bluuebunny/crossref_metadata_2025_split huggingface dataset:
Practical Small Vessel Disease Score Relates to Stroke, Dementia, and Death
Authors: Yilmaz Pinar , Ikram M. Kamran , Niessen Wiro J. , Ikram M. Arfan , Vernooij Meike W. 
Published: December 2018

Background and Purpose—
In the general population, we investigated the association of a recently developed cerebral small vessel disease (CSVD) sum score with stroke, dementia, and mortality.

Methods—
One thousand six hundred fifty-one stroke-free and nondemented participants (mean age, 73.3 years; 54.5% women) of the population-based Rotterdam Study underwent brain magnetic resonance imaging (1.5T) in 2005–2011 and were followed for stroke, dementia, and mortality until 2016–2017. The CSVD sum score was composed by counting the presence of 4 magnetic resonance imaging markers (white matter hyperintensities, lacunes, cerebral microbleeds, and perivascular spaces; range, 0–4). We determined the association of the CSVD score with risk of stroke, dementia, and mortality using Cox models, adjusting for age, sex, and other Framingham Stroke Risk Profile predictors. Additionally, we assessed mortality as a competing risk for stroke and dementia and calculated absolute risk estimates for all outcomes.

Results—
During a mean follow-up of 7.2 years, 66 participants developed stroke, 76 developed dementia, and 306 died. The Framingham Stroke Risk Profile–adjusted hazard ratios of 1 point higher sum score were 1.54 (95% CI, 1.16–2.03) for stroke, 1.25 (95% CI, 0.95–1.64) for dementia, and 1.15 (95% CI, 1.01–1.31) for mortality. No significant differences were seen for subdistribution hazard ratios for stroke and dementia. A higher CSVD score yielded higher absolute risk estimates for all outcomes, calculated during 10 years.

Conclusions—
The CSVD score is a practical measure of global vascular brain injury. A higher sum score on magnetic resonance imaging is associated with higher risk of suffering a stroke, developing dementia, and death.
Anticoagulation Therapy for Atrial Fibrillation in Patients With Alzheimer’s Disease
Authors: Ruiz Vargas Estefanía , Sposato Luciano A. , Lee Spencer A. W. , Hachinski Vladimir , Cipriano Lauren E. 
Published: December 2018

Background and Purpose—
Direct oral anticoagulants (DOACs) are safer, at least equally efficacious, and cost-effective compared to warfarin for stroke prevention in atrial fibrillation (AF) but they remain underused, particularly in demented patients. We estimated the cost-effectiveness of DOACs compared with warfarin in patients with AF and Alzheimer’s disease (AD).

Methods—
We constructed a microsimulation model to estimate the lifetime costs, quality-adjusted life-years (QALYs), and cost-effectiveness of anticoagulation therapy (adjusted-dose warfarin and various DOACs) in 70-year-old patients with AF and AD from a US societal perspective. We stratified patient cohorts based on stage of AD and care setting. Model parameters were estimated from secondary sources. Health benefits were measured in the number of acute health events, life-years, and QALYs gained. We classified alternatives as cost-effective using a willingness-to-pay threshold of $100 000 per QALY gained.

Results—
For patients with AF and AD, compared with warfarin, DOACs increase costs but also increase QALYs by reducing the risk of stroke. For mild-AD patients living in the community, edoxaban increased lifetime costs by $6603 and increased QALYs by 0.076 compared to warfarin, yielding an incremental cost-effectiveness ratio of $86 882/QALY gained. Even though DOACs increased QALYs compared with warfarin for all patient groups (ranging from 0.019 to 0.085 additional QALYs), no DOAC treatment alternative had an incremental cost-effectiveness ratio <$150 000/QALY gained for patients with moderate to severe AD. For patients living in a long-term care facility with mild AD, the DOAC with the lowest incremental cost-effectiveness ratio (rivaroxaban) costs $150 169 per QALY gained; for patients with more severe AD, the incremental cost-effectiveness ratios were higher.

Conclusions—
For patients with AF and mild AD living in the community, edoxaban is cost-effective compared with warfarin. Even though patients with moderate and severe AD living in the community and patients with any stage of AD living in a long-term care setting may obtain positive clinical benefits from anticoagulation treatment, DOACs are not cost-effective compared with warfarin for these populations. Compared to aspirin, no oral anticoagulation (warfarin or any DOAC) is cost effective in patients with AF and AD.
Clot Migration Is Associated With Intravenous Thrombolysis in the Setting of Acute Ischemic Stroke
Authors: Ren Yifan , Churilov Leonid , Mitchell Peter , Dowling Richard , Bush Steve , Yan Bernard 
Published: December 2018

Background and Purpose—
Clot migration to distal intracranial arterial segments was observed in patients presented with acute large vessel occlusions. It is postulated that the exposure of patients to intravenous thrombolysis (IVT) increases the risk of clot migration and associated with inaccessibility of the clot by endovascular thrombectomy (EVT). In this study, we aimed to investigate the incidence of clot migration and its association with IVT before EVT.

Methods—
We conducted a single-center retrospective analysis of patients who had EVT during the period 2009 to 2016. Patients who fulfilled clinical criteria were treated with bridging IVT and those who did not were treated with direct EVT. Clot position was assessed by pretreatment computed tomography angiogram or magnetic resonance angiogram and was compared with clot position identified by digital subtraction angiography before planned endovascular thrombectomy.

Results—

Of 314 included patients, clot migration occurred in 43 patients (13.7%). The proportion of clot migration was 18.7% (39 of 209) in patients who had bridging IVT with EVT compared with 3.8% (4 of 105) in direct EVT (
P
=0.001). Of the 39 patients who had clot migration in the bridging IVT with EVT, 59.0% (23 of 39) demonstrated clot inaccessibility compared with 25.0% (1 of 4) in clot migration cases in the direct EVT group (
P
=0.011).

Conclusions—
The incidence of clot migration was significantly increased in the setting of bridging IVT before EVT, leading to increased proportion of clot inaccessibility by EVT.
Trained Immunity Characteristics Are Associated With Progressive Cerebral Small Vessel Disease
Authors: Noz Marlies P. , ter Telgte Annemieke , Wiegertjes Kim , Joosten Leo A. B. , Netea Mihai G. , de Leeuw Frank-Erik , Riksen Niels P. 
Published: December 2018

Background and Purpose—
Cerebral small vessel disease (cSVD) is the major vascular cause of cognitive decline and dementia. The pathogenesis of cSVD remains largely unknown, although several studies suggest a role for systemic inflammation. In certain pathophysiological situations, monocytes can reprogram toward a long-term proinflammatory phenotype, which has been termed trained immunity. We hypothesize that trained immunity contributes to the progression of cSVD.

Methods—
Individuals with mild-to-severe cSVD participated in the study. Severity of cSVD was determined by the white matter hyperintensities (WMH) volume (mL) on magnetic resonance imaging in 2006, 2015, and the progression between 2006 and 2015 (ΔWMH). Cytokine production was assessed after ex vivo stimulation of peripheral blood mononuclear cells and monocytes. Additionally, monocyte subsets were identified by flow cytometry.

Results—

Fifty-one subjects (70±6 years, 60% men, 5.1±6.4 mL ΔWMH) were included. Circulating hsIL (high-sensitivity interleukin)-6 correlated with cSVD (
P
=0.005, r
s
=0.40). Cytokine production capacity by monocytes was associated with cSVD progression. Basal IL-8 and IL-17 production (
P
=0.08, r
s
=0.25;
P
=0.03, r
s
=0.30) and IL-6 production after Pam3Cys stimulation in monocytes was associated with cSVD (n=35:
P
=0.008, r
s
=0.44). Conversely, interferon (IFN)-γ production in
Candida
albicans
stimulated peripheral blood mononuclear cells was negatively correlated with cSVD (
P
=0.009, r
s
=−0.36). Flow cytometry revealed a correlation of the intermediate monocyte subset with cSVD (
P
=0.01, r
s
=0.36).

Conclusions—
Severity and progression of cSVD are not only correlated with systemic inflammation (hsIL-6) but also with trained immunity characteristics of circulating monocytes, in terms of an altered cytokine production capacity and a shift toward the proinflammatory intermediate monocyte subset.
Renal Function and Risk Stratification of Patients With Embolic Stroke of Undetermined Source
Authors: Ntaios George , Lip Gregory Y.H. , Lambrou Dimitris , Michel Patrik , Perlepe Kalliopi , Eskandari Ashraf , Nannoni Stefania , Sirimarco Gaia , Strambo Davide , Vemmos Konstantinos , Koroboki Eleni , Manios Efstathios , Vemmou Anastasia , Rodríguez-Campello Ana , Cuadrado-Godia Elisa , Roquer Jaume , Arnao Valentina , Caso Valeria , Paciaroni Maurizio , Diez-Tejedor Exuperio , Fuentes Blanca , Rodríguez Pardo Jorge , Arauz Antonio , Ameriso Sebastian F. , Pertierra Lucía , Gómez-Schneider Maia , Hawkes Maximiliano A. , Bandini Fabio , Chavarria Cano Beatriz , Mohedano Ana Maria Iglesias , García Pastor Andrés , Gil-Núñez Antonio , Putaala Jukka , Tatlisumak Turgut , Barboza Miguel A. , Karagkiozi Efstathia , Makaritsis Konstantinos , Papavasileiou Vasileios 
Published: December 2018

Background and Purpose—
We aimed to assess if renal function can aid in risk stratification for ischemic stroke or transient ischemic attack (TIA) recurrence and death in patients with embolic stroke of undetermined source (ESUS).

Methods—
We pooled 12 ESUS datasets from Europe and America. Renal function was evaluated using the estimated glomerular filtration rate (eGFR) and analyzed in continuous, binary, and categorical way. Cox-regression analyses assessed if renal function was independently associated with the risk for ischemic stroke/TIA recurrence and death. The Kaplan-Meier product limit method estimated the cumulative probability of ischemic stroke/TIA recurrence and death.

Results—

In 1530 patients with ESUS followed for 3260 patient-years, there were 237 recurrences (15.9%) and 201 deaths (13.4%), corresponding to 7.3 ischemic stroke/TIA recurrences and 5.6 deaths per 100 patient-years, respectively. Renal function was not associated with the risk for ischemic stroke/TIA recurrence when forced into the final multivariate model, regardless if it was analyzed as continuous (hazard ratio, 1.00; 95% CI, 0.99–1.00 for every 1 mL/min), binary (hazard ratio, 1.27; 95% CI, 0.87–1.73) or categorical covariate (likelihood-ratio test 2.59,
P
=0.63 for stroke recurrence). The probability of ischemic stroke/TIA recurrence across stages of renal function was 11.9% for eGFR ≥90, 16.6% for eGFR 60–89, 21.7% for eGFR 45–59, 19.2% for eGFR 30–44, and 24.9% for eGFR <30 (likelihood-ratio test 2.59,
P
=0.63). The results were similar for the outcome of death.

Conclusions—
The present study is the largest pooled individual patient-level ESUS dataset, and does not provide evidence that renal function can be used to stratify the risk of ischemic stroke/TIA recurrence or death in patients with ESUS.
Atmospheric Motion Vectors Derived from an Infrared Window Channel of a Geostationary Satellite Using Particle Image Velocimetry
Authors: Chuang Wei-Liang , Chou Chien-Ben , Chang Kuang-An , Chang Yu-Cheng , Chin Hsin-Lung 
Published: December 2018

AbstractAs the new-generation geostationary satellite Himawari-8 provides a greater frequency and more observation channels than its predecessor, the Multifunctional Transport Satellite series (e.g., MTSAT-2), an opportunity arises to generate atmospheric motion vectors (AMVs) with an increased accuracy and extensive distribution over eastern Asia. In this work AMVs were derived from consecutive images of an infrared-window channel (IR1) of the Himawari-8 satellite using particle image velocimetry (PIV) based on the theory of cross-correlation schemes. A multipass scheme and an adaptive interrogation scheme were also employed to increase spatial resolution and accuracy. For height assignment, an infrared-window method was applied for opaque cloud, while an H2O-intercept method was employed for semitransparent cloud. Validation was conducted by comparing the PIV-derived AMVs with wind fields obtained from NWP analysis, radiosonde observations, and the operational system from the Meteorological Satellite Center (MSC) of the Japan Meteorological Agency (JMA) or JMA/MSC. The comparison of wind velocity maps with the NWP data shows that the PIV-derived AMVs are capable of quantitatively depicting full-field wind field maps and strong jets in atmospheric circulation. Through comparisons with radiosonde observations, the root-mean-square error and wind speed bias (4.29 and −1.05 m s−1) of the PIV-derived AMVs are comparable to, although slightly greater than, that of the NWP data (3.88 and −0.26 m s−1). Based on comparison between the PIV-derived AMVs and wind fields obtained from the JMA/MSC operational system, the PIV-derived AMVs are again comparable, producing a slightly lower error but a larger wind speed bias (−1.05 vs 0.20 m s−1). This also implies that a better height assignment algorithm is necessary.
Impact of Future Climate and Vegetation on the Hydrology of an Arctic Headwater Basin at the Tundra–Taiga Transition
Authors: Krogh Sebastian A. , Pomeroy John W. 
Published: December 2018

Abstract
The rapidly warming Arctic is experiencing permafrost degradation and shrub expansion. Future climate projections show a clear increase in mean annual temperature and increasing precipitation in the Arctic; however, the impact of these changes on hydrological cycling in Arctic headwater basins is poorly understood. This study investigates the impact of climate change, as represented by simulations using a high-resolution atmospheric model under a pseudo-global-warming configuration, and projected changes in vegetation, using a spatially distributed and physically based Arctic hydrological model, on a small headwater basin at the tundra–taiga transition in northwestern Canada. Climate projections under the RCP8.5 emission scenario show a 6.1°C warming, a 38% increase in annual precipitation, and a 19 W m−2 increase in all-wave annual irradiance over the twenty-first century. Hydrological modeling results suggest a shift in hydrological processes with maximum peak snow accumulation increasing by 70%, snow-cover duration shortening by 26 days, active layer deepening by 0.25 m, evapotranspiration increasing by 18%, and sublimation decreasing by 9%. This results in an intensification of the hydrological regime by doubling discharge volume, a 130% increase in spring runoff, and earlier and larger peak streamflow. Most hydrological changes were found to be driven by climate change; however, increasing vegetation cover and density reduced blowing snow redistribution and sublimation, and increased evaporation from intercepted rainfall. This study provides the first detailed investigation of projected changes in climate and vegetation on the hydrology of an Arctic headwater basin, and so it is expected to help inform larger-scale climate impact studies in the Arctic.
Focused extracorporeal shock wave therapy for greater trochanteric pain syndrome with gluteal tendinopathy: a randomized controlled trial
Authors: Carlisi Ettore , Cecini Miriam , Di Natali Giuseppe , Manzoni Federica , Tinelli Carmine , Lisi Claudio 
Published: December 2018

Objectives: To investigate if focused extracorporeal shock wave therapy (f-ESWT) is an effective treatment in a population affected by greater trochanteric pain syndrome (GTPS). Design: Randomized controlled trial, with blind outcome assessors. Setting: Outpatients, University Hospital. Subjects: A total of 50 patients affected by GTPS with gluteal tendinopathy. Interventions: The study group was assigned to receive f-ESWT, the control group received ultrasound therapy (UST). Main measures: We assessed hip pain and lower limb function by means of a numeric rating scale (p-NRS) and the Lower Extremity Functional Scale (LEFS scale), respectively. The first follow-up evaluation (2M-FUP) was performed two months after the first treatment session, the second (6M-FUP) was carried out six months later. Results: The mean age of the population was 61.24 (9.26) years. A marked prevalence of the female sex was recorded (44 subjects, 86%). The statistical analysis showed a significant pain reduction over time for the study group and the control group, the f-ESWT proving to be significantly more effective than UST ( P < 0.05) at the 2M-FUP (2.08 vs 3.36) and at the 6M-FUP (0.79 vs 2.03). A marked improvement of the LEFS total score was observed in both groups as well, but we found no statistical differences in the comparisons between groups. Conclusion: Our findings support the hypothesis that f-ESWT is effective in reducing pain, both in the short-term and in the mid-term perspective. We also observed a functional improvement in the affected lower limb, but, in this case, f-ESWT showed not to be superior to UST.
Effects of the Satir Model on Mental Health: A Randomized Controlled Trial
Authors: Lau Way Kwok-Wai , Leung Pamela Pui-Yu , Chung Catherine Lai-Ping 
Published: December 2018

Objective: This randomized controlled trial examined the effect of an intensive experiential workshop based on the Satir growth model (SGM) that aims at cultivating self-transformation. Method: Ninety-six adult participants were randomly assigned to the intervention group (52 participants) or the wait-list control group. The role of self-transformation, measured by the Perceived Self-Transformation Scale, in the relationship between affects and mental health problems was examined using mediation analyses. Results: After the workshop, the intervention group demonstrated higher levels of self-transformation (η2 = .308, p < .001), as well as significant improvement ( p < .001) in positive (η2 = .557) and negative (η2 = .293) affects, self-esteem (η2 = .538), spirituality (η2 = .473), and mental health problems (η2 = .386). Importantly, increased self-transformation after the workshop partially mediated the relationship between reduced negative affect and mental health problems in the intervention group (indirect effect: β = 0.163, 95% confidence interval [0.035, 0.343]). Conclusion: Findings of this study suggest that the SGM-based intervention can be effective in ameliorating mental health problems.
Providing End-of-Life Care: Increased Empathy and Self-efficacy Among Student Caregivers in Residential Homes for the Dying
Authors: Weisse Carol S. , Melekis Kelly , Hutchins Bailey 
Published: December 2018

Background: Health-care providers report a lack of training in end-of-life care and limited opportunities exist to learn about the dying process in home settings where most prefer to die. Aim: To evaluate the effectiveness of a Community Action, Research, and Education (CARE) program designed to promote empathy and self-efficacy communicating with and caring for terminally ill patients. Methods: This mixed-methods study collected pre–post data from 18 undergraduates (7 men≤ 11 women) in a 8-week immersive program where they served as primary caregivers in residential homes for the dying providing 200 hours of bedside care to hospice patients during their final days. Quantitative measures assessed empathy using the Jefferson Scale of Empathy-Health Professions (JSE-HPS) version and self-efficacy using a 20-question palliative care skill assessment. Qualitative analyses were conducted on reflective journals to further assess knowledge, skill, and value development. Results: Paired t tests revealed significant increases in empathy ( P < .05) and self-efficacy ( P < .001) to provide end-of-life care. Thematic analysis of reflective journals further demonstrated specific instances of empathy and self-efficacy. Conclusions: Community-run residential homes for the dying offer a unique opportunity for skills training in end-of-life care. The opportunity to serve as a caregiver for the dying improved students’ confidence and ability to provide empathic patient- and family-centered end-of-life care to hospice patients in their final days.
Healthy Eating Index: Assessment of the Diet Quality of a Brazilian Elderly Population
Authors: Fernandes Dalila Pinto de Souza , Lopes Duarte Maria Sônia , Pessoa Milene Cristine , Castro Franceschini Sylvia do Carmo , Queiroz Ribeiro Andréia 
Published: December 2018

Background: The food consumption assessment is necessary to monitor elderly’s nutritional status because it allows detecting nutrition deficits and guiding the elaboration of effective conducts. Objective: The objective of this study is to assess the global quality of the elderly’s diet in Viçosa—MG, Brazil. Methods: This is a population-based cross-sectional study, involving noninstitutionalized elderly. Diet quality was assessed through the Brazilian Healthy Eating Index-Revised (BHEI-R) validated to the Brazilian population. Results: The study comprised 620 elderly individuals. The mean total BHEI-R score was 64.28. The worse consumption scores concerned the components Whole grains, Milk and derivatives, Sodium, Total fruit, and Whole fruit. Approximately 82% scored zero (0%) for Whole grains and 67% for Sodium. Men presented significantly lower scores than women, who have presented maximal score in the same items. Women’s scores were not only significantly higher for Total fruit, Whole fruit, Milk and derivatives, but also significantly lower for Saturated fat. Discussion: Most elderly need to improve their diet quality. Strategies heading toward the improvement of diet quality must be priority in policies to health promotion toward the healthy and active aging.
Dermoscopic Monitoring for Treatment and Follow-Up of Actinic Keratosis With 5-Aminolaevulinic Acid Photodynamic Therapy
Authors: Xiaoqin Yang , Chan Hu , Long Wen , Yuting Xu , Keyal Uma , Guolong Zhang , Peiru Wang , Xiuli Wang 
Published: December 2018

Objectives: To assess the usefulness of dermoscopy in monitoring the treatment response and recurrence of actinic keratosis treated with 5-aminolaevulinic acid photodynamic therapy. Methods: In total, 35 patients with 75 actinic keratosis lesions were treated with 5-aminolaevulinic acid photodynamic therapy. The patients were divided randomly into 2 groups, dermoscopic group and the control group. Sixteen patients with 35 actinic keratosis lesions were treated with dermoscopic monitoring to determine the end point of the treatment. The remaining 19 patients with 40 skin lesions served as control and treated without dermoscopic monitoring and observed with naked eyes. At 1-year follow-up, patients were examined to look for the recurrence rate of the disease. Results: In the dermoscopic group, 1 (2.85%) of 35 actinic keratosis lesions showed recurrence of disease after 6 months of treatment. The recurrence was noted with red pseudo-network and scales at the treated site, whereas in the control group, 5 (12.5%) of 40 lesions showed recurrence. Conclusions: Dermoscopy can be a useful tool for monitoring the skin lesions in patients with actinic keratosis during photodynamic therapy and follow-up.