bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract P530: Safety of Intravenous Cangrelor in Acute Ischemic Stroke
Authors: Salahuddin Hisham , Dawod Giana , Zaidi Syed F , Jumaa Mouhammad A 
Published: March 2021

Introduction:
Mechanical Thrombectomy often requires immediate antiplatelet therapy when emergent stenting is needed. Intravenous cangrelor (CGR) is a potent reversible intravenous antiplatelet with a fast onset, a short half-life, and predictable pharmacokinetics. We sought to evaluate the safety and efficacy of this drug in MT patients.

Methods:
We performed a retrospective case control study at a CSC between 3/2016 and 4/2020. Patients who received intravenous CGR within 6 hours of admission (between 10/2019 - 4/2020) were compared with patients with anterior circulation tandem MCA occlusions who required stenting and oral antiplatelet therapy (between 3/16 - 10/19), prior to the availability of CGR at our facility.

Results:
We identified 35 patients, 12 of whom received IV CGR and 23 received acute oral antiplatelets for tandem occlusions. Average age of the cohort was 68.5 ± 13.4. Baseline characteristics including co-morbidities, rate of IV tPA, and time metrics were similar between the two groups.

In the CGR group, nine patients had tandem anterior circulation occlusions, two had basilar occlusions, and one patient had an MCA occlusion secondary to severe stenosis. Eleven of the twelve patients in the CGR group required acute stenting. Intravenous CGR was used for an average of 20.2 hours after which patients were transitioned to aspirin and ticagrelor (33%) or clopidogrel (67%).
Successful recanalization was achieved in all patients who received IV-CGR and in 95.7% of the tandem group. Final infarct volumes were comparable between the CGR and tandem cohorts (7.1 vs 15.5 ml; p=0.75). There were two cases of asymptomatic hemorrhage in both the CGR group and the tandem cohort, and one case of symptomatic ICH in the tandem cohort. Final functional outcomes (83.3% vs 60.9%; p=0.259) and mortality at three months (13% vs. 17%; p=1) were similar between the two groups.

Conclusions:
IV CGR is a promising medication for patients with acute ischemic stroke who require an immediate antiplatelet effect and is comparable in safety and efficacy to oral antiplatelets in the acute period of ischemic stroke. Larger prospective studies on the efficacy and safety of CGR in neurointervention are warranted.
Association Between Stroke and Subsequent Risk of Suicide
Authors: Vyas Manav V. , Wang Jeffrey Z. , Gao Meah M. , Hackam Daniel G. 
Published: March 2021

Background and Purpose:
Poor mental health and depression are well-recognized sequelae of stroke; however, the association between stroke and subsequent risk of suicide is unknown.

Methods:
We systematically searched MEDLINE, Embase, PsycINFO, and Google Scholar from their inception to September 15, 2020, using keywords and database-specific subjects. We independently adjudicated and selected observational studies that reported suicide attempts or death by suicide in stroke survivors and a comparison group, consisting either of people without a history of stroke or the general population. We evaluated study quality using the Newcastle Ottawa scale. Using random-effects meta-analysis, we calculated the pooled adjusted risk ratio (RR) of suicide in stroke survivors and separately calculated the pooled adjusted RR of suicide attempt and death by suicide. Using prespecified analyses, we explored study-level factors to explain heterogeneity.

Results:

We screened 4093 articles and included 23 studies of fair quality, totaling over 2 million stroke survivors, of whom 5563 attempted suicide or died by suicide. Compared to the nonstroke group, the pooled adjusted RR of suicide in stroke survivors was 1.73 (95% CI, 1.53–1.96,
I
2
=93%), with a significantly (
P
=0.03) higher adjusted risk of suicide attempt (RR, 2.11 [1.73–2.56]) than of death by suicide (RR, 1.61 [1.41–1.84]). A longer follow-up time in cohort studies was associated with a lower risk of suicide (RR, 0.97 [0.95–0.99] for every 1-year increase).

Conclusions:
Stroke should be considered as a risk factor for suicide. Comprehensive strategies to screen and treat depression and suicidal ideation in stroke survivors should be developed to reduce the burden of suicide in stroke survivors.
Youth as Agenda-Setters between Donors and Beneficiaries: The Limited Role of Libyan Youth after 2011
Authors: Loschi Chiara 
Published: March 2021

Abstract
Based on interviews with young Libyan professionals carried out between 2017 and 2018, this paper examines their role as agenda-setters in international organizations operating in their country since 2011. The growing foreign demand for local expertise after the fall of the old regime was met mostly by the young activists who had helped organize the 2011 uprisings. For foreign organizations, Libyan youth have come to embody brokers, fixers, go-betweens, and persons-in-between, becoming key supporting actors in international project implementation. Despite the opportunities seemingly afforded by the collapse of the old regime, this paper shows that Libyan youth, torn between desires for political change and professional advancement, have struggled to influence the agendas of international organizations, leading to feelings of disenfranchisement. The transformative capacity of international projects is thus often limited by this new class of young, globalized elites who are disengaged from the local needs and realities facing Libyan civil society.
Ontogeny of divided vascular cylinders in Serjania: the rise of a novel vascular architecture in Sapindaceae
Authors: Rizzieri Yanã C. , Brandes Arno F.N. , Cunha Neto Israel L. , Somner Genise V. , Lima Michaela J.N. , Pereira André , Tamaio Neusa 
Published: March 2021

Abstract
Sapindaceae lianas are remarkable for the diversity of cambial variants found in their stems. One of the family’s exclusive cambial variant is the divided vascular cylinder, which occurs in eight species of the genus Serjania. This cambial variant is marked by 5 peripheral vascular cylinders around a large pith. We performed a comparative developmental analysis, integrating traditional plant anatomy techniques with high-resolution X-ray micro-computed tomography to investigate the structure and development of the stems of three species with divided vascular cylinder. Our observations showed that the initial stages of stem development were similar to those described in the literature, however, on later developmental stages a central vascular cylinder appears in all species. The ontogeny of these stems are marked by three main processes: (i) dissection of vascular tissue from the peripheral vascular cylinders; (ii) development of new cambial arcs through the redifferentiation of pith cells; and (iii) recruitment of cambial cells from the inner portions of the vascular cambium of the peripheral vascular cylinders, forming a novel central vascular cylinder where the pith was, surrounded by five initial peripheral cylinders. As an ulterior developmental stage, some older stems also develop neoformations and connections between the different vascular cylinders. While our findings support previous descriptions of divided vascular cylinders, this is the first study illustrating the formation of the central vascular cylinder in this cambial variant. Our observations further corroborate that Serjania is the lineage with the highest and some of the most complex forms of cambial variants among all vascular plants.
Do Firm Growth Models Work in Service Industries in Developing Economies? An Investigation of the Relationship Between Firms’ Growth, Size and Age
Authors: Villari Boby Chaitanya , Subramanian Balaji , Kumar Piyush , Hota Pradeep Kumar 
Published: March 2021

Growth models such as Gibrat’s law and Jovanovic’s theory that examine the relationship between the firms’ growth, age and size have either been tested on data from developed economies or from the manufacturing sectors in developing economies. This study checks the suitability of these models in service sectors in developing economies as service sectors have distinct characteristics and developing economies such as India are heavily dependent on this sector. The current study considers three major service sectors contributing to India’s economy vis-à-vis financial services, information technology and real estate for the period 2002–2005. We observed that during 2002–2005, India’s economy was stable without wide fluctuations in economic performance, such as gross domestic product, unemployment or inflation. These sectors not only had a significant impact on economic growth but also had comprehensive microeconomic data. Our results negate both Gibrat’s law and Jovanovic’s theory. We argue that service sectors which are knowledge-intensive will experience different growth patterns compared to manufacturing sectors. We find a definite and significant relationship between firms’ growth and their size and age. Also, we find concluding evidence that younger firms up to 10 years of age struggle a lot more than older firms in the Indian service sector. JEL: D20, D21, D22, D02
Two randomized, double-blind, placebo-controlled trials and one open-label, long-term trial of brexpiprazole for the acute treatment of bipolar mania
Authors: Vieta Eduard , Sachs Gary , Chang Denise , Hellsten Johan , Brewer Claudette , Peters-Strickland Timothy , Hefting Nanco 
Published: March 2021

Background: Brexpiprazole is a dopamine/serotonin receptor partial agonist (D2, 5-HT1A) and antagonist (5-HT2A) approved for treatment of schizophrenia and major depressive disorder (adjunct to antidepressants). Aims: This study aimed to investigate brexpiprazole as monotherapy in acute mania (bipolar I disorder) in two short-term (ST) studies (study 080 and study 081) and one open-label (OL) extension (study 083). Methods: ST studies were three-week randomized, double-blind, flexible dose (2–4 mg/day), placebo-controlled studies. The primary endpoint was mean change in Young Mania Rating Scale (YMRS) total score from baseline to day 21. The OL study was a 26-week flexible dose (2–4 mg/day) study for patients completing the ST studies. Results: A total of 164 and 158 (study 080) and 170 and 162 (study 081) inpatients with DSM-5 mania with/without mixed features were randomized to placebo or brexpiprazole, respectively. The primary analyses did not show a statistically significant difference between brexpiprazole and placebo: study 080: least squares mean difference (95% confidence limits): 0.14 (−1.74, 2.03), p = 0.8797; study 081: −1.62 (−3.56, 0.32), p = 0.1011. OL study patients ( n = 381) demonstrated a gradual improvement in YMRS total score. Akathisia was the only adverse event, with an incidence of ⩾5% with brexpiprazole and more than placebo in the ST studies, or ⩾5% in the OL study. Brexpiprazole was more efficacious in patients with impaired or no insight (predominantly EU patients) than in patients with excellent insight (predominantly US patients). Conclusions: Further studies are necessary to address the potential efficacy of brexpiprazole in acute mania, which should ensure that the study sample is severe enough (especially with regard to insight), and that the dose/titration schedule is not too modest.
Comparison Between Osteochondral Autograft Transplantation and Arthroscopic Fragment Resection for Large Capitellar Osteochondritis Dissecans in Adolescent Athletes: A Minimum 5 Years’ Follow-up
Authors: Ueda Yusuke , Sugaya Hiroyuki , Takahashi Norimasa , Matsuki Keisuke , Tokai Morihito , Morioka Takeshi , Hoshika Shota , Takeuchi Yasutaka 
Published: March 2021

Background: The choice of surgical option for unstable large capitellar osteochondritis dissecans (OCD) lesions in skeletally immature athletes remains controversial. Purpose/Hypothesis: The purpose was to investigate functional and radiographic outcomes after arthroscopic fragment resection and osteochondral autograft transplantation (OAT) for unstable large capitellar OCD lesions in skeletally immature athletes with a minimum 5 years’ follow-up. We hypothesized that the outcomes after OAT for large capitellar OCD lesions would be superior to those after arthroscopic fragment resection. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 19 elbows in 19 patients (17 male and 2 females) who underwent arthroscopic resection were assigned to group 1 (mean age, 14 years [range, 13-15 years]), whereas 29 elbows in 29 patients (29 male) who underwent OAT were assigned to group 2 (mean age, 14 years [range, 13-15 years]), with the mean follow-up of 8 (range, 5-11 years) and 7 (range, 5-13 years) years, respectively. All OCD lesions were larger than one-half of the radial head diameter. Functional scores, patient satisfaction, and range of motion were compared between the groups. Radiographic changes, including superior migration, radial head enlargement, and osteoarthritis (OA) grade, were examined. Results: All patients returned to sports activity. Functional scores, patient satisfaction, and flexion at the final follow-up were significantly improved in both groups compared with preoperative values, and differences were not significant between groups at the final follow-up. Extension showed a significant improvement in both groups (group 1: –17° to 0°; group 2: –18° to −6°; P < .001). Extension in group 1 was significantly better than that in group 2 at the final follow-up ( P = .045). No elbows developed postoperative severe OA in group 1, whereas 3 elbows in group 2 had grade 3 OA; these 3 elbows had preoperative superior migration and radial head enlargement. Conclusion: No differences were observed in clinical and radiographic outcomes between patients undergoing arthroscopic fragment resection and OAT, except for elbow extension, at a minimum 5 years’ follow-up. We believe that for adolescents with large capitellar OCD lesion, OAT is a good option for skeletally immature elbows and that arthroscopic fragment resection is a reliable and less invasive surgical option for relatively mature elbows.
Oxygen concentration distribution in a pulse detonation engine with nozzle–ejector combinational structures
Authors: Wang Zhiwu , Wei Lisi , Qin Weifeng , Liang Zijian , Zhang Kun 
Published: March 2021

Pulse detonation engines (PDEs) with three different types of nozzle–straight ejector combinational structures at three different ejector positions were simulated by the unsteady 2-D axisymmetric method to understand the influence of nozzle–ejector combinational structures on the performance of PDEs. Three types of nozzles included the straight nozzle, convergent nozzle, and convergent–divergent (CD) nozzle. Three ejector positions were considered according to the ratio of the distance between the nozzle outlet and the ejector inlet to the diameter of PDEs (Δx/d). Propane was used as the fuel and air as the oxidizer. The simulation results indicated that for the PDE with the straight nozzle, it took the shortest time for high-temperature burnt gas to exhaust from the detonation tube. For the PDE with the CD nozzle, the time at which the ejector was filled with external air was the fastest. Within the time range of t = 0–10 ms, the ejected air was less than the original air in the ejector among all the nine combinational structures. The maximum ejected air was obtained with the convergent nozzle, followed by the CD nozzle, and the minimum with the straight nozzle. For certain nozzles, the maximum air was ejected at the ejector position of Δx/d = +1, followed by the ejector position of Δx/d = 0, and the minimum at the ejector position of Δx/d = −1. For the convergent nozzle–ejector combinational structure, the air ejection speed was the fastest. Oxygen concentration distribution in the PDE with the CD nozzle was more uniform along the axial direction than the other nozzles.
A meta-analysis of aspirin and subarachnoid hemorrhage in patients with intracranial aneurysms yields different results to the general population
Authors: Ewbank Frederick , Birks Jacqueline , Bulters Diederik 
Published: March 2021

Background Some studies have shown a protective association between aspirin use and subarachnoid hemorrhage. Other studies have found no relationship or the reverse. These studies differ in their study populations and definitions of subarachnoid hemorrhage. Aims Our aim was to establish (1) if there is an association between aspirin and subarachnoid hemorrhage, (2) how this differs between the general population and those with intracranial aneurysms. Summary of review Studies reporting aspirin use and the occurrence of subarachnoid hemorrhage were included and grouped based on population (general population vs. aneurysm population). Odds ratios, hazard ratios, and confidence intervals were combined in random-effects models. Eleven studies were included. Overall, there was an association between aspirin and subarachnoid hemorrhage (OR 0.68 [0.48, 0.96]). However, populations were diverse and heterogeneity between studies high ( p < 0.00001), questioning the validity of combining these studies and justifying analysis by population. In the general population, there was no difference in aspirin use between individuals with and without subarachnoid hemorrhage (OR 1.15 [0.96, 1.38]). In patients with intracranial aneurysms, aspirin use was greater in patients without subarachnoid hemorrhage (OR 0.37 [0.24, 0.58]), although these studies were at higher risk of bias. Conclusions There is an association between aspirin use and subarachnoid hemorrhage in patients with intracranial aneurysms. This apparent protective relationship is not seen in the general population. Prospective randomized studies are required to further investigate the effect of aspirin on unruptured intracranial aneurysms.
Teleneurology Comprehensive Inpatient Consultations Expedite Access to Care and Decreases Hospital Length of Stay
Authors: McCormick Robert , Estrada Juan , Whitney Cynthia , Hinrichsen Mona , Lee Patrick T. , Cohen Adam B. , Schwamm Lee , Matiello Marcelo 
Published: March 2021

Background and Purpose: While the successful provision of telestroke care has been well documented in the literature, studies on the impact of comprehensive teleneurology service (TN) to hospital measures are lacking. We evaluated 3 traditional health services metrics of hospital performance: time from consult request to consult completion, inpatient length of stay (LOS), and the rate of patients transferred for tertiary care. Methods: Medical records (n = 899) from 3 community hospitals and our TN consultation database were retrospectively reviewed during the 2 years before (n = 703, 3 hospitals) and 4 months (n = 2 hospitals) to 2 years (n = 1 hospital) after implementation (n = 196) of a TN program for routine and urgent consult requests. Consult order time, consult completion time, total length of stay and discharge disposition were compared across the pre-TN implementation group, which consisted of in-person consultations and the post-TN implementation group, which consisted of TN consultations only. Results: After TN implementation, median length of stay decreased 28% (3.9 vs. 2.8 days, p < 0.0001) and median time from consult order to consult completion decreased by 74% across all diagnoses (5.8 vs. 1.5 hours, p < 0.0001). There were no significant differences in the percentage of patients discharged home (52.3% vs. 56.1%, p = 0.10) or transferred to tertiary care (6.1% to 9.2%, p = 0.10). Conclusions: Implementation of TN program was associated with significant reductions in LOS and time to consultation completion without an increase in shunting of patients to more advanced facilities. Further research is warranted to confirm these findings in independent cohorts and other models of teleneurology delivery.
Preoperative “Cervical Axis” Deviation Increases the Risk of Distal Adding-On Following Surgery in Lenke 1 and 2 Adolescent Idiopathic Scoliosis Patients
Authors: Chan Chris Yin Wei , Ch’ng Pei Ying , Lee Sin Ying , Chung Weng Hong , Chiu Chee Kidd , Kwan Mun Keong 
Published: March 2021

Study Design: Retrospective. Purpose: To evaluate the relationship between shoulder/ neck imbalance with distal adding-on phenomenon and to identify other risk factors in Lenke 1 and 2 (non-AR curves) adolescent idiopathic scoliosis (AIS) patients. Methods: 100 Lenke 1 and 2 AIS patients with lowest instrumented vertebra (LIV) cephalad to or at L1 were recruited. Medial shoulder/ neck balance was represented by T1-tilt and cervical axis (CA). Lateral shoulder balance was represented by clavicle angle (Cla-A) and radiographic shoulder height (RSH). Distal adding-on phenomenon was diagnosed when there was disc wedging below LIV of >5o at final follow-up. Predictive factors and odds ratio were derived using univariate and multivariate logistic regression analysis. Results: Mean age of this cohort was 15.9 ± 4.4 years. Mean follow-up duration was 30.9 ± 9.6 months. Distal adding-on phenomenon occurred in 19 patients (19.0%). Only Risser grade, preoperative CA and final follow-up lumbar Cobb angle were the independent factors. A positive preoperative CA deviation increased the odds of distal adding-on by 5.4 times (95% CI 1.34-21.51, P = 0.018). The mean immediate postoperative T1-tilt, CA, RSH and Cla-A were comparable between the group with distal adding-on and the group without. Conclusion: Distal adding-on phenomenon occurred in 19.0% of patients. Preoperative “Cervical Axis” was an important factor and it increased the risk of distal adding-on by 5.4 times. Other significant predictive factors were Risser grade and lumbar Cobb angle at final follow-up. Immediate postoperative shoulder or neck imbalance was not a significant factor for postoperative distal adding-on phenomenon.
Acellular Cartilage Repair Technique Based on Ultrapurified Alginate Gel Implantation for Advanced Capitellar Osteochondritis Dissecans
Authors: Momma Daisuke , Onodera Tomohiro , Kawamura Daisuke , Urita Atsushi , Matsui Yuichiro , Baba Rikiya , Funakoshi Tadanao , Kondo Makoto , Endo Toshiya , Kondo Eiji , Iwasaki Norimasa 
Published: March 2021

Background: One of the most important limitations of osteochondral autograft transplant is the adverse effect on donor sites in the knee. Ultrapurified alginate (UPAL) gel is a novel biomaterial that enhances hyaline-like cartilage repair for articular defects. To avoid the need for knee cartilage autografting when treating osteochondritis dissecans (OCD) of the capitellum, we developed a surgical procedure involving a bone marrow stimulation technique (BMST) augmented by implantation of UPAL gel. Hypothesis: BMST augmented by UPAL gel implantation improves the cartilage repair capacity and provides satisfactory clinical outcomes in OCD of the capitellum. Study Design: Case series; Level of evidence, 4. Methods: A total of 5 athletes with advanced capitellar OCD in the dominant elbow underwent BMST augmented by implantation of UPAL gel. The osteochondral defects were filled with UPAL gel after BMST. At a mean follow-up of 97 weeks, all patients were evaluated clinically and radiographically. Results: At final follow-up, all 5 patients had returned to competitive-level sports, and 4 patients were free from elbow pain. The mean Timmerman-Andrews score significantly improved from 100 to 194 points. Radiographically, all patients exhibited graft incorporation and a normal contour of the subchondral cortex. Magnetic resonance imaging showed that the preoperative heterogeneity of the lesion had disappeared, and the signal intensity had returned to normal. Arthroscopic examinations consistently exhibited improvement in the International Cartilage Regeneration and Joint Preservation Society (ICRS) grade of lesions from 3 or 4 to 1 or 2 in 4 patients at 85 weeks postoperatively. Histologic analysis of biopsy specimens revealed an average total ICRS Visual Assessment Scale II histologic score of 1060. Conclusion: The acellular cartilage repair technique using UPAL gel for advanced capitellar OCD provided satisfactory clinical and radiographic results. The present results suggest that this novel technique is a useful, minimally invasive approach for treating cartilaginous lesions in athletes.