bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival and Outcome After Poor-Grade Aneurysmal Subarachnoid Hemorrhage in Elderly Patients
Authors: Goldberg Johannes , Schoeni Daniel , Mordasini Pasquale , Z’Graggen Werner , Gralla Jan , Raabe Andreas , Beck Jürgen , Fung Christian 
Published: December 2018

Background and Purpose—
Whether maximal treatment should be offered to elderly patients suffering from poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is controversial. The survival of patients in this subgroup beyond the usual outcome measurements 6 to 12 months after aSAH is unclear. The purpose of this study is to provide survival and outcome data to support clinicians making decisions on treatment for this subgroup of patients.

Methods—
We performed a retrospective analysis of the Bernese SAH database for poor-grade (World Federation of Neurosurgical Societies grade IV and V) elderly patients (age ≥60 years) suffering from aSAH admitted to our institution from 2005 to 2017. Patients were divided into 3 age groups (60–69, 70–79, and 80–90 years). Survival analysis was performed to estimate mean survival and hazard ratios for death. Binary logarithmic regression was used to estimate the odds ratio for favorable (modified Rankin Scale score of 0–3) and unfavorable (modified Rankin Scale score of 4–6) outcome.

Results—

Increasing age was associated with an increasing risk of death after aSAH. The hazard ratio increased by 6% per year of age (
P
<0.001; hazard ratio, 1.06; 95% CI, 1.03–1.09) and 76% per decade (
P
<0.001; hazard ratio, 1.76; 95% CI, 1.35–2.29). Mean survival was 56.3±8 months (patients aged 60–69 years), 31.6±7.6 months (70–79 years), and 7.6±5.8 months (80–90 years). Unfavorable outcomes 6 to 12 months after aSAH were strongly related to older age. The odds ratio increased by 11% per year of age (
P
<0.001; odds ratio, 1.11; 95% CI, 1.05–1.18) and 192% per decade (
P
<0.001; odds ratio, 2.92; 95% CI, 1.63–5.26).

Conclusions—
Risk for death and unfavorable outcome increases markedly with older age in elderly patients with poor-grade aSAH. Despite a high initial mortality, treatment resulted in a reasonable proportion of favorable outcomes up to 79 years of age and only a small number of patients who were moderately or severely disabled 6 to 12 months after aSAH. Mean survival and proportion of favorable outcomes decreased markedly in patients older than 80 years.
Increased Use of Ticagrelor After Myocardial Infarction Is Not Associated With Intracranial Hemorrhage
Authors: Graipe Anna , Söderström Lars , Mooe Thomas 
Published: December 2018

Background and Purpose—
Guidelines recommend dual antiplatelet treatment with ticagrelor instead of clopidogrel after acute myocardial infarction. Ticagrelor increases major and minor noncoronary artery bypass graft bleeding compared with clopidogrel, but whether the risk of intracranial hemorrhage (ICH) increases is unknown. We aimed to examine any association between ticagrelor and ICH and to identify predictors of ICH among unselected patients after acute myocardial infarction.

Methods—
Patients with acute myocardial infarction were identified using the Register of Information and Knowledge About Swedish Heart Intensive Care Admissions, and the data were combined with the Swedish National Patient Registry to identify ICH occurrence. To avoid obvious selection bias related to the choice of dual antiplatelet treatment, we divided the study cohorts into 2 time periods of similar length using the first prescription of ticagrelor as a cutoff point (December 20, 2011). The risk of ICH during the first period (100% clopidogrel treatment) versus the second period (52.1% ticagrelor and 47.8% clopidogrel treatment) was assessed using Kaplan-Meier analysis. Cox proportional-hazards regression analyses, with assessment of interactions between all significant variables, were used to identify predictors of ICH.

Results—

The analysis included 47 674 patients with acute myocardial infarction. The cumulative incidence of ICH during the first period was 0.59% (91 cases [95% CI, 0.49–0.69]) versus 0.52% (97 cases [95% CI, 0.43–0.61]) during the second period (
P
=0.83).

In multivariable Cox analysis, study period (second versus first period) was not predictive of ICH. Interaction analyses showed that age and prior cardiovascular morbidities were of importance in predicting the risk of ICH.

Conclusions—
The increased use of ticagrelor was not associated with ICH, whereas age and prior cardiovascular morbidities were related to the risk of ICH and interacted significantly.
Feasibility of Thrombectomy in Treating Acute Ischemic Stroke Because of Cervical Artery Dissection
Authors: Li Shun , Zi Wenjie , Chen Jingjing , Zhang Shuai , Bai Yongjie , Guo Yongtao , Shang Xianjin , Sun Bo , Liang Meng , Liu Yong , Wan Yue , Wang Mengmeng , Zhao Min , Liu Rui , Zhu Wusheng , Liu Xinfeng , Xu Gelin 
Published: December 2018

Background and Purpose—
Acute ischemic stroke caused by cervical artery dissection tend to result in unfavorable outcomes even with appropriate medical treatment. This study evaluated the safety and effectiveness of endovascular thrombectomy in treating acute ischemic stroke associated with cervical artery dissection.

Methods—
Patients with acute ischemic stroke and with large artery occlusion associated with dissection were selected. Propensity score matching was performed to increase the comparability. Patients with a 90-day modified Rankin Scale score of 0 to 2 were defined as with favorable outcome.

Results—

Eighty patients with and 80 patients without thrombectomy were enrolled. After propensity score matching, 48 patients with and 48 patients without thrombectomy were matched for further analysis. Proportion of favorable outcome (modified Rankin Scale score of 0–2) was higher in patients with thrombectomy than in those without (66.7% versus 39.6%;
P
=0.008). There were no significance differences about the incidence of symptomatic intracranial hemorrhage (8.3% versus 4.2%;
P
=0.677) and the 90-day mortality (10.4% versus 6.3%;
P
=0.714) between matched patients with and without thrombectomy.

Conclusions—
Endovascular thrombectomy seems to be an effective treatment in selected patients with acute ischemic stroke associated with cervical artery dissection, but the safety of thrombectomy needs further research.
Severe Lesions Involving Cortical Cholinergic Pathways Predict Poorer Functional Outcome in Acute Ischemic Stroke
Authors: Qu Jian-Feng , Chen Yang-Kun , Luo Gen-Pei , Zhao Jiang-Hao , Zhong Huo-Hua , Yin Han-Peng 
Published: December 2018

Background and Purpose—
The aim of the study was to assess the effect of lesion severity in cortical cholinergic pathways in acute ischemic stroke patients on functional outcomes.

Methods—
The study sample consisted of 214 men (70.9%) and 88 women (29.1%) with acute ischemic stroke. We used the Cholinergic Pathways Hyperintensities Scale (CHIPS) to assess the severity of lesions in cortical cholinergic pathways using brain magnetic resonance imaging. The other magnetic resonance imaging parameters included infarction, white matter lesions, and medial temporal lobe atrophy. Functional outcome was assessed using the Lawton activities of daily living (ADL) scale at 3 and 6 months after the index stroke. We also assessed disability status using the modified Rankin Scale.

Results—

Univariate analysis showed that patients with poor functional outcomes were older, more likely to be men, had a higher National Institutes of Health Stroke Scale (NIHSS) score on admission, and had more frequent histories of previous stroke and infection complications. They also had significantly more frequent cortical infarcts, left subcortical infarcts, a larger infarct volume, more severe medial temporal lobe atrophy, and periventricular hyperintensities, and higher CHIPS scores. In the multiple regression analysis, model 1 showed that age and NIHSS score on admission were significant predictors of poor ADL at 3 months, with an
R
2
of 45.4% fitting the model. Age, NIHSS score on admission and stroke subtype were also significant predictors of poor ADL at 6 months, with an
R
2
of 37.9% fitting the model. In model 2, sex, previous stroke, NIHSS score on admission, right cortical infarcts, left subcortical infarcts and CHIPS score were significant predictors for poor ADL at 3 months, with an
R
2
of 53.5%. NIHSS score on admission, stroke subtype, and CHIPS score were significant predictors for poor ADL at 6 months, with an
R
2
of 40.2%. After adjustment for confounders, CHIPS score was also a significant predictor for poor modified Rankin Scale, both at 3 and 6 months. Even after removing patients with moderate-to-severe white matter lesions, higher CHIPS scores still correlated with poorer ADL and modified Rankin Scale both at both 3 and 6 months.

Conclusions—
In patients with acute ischemic stroke, cortical cholinergic pathways impairment is common, and the severity of lesions in the cortical cholinergic pathways may significantly predict a poorer functional outcome.

Clinical Trial Registration—

URL:
http://www.chictr.org.cn/index.aspx
. Unique identifier: ChiCTR1800014982.
Temporal Trends in Emergency Medical Services and General Practitioner Use for Acute Stroke After Australian Public Education Campaigns
Authors: Bray Janet E. , Finn Judith , Cameron Peter , Smith Karen , Straney Lahn , Cartledge Susie , Nehme Ziad , Lim Michael , Bladin Christopher 
Published: December 2018

Background and Purpose—
The Australian Stroke Foundation ran annual paid advertising between 2004 and 2014, using the FAST (Face, Arm, Speech, Time) campaign from 2006 and adding the message to call emergency medical services in 2007. In this study, we examined temporal trends in emergency medical services use and referrals from general practitioners in the Australian state of Victoria to evaluate the impact of these campaigns.

Methods—
Using data from 33 public emergency departments, contributing to the Victorian Emergency Minimum Dataset, we examined trends in emergency department presentations for 118 000 adults with an emergency diagnosis of stroke or transient ischemic attack between 2003 and 2015. Annual trends were examined using logistic regression using a precampaign period (January 2003 to August 2004) as reference and adjusting for demographic variables.

Results—

Compared with the precampaign period, significant increases in emergency medical services use were seen annually between 2008 and 2015 (all
P
<0.001, eg, 2015; adjusted odds ratio, 1.16; 95% CI, 1.10–1.23). In contrast, a decrease was seen in patients presenting via general practitioners across all campaign years (all
P
<0.001, eg, 2015; adjusted odds ratio, 0.48; 95% CI, 0.44–0.53).

Conclusions—
Since the Stroke Foundation campaigns began, a greater proportion of stroke and transient ischemic attack patients are presenting to hospital by emergency medical services and appear to be bypassing their general practitioners.
Fatal Stroke in Pregnancy and the Puerperium
Authors: Lappin Julia M. , Darke Shane , Duflou Johan , Kaye Sharlene , Farrell Michael 
Published: December 2018

Background and Purpose—
Fatal stroke during pregnancy and the puerperium is rare. Pregnancy-related hypertension and vascular abnormalities underlie significant proportions of pregnancy-related stroke, but up to one-quarter are of no known cause.

Methods—
Case series of fatal pregnancy-related stroke. All cases where the cause of death was attributed to stroke during pregnancy/postpartum were retrieved from the National Coronial Information System database (January 1, 2009 to December 31, 2016).

Results—
Fourteen fatal strokes were identified, all hemorrhagic in origin. Underlying causes included pregnancy-related hypertension, rupture of vascular malformations, vasculitis, and cardiomyopathy.

Conclusions—
Fatal pregnancy-related stroke occurred secondary to hemorrhages of heterogeneous causes, including pregnancy-related hypertension and previously undiagnosed risk factors.
Samuel Beckett in Virtual Reality: Exploring Narrative Using Free Viewpoint Video
Authors: O’Dwyer Néill , Johnson Nicholas , Bates Enda , Pagés Rafael , Ondřej Jan , Amplianitis Konstantinos , Monaghan David , Smolic Aljoša 
Published: December 2018

Abstract
This article describes an investigation of interactive narrative in virtual reality (VR) through Samuel Beckett's theatrical text Play. Actors are captured in a green screen environment using free-viewpoint video (FVV). Built in a game engine, the scene is complete with binaural spatial audio and six degrees of freedom of movement. The project explores how ludic qualities in the original text elicit the conversational and interactive specificities of the digital medium. The work affirms potential for interactive narrative in VR, opens new experiences of the text and highlights the reorganization of the author-audience dynamic.
Observed Rainfall Trends over Singapore and the Maritime Continent from the Perspective of Regional-Scale Weather Regimes
Authors: Hassim Muhammad E. E. , Timbal Bertrand 
Published: December 2018

AbstractStraddling the Asian–Australian monsoon region, the Maritime Continent (MC) experiences substantial rainfall variations from diurnal to interannual and longer time scales. In this study, rainfall over Singapore and the wider MC region are analyzed using objectively identified weather regimes. Eight regional-scale weather regimes are derived byk-means clustering of local vertical profiles of zonal and meridional winds, temperature, and specific humidity extracted over Singapore from ERA-Interim data for the period December 1980–November 2014. The composite synoptic flow and rainfall patterns over the region show that the weather regimes correspond to the seasonal migration of the intertropical convergence zone (ITCZ) across the equator. For Singapore, the regimes depict seasonal rainfall variability by capturing the alternating dry and wet phases of the prevailing local monsoon and transition periods associated with the regional-scale ITCZ movement. Following previous work, the regimes are used to examine the annual rainfall trend by calculating the contributions due to 1) changes in regime frequency, indicating regional-scale circulation changes, and 2) changes in within-regime precipitation, indicating altered thermodynamic conditions. The overall trend observed at Singapore and many other MC locations is overwhelmingly due to changes in within-regime precipitation. However, the overall trend masks the larger contribution resulting from regime frequency changes as these circulation changes tend to offset one another in reality. In many MC areas (including Singapore), summed rainfall changes due to regime frequency changes outweigh those due to changes in within-regime rainfall, when aggregated in an absolute sense.
A Systematic Comparison of Tropical Waves over Northern Africa. Part I: Influence on Rainfall
Authors: Schlueter Andreas , Fink Andreas H. , Knippertz Peter , Vogel Peter 
Published: December 2018

Abstract
Low-latitude rainfall variability on the daily to intraseasonal time scale is often related to tropical waves, including convectively coupled equatorial waves, the Madden–Julian oscillation (MJO), and tropical disturbances (TDs). Despite the importance of rainfall variability for vulnerable societies in tropical Africa, the relative influence of tropical waves for this region is largely unknown. This article presents the first systematic comparison of the impact of six wave types on precipitation over northern tropical Africa during the transition and full monsoon seasons, using two satellite products and a dense rain gauge network. Composites of rainfall anomalies in the different datasets show comparable modulation intensities in the West Sahel and at the Guinea Coast, varying from less than 2 to above 7 mm day−1 depending on the wave type. African easterly waves (AEWs) and Kelvin waves dominate the 3-hourly to daily time scale and explain 10%–30% locally. On longer time scales (7–20 days), only the MJO and equatorial Rossby (ER) waves remain as modulating factors and explain about up to one-third of rainfall variability. Eastward inertio-gravity waves and mixed Rossby–gravity (MRG) waves are comparatively unimportant. An analysis of wave superposition shows that low-frequency waves (MJO, ER) in their wet phase amplify the activity of high-frequency waves (TD, MRG) and suppress them in the dry phase. The results stress that more attention should be paid to tropical waves when forecasting rainfall over northern tropical Africa.
An Objective Climatology of Tropical Cyclone Diurnal Pulses in the Atlantic Basin
Authors: Ditchek Sarah D. , Molinari John , Corbosiero Kristen L. , Fovell Robert G. 
Published: December 2018

Abstract
Storm-centered IR brightness temperature imagery was used to create 6-h IR brightness temperature difference fields for all Atlantic basin tropical cyclones from 1982 to 2017. Pulses of colder cloud tops were defined objectively by determining critical thresholds for the magnitude of the IR differences, areal coverage of cold-cloud tops, and longevity. Long-lived cooling pulses (≥9 h) were present on 45% of days overall, occurring on 80% of major hurricane days, 64% of minor hurricane days, 46% of tropical storm days, and 24% of tropical depression days. These cooling pulses propagated outward between 8 and 14 m s−1. Short-lived cooling pulses (3–6 h) were found 26.4% of the time. Some days without cooling pulses had events of the opposite sign, which were labeled warming pulses. Long-lived warming pulses occurred 8.5% of the time and propagated outward at the same speed as their cooling pulse counterparts. Only 12.2% of days had no pulses that met the criteria, indicating that pulsing is nearly ubiquitous in tropical cyclones. The environment prior to outward propagation of cooling pulses differed from warming pulse and no pulse days by having more favorable conditions between 0000 and 0300 LT for enhanced inner-core convection: higher SST and ocean heat content, more moisture throughout the troposphere, and stronger low-level vorticity and upper-level divergence.
Strength Outlooks for the El Niño–Southern Oscillation
Authors: L’Heureux Michelle L. , Tippett Michael K. , Takahashi Ken , Barnston Anthony G. , Becker Emily J. , Bell Gerald D. , Di Liberto Tom E. , Gottschalck Jon , Halpert Michael S. , Hu Zeng-Zhen , Johnson Nathaniel C. , Xue Yan , Wang Wanqiu 
Published: December 2018

Abstract
Three strategies for creating probabilistic forecast outlooks for El Niño–Southern Oscillation (ENSO) are compared. One is subjective and is currently used by the NOAA/Climate Prediction Center (CPC) to produce official ENSO outlooks. A second is purely objective and is based on the North American Multimodel Ensemble (NMME). A new third strategy is proposed in which the forecaster only provides the expected value of the Niño-3.4 index, and then categorical probabilities are objectively determined based on past skill. The new strategy results in more confident probabilities compared to the subjective approach and higher verification scores, while avoiding the significant forecast busts that sometimes afflict the NMME-based objective approach. The higher verification scores of the new strategy appear to result from the added value that forecasters provide in predicting the mean, combined with more reliable representations of uncertainty, which is difficult to represent because forecasters often assume less confidence than is justified. Moreover, the new approach can produce higher-resolution probabilistic forecasts that include ENSO strength information and that are difficult, if not impossible, for forecasters to produce. To illustrate, a nine-category ENSO outlook based on the new strategy is assessed and found to be skillful. The new approach can be applied to other outlooks where users desire higher-resolution probabilistic forecasts, including the extremes.
Amnion-derived mesenchymal stem cells improve viability of endothelial cells exposed to shear stress in ePTFE grafts
Authors: Pfeiffer Dagmar , Wankhammer Karin , Stefanitsch Christina , Hingerl Kerstin , Huppertz Berthold , Dohr Gottfried , Desoye Gernot , Lang Ingrid 
Published: December 2018

Purpose: Blood vessel reconstruction is an increasing need of patients suffering from cardiovascular diseases. For the development of microvascular prostheses, efficient endothelialization is mandatory to prevent graft occlusion. Here, we assessed the impact of amnion-derived mesenchymal stem/stromal cells (hAMSC), known for their important angiogenic potential, on the integrity and stability of endothelial cells exposed to shear stress in vascular grafts. Methods: Human placental endothelial cells (hPEC) were cultured at the inner surface of an expanded polytetrafluoroethylene (ePTFE) graft positioned within a bioreactor and exposed to a minimal shear stress of 0.015 dyne/cm2 or a physiological shear stress of 0.92 dyne/cm2. hAMSC attached to the outer graft surface were able to interact with human placental endothelial cells by paracrine factors. Results: Microscopical analysis and evaluation of glucose/lactate metabolism evidenced successful cell seeding of the graft: hPEC formed a stable monolayer, hAMSC showed a continuous growth during 72 h incubation. hAMSC improved the viability of hPEC exposed to 0.015 dyne/cm2 as shown by a decreased lactate dehydrogenase release of 13% after 72 h compared to hPEC single culture. The viability-enhancing effect of hAMSC on hPEC was further improved by 13% under physiological shear stress. Angiogenesis array analysis revealed that hPEC exposed to physiological shear stress and hAMSC co-culture reduced the secretion of angiogenin, GRO, MCP-1, and TIMP-2. Conclusion: hAMSC exerted best survival-enhancing effects on hPEC under exposure to physiological shear stress and modulated endothelial function by paracrine factors. Our data support further studies on the development of grafts functionalized with hAMSC–derived secretomes to enable fast clinical application.
Plasma rich in growth factors for the treatment of dry eye from patients with graft versus host diseases
Authors: Sanchez-Avila Ronald M , Merayo-Lloves Jesus , Muruzabal Francisco , Orive Gorka , Anitua Eduardo 
Published: December 2018

Purpose: To evaluate the efficacy and safety of plasma rich in growth factors eye drops for the treatment of corneal and ocular surface disorders in patients with graft versus host disease. Methods: This retrospective and longitudinal study included graft versus host disease patients with ocular disorders. The resolution of corneal ulcers (area and density staining) was evaluated as primary outcome. Best corrected visual acuity, intraocular pressure, tear film breakup time, Schirmer test, ocular surface disease index, and visual analog score were evaluated as secondary outcomes. All variables were analyzed before and after plasma rich in growth factors treatment. The safety of plasma rich in growth factors treatment was also assessed. Results: Twelve patients (23 eyes) with ocular graft versus host disease were evaluated. Statistically significant improvement in the area (75.7%) and density (73.3%) of the corneal staining, in best corrected visual acuity (74.7%), in ocular surface disease index scale (75.4%), visual analog score frequency (81.4%) and visual analog score severity (81.9%), and an increase of 3.8 s in tear film breakup time and 6 mm in Schirmer test was observed after plasma rich in growth factors treatment (p < 0.001). Some potential modifiers of the therapeutic effect were identified. All patients achieved corneal stability without perforation risk. No adverse events associated with the plasma rich in growth factors were observed. Conclusion: Immunosafe plasma rich in growth factors eye drops for the treatment of patients with ocular graft versus host disease could be safe and effective, showing a high rate of corneal ulcer resolution and dry eye disease control. Plasma rich in growth factors eye drops may help to maintain corneal stability and prevent it against higher ocular complications.