bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of Corticospinal Tract Lesion for Predicting Outcome in Small Perfusion Stroke
Authors: Zhou Ying , Zhang Ruiting , Yan Shenqiang , Zhang Meixia , Chen Zhicai , Hu Haitao , Zhang Minming , Bivard Andrew , Lin Longting , Parsons Mark W. , Lou Min 
Published: October 2018

Background and Purpose—
Whether patients with small perfusion lesions benefit from thrombolysis remains an uncertainty. We assessed acute ischemic stroke patients with a total perfusion lesion of <15 mL and tested the hypothesis the pattern of corticospinal tract (CST) involvement might predict outcome in thrombolysis-eligible patients.

Methods—
We used a prospectively collected cohort of acute ischemic stroke patients being assessed for thrombolysis at 7 centers. Three neurologists categorized the presence of hypoperfusion and infarction within CST. Excellent outcome was defined as 90-day modified Rankin Scale score 0 to 1.

Results—

Of 2654 patients, 407 had a perfusion lesion <15 mL and were clinically eligible for thrombolysis (243 being treated). Median National Institutes of Health Stroke Scale was 5.0, and 312 (76.7%) patients achieved excellent outcome. Alteplase treatment was an independent unfavorable factor for excellent outcome (alteplase-treated 72.0% versus untreated 83.5%; odds ratio, 0.541;
P
=0.025). For patients with CST hypoperfusion without CST infarction, alteplase treatment was an independent favorable factor for excellent outcome (alteplase-treated 75.6% versus untreated 47.1%; odds ratio, 4.096;
P
=0.045). Among patients with CST infarction, alteplase treatment was an independent unfavorable factor for excellent outcome (alteplase-treated 30.6% versus untreated 88.9%; odds ratio, 0.002;
P
=0.003). Among patients without either CST hypoperfusion or CST infarction, alteplase treatment was not an independent influencing factor for excellent outcome (alteplase-treated 80.1% versus untreated 87.7%;
P
=0.258).

Conclusions—
Only patients with CST hypoperfusion without CST infarction among eligible acute ischemic stroke patients with small perfusion lesions could benefit from thrombolysis, which needs to be confirmed in future prospective studies. Patient selection, including an assessment of lesion location rather than purely lesion volume, may be ideal.
Cav-1 (Caveolin-1) and Arterial Remodeling in Adult Moyamoya Disease
Authors: Chung Jong-Won , Kim Dong Hee , Oh Mi Jeong , Cho Yeon Hee , Kim Eun Hee , Moon Gyeong Joon , Ki Chang-Seok , Cha Jihoon , Kim Keon Ha , Jeon Pyoung , Yeon Je Young , Kim Gyeong-Moon , Kim Jong-Soo , Hong Seung Chyul , Bang Oh Young 
Published: October 2018

Background and Purpose—
Moyamoya disease (MMD) is a unique cerebrovascular occlusive disease characterized by progressive stenosis and negative remodeling of the distal internal carotid artery (ICA). We hypothesized that cav-1 (caveolin-1)—a protein that controls the regulation of endothelial vesicular trafficking and signal transduction—is associated with negative remodeling in MMD.

Methods—

We prospectively recruited 77 consecutive patients with MMD diagnosed via conventional angiography. Seventeen patients with intracranial atherosclerotic stroke and no
RNF213
mutation served as controls. The outer distal ICA diameters were examined using high-resolution magnetic resonance imaging. We evaluated whether the degree of negative remodeling in the patients with MMD was associated with
RNF213
polymorphism, cav-1 levels, or various clinical and vascular risk factors. We also investigated whether the derived factor was associated with negative remodeling at the cellular level using the tube formation and apoptosis assays.

Results—

The serum cav-1 level was lower in the patients with MMD than in the controls (0.47±0.29 versus 0.86±0.68 ng/mL;
P
=0.034). The mean ICA diameter was 2.48±0.98 mm for the 126 affected distal ICAs in patients with MMD and 3.84±0.42 mm for the asymptomatic ICAs in the controls (
P
<0.001). After adjusting for confounders, cav-1 levels (coefficient, 1.018;
P
<0.001) were independently associated with the distal ICA diameter in patients with MMD. In vitro analysis showed that cav-1 downregulation suppressed angiogenesis in the endothelial cells and induced apoptosis in the smooth muscle cells.

Conclusions—
Our findings suggest that cav-1 may play a major role in negative arterial remodeling in MMD.
Cancer Exacerbates Ischemic Brain Injury Via Nrp1 (Neuropilin 1)-Mediated Accumulation of Regulatory T Cells Within the Tumor
Authors: Wang Long , Zhou Yuxi , Yin Jiemin , Gan Yu , Wang Xin , Wen Daxiang , Thomson Angus W. , Hu Xiaoming , Yang Liqun , Stetler R. Anne , Li Peiying , Yu Weifeng 
Published: October 2018

Background and Purpose—
Adoptive transfer of regulatory T cells (Tregs) protect against stroke; however, Treg-based therapy raises concerns in stroke patients with cancer because of the immunosuppressive function of Tregs. The purpose of this study was to investigate the role of Tregs in cerebral ischemic brain injury with concomitant cancer.

Methods—

To establish a cancer phenotype, MC38 colon cancer or B16 melanoma cells (5×10
5
/mice) were injected subcutaneously into C57BL/6J mice 2 to 3 weeks before distal middle cerebral artery occlusion surgery. Infarct volume, neuroinflammation, and Tregs infiltration were measured by 2,3,5-triphenyltetrazolium chloride staining, immunofluorescence staining, real-time polymerase chain reaction, and flow cytometry. Mechanistically, Nrp1 (neuropilin-1) monoclonal antibody was used to block the Nrp1 effect on Tregs ex vivo before being transferred into recombination activating gene 1 (Rag1-/-) stroke mice, which are devoid of T and B cells, or a Nrp1 neutralization antibody was injected systemically into cancer-bearing wild-type mice after stroke.

Results—
Cancer-bearing mice with stroke exhibited augmented neuroinflammation and fewer Tregs in the brain, but more infiltration of Tregs to the tumor was apparent after distal middle cerebral artery occlusion. Depletion of Tregs increased infarct volume in stroke mice but did not further exacerbate brain injury in cancer-bearing stroke mice. Nrp1 blocking ex vivo or Nrp1 systemic neutralization attenuated ischemic brain injury and reversed accumulation of Tregs within tumor after stroke in cancer-bearing mice.

Conclusions—
Nrp1 signaling mediated accumulation of Tregs within tumor might play a critical role in exacerbating ischemic brain injury in cancer-bearing mice and may represent a promising immune modulatory target for the combined condition of cancer and stroke.
Direct Transfer to Angio-Suite to Reduce Workflow Times and Increase Favorable Clinical Outcome
Authors: Mendez Beatriz , Requena Manuel , Aires Ana , Martins Nuno , Boned Sandra , Rubiera Marta , Tomasello Alejandro , Coscojuela Pilar , Muchada Marián , Rodríguez-Luna David , Rodríguez-Villatoro Noelia , Juega Jesús , Pagola Jorge , Molina Carlos A. , Ribó Marc 
Published: October 2018

Background and Purpose—
Time to reperfusion is fundamental in reducing morbidity and mortality in acute stroke. We aimed to demonstrate that direct transfer to angio-suite (DTAS) of patients with suspected large vessel occlusion stroke improves workflow times and outcomes.

Methods—
A case-control matched study of the first 79 DTAS patients with confirmed large vessel occlusion (cases) and 145 no-DTAS patients (controls). DTAS protocol included a cone beam computed tomography in the angio-suite to rule out intracerebral hemorrhage for those patients with no prior neuroimaging in a referring center. Cases and controls were matched by location of vessel occlusion, age, baseline National Institutes of Health Stroke Scale (NIHSS) score and time from symptoms onset to Comprehensive Stroke Center arrival. Dramatic clinical improvement was defined as a decrease in NIHSS score of >10 points or final NIHSS score of ≤2. Favorable outcome was defined as modified Rankin Scale score of ≤2 at 90 days.

Results—

During an 18 months period a total of 97 patients were directly transferred to the angio-suite after admission: 11 (11.6%) showed an intracerebral hemorrhage on cone beam computed tomography, 7 (7.2%) did not have a large vessel occlusion on initial angiogram, and 79 (76.3%) had a large vessel occlusion and received endovascular treatment (cases). There were no differences in age, baseline NIHSS score, level of occlusion and time from onset-to-door between cases and controls. The median door-to-groin time (16 [12–20] versus 70 [45–105] minutes;
P
<0.01) and onset-to-groin times (222 [152–282] versus 259 [190–345] minutes;
P
<0.01) were shorter in the DTAS group. At 24 hours, DTAS patients presented lower NIHSS score (7 [4–16] versus 14 [4–20];
P
=0.01), higher rate of dramatic improvement (50.6% Vs. 31.7%;
P
=0.04), and higher rate of favorable clinical outcome at 90 days (41% versus 28%;
P
=0.05). A logistic regression model adjusting for all matching variables showed that DTAS protocol was independently associated with 3 months favorable outcome (odds ratio, 2.5; 95% CI, 1.2–5.3;
P
=0.01).

Conclusions—
DTAS is an effective strategy to reduce workflow time which may significantly increase the odds of achieving a favorable outcome.
Dual-Task Exercise Reduces Cognitive-Motor Interference in Walking and Falls After Stroke
Authors: Pang Marco Yiu Chung , Yang Lei , Ouyang Huixi , Lam Freddy Man Hin , Huang Meizhen , Jehu Deborah Ann 
Published: October 2018

Background and Purpose—
Functional community ambulation requires the ability to perform mobility and cognitive task simultaneously (dual-tasking). This single-blinded randomized controlled study aimed to examine the effects of dual-task exercise in chronic stroke patients.

Methods—
Eighty-four chronic stroke patients (24 women; age, 61.2±6.4 years; time since stroke onset, 75.3±64.9 months) with mild to moderate motor impairment (Chedoke-McMaster leg motor score: median, 5; interquartile range, 4–6) were randomly allocated to the dual-task balance/mobility training group, single-task balance/mobility group, or upper-limb exercise (control) group. Each group exercised for three 60-minute sessions per week for 8 weeks. The dual-task interference effect was measured for the time to completion of 3 mobility tests (forward walking, timed-up-and-go, and obstacle crossing) and for the correct response rate during serial-3-subtractions and verbal fluency task. Secondary outcomes included the Activities-specific Balance Confidence Scale, Frenchay Activities Index, and Stroke-specific Quality of Life Scale. The above outcomes were measured at baseline, immediately after, and 8 weeks after training. Fall incidence was recorded for a 6-month period posttraining.

Results—

Only the dual-task group exhibited reduced dual-task interference in walking time posttraining (forward walking combined with verbal fluency [9.5%,
P
=0.014], forward walking with serial-3-subtractions [9.6%,
P
=0.035], and the timed-up-and-go with verbal fluency [16.8%,
P
=0.001]). The improvements in dual-task walking were largely maintained at the 8-week follow-up. The dual-task cognitive performance showed no significant changes. The dual-task program reduced the risk of falls and injurious falls by 25.0% (95% CI, 3.1%–46.9%;
P
=0.037) and 22.2% (95% CI, 4.0%–38.4%;
P
=0.023), respectively, during the 6-month follow-up period compared with controls. There was no significant effect on other secondary outcomes (
P
>0.05).

Conclusions—
The dual-task program was effective in improving dual-task mobility, reducing falls and fall-related injuries in ambulatory chronic stroke patients with intact cognition. It had no significant effect on activity participation or quality of life.

Clinical trial registration—

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02270398.
An Evaluation of Paired Regional/Convection-Allowing Forecast Vertical Thermodynamic Profiles in Warm-Season, Thunderstorm-Supporting Environments
Authors: Evans Clark , Weiss Steven J. , Jirak Israel L. , Dean Andrew R. , Nevius David S. 
Published: October 2018

Abstract
This study evaluates forecast vertical thermodynamic profiles and derived thermodynamic parameters from two regional/convection-allowing model pairs, the North American Mesoscale Forecast System and the North American Mesoscale Nest model pair and the Rapid Refresh and High Resolution Rapid Refresh model pair, in warm-season, thunderstorm-supporting environments. Differences in bias and mean absolute error between the regional and convection-allowing models in each of the two pairs, while often statistically significant, are practically small for the variables, parameters, and vertical levels considered, such that the smaller-scale variability resolved by convection-allowing models does not degrade their forecast skill. Model biases shared by the regional and convection-allowing models in each pair are documented, particularly the substantial cool and moist biases in the planetary boundary layer arising from the Mellor–Yamada–Janjić planetary boundary layer parameterization used by the North American Mesoscale model and the Nest version as well as the middle-tropospheric moist bias shared by the Rapid Refresh and High Resolution Rapid Refresh models. Bias and mean absolute errors typically have larger magnitudes in the evening, when buoyancy is a significant contributor to turbulent vertical mixing, than in the morning. Vertical thermodynamic profile biases extend over a deep vertical layer in the western United States given strong sensible heating of the underlying surface. The results suggest that convection-allowing models can fulfill the use cases typically and historically met by regional models in operations at forecast entities such as the Storm Prediction Center, a fruitful finding given the proposed elimination of regional models with the Next-Generation Global Prediction System initiative.
High expression of E-cadherin and Ki-67 associated with functional/dysfunctional phenotypes of tumor-infiltrating lymphocytes among Chinese patients with operable breast cancer
Authors: Wang Ruibin , Shi Feng , Zhao Lin , Zhao Yanjie , Wu Guangjiang , Song Qing-Kun 
Published: October 2018

Objective Breast cancer has become the most common cancer in women in China, and the clinicopathological features differ from those in Western patients. This study was performed to investigate the distribution of programmed cell death protein 1 (PD-1)+/PD-1− tumor-infiltrating lymphocytes (TILs) and its association with clinicopathological features among Chinese patients with breast cancer. Methods In total, 133 consecutive patients with primary breast cancer were recruited into this cross-sectional study from 2012 to 2013. TILs were measured by cell counts under high-power fields (HPFs). Immunohistochemistry was used to detect PD-1 expression on tumor-infiltrating lymphocytes in the microenvironment. Results The median cell counts of the overall TILs, PD-1+ TILs, and PD-1− TILs were 80, 18, and 55/HPF, respectively. The number of PD-1− TILs was significantly lower in older than younger patients (50 vs. 60/HPF). Patients with positive E-cadherin expression had more PD-1− TILs than patients with negative E-cadherin expression (57 vs. 27/HPF). The Ki-67 index was positively correlated with the cell counts of PD-1+ TILs, and the correlation coefficient was 0.29. Conclusions PD-1 expression on TILs had different clinicopathological features in Chinese patients with breast cancer. E-Cadherin expression was associated with PD-1− TILs; however, Ki-67 expression was associated with PD-1+ TILs.
Prognostic impact of right bundle branch block in hospitalized patients with idiopathic dilated cardiomyopathy: a single-center cohort study
Authors: Lai Li , Jiang Rong , Fang Wei , Yan Chao , Tang Yibin , Hua Wei , Fu Michael , Li Xiaoping , Luo Rong 
Published: October 2018

Objective Idiopathic dilated cardiomyopathy (IDCM) is a primary myocardial disease resulting in symptoms of heart failure. Right bundle branch block (RBBB) is associated with increased cardiovascular risk and all-cause mortality. Therefore, the present study was performed to identify the prognostic impact of RBBB in patients with IDCM. Methods In total, 165 hospitalized patients with IDCM were evaluated. Receiver operating characteristic curve analysis was used to determine the cutoff point, and Cox regression was used to assess risk factors. Results After a median follow-up of 73.1 months (interquartile range, 36.1–88.7 months), 59 (35.8%) patients had died. All-cause mortality was significantly higher in patients with than without RBBB (log-rank χ2 = 9.400), P<0.05. Significant independent predictors of all-cause mortality in patients with IDCM were RBBB (hazard ratio, 2.898; 95% confidence interval, 1.201–6.995) and the left ventricular end-diastolic dimension (LVEDD) (hazard ratio, 1.034; 95% confidence interval, 1.004–1.066) at admission. Patients with RBBB and an LVEDD of ≥63 mm had the highest mortality (log-rank χ2 = 14.854), P<0.05. Conclusion RBBB was an independent predictor of all-cause mortality, and the combination of RBBB and LVEDD provided more clinically relevant information than RBBB alone for assessing the risk of all-cause mortality in patients with IDCM.
Effects of bone cement filling in rabbit proximal femoral medullary cavity on distal femoral blood flow and metabolism
Authors: Xi Li-Cheng , Li Hong-Yu , Zhang Ming , Huang Si-Cheng 
Published: October 2018

Objective A rabbit model was used to evaluate the effects of bone-cemented hip arthroplasty on distal femoral blood flow and metabolism relative to that of the non-cemented contralateral leg. Methods The marrow cavity of the right hind femur was filled with bone cement. At each of the following time points, rabbits were randomly selected to receive an injection of one dose of 99mTc-methylene diphosphonate and then immediately scanned using a gamma camera: immediately postoperatively and at 4 and 8 weeks postoperatively. A BL-410 model biofunction experimental system was used to analyze the acquired images and determine the radioactive counts of each hind leg. Results The X-ray and photographic images of the right femoral bones confirmed successful filling of the marrow cavity with bone cement. The radioactive counts were significantly lower in the experimental than control legs at each time point. The ratio of the radioactive count of the experimental to control leg increased considerably at each time point, but each ratio was <1. Conclusion Blocking the proximal femoral medullary cavity with bone cement was associated with significant lowering of the blood circulation of the femur and marrow, decreasing the distal femoral blood flow and bone metabolic rate.
Neonatal nurse practitioner ethics knowledge and attitudes
Authors: Famuyide Mobolaji , Compretta Caroline , Ellis Melanie 
Published: October 2018

Background: Neonatal nurse practitioners have become the frontline staff exposed to a myriad of ethical issues that arise in the day-to-day environment of the neonatal intensive care unit. However, ethics competency at the time of graduation and after years of practice has not been described. Research aim: To examine the ethics knowledge base of neonatal nurse practitioners as this knowledge relates to decision making in the neonatal intensive care unit and to determine whether this knowledge is reflected in attitudes toward ethical dilemmas in the neonatal intensive care unit. Research design: This was a prospective cohort study that examined decision making at the threshold of viability, life-sustaining therapies for sick neonates, and a ranking of the five most impactful ethical issues. Participants and research context: All 47 neonatal nurse practitioners who had an active license in the State of Mississippi were contacted via e-mail. Surveys were completed online using Survey Monkey software. Ethical considerations: The study was approved by the University of Mississippi Medical Center Institutional Review Board (IRB; #2015-0189). Findings: Of the neonatal nurse practitioners who completed the survey, 87.5% stated that their religious practices affected their ethical decision making and 76% felt that decisions regarding life-sustaining treatment for a neonate should not involve consultation with the hospital’s legal team or risk management. Only 11% indicated that the consent process involved patient understanding of possible procedures. Participating in the continuation or escalation of care for infants at the threshold of viability was the top ethical issue encountered by neonatal nurse practitioners. Discussion: Our findings reflect deficiencies in the neonatal nurse practitioner knowledge base concerning ethical decision making, informed consent/permission, and the continuation/escalation of care. Conclusion: In addition to continuing education highlighting ethics concepts, exploring the influence of religion in making decisions and knowing the most prominent dilemmas faced by neonatal nurse practitioners in the neonatal intensive care unit may lead to insights into potential solutions.
Study of the use of complementary and alternative medicine by cancer patients at Kenyatta National Hospital, Nairobi, Kenya
Authors: Ong’udi Maryanne , Mutai Pegotty , Weru Irene 
Published: October 2018

Introduction Cancer is not only a burden in the country but also a global burden with among the highest rate of mortality. In spite of the great strides made by the conventional therapy, many cancer patients have resorted to using complementary and alternative medicine (CAM) as human beings have an innate urge to try new and alternative ways to relieve their suffering. Objectives There is a need for us to establish if the cancer patients at Kenyatta National Hospital, Nairobi use CAM, to establish the socio-demographic characteristics of patients in the oncology clinic, to establish the types and patterns of CAM use, to establish the reasons and factors that may contribute to CAM use and if the primary health care provider is aware that they are using CAM. Methodology Face-to-face interviews using semi-structured questionnaires were used to determine the use of CAM by the cancer patients. All consenting cancer patients who satisfied the inclusion criteria were interviewed as they presented to the oncology clinic. Results A total of 78 respondents were interviewed during the study out of which 35 (44.9%) were male, while 43 (55.1%) were female. The age distribution was from 18 to above. Eleven patients (14.1%) have used CAM at one point during their treatment. The use of CAM was not affected by the age, gender, and marital status, level of education and level of income. The most frequently used CAM was herbal medicine; 64.0% of the patients used CAM with the hope of curing their disease, while 36.0% used it with the hope of getting symptomatic relief. Among the CAM users, only 45.0% were satisfied with the use of it, while 55.0% were disappointed as it did not meet their expectations and would therefore never recommend the of CAM to anyone else; 27.0% obtained some benefit from the use of CAM, 27.0% did not experience any benefit and a further 46.0% were unclear about any notable benefit experienced; 55.0% of the CAM users had disclosed their use of CAM to the doctor, while 45.0% did not disclose this reason mostly because they do not feel it is important to let the doctor know as he/she never asks. Conclusion The prevalence of CAM use among cancer patients in Kenyatta National Hospital ranks lower compared to other countries. The most common type of CAM in use is herbal medicine. However, most patients do not obtain the expected benefits and do not disclose this information to the doctors as they feel it is not important.