bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aqp-1
Gene Knockout Attenuates Hypoxic Pulmonary Hypertension of Mice
Authors: Liu Mingcheng , Liu Qiwang , Pei Yandong , Gong Miaomiao , Cui Xiaolin , Pan Jinjin , Zhang Yunlong , Liu Yang , Liu Ying , Yuan Xiaocheng , Zhou Haoran , Chen Yiying , Sun Jian , Wang Lin , Zhang Xiya , Wang Rui , Li Shao , Cheng Jizhong , Ding Yanchun , Ma Tonghui , Yuan Yuhui 
Published: December 2018

Objective—
Hypoxic pulmonary hypertension (HPH) is characterized by proliferative vascular remodeling. Abnormal pulmonary artery smooth muscle cells proliferation and endothelial dysfunction are the primary cellular bases of vascular remodeling. AQP1 (aquaporin-1) is regulated by oxygen level and has been observed to play a role in the proliferation and migration of pulmonary artery smooth muscle cells. The role of AQP1 in HPH pathogenesis has not been directly determined to date. To determine the possible roles of AQP1 in the pathogenesis of HPH and explore its possible mechanisms.

Approach and Results—

Aqp1
knockout mice were used, and HPH model was established in this study. Primary pulmonary artery smooth muscle cells, primary mouse lung endothelial cells, and lung tissue sections from HPH model were used. Immunohistochemistry, immunofluorescence and Western blot, cell cycle, apoptosis, and migration analysis were performed in this study. AQP1 expression was upregulated by chronic hypoxia exposure, both in pulmonary artery endothelia and medial smooth muscle layer of mice.
Aqp1
deficiency attenuated the elevation of right ventricular systolic pressures and mitigated pulmonary vascular structure remodeling. AQP1 deletion reduced abnormal cell proliferation in pulmonary artery and accompanied with accumulation of HIF (hypoxia-inducible factor). In vitro,
Aqp1
deletion reduced hypoxia-induced proliferation, apoptosis resistance, and migration ability of primary cultured pulmonary artery smooth muscle cells and repressed HIF-1α protein stability. Furthermore,
Aqp1
deficiency protected lung endothelial cells from apoptosis in response to hypoxic injury.

Conclusions—

Our data showed that
Aqp1
deficiency could attenuate hypoxia-induced vascular remodeling in the development of HPH. AQP1 may be a potential target for pulmonary hypertension treatment.
Association of Kidney Function With 30-Day and 1-Year Poststroke Mortality and Hospital Readmission
Authors: El Husseini Nada , Fonarow Gregg C. , Smith Eric E. , Ju Christine , Sheng Shubin , Schwamm Lee H. , Hernandez Adrian F. , Schulte Phillip J. , Xian Ying , Goldstein Larry B. 
Published: December 2018

Background and Purpose—
Kidney dysfunction is common among patients hospitalized for ischemic stroke. Understanding the association of kidney disease with poststroke outcomes is important to properly adjust for case mix in outcome studies, payment models and risk-standardized hospital readmission rates.

Methods—
In this cohort study of fee-for-service Medicare patients admitted with ischemic stroke to 1579 Get With The Guidelines-Stroke participating hospitals between 2009 and 2014, adjusted multivariable Cox proportional hazards models were used to determine the independent associations of estimated glomerular filtration rate (eGFR) and dialysis status with 30-day and 1-year postdischarge mortality and rehospitalizations.

Results—
Of 204 652 patients discharged alive (median age [25th–75th percentile] 80 years [73.0–86.0], 57.6% women, 79.8% white), 48.8% had an eGFR ≥60, 26.5% an eGFR 45 to 59, 16.3% an eGFR 30 to 44, 5.1% an eGFR 15 to 29, 0.6% an eGFR <15 without dialysis, and 2.8% were receiving dialysis. Compared with eGFR ≥60, and after adjusting for relevant variables, eGFR <45 was associated with increased 30-day mortality with the risk highest among those with eGFR <15 without dialysis (hazard ratio [HR], 2.09; 95% CI, 1.66–2.63). An eGFR <60 was associated with increased 1-year poststroke mortality that was highest among patients on dialysis (HR, 2.65; 95% CI, 2.49–2.81). Dialysis was also associated with the highest 30-day and 1-year rehospitalization rates (HR, 2.10; 95% CI, 1.95–2.26 and HR, 2.55; 95% CI, 2.44–2.66, respectively) and 30-day and 1-year composite of mortality and rehospitalization (HR, 2.04; 95% CI, 1.90–2.18 and HR, 2.46; 95% CI, 2.36–2.56, respectively).

Conclusions—
Within the first year after index hospitalization for ischemic stroke, eGFR and dialysis status on admission are associated with poststroke mortality and hospital readmissions. Kidney function should be included in risk-stratification models for poststroke outcomes.
Endocrine Regulator rFGF21 (Recombinant Human Fibroblast Growth Factor 21) Improves Neurological Outcomes Following Focal Ischemic Stroke of Type 2 Diabetes Mellitus Male Mice
Authors: Jiang Yinghua , Liu Ning , Wang Qingzhi , Yu Zhanyang , Lin Li , Yuan Jing , Guo Shuzhen , Ahn Bum Ju , Wang Xiao-Jie , Li Xiaokun , Lo Eng H. , Sun Xiaochuan , Wang Xiaoying 
Published: December 2018

Background and Purpose—
The complexity and heterogeneity of stroke, as well as the associated comorbidities, may render neuroprotective drugs less efficacious in clinical practice. Therefore, the development of targeted therapies to specific patient subsets has become a high priority in translational stroke research. Ischemic stroke with type 2 diabetes mellitus has a nearly double mortality rate and worse neurological outcomes. In the present study, we tested our hypothesis that rFGF21 (recombinant human fibroblast growth factor 21) administration is beneficial for improving neurological outcomes of ischemic stroke with type 2 diabetes mellitus.

Methods—
Type 2 diabetes mellitus db/db and nondiabetic genetic control db/+ mice were subjected into permanent focal ischemia of distal middle cerebral artery occlusion, we examined the effects of poststroke administration with rFGF21 in systemic metabolic disorders, inflammatory gatekeeper PPARγ (peroxisome proliferator-activated receptor γ) activity at 3 days, mRNA expression of inflammatory cytokines and microglia/macrophage activation at 7 days in the perilesion cortex, and last neurological function deficits, ischemic brain infarction, and white matter integrity up to 14 days after stroke of db/db mice.

Results—
After permanent focal ischemia, diabetic db/db mice presented confounding pathological features, including metabolic dysregulation, more severe brain damage, and neurological impairment, especially aggravated proinflammatory response and white matter integrity loss. However, daily rFGF21 treatment initiated at 6 hours after stroke for 14 days significantly normalized systemic metabolic disorders, rescued PPARγ activity decline, inhibited proinflammatory cytokine mRNA expression, and M1-like microglia/macrophage activation in the brain. Importantly, rFGF21 also significantly reduced white matter integrity loss, ischemic brain infarction, and neurological function deficits up to 14 days after stroke. The potential mechanisms of rFGF21 may in part consist of potent systematic metabolic regulation and PPARγ-activation promotion-associated antiproinflammatory roles in the brain.

Conclusions—
Taken together, these results suggest rFGF21 might be a novel and potent candidate of the disease-modifying strategy for treating ischemic stroke with type 2 diabetes mellitus.
The 2CAN Score
Authors: Chang Philip , Ruff Ilana , Mendelson Scott J. , Caprio Fan , Bergman Deborah L. , Prabhakaran Shyam 
Published: December 2018

Background and Purpose—
A quarter of acute strokes occur in patients hospitalized for another reason. A stroke recognition instrument may be useful for non-neurologists to discern strokes from mimics such as seizures or delirium. We aimed to derive and validate a clinical score to distinguish stroke from mimics among inhospital suspected strokes.

Methods—
We reviewed consecutive inpatient stroke alerts in a single academic center from January 9, 2014, to December 7, 2016. Data points, including demographics, stroke risk factors, stroke alert reason, postoperative status, neurological examination, vital signs and laboratory values, and final diagnosis, were collected. Using multivariate logistic regression, we derived a weighted scoring system in the first half of patients (derivation cohort) and validated it in the remaining half of patients (validation cohort) using receiver operating characteristics testing.

Results—
Among 330 subjects, 116 (35.2%) had confirmed stroke, 43 (13.0%) had a neurological mimic (eg, seizure), and 171 (51.8%) had a non-neurological mimic (eg, encephalopathy). Four risk factors independently predicted stroke: clinical deficit score (clinical deficit score 1: 1 point; clinical deficit score ≥2: 3 points), recent cardiac procedure (1 point), history of atrial fibrillation (1 point), and being a new patient (<24 hours from admission: 1 point). The score showed excellent discrimination in the first 165 patients (derivation cohort, area under the curve=0.93) and remaining 165 patients (validation cohort, area under the curve=0.88). A score of ≥2 had 92.2% sensitivity, 69.6% specificity, 62.2% positive predictive value, and 94.3% negative predictive value for identifying stroke.

Conclusions—
The 2CAN score for recognizing inpatient stroke performs well in a single-center study. A future prospective multicenter study would help validate this score.
National Institutes of Health Stroke Scale Zero Strokes
Authors: Eskioglou Elissavet , Huchmandzadeh Millotte Mitra , Amiguet Michael , Michel Patrik 
Published: December 2018

Background and Purpose—
We aimed to characterize acute ischemic stroke patients who have an immeasurable deficit on the admission National Institutes of Health Stroke Scale (NIHSS), and to evaluate their long-term outcome.

Methods—
We retrospectively compared all acute ischemic stroke patients with an admission NIHSS of 0 in the Acute Stroke Registry and Analysis of Lausanne from 2003 to 2013 with all other acute ischemic stroke patients. We compared demographics, clinical, radiological, and laboratory findings. Outcome was considered favorable at 3 months if the modified Rankin Scale score corrected for prestroke disability was ≤1. Stroke recurrences >12 months were also assessed.

Results—
Comparing 108 NIHSS zero (NIHSS=0) patients with the 2889 other strokes by multivariate analysis, NIHSS=0 had lower prestroke disability, longer onset-to-hospital delays and more lacunar and infratentorial strokes. NIHSS=0 patients were less likely to have early ischemic changes on acute computed tomography, had less arterial pathology and lower creatinine levels. They were more likely to have favorable modified Rankin Scale score after correction for prestroke modified Rankin Scale score (zero versus others: 83.2% versus 44.6%) and less likely to die (3.9% versus 13.3%) at 12 months. Stroke and transient ischemic attack recurrence rates were similar (11% versus 11.4%), however.

Conclusions—
Patients with NIHSS=0 strokes are characterized by lacunar and infrantentorial strokes, normal acute computed tomography, and less arterial pathology. However, a significant proportion face recurrent ischemic events and persistent handicap at 12 months. Therefore, NIHSS=0 stroke patients require aggressive secondary prevention and adequate follow-up.
Infections Increase the Risk of 30-Day Readmissions Among Stroke Survivors
Authors: Boehme Amelia K. , Kulick Erin R. , Canning Michelle , Alvord Trevor , Khaksari Bijan , Omran Setareh , Willey Joshua Z. , Elkind Mitchell S.V. 
Published: December 2018

Background and Purpose—
Hospitals are increasingly using 30-day readmission (30dRA) to define the quality of care and reimbursement. We hypothesized that common infections occurring during the stroke stay are associated with 30dRA.

Methods—

We conducted a weighted analysis of the federally managed 2013 National Readmission Database to assess the relationship between infection during a stroke hospitalization and 30dRA among ischemic stroke survivors. Ischemic stroke, common infections (defined as sepsis, pneumonia, and urinary tract infection), and comorbidities were identified using
International Classification of Diseases Ninth Revision
(
ICD-9
) diagnosis codes, and intravenous tPA (tissue-type plasminogen activator) or intra-arterial therapy was identified using
ICD-9
procedure codes. Survey design logistic regression models were fit to estimate crude and adjusted odds ratios and 95% CI for the association between infections and 30dRA.

Results—
Among 319 317 ischemic stroke patients, 12.1% were readmitted within 30 days, and 29% had an infection during their index hospitalization. Patients with infection during their stroke admission had a 21% higher odds of being readmitted than patients without any type of infection (adjusted odds ratio, 1.21; 95% CI, 1.16–1.26). The association between infection and unplanned readmission was similar with an increased odds of unplanned readmission (adjusted odds ratio, 1.23; 95% CI, 1.18–1.29). When assessing specific types of infections, only urinary tract infections were associated with 30dRA in adjusted models (odds ratio, 1.10; 95% CI, 1.04–1.16).

Conclusions—
In a nationally representative cohort, patients who had a common infection during their stroke hospitalization were at increased odds of being readmitted. Patients with infection may benefit from earlier poststroke follow-up or closer monitoring.
Normalized Hail Particle Size Distributions from the T-28 Storm-Penetrating Aircraft
Authors: Field Paul R. , Heymsfield Andrew J. , Detwiler Andrew G. , Wilkinson Jonathan M. 
Published: December 2018

AbstractHail and graupel are linked to lightning production and are important components of cloud evolution. Hail can also cause significant damage when it precipitates to the surface. The accurate prediction of the amount and location of hail and graupel and the effects on the other hydrometeor species depends upon the size distribution assumed. Here, we use ~310 km of in situ observations from flights of the South Dakota School of Mines and Technology T-28 storm-penetrating aircraft to constrain the representation of the particle size distribution (PSD) of hail. The maximum ~1-km hail water content encountered was 9 g m−3. Optical probe PSD measurements are normalized using two-moment normalization relations to obtain an underlying exponential shape. By linking the two normalizing moments through a power law, a parameterization of the hail PSD is provided based on the hail water content only. Preliminary numerical weather simulations indicate that the new parameterization produces increased radar reflectivity relative to commonly used PSD representations.
Evaluating the Reliability of the U.S. Cooperative Observer Program Precipitation Observations for Extreme Events Analysis Using the LTAR Network
Authors: Demaria Eleonora M. C. , Goodrich David C. , Kunkel Kenneth E. 
Published: December 2018

AbstractThe detection and attribution of changes in precipitation characteristics relies on dense networks of rain gauges. In the United States, the COOP network is widely used for such studies even though there are reported inconsistencies due to changes in instruments and location, inadequate maintenance, dissimilar observation time, and the fact that measurements are made by a group of dedicated volunteers. Alternately, the Long-Term Agroecosystem Research (LTAR) network has been consistently and professionally measuring precipitation since the early 1930s. The purpose of this study is to compare changes in extreme daily precipitation characteristics during the warm season using paired rain gauges from the LTAR and COOP networks. The comparison, done at 12 LTAR sites located across the United States, shows underestimation and overestimation of daily precipitation totals at the COOP sites compared to the reference LTAR observations. However, the magnitude and direction of the differences are not linked to the underlying precipitation climatology of the sites. Precipitation indices that focus on extreme precipitation characteristics match closely between the two networks at most of the sites. Our results show consistency between the COOP and LTAR networks with precipitation extremes. It also indicates that despite the discrepancies at the daily time steps, the extreme precipitation observed by COOP rain gauges can be reliably used to characterize changes in the hydrologic cycle due to natural and human causes.
Impact of Timing Between Insulin Administration and Meal Consumption on Glycemic Fluctuation and Outcomes in Hospitalized Patients With Type 2 Diabetes
Authors: Lim Shu Fang , Jong Michelle , Chew Daniel Ek Kwang , Lee Joyce Yu-Chia 
Published: December 2018

Background The effect of time interval from insulin injection to meal consumption (“insulin-meal”) on glycemic fluctuation and outcomes is not well understood. Objective This study aims to investigate the impact of coordinated versus mismatched insulin-meal administration on glycemic fluctuation and outcomes among hospitalized patients with type 2 diabetes (T2D). Methods Hospitalized patients with T2D who received at least 1 dose of insulin as part of sliding scale regimen were included. Data such as capillary blood glucose values and insulin-meal time intervals were collected. Results A total of 215 patients with 840 insulin-meal encounters were eligible for the study. Compared to the insulin-meal mismatch group (n = 206), the coordinated insulin-meal administration group (n = 9) had lower mean glycemic fluctuation (6.5 [2.6] mmol/L vs 5.6 [2.5] mmol/L or 117 [47] mg/dL vs 100 [45] mg/dL). Encounters with the insulin-meal time interval of 30 to 45 minutes (n = 172) were associated with the lowest percentage of severe hyperglycemia occurrences (13%) as compared to encounters with time interval of 0 to 29 minutes (n = 280, 15%) and more than 45 minutes (n = 246, 16%). Conclusion Coordinated insulin-meal administration was associated with lower glycemic fluctuation among hospitalized patients with T2D.
Pilot Study of Visual and Quantitative Image Analysis of Facial Surface Asymmetry in Unilateral Complete Cleft Lip and Palate
Authors: Kimura Namiko , Kim Hyoungseop , Okawachi Takako , Fuchigami Takao , Tezuka Masahiro , Kibe Toshiro , Amir Muhammad Subhan , Inada Emi , Ishihata Kiyohide , Nozoe Etsuro , Nakamura Norifumi 
Published: December 2018

Objective: To visualize and quantitatively analyze facial surface asymmetry following primary cleft lip repair in patients with unilateral cleft lip and palate (UCLP) and to compare this with noncleft controls. Design: Retrospective comparative study. Patients: Twenty-two patients with complete UCLP who underwent primary lip repair from 2009 to 2013 were enrolled in this study. The preserved 3-dimensional (3D) data of 23 healthy Japanese participants with the same age were used as controls. Interventions: All patients had received primary labioplasty in accordance with Cronin triangular flap method with orbicular oris muscle reconstruction. Main Outcome Measures: Shadow and zebra images established from moiré images, which were reconstructed from 3D facial data using stereophotogrammetry, were bisected and reversed by the symmetry axes (the middle line of the face). The discrepancies of the gravity and density between cleft and noncleft sides in 2 regions of interest, facial and lip areas, were then calculated and compared with those of healthy participants. Results: In the UCLP group, the mean discrepancies of gravity on shadow and zebra images were 1.76 ± 0.70 and 2.63 ± 1.72 pixels, respectively, in the facial area and 1.31 ± 0.36 and 3.83 ± 2.08 pixels, respectively, in the lip area. There was a significant difference in the mean discrepancies of gravity and density on zebra images in the lip area between the UCLP and control groups. Conclusions: Our image analysis of digital facial surface asymmetry in patients with UCLP provides visual and quantitative information, and it may contribute to improvements in muscle reconstruction on cleft lip repair.
Ocular manifestations of hydroa vacciniforme in a Black child
Authors: Höllhumer Roland 
Published: December 2018

Purpose: To report the clinical presentation (systemic and ocular) of hydroa vacciniforme in a Black South African child. Methods: Case report. Results: A 14-year-old Black boy was seen at the corneal service with cutaneous erosions, varioliform scarring, corneal scarring, cicatricial conjunctivitis and central crystalline corneal opacity. Conclusion: We report the first case in the literature of ocular hydroa vacciniforme in a young Black South Africa boy.
Comparison of alteplase and urokinase for pharmacomechanical thrombolysis of clotted hemodialysis access
Authors: Tan Ru Yu , Pang Suh Chien , Teh Swee Ping , Lee Kian Guan , Chong Tze Tec , Gogna Apoorva , Tan Chieh Suai 
Published: December 2018

Background: Percutaneous pharmacomechanical thrombolysis is increasingly used to salvage thrombosed hemodialysis access. We aim to evaluate the effectiveness of alteplase compared to urokinase in percutaneous pharmacomechanical thrombolysis clotted access. Methods: Records of patients who underwent pharmacomechanical thrombolysis at Interventional Nephrology Suite in a tertiary teaching hospital from 1 January 2016 to 31 December 2016 were reviewed. Technical and clinical success rates, thrombosis-free and cumulative survivals, procedure time, and radiation dose imparted to patients were compared for pharmacomechanical thrombolysis with urokinase versus alteplase. Results: A total of 122 incident patients underwent pharmacothrombolysis (n = 53 for urokinase, n = 69 for alteplase) during the study period. The mean dose of urokinase and alteplase used was 176,897 ± 73,418 units and 3.7 ± 0.8 mg, respectively. Pharmacomechnical thrombolysis using urokinase versus alteplase has similar technical success rate (98.1% vs 97.1%, p = 0.599), clinical success rate (88.7% vs 97.1%, p = 0.068), complication rate (9.4% vs 13.0%, p = 0.373), and primary patency rates at 3 months (57.1% vs 70.1%, p = 0.106). Thrombosis-free survivals of the vascular access were 113.2 (35.3, 196) days versus 122 (84, 239) days (p = 0.168). Cumulative survivals were 239 (116, 320) vs 213 (110.5, 316.5) days (p = 0.801). Procedure time, fluoroscopy time, skin dose, and dose were significantly lower for pharmacomechanical thrombolysis using alteplase compared to urokinase (p = 0.045, p < 0.0001, p = 0.006, p = 0.001, respectively). Stenting was found to be associated with successful dialysis following thrombolysis on univariate analysis (odds ratio: 9.167, 95% confidence interval: 1.391–19.846, p = 0.021), although this was no longer significant in multivariate analysis (p = 0.078). Conclusion: Alteplase is an effective and safe alternative to urokinase for pharmacomechanical thrombolysis of clotted vascular access.