bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous Thrombolytic Therapy in Acute Stroke
Authors: Tong David C , Yenari Midori A , Albers Greg W 
Published: January 2017

The article reviews the experimental basis of thrombolytic therapy, and summarizes the results of the recent trials of thrombolysis. Five large clinical trails have evaluated intravenous thrombolytic therapy for the treatment of hyperacute (< 6 h) stroke. Three of these studies were negative, one was equivocal, and one was strongly positive. The failure to demonstrate efficacy definitively in four of these trials may be related to a number of methodological factors, including the type and dose of drug administered, the timing of drug administered, and the method of patient selection for treatment. The NINDS recombinant tissue plasminogen activator (rt-PA) study showed that thrombolytic therapy can be of substantial benefit when administered within 3 h of stroke onset using strict patient selection criteria and rt-PA is now FDA approved for treatment of acute stroke. However, the risk of clinically significant bleeding is elevated. To achieve the favorable risk/benefit ratio demonstrated in the NINDS trial, patients must be screened by experienced clinicians for contraindications to thrombolysis and the acute computerized tomography (CT) brain scan must be carefully, evaluated for radiographic features that increase the risk of cerebral hemorrhage. Guidelines for the use of rt-PA are provided, as well as insights into future thrombolytic treatment strategies.
Intraductal Papillary Mucinous Tumor of the Pancreas (IPMT): Follow-Up of Twelve Cases
Authors: Khalid A. , Funch-Jensen P. , Bendix J. , Hamilton S. Dutoit , Kruse A. , Mortensen F. Viborg 
Published: January 2017

Introduction: Intraductal papillary mucinous tumours (IPMT) were described as a distinct entity in I982. The extent of surgical resection for this disease remains controversial. Methods: Twelve patients with a diagnosis of IPMT were included in the present retrospective study. Results: Ten out of twelve patients had symptoms suggesting chronic pancreatitis. Two patients were not operated on due to biopsy-verified metastases in the liver. Nine patients were treated with a total pancreatectomy and one with a pancreaticoduodenectomy. In the ten patients operated on for IPMT, histological examination showed eight non-invasive- and two invasive carcinomas. In six cases, multifocal extensive intraductal changes were found, affecting either most of or the whole pancreas. There was no perioperative mortality. Six patients were alive at follow-up without recurrence and four patients were dead, two of them with recurrence. Conclusion: IPMTs represent a subgroup of pancreatic neoplasms with a favourable prognosis, and the resection should aim at removing all dysplastic foci. In cases with diffuse dilatation of the main pancreatic duct, widespread tumour involvement of the duct system can be expected and total pancreatectomy should be the operation of choice.
Accuracy of Sentinel Node Biopsy in Breast Cancer Patients with a High Prevalence of Axillary Metastases
Authors: Moghimi M. , Ghoddosi I. , Rahimabadi A. E. , Sheikhvatan M. 
Published: January 2017

Background: Sentinel lymph node biopsy (SLNB) has become a standard diagnostic tool for axillary staging of breast cancer and has many advantages in comparison with axillary dissection. The goal of our study was to determine accuracy and predictive value of SLNB for assessing the axillary lymph nodes involvement in breast cancer. Materials and Methods: Thirty three patients with breast cancer at Mehr and Taleghani hospitals in Tehran between July 2005 and 2006 were randomly selected. All women underwent presurgical lymphoscintigraphic mapping followed by sentinel node biopsy guided by intraoperative gamma probe and blue dye. Sentinel nodes were examined by standard hematoxylin and eosin (H&E) staining. Among studied patients, T1 stage accounted for 3%% of the patients, T2 for 6%, T3 for 66.7% and T4 for 24.3%. Statistical analyses were performed by evaluating of sensitivity, specificity, accuracy, and positive and negative predictive values of SLNB in comparison to axillary lymph node dissection (ALND). Results: The sentinel lymph nodes in 30.3% of patients were well imaged by lymphoscintigraphy. A mean of 4.8 sentinel lymph nodes were removed per patient. Sensitivity and specificity of SLNB were 92% and 87.5%, respectively. Totally, in comparison to ALND, the accuracy of SLNB was 90.9% and false negative rate of this method was also 8%. Conclusion: Our experience shows SLNB to be reliable and accurate for axillary staging in breast cancer patients with a high prevalence of axillary metastases and can be replaced diagnostic ALND in our breast cancer centers.
Endovascular Management of Central Retinal Arterial Occlusion
Authors: Agarwal Nitin , Gala Nihar B. , Baumrind Benjamin , Hansberry David R. , Thabet Ahmad M. , Gandhi Chirag D. , Prestigiacomo Charles J. 
Published: January 2017

Background and Importance: Central retinal artery occlusion (CRAO) is an ophthalmologic emergency due to the sudden cessation of circulation to the inner retinal layer. Without immediate treatment, permanent blindness may ensue. Several treatment options exist, ranging from noninvasive medical management to thrombolysis. Nonetheless, ongoing debate exists regarding the best therapeutic strategy. Case Presentation: The authors present the case of a 78-year-old woman with a medical history of hypercholesterolemia and rheumatoid arthritis who experienced complete loss of vision in her left eye. Following ophthalmologic evaluation demonstrating left CRAO, anterior chamber paracentesis was performed. Endovascular intervention was performed via local intra-arterial fibrinolysis with alteplase. Her vision returned to 20/20 following the procedure. In general, conventional therapies have not significantly improved patient outcomes. Conclusion: Several management options exist for CRAO. In general, conservative measures have not been reported to yield better patient outcomes as compared to the natural history of this medical emergency. Endovascular approaches are another option as observed with this case reported. In cases of CRAO, therapeutic strategies such as intra-arterial fibrinolysis utilize a local infusion of reactive tissue plasminogen activator directly at the site of occlusion via catheterization of the ophthalmic artery. Although several case series do show promising results after treating CRAO with intra-arterial fibrinolysis, further studies are required given the reports of complications.
Angiographic Findings and Clinical Significance of the Anterior and Posterior Spinal Arteries in Therapeutic Parent Artery Occlusion for Vertebral Artery Aneurysms
Authors: Iwai T. , Naito I. , Shimaguchi H. , Suzuki T. , Tomizawa S. 
Published: January 2017

Three of 16 patients with vertebral artery (VA) aneurysms treated by parent artery occlusion suffered ischemic complications. The cause of the ischemic complications was brain stem or upper cervical spinal cord infarction due to occlusion of the anterior spinal artery (ASA), posterior spinal artery (PSA) and perforating arteries arising from the VA. Angiographic detection of ASA and PSA was studied in 71 consecutive patients (142 VAs) with various diseases who underwent digital subtraction angiography. The ASA and PSA originated from the bilateral VAs in 14% and 9%, unilateral VA in 73% and 35%, and were not detected in 13% and 56%, respectively. These results indicate that the rate of angiographic detection of the ASA originating from the bilateral VAs is considerably lower than that of previously reported anatomical studies. Special attention must be paid to the ASA, PSA and perforating arteries on preoperative vertebral angiography to prevent ischemic complications associated with therapeutic parent artery occlusion for VA aneurysms.
Associated Cerebral and Spinal AVM in Infant and Adult
Authors: Mazighi M. , Porter P. , Alvarez H. , Rodesch G. , Meisel J. , Brock M. , Lasjaunias P. 
Published: January 2017

We report two cases of a rare association of brain and spinal arteriovenous malformation (AVM) in an infant and in an adult. Both patients were embolised with glue with good clinical and morphological results. The first patient is an infant with a suspected family history of Rendu Osler Weber disease with multiple AVMs: two hemispheric cerebellar lesions (one of them revealed by a ventricular haemorrhage) and one cervical spinal cord AVM (SCAVM). The associated SCAVM fortuitously bled one month after treatment of the symptomatic cerebellar AV shunt. In the adult case, the management first involved a symptomatic SCAVM with favourable outcome; the cerebral AVM bled secondarily and was then excluded by endovascular approach.
Security of patient data when decommissioning ultrasound systems
Authors: Moggridge James 
Published: January 2017

Background Although ultrasound systems generally archive to Picture Archiving and Communication Systems (PACS), their archiving workflow typically involves storage to an internal hard disk before data are transferred onwards. Deleting records from the local system will delete entries in the database and from the file allocation table or equivalent but, as with a PC, files can be recovered. Great care is taken with disposal of media from a healthcare organisation to prevent data breaches, but ultrasound systems are routinely returned to lease companies, sold on or donated to third parties without such controls. Methods In this project, five methods of hard disk erasure were tested on nine ultrasound systems being decommissioned: the system’s own delete function; full reinstallation of system software; the manufacturer’s own disk wiping service; open source disk wiping software for full and just blank space erasure. Attempts were then made to recover data using open source recovery tools. Results All methods deleted patient data as viewable from the ultrasound system and from browsing the disk from a PC. However, patient identifiable data (PID) could be recovered following the system’s own deletion and the reinstallation methods. No PID could be recovered after using the manufacturer’s wiping service or the open source wiping software. Conclusion The typical method of reinstalling an ultrasound system’s software may not prevent PID from being recovered. When transferring ownership, care should be taken that an ultrasound system’s hard disk has been wiped to a sufficient level, particularly if the scanner is to be returned with approved parts and in a fully working state.
No Clinically Significant Difference Between Adult and Pediatric IKDC Subjective Knee Evaluation Scores in Adults
Authors: Stegmeier Nicole , Oak Sameer R. , O’Rourke Colin , Strnad Greg , Spindler Kurt P. , Jones Morgan , Farrow Lutul D. , Andrish Jack , Saluan Paul 
Published: January 2017

Background: Two versions of the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation form currently exist: the original version (1999) and a recently modified pediatric-specific version (2011). Comparison of the pediatric IKDC with the adult version in the adult population may reveal that either version could be used longitudinally. Hypothesis: We hypothesize that the scores for the adult IKDC and pediatric IKDC will not be clinically different among adult patients aged 18 to 50 years. Study Design: Randomized crossover study design. Level of Evidence: Level 2. Methods: The study consisted of 100 participants, aged 18 to 50 years, who presented to orthopaedic outpatient clinics with knee problems. All participants completed both adult and pediatric versions of the IKDC in random order with a 10-minute break in between. We used a paired t test to test for a difference between the scores and a Welch’s 2-sample t test to test for equivalence. A least-squares regression model was used to model adult scores as a function of pediatric scores, and vice versa. Results: A paired t test revealed a statistically significant 1.6-point difference between the mean adult and pediatric scores. However, the 95% confidence interval (0.54-2.66) for this difference did not exceed our a priori threshold of 5 points, indicating that this difference was not clinically important. Equivalence testing with an equivalence region of 5 points further supported this finding. The adult and pediatric scores had a linear relationship and were highly correlated with an R2 of 92.6%. Conclusion: There is no clinically relevant difference between the scores of the adult and pediatric IKDC forms in adults, aged 18 to 50 years, with knee conditions. Clinical Relevance: Either form, adult or pediatric, of the IKDC can be used in this population for longitudinal studies. If the pediatric version is administered in adolescence, it can be used for follow-up into adulthood.
Do primary care physicians use the 5As in counselling obese patients? A qualitative study
Authors: Lee Jean-Jasmin Mi-Li , Tung Yew Cheong , Tai Kit Ping , Tay Samantha Alexis , Cheng Shu Juan , Ang Seng Bin , Tan Ngiap Chuan 
Published: January 2017

Background: Obesity is a global public health problem. A systematic review showed that intensive behavioural counselling is effective in weight management amongst patients with obesity, but little is known if primary care physicians (PCPs) are involved in delivering such counselling. Studies revealed that patients had weight reduction if they were counselled by PCPs who used the 5As (Ask, Assess, Advise, Agree and Assist) method, but PCPs varied in their use of this tool. We aimed to explore the local PCP modalities of obesity counselling and if their approaches and methods corresponded to the 5As tool. Methods: Qualitative data were obtained from interviews with 50 PCPs from public and private primary care practices during six focus group discussions and seven in-depth interviews. The interviews were audio-recorded, transcribed, audited and analysed iteratively based on the grounded theory. Emergent themes were first externally validated, and then finalized after rounds of deliberations amongst the investigators. Results: PCPs varied in their approach in obesity counselling, focusing predominantly on “Ask”, “Assess” and “Advise” in the 5As tool. “Asking” was indirect and “Assessment” rarely covered the effects of obesity on psychosocial functioning. Dietary and lifestyle modifications were the main foci in “Advise”. “Agree” was least performed. Polyclinic doctors tended to “Assist” patients with referral to other healthcare workers for further weight management, but few deliberately “Arrange” to review progress in weight management, citing barriers. Conclusion: PCPs varied in their method of obesity counselling, pending on context and setting of their practices. In contrast to “Ask’, “Assess” and “Advise”, the use of “Agree” and “Arrange” was uncommon.
Ultrasensitive detection of oncogenic human papillomavirus in oropharyngeal tissue swabs
Authors: Isaac Andre , Kostiuk Morris , Zhang Han , Lindsay Cameron , Makki Fawaz , O'Connell Daniel A. , Harris Jeffrey R. , Cote David W. J. , Seikaly Hadi , Biron Vincent L. 
Published: January 2017

Background The incidence of oropharyngeal squamous cell carcinoma (OPSCC) caused by oncogenic human papillomavirus (HPV) is rising worldwide. HPV-OPSCC is commonly diagnosed by RT-qPCR of HPV E6 and E7 oncoproteins or by p16 immunohistochemistry (IHC). Droplet digital PCR (ddPCR) has been recently reported as an ultra-sensitive and highly precise method of nucleic acid quantification for biomarker analysis. To validate the use of a minimally invasive assay for detection of oncogenic HPV based on oropharyngeal swabs using ddPCR. Secondary objectives were to compare the accuracy of ddPCR swabs to fresh tissue p16 IHC and RT-qPCR, and to compare the cost of ddPCR with p16 IHC. Methods We prospectively included patients with p16+ oral cavity/oropharyngeal cancer (OC/OPSCC), and two control groups: p16− OC/OPSCC patients, and healthy controls undergoing tonsillectomy. All underwent an oropharyngeal swab with ddPCR for quantitative detection of E6 and E7 mRNA. Surgical specimens had p16 IHC performed. Agreement between ddPCR and p16 IHC was determined for patients with p16 positive and negative OC/OPSCC as well as for healthy control patients. The sensitivity and specificity of ddPCR of oropharyngeal swabs were calculated against p16 IHC for OPSCC. Results 122 patients were included: 36 patients with p16+OPSCC, 16 patients with p16−OPSCC, 4 patients with p16+OCSCC, 41 patients with p16−OCSCC, and 25 healthy controls. The sensitivity and specificity of ddPCR of oropharyngeal swabs against p16 IHC were 92 and 98% respectively, using 20–50 times less RNA than that required for conventional RT-qPCR. Overall agreement between ddPCR of tissue swabs and p16 of tumor tissue was high at κ = 0.826 [0.662-0.989]. Conclusion Oropharyngeal swabs analyzed by ddPCR is a quantitative, rapid, and effective method for minimally invasive oncogenic HPV detection. This assay represents the most sensitive and accurate mode of HPV detection in OPSCC without a tissue biopsy in the available literature.
Endothelial cell regulation of salivary gland epithelial patterning
Authors: Kwon Hae Ryong , Nelson Deirdre A. , DeSantis Kara A. , Morrissey Jennifer M. , Larsen Melinda 
Published: January 2017

ABSTRACT
Perfusion-independent regulation of epithelial pattern formation by the vasculature during organ development and regeneration is of considerable interest for application in restoring organ function. During murine submandibular salivary gland development, the vasculature co-develops with the epithelium during branching morphogenesis; however, it is not known whether the vasculature has instructive effects on the epithelium. Using pharmacological inhibitors and siRNA knockdown in embryonic organ explants, we determined that VEGFR2-dependent signaling is required for salivary gland epithelial patterning. To test directly for a requirement for endothelial cells in instructive epithelial patterning, we developed a novel ex vivo cell fractionation/reconstitution assay. Immuno-depletion of CD31+ endothelial cells in this assay confirmed a requirement for endothelial cells in epithelial patterning of the gland. Depletion of endothelial cells or inhibition of VEGFR2 signaling in organ explants caused an aberrant increase in cells expressing the ductal proteins K19 and K7, with a reduction in Kit+ progenitor cells in the endbuds of reconstituted glands. Addition of exogenous endothelial cells to reconstituted glands restored epithelial patterning, as did supplementation with the endothelial cell-regulated mesenchymal factors IGFBP2 and IGFBP3. Our results demonstrate that endothelial cells promote expansion of Kit+ progenitor cells and suppress premature ductal differentiation in early developing embryonic submandibular salivary gland buds.
Primate embryogenesis predicts the hallmarks of human naïve pluripotency
Authors: Boroviak Thorsten , Nichols Jennifer 
Published: January 2017

ABSTRACT
Naïve pluripotent mouse embryonic stem cells (ESCs) resemble the preimplantation epiblast and efficiently contribute to chimaeras. Primate ESCs correspond to the postimplantation embryo and fail to resume development in chimaeric assays. Recent data suggest that human ESCs can be ‘reset’ to an earlier developmental stage, but their functional capacity remains ill defined. Here, we discuss how the naïve state is inherently linked to preimplantation epiblast identity in the embryo. We hypothesise that distinctive features of primate development provide stringent criteria to evaluate naïve pluripotency in human and other primate cells. Based on our hypothesis, we define 12 key hallmarks of naïve pluripotency, five of which are specific to primates. These hallmarks may serve as a functional framework to assess human naïve ESCs.
Vegfd modulates both angiogenesis and lymphangiogenesis during zebrafish embryonic development
Authors: Bower Neil I. , Vogrin Adam J. , Le Guen Ludovic , Chen Huijun , Stacker Steven A. , Achen Marc G. , Hogan Benjamin M. 
Published: January 2017

ABSTRACT
Vascular endothelial growth factors (VEGFs) control angiogenesis and lymphangiogenesis during development and in pathological conditions. In the zebrafish trunk, Vegfa controls the formation of intersegmental arteries by primary angiogenesis and Vegfc is essential for secondary angiogenesis, giving rise to veins and lymphatics. Vegfd has been largely thought of as dispensable for vascular development in vertebrates. Here, we generated a zebrafish vegfd mutant by genome editing. vegfd mutants display significant defects in facial lymphangiogenesis independent of vegfc function. Strikingly, we find that vegfc and vegfd cooperatively control lymphangiogenesis throughout the embryo, including during the formation of the trunk lymphatic vasculature. Interestingly, we find that vegfd and vegfc also redundantly drive artery hyperbranching phenotypes observed upon depletion of Flt1 or Dll4. Epistasis and biochemical binding assays suggest that, during primary angiogenesis, Vegfd influences these phenotypes through Kdr (Vegfr2) rather than Flt4 (Vegfr3). These data demonstrate that, rather than being dispensable during development, Vegfd plays context-specific indispensable and also compensatory roles during both blood vessel angiogenesis and lymphangiogenesis.
Carotid Stent Mobility with Regard to Head Movements: In Vitro Analysis
Authors: Floris Vos A. W. , Linsen Matteus A. M. , Diks Jeroen , Rauwerda Jan A. , Wisselink Willem 
Published: January 2017

Given that considerable motion of the carotid artery is present during head movements, we hypothesized that a flexible stent with low torsion might be favorable to avoid stress imparted to the stent and carotid artery. Therefore, we evaluated the flexibility of different expanded carotid stents before and after deployment in a carotid artery in vitro. Subsequently, we evaluated torsion of the bare expanded stents. Five stents (Wallstent [Boston Scientific Corp., Natick, MA], Acculink [Guidant Corp., Indianapolis, IN], Precise [Cordis Corp., Johnson & Johnson Company, Warren, NJ], Carotid SE [Medtronic AVE, Santa Rosa, CA], and Protégé [EV3, Plymouth, MN]) were tested. Flexibility was determined using a three-point bend test recording the bending load (BL) in grams required to flex the stent 25°. Increased BL implies decreased flexibility. Torsion was measured by recording the rotation load (RL) in grams required to rotate the stents 30° along its axis. Increased RL implies increased torsion. In the bare expanded state, the median BL was 6 g (range 1–22 g). The BL increased to 38 g (range 20–41 g) after deployment in a carotid artery, with the Carotid SE (21 g) and Wallstent (36 g) showing significantly lower BL ( p < .0001 and p = .0016, respectively). Overall, the RL was 11 g (range 1–76 g). Significantly higher RL was required to rotate the Wallstent (73 g) and Precise (20 g) stents ( p < .0001). The flexibility of the currently used stents decreases after deployment in a carotid artery irrespective of its flexibility in the bare state. Two stents showed increased torsion compared with the other stents. Limitations in both flexibility and torsion might influence the long-term performance of carotid angioplasty stenting.