean–Atmosphere Dataset, version 3.0 (ICOADS3.0), were recently identified that introduce offsets of as much as 1°C and have first-order implications for regional temperature trends. In this study, the origin of these groupwise offsets is explored through covariation between offsets and diurnal cycle amplitudes. Examination of an extended bucket model leads to expectations for offsets and amplitudes to covary in either sign, whereas misclassified engine room intake (ERI) temperatures invariably lead to negative covariance on account of ERI measurements being warmer and having a smaller diurnal amplitude. An analysis of ICOADS3.0 SST measurements that are inferred to come from buckets indicates that offsets after the 1930s primarily result from the misclassification of ERI measurements in points of five lines of evidence. 1) Prior to when ERI measurements become available in the 1930s, offset–amplitude covariance is weak and generally positive, whereas covariance is stronger and generally negative subsequently. 2) The introduction of ERI measurements in the 1930s is accompanied by a wider range of offsets and diurnal amplitudes across groups, with 3) approximately 20% of estimated diurnal amplitudes being significantly smaller than buoy and drifter observations. 4) Regressions of offsets versus amplitudes intersect independently determined end-member values of ERI measurements. 5) Offset-amplitude slopes become less negative across all regions and seasons between 1960 and 1980, when ERI temperatures were independently determined to become less warmly biased. These results highlight the importance of accurately determining measurement procedures for bias corrections and reducing uncertainty in historical SST estimates.
Preinjury Antiplatelet Use Does Not Increase the Risk of Progression of Small Intracranial Hemorrhage
Authors: Billings Joshua D. , Khan Abid D. , McVicker John H. , Schroeppel Thomas J. 
Published: August 2020

Background The modified brain injury guidelines (mBIG) provide an algorithm for surgeons to manage some mild traumatic brain injury (TBI) with intracranial hemorrhage (ICH) without neurosurgical consultation or repeat imaging. Currently, antiplatelet use among patients with any ICH classifies a patient at the highest level, mBIG 3. This study assesses the risk of clinical progression among patients taking antiplatelet medications with mild TBI with ICH. Methods A retrospective analysis of patients with traumatic ICH over a 5-year period was conducted. Demographics, injury severity, and outcome data were collected for each patient. Patients taking antiplatelet agents were reclassified as if they were not taking these medications. Patients who would have met criteria for a lower classification (mBIG 1 or 2) without antiplatelet agents were designated mBIG 3 Antiplatelet and compared with all other mBIG 1 and 2 patients. Results 736 patients met the inclusion criteria. 158 patients were taking antiplatelet medications and 53 were reclassified as mBIG 3 Antiplatelet. When comparing mBIG 3 Antiplatelet to the 226 patients originally classified as mBIG 1 and 2, mBIG 3 Antiplatelet patients were more likely to undergo repeat head computed tomography (98.1% vs 76.6%; P < .001) and neurosurgical consultation (94.2% vs 76.5%; P < .001) but had no significant differences in outcomes. No mBIG 3 Antiplatelet patients had a worsening examination or needed operative intervention. Discussion This data suggests that antiplatelet medication use should not automatically classify a patient as mBIG 3. Adoption of this strategy would better utilize resources and avoid unnecessary costs without sacrificing care.
Effect of cerebral microhemorrhages on neurocognitive functions in patients with end-stage renal disease
Authors: Atay Musa , Alkan Alpay , Toprak Huseyin , Halac Gulistan , Erkoc Reha 
Published: August 2020

Background Death is the most serious complication of intracerebral hemorrhage. Microbleeding can be a precursor of intracerebral hemorrhage. Susceptibility weighted imaging (SWI) should be included in imaging protocols for some specific groups such diabetic hemodialysis patients in terms of prediction of macrohemorrhages. Purpose To investigate intracerebral microbleeding in hemodialysis patients and the correlation between microbleeding and neurocognitive impairment. Material and Methods Forty-nine hemodialysis cases were involved in the study. Locations of microbleeding, correlation between microbleeding and hypertension, diabetes mellitus (DM), age, and duration of dialysis were analyzed. Standardized mini-mental test was performed. The tested cases were divided into two groups: intracerebral microbleeding (group 1, n = 26) and without intracerebral microbleeding (group 2, n = 17). Results Incidence of microbleeding and macrohemorrhage was noted as 59% and 14%, respectively, in all cases. All macrohemorrhagic cases also have microbleeding. In group 1, neurocognitive impairment was detected in 10 (38.4%) cases: six and four cases with moderate and mild impairment, respectively. In group 2, neurocognitive impairment was detected in 2 (11.7%) cases, both with mild impairment. A significant positive correlation was detected between microbleeding and neurocognitive impairment ( P = 0.031). Although there was no correlation between attention disorder and microbleeding, a positive correlation was detected between close memory impairment and microbleeding ( P = 0.027). A positive correlation was detected between DM and microbleeding ( P = 0.027). Conclusion In hemodialysis patients, microbleeding can be a cause of neurocognitive impairment which will be important for guide to treatment protocols. SWI should be included in the imaging protocol of diabetic hemodialysis patients with neurocognitive deterioration.
Texture analysis of dual-phase contrast-enhanced CT in the diagnosis of cervical lymph node metastasis in patients with papillary thyroid cancer
Authors: Su Guo-Yi , Xu Xiao-Quan , Zhou Yan , Zhang Hao , Si Yan , Shen Mei-Ping , Wu Fei-Yun 
Published: August 2020

Background Computed tomography texture analysis (CTTA) provides objective and quantitative information regarding tumor heterogeneity beyond visual inspection. However, no study has yet used CTTA to differentiate metastatic from non-metastatic cervical lymph node in patients with papillary thyroid cancer (PTC). Purpose To evaluate the value of texture analysis of dual-phase contrast-enhanced CT images in diagnosing cervical lymph node metastasis in patients with PTC. Material and Methods Metastatic (n = 27) and non-metastatic (n = 32) cervical lymph nodes were analyzed retrospectively. Texture analyses were performed on both arterial (A) and venous (V) phase CT images. Texture parameters, including mean gray-level intensity, skewness, kurtosis, entropy, and uniformity, were obtained and compared between groups. Receiver operating characteristic (ROC) curves analyses and multivariate logistic regression analysis were used in our study. Results Metastatic lymph nodes showed significantly higher A-mean gray-level intensity, A-entropy, and lower A-kurtosis and V-kurtosis (all P < 0.001) than non-metastatic mimics. The ROC curve analyses indicated that A-kurtosis demonstrated an optimal diagnostic area under the curve (AUC; 0.884) and specificity (92.59%), while the A-mean gray-level intensity showed optimal diagnostic sensitivity (90.62%). Multivariate logistic regression analysis showed that A-mean gray-level intensity ( P = 0.006, odds ratio [OR] = 24.297) and V-kurtosis ( P = 0.014, OR = 19.651) were the independent predictor for metastatic cervical lymph node. Conclusion Dual-phase contrast-enhanced CCTA—especially A-mean gray-level intensity and V-kurtosis—may have the potential to diagnose metastatic cervical lymph node in patients with PTC.
Adherence to guidelines aimed at preventing post-contrast acute kidney injury (PC-AKI) in radiology practices: a survey study
Authors: Dekkers Ilona A , Olchowy Cyprian , Thomsen Henrik S , van der Molen Aart J 
Published: August 2020

Background New insights into post-contrast acute kidney injury (PC-AKI) have recently led to the guidelines on the prevention of PC-AKI being updated. However, little is known about the barriers and facilitators involved in guideline adherence by radiology practices. Purpose To evaluate barriers and facilitators to the adherence of PC-AKI guidelines. Material and Methods Radiologists visiting the European Society of Urogenital Radiology (ESUR) 2018 meeting, as well as ESUR members were contacted to fill in an electronic questionnaire on the implementation of PC-AKI guidelines applying to their local radiology practices. Results Of the 145 responding radiologists representing radiology practices, 127 (88%) confirmed having a PC-AKI protocol in place in their radiology practice, of which 61 (48%) used a protocol as specified in a (inter)national guideline. The majority of radiology practices of the respondents used the ESUR guideline (40%). Barriers for not using PC-AKI prevention guidelines were related to a lack of outcome expectancy. Barriers for not using the protocol as specified were related to a lack of agreement with specific recommendations, lack of motivation, guideline-specific factors, and environmental factors. Self-reported facilitators consisted of guideline-specific factors. Conclusion Guidelines for the prevention of PC-AKI seem to be widely implemented among radiology practices, and regularly locally modified because of barriers involved in agreement and behavior. Knowledge of the barriers and facilitators of guideline adherence will aid future efforts aimed at bridging the gap between awareness and implementation of evidence-based guidelines in radiology practices.
AD-Related CSF Biomarkers Across Distinct Levels of Cognitive Impairment: Correlations With Global Cognitive State
Authors: Ibarra Romel , Radanovic Marcia , Pais Marcos V. , Talib Leda L. , Forlenza Orestes V. 
Published: August 2020

Aim: Associations between cerebrospinal fluid (CSF) biomarkers of Alzheimer’s disease (AD) with the severity of cognitive impairment are unclear. We examined the correlations between CSF biomarkers and cognitive performance in the AD continuum. Methods: We studied 143 elderly patients: cognitively unimpaired (n = 51), mild cognitive impairment (MCI) amnestic (n = 55) and nonamnestic (n = 20), and mild AD (n = 17) assessed with the Cambridge Cognitive Test (CAMCOG). We correlated total CAMCOG and its subdomains with CSF Aβ42, T-tau, p-tau levels, and Aβ42/p-tau. Results: In the total sample, T-tau and Aβ42/p-tau correlated with the total CAMCOG ( P < .01); all biomarkers correlated with memory ( P < .001); T-tau correlated with language ( P < .01). Conclusion: Memory and T-tau levels may be the most suitable parameters to reflect cognitive/CSF biomarker correlations. At present, such correlations are of little use in routine clinical practice.
Challenges in Serious Game Design and Development: Educators’ Experiences
Authors: Dimitriadou Anastasia , Djafarova Naza , Turetken Ozgur , Verkuyl Margaret , Ferworn Alexander 
Published: August 2020

Background. Relatively little is known about the role of educators in serious game design and development and their experiences with serious game implementation. We investigate educators’ perceived challenges deriving from their involvement as subject matter experts during the serious game development trajectory. Methods. A secondary analysis of data collected through an exploratory survey about serious game design and development approaches was carried out. The sample included 41 educators from post-secondary education institutions across North America. An in-depth analysis of qualitative data revealed educators’ roles in game development, the challenges they faced, and the strategies they deployed in serious game design, development, and implementation. Results. Educators, as serious game designers, perceived challenges to be administrative, design-related, attitudinal, and communicative. Strategies deployed to overcome challenges during the concept development, pre-production, and production stages of game design include the creation of games that balance learning and fun, and enhanced team collaboration through cultural mediation. During the post-production stage, although challenges are acknowledged and some strategies, such as improving the usability of a game, are deployed, a clear pattern in challenges and mitigating strategies could not be observed. Conclusion. Serious game design and development can be improved by nurturing diversity of ideas and adopting creative design and development methodologies. Serious game implementation can be improved by devising effective administrative and attitudinal strategies, and incorporating diversity of ideas into target curricula. Additionally, clear directives about usability should be devised, and academic objectivity towards serious games needs to be be created. Strategies to achieve these goals should focus on developing trust between target users, the technical development team, and educators as serious game implementers.
Prevalence and Predictors of Out-of-Target LDL Cholesterol 1 to 3 Years After Myocardial Infarction. A Subanalysis From the EYESHOT Post-MI Registry
Authors: Silverio Angelo , Benvenga Rossella Maria , Piscione Federico , Gulizia Michele M. , Meessen Jennifer M. T. A. , Colivicchi Furio , Nardi Federico , Baldi Cesare , Galasso Gennaro , Vecchione Carmine , Di Lenarda Andrea , Gabrielli Domenico , De Luca Leonardo 
Published: August 2020

Background: There is an incomplete understanding of the prevalence and predictors of attainment of low-density lipoprotein cholesterol (LDL-C) goal after myocardial infarction (MI). Aim: To evaluate the prevalence of achievement of LDL-C goal of 70 mg/dL, to identify the baseline features associated with suboptimal lipid control, and to assess the use of LDL-C-lowering drug therapies (LLT) beyond the first year after MI. Methods: The EYESHOT Post-MI was a prospective, cross-sectional, Italian registry, which enrolled patients presenting to cardiologist 1 to 3 years after MI. In this retrospective post-hoc analysis, patients were categorized in 2 groups according to the achievement or not of the LDL-C goal of 70 mg/dL. Univariable and multivariable logistic regression analyses were performed to identify the baseline features associate with LDL-C≥70 mg/dL. Results: The study population included 903 patients (mean age 65.5 ± 11.5 years). Among them, LDL-C was ≥70 mg/dL in 474 (52.5%). Male sex ( P = 0.031), hypertension ( P = 0.024), prior percutaneous coronary intervention ( P = 0.016) and high education level ( P = 0.008) were higher in the LDL-C <70 group. At multivariable analysis, low education level was an independent predictor of LDL-C≥70 mg/dL (OR:1.582; 95%CI, 1.156-2.165; P = 0.004). Conversely, hypertension increased the probability to achieve the LDL-C goal (OR:0.650; 95%CI, 0.443-0.954; P = 0.028). Among off-target patients, LLT was not modified in the majority of cases (67.3%), intensified in 85 (18.6%), and actually reduced in 63 patients (13.8%). Conclusions: In patients presenting to cardiologists 1 to 3 years from the last MI event, LDL-C is not under control in a large proportion of patients, particularly in those with a low education level or without hypertension. LLT is underused in this very-high-risk setting.
Intravitreal ranibizumab versus dexamethasone implant in macular edema due to branch retinal vein occlusion: Systematic review and meta-analysis
Authors: Pranata Raymond , Vania Amelinda , Vania Rachel , Victor Andi Arus 
Published: August 2020

Purpose: Intravitreal ranibizumab (RNB) and dexamethasone intravitreal implant (DII) were developed in the recent past and has been widely used for macular edema secondary to BRVO. We aimed to assess the efficacy and safety of intravitreal ranibizumab (RNB) compared to dexamethasone intravitreal implant (DII) in patients with macular edema secondary to branch retinal vein occlusion (BRVO). Methods: We performed a comprehensive search on topics that assess RNB and DII in patients with macular edema secondary to BRVO from several electronic databases. Results: There were 678 subjects from five studies. Ranibizumab was associated with a greater increase in best-corrected visual acuity (BCVA; mean difference 9.13, I2: 0%) compared to DII. Ranibizumab also demonstrated a greater ⩾10 (OR 2.76, I2: 0%) and ⩾15 letters (OR 2.78, I2: 0%) gain. RNB has better BCVA (logMAR scale) improvement at 6 months’ follow up (mean difference −0.15, I2: 64%) in favor of RNB. Higher IOP was found in DII group on follow-up (mean difference −2.92, I2: 89%) and RNB has lesser IOP ⩾10 mmHg increase compared to DII (OR 0.08, I2: 0%). Cataract formation and/or progression was less in RNB (OR 0.53, I2: 75%). The need for rescue laser was similar the two groups. Conclusion: Intravitreal RNB was more effective with less pronounced effect on IOP and cataract formation and/or progression compared to DII for patients with macular edema secondary to BRVO.
Trocar assisted nonappositional repair of iridodialysis
Authors: Narang Priya , Agarwal Amar 
Published: August 2020

Purpose: To describe trocar-assisted method of Nonappositional repair of iridodialysis. Methods: The technique described involves placement of a 25 G trocar at the limbus wherein the lumen of the cannula works as a guide to introduce a double arm polypropylene suture attached to the long arm needle thereby preventing any accidental entrapment of corneal fibers into the needle. Results: The technique was performed in 7 cases and no entrapment of corneal tissue was observed while maneuvering the suture needle through paracentesis incision during an iridodialysis repair procedure. Anterior segment optical coherence tomography demonstrated closure of the limbal trocar wound at 1-week follow-up. No incidence of wound leak or Descemets membrane detachment was observed. Conclusion: The technique allows performing iridodialysis repair in technically challenging situations by directing the needle appropriately and preventing any undulating movement inside the anterior chamber. The trocar-assisted method serves as an effective method to perform non-appositional iridodialysis repair.