bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-059 Seizure prophylaxis in aneurysmal subarachnoid haemorrhage: a survey of leading cerebrovascular centres
Authors: Dewan M , Mocco J 
Published: July 2013

IntroductionSeizure in the days following subarachnoid haemorrhage occurs in 6–18% of patients with a ruptured intracranial aneurysm. Not only may seizure confound the neurologic exam, but it may also place patients with an unsecured lesion at increased risk for re-rupture. Seizure prophylaxis in this patient population is controversial, and there remains no level I data regarding the effectiveness of seizure prophylaxis after subarachnoid haemorrhage.MethodsA brief 8-question survey was sent to 20 major US centres with cerebrovascular neurosurgical specialisation. Respondents were asked about institutional practices regarding seizure prophylaxis, including preferred medications and duration of therapy, as well as seizure surveillance with electroencephalography.ResultsAll 20 survey requests were completed and returned. 10 respondents (50%) reported routine use of anti-convulsant for seizure prophylaxis, while 10 (50%) did not. Among respondents using prophylaxis, levetiracetam was the drug of choice for most (80%), while phenytoin was used to a varying degree by two centres. The duration of levetiracetam prophylaxis ranged from 1–30 days following SAH. No centres employed EEG routinely, however most supported EEG use when the neurologic exam was unreliable or inexplicably declining. Nineteen (95%) respondents agreed that a trial randomising patients to levetiracetam or no anti-seizure medication is warranted at this time, and all 20 (100%) believed that such a trial would be ethical.ConclusionsThe routine use of seizure prophylaxis following aneurysmal subarachnoid haemorrhage is controversial. Among a sampling of 20 major academic centres, one half administers seizure prophylaxis, while the other half does not. The majority believes a trial randomising patients to receive seizure prophylaxis is both timely and ethical.DisclosuresM. Dewan: None. J. Mocco: None.
E-073 Transarterial Venous Sinus Occlusion for Cranial Dural Arteriovenous Fistulas
Authors: Rabinov J , Yoo A , Leslie-Mazwi T , Ogilvy C , Hirsch J 
Published: July 2013

PurposeTo present trans-arterial venous sinus occlusion technique for dural arteriovenous fistulas of the transverse and sigmoid sinuses.Materials and MethodsNine cases of dural arteriovenous sinus fistula of the transverse and sigmoid sinuses were treated with trans-arterial closure of the arterial supply and the venous sinus using ethylene vinyl alcohol copolymer (ONYX). Five patients were male and four were female. Age range was30–73. Patients presented with stroke, intracranial haemorrhage, seizure, headache or memory changes. Six patients had patent sinuses and three patients had fistulas involving isolated sinus segments which were Cognard IIa + b and Cognard IIb respectively. Criteria for selection for this treatment included complex multi-hole fistulas involving a broad surface of the sinus. External carotid artery branches could be directly embolised when considered safe. High risk arterial supply from ICA parenchymal vessels of the brain or ECA cranial nerve were embolised via retrograde collaterals. The affected venous sinus was a non-dominant or co-dominant sinus. Vein of Labbe had to be spared.ResultsONYX embolisation DAVF closure was accomplished in all nine patients with a total of 15 embolisation procedures. No cranial nerve neuropathies or strokes occurred related to arterial embolisation. No patients incurred strokes related to the venous sinus embolisation. DAVF closure was found to be durable at three months in eight patients with one patient pending follow up.ConclusionTrans-arterial closure of transverse and sigmoid sinus provides an alternative to venous sinus coil occlusion, surgical skeletonization or radiosurgery. High risk arterial collaterals can be closed via artery-artery or artery-sinus-artery embolisation. In this small cohort, closure of dural AV fistulas was durable at three months with low complication rates.DisclosuresJ. Rabinov: None. A. Yoo: None. T. Leslie-Mazwi: None. C. Ogilvy: None. J. Hirsch: None.
E-001 Update on the PISTE trial (Pragmatic Ischaemic Stroke Thrombectomy Evaluation)
Authors: White P , Muir K , Ford G , Brown M , Clifton A 
Published: July 2013

BackgroundThe KEY current clinical question in acute stroke management is whether a treatment policy of modern intra-arterial thrombectomy (IAT) added to IV thrombolysis (IVT) improve clinical outcomes over IVT alone. If the answer is yes and it applies to most patients with large vessel occlusive stroke, then the implications for acute stroke care and health services are enormous.MethodsPISTE is a UK based prospective, randomised controlled multicentre parallel group trial (PROBE design) of adjunctive modern mechanical thrombectomy (stentrievers with use of conscious sedation where possible) compared with intravenous thrombolysis in patients with acute ischaemic stroke due to an occluded anterior circulation major intracranial vessel. Concealed allocation. Funded by grant from the Stroke Association with some support from industry. Angiographic secondary outcomes will be blinded to allocation and independently adjudicated.Abstract E-001 Table 1Primary outcomemRS 0–2 versus 3–6 at 3mSecondary outcomes24h Recanalisation rate Early major neurological improvement (8 points NIHSS) Days at home by 90 daysFull recovery (mRS 0–1)Safety outcomesSICH (ECASS 2)24–48h MortalityAny ICH Extracranial bleedingResultsThis is a RCT in active recruitment phase but information on progress to date and aggregated cohort recruited will be presented.The pre-planned PRISMA compliant meta-analysis of ongoing European academic IAT trials will be outlined.ConclusionPragmatic treatment policy trials are essential in hyperacute stroke intervention and are feasible within acceptable timeframes.DisclosuresP. White: 1; C; Covidien, Codman, Microvention, Acandis. 2; C; Microvention, Codman. K. Muir: 1; C; Covidien, Codman, Acandis. G. Ford: None. M. Brown: None. A. Clifton: None.
O-006 Advanced Age Remains a Strong Independent Predictor of Neurologic Outcome Despite Core Infarct Imaging for Patient Selection
Authors: Heck D , Brown M 
Published: July 2013

AbstractBody Age is a consistent independent predictor of outcome in ischaemic stroke trials. From January 2011 until December of 2012, 85 patients at our institution underwent ischaemic stroke intervention in the anterior circulation in a community based practice at a hospital currently designated as a Comprehensive Stroke Center. All patients were prospectively entered into our ischaemic stroke intervention database. Patients were selected for intervention based on non-invasive imaging confirmation of a large vessel occlusion (LVO) and core infarct imaging, mostly with MRI, and in some cases with CTA/Aspects score. Most patients were treated with mechanical intervention. In 2011, patients were treated preferentially with general anaesthesia, but in 2012 local anaesthesia became the preference. All patients were admitted to a neuroscience intensive care unit staffed by fellowship-trained neurointensivists and received inpatient or outpatient rehabilitation as deemed appropriate. Ninety day MRS was determined on 84 of 85 patients by a practitioner certified in the MRS, with one patient lost to follow-up. The overall mortality at 90 days was 32%. The mortality in patients younger than 75 (n=47) was lower than those 75 or older (n=37) (27% vs 44%). Symptomatic haemmorhagic stroke conversion occurred in 4 patients (5%), 3 over the age of 80 and one 57 year old, and was fatal in all. Good neurologic outcome (MRS 0–2) was obtained in 42% of patients overall, 51% of the younger patients compared with just 29% of the older patients. The baseline NIHSS was just one point lower in the younger group (Mean 16.5 and 17.5, Median 17 and 18, respectively). Revascularisation rates in the younger group were not superior to the older group (TICI 2B or higher 77% and 81%, respectively). There was also no difference in utilisation of general anaesthesia (58% in the younger group and 54% in the older group). In summary, despite the use of advanced imaging to select patients for interventional stroke management, and similar revascularisation rates amongst older and younger patients, age remains a very strong predictor of neurologic outcome. Patients 75 and older had a much higher mortality at 90 days and were much less likely to have a favourable neurologic outcome. These differences may be multifactorial. It is of course possible that an absolute improvement in outcome from stroke intervention can be maintained across the age spectrum, despite overall less favourable outcomes in older patients. Future randomised trials might consider lower age limits than historically utilised to maximise the chance of demonstrating improved outcomes with interventional stroke management.DisclosuresD. Heck: None. M. Brown: None.
E-040 Initial Multi-Centre Experience with the Penumbra PC 400 Detachable Coil
Authors: Patel A , Moyle H , Chaudry I , Frei D , Bellon R , Huddle D , Baxter B , Quarfordt S , Turner R , Turk A 
Published: July 2013

Introduction/PurposeAneurysm coil technology has changed considerably since the introduction of the GDC coil. We evaluated our initial clinical experience with a novel 0.020 Penumbra PC 400 coil to determine device safety and acute performance.Materials and MethodsBetween 2/2011 and 9/2012, 133 aneurysms were coiled with Penumbra PC 400 coils; 84 elective and 49 ruptured, at four high volume centres.ResultsAverage aneurysm size was 8 mm with 28% PCOM, 43% other ICA locations, 21% ACOM and the remaining Basilar, MCA and Vertebral. 15% of the cases were treated with balloon assisted coiling, 18% were stent assisted coiling, and 4% utilised both balloons and stents. Packing density could be accurately calculated in 97 aneurysms. Average packing density was 38.7%. 32% of the cases achieved an initial Raymond Scale of 1, 24% achieved a Raymond scale of 2, and 43% were Raymond Scale of 3. Almost half (66) of the patients have angiographic follow up at the time of this abstract. Based on the same/better/worse scale, vast majority of aneurysms showed stable or improved angiographic outcomes at 6 months and one year. Thirty-six had improved, 24 remained unchanged and 6 worsened, 0 patients required re-treatment. We experienced a 5% rate of peri-procedural adverse events. 3 (2%) were thromboembolic, all 3 patients were SAH cases, of which 2 had no clinical sequelae. 4 (3%) were aneurysm perforations, 3 with no clinical sequelae, and one SAH H/H grade 4 patient died, resulting in an overall morbidity and mortality of 2 (1.5%). We continue to use the coils and accrue follow up and will update results at the time of the meeting.ConclusionThe new Penumbra PC 400 coils are unique 0.020 coils that show very high average packing density and long term occlusion rates with a safe profile.DisclosuresA. Patel: 3; C; Penumbra, Inc. H. Moyle: None. I. Chaudry: 3; C; Penumbra, Inc. D. Frei: 3; C; Penumbra, Inc. R. Bellon: None. D. Huddle: None. B. Baxter: 3; C; Penumbra, Inc. S. Quarfordt: None. R. Turner: None. A. Turk: 3; C; Penumbra, Inc.
E-041 Is there an Interventional Role in Thyrotoxic Crisis?
Authors: Morgan R , Best S , Connor C , Johnson P , Madarang J 
Published: July 2013

Learning ObjectivesProvide a clinical review of thyrotoxic crisis (thyroid storm).Review the limited published data currently available on thyroid arterial embolisation as treatment of thyrotoxic crisis.Provide pictorial anatomic review of thyroid arterial supply.Present a case of thyrotoxic crisis refractory to medical management and unsuitable for surgical intervention, which underwent thyroid arterial embolisation.BackgroundThyrotoxic crisis is an acute exacerbation of thyrotoxicosis, which can be precipitated by a multitude of causes. It has an overall mortality rate of20–30%, however if treatment is delayed the mortality rate increases up to approximately 75%. Treatment requires vigorous medical management and while thyroidectomy is often necessary, the severity of the exacerbation often makes this patient population poor surgical candidates. A limited number of published case reports demonstrate thyroid arterial embolisation as a treatment options for unstable patients with thyrotoxic crisis. Embolisation is via the bilateral superior and inferior thyroid arteries.Clinical Findings/Procedure DetailsThis poster presents will review a case of a 69 year old male with intractable thyrotoxic crisis, despite appropriate medical management. The patient was not a surgical candidate due to prior episodes of cardiac and respiratory arrest secondary to sustained ventricular fibrillation. Given the patient’s overall poor prognosis and lack of treatment options, arterial embolisation of the thyroid was considered. The patient underwent bilateral superior and inferior thyroid artery embolisations using 500 to 700 micron embospheres. Following embolisation there was interval increase in T4 and T3, as previously reported, but no further episodes of sustained ventricular fibrillation occurred and a curative thyroidectomy was performed one week later.ConclusionThe case report in combination with the limited published data suggests thyroid embolisation may have a role in treatment of nonsurigical refractory thyrotoxic crisis. Further research is needed to determine if thyroid embolisation could help reduce the high mortality rate associated with thyrotoxic crisis.DisclosuresR. Morgan: None. S. Best: None. C. Connor: None. P. Johnson: None. J. Madarang: None.
Notch1-Induced Brain Tumor Models the Sonic Hedgehog Subgroup of Human Medulloblastoma
Authors: Natarajan Sivaraman , Li Yaochen , Miller Emily E. , Shih David J. , Taylor Michael D. , Stearns Timothy M. , Bronson Roderick T. , Ackerman Susan L. , Yoon Jeong K. , Yun Kyuson 
Published: July 2013

Abstract
While activation of the Notch pathway is observed in many human cancers, it is unknown whether elevated Notch1 expression is sufficient to initiate tumorigenesis in most tissues. To test the oncogenic potential of Notch1 in solid tumors, we expressed an activated form of Notch1 (N1ICD) in the developing mouse brain. N1ICD;hGFAP-cre mice were viable but developed severe ataxia and seizures, and died by weaning age. Analysis of transgenic embryo brains revealed that N1ICD expression induced p53-dependent apoptosis. When apoptosis was blocked by genetic deletion of p53, 30% to 40% of N1ICD;GFAP-cre;p53+/− and N1ICD;GFAP-cre;p53−/− mice developed spontaneous medulloblastomas. Interestingly, N1ICD-induced medulloblastomas most closely resembled the sonic hedgehog subgroup of human medulloblastoma at the molecular level. Surprisingly, N1ICD-induced tumors do not maintain high levels of the Notch pathway gene expression, except for Notch2, showing that initiating oncogenic events may not be decipherable by analyzing growing tumors in some cases. In summary, this study shows that Notch1 has an oncogenic potential in the brain when combined with other oncogenic hits, such as p53 loss, and provides a novel mouse model of medulloblastoma. Cancer Res; 73(17); 5381–90. ©2013 AACR.
Diagnostic Chest X-Rays and Breast Cancer Risk before Age 50 Years for BRCA1 and BRCA2 Mutation Carriers
Authors: John Esther M. , McGuire Valerie , Thomas Duncan , Haile Robert , Ozcelik Hilmi , Milne Roger L. , Felberg Anna , West Dee W. , Miron Alexander , Knight Julia A. , Terry Mary Beth , Daly Mary , Buys Saundra S. , Andrulis Irene L. , Hopper John L. , Southey Melissa C. , Giles Graham G. , Apicella Carmel , Thorne Heather ,   for the Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer (kConFab), Whittemore Alice S. 
Published: July 2013

Abstract
Background: The effects of low-dose medical radiation on breast cancer risk are uncertain, and few studies have included genetically susceptible women, such as those who carry germline BRCA1 and BRCA2 mutations.
Methods: We studied 454 BRCA1 and 273 BRCA2 mutation carriers ages younger than 50 years from three breast cancer family registries in the United States, Canada, and Australia/New Zealand. We estimated breast cancer risk associated with diagnostic chest X-rays by comparing mutation carriers with breast cancer (cases) with those without breast cancer (controls). Exposure to chest X-rays was self-reported. Mammograms were not considered in the analysis.
Results: After adjusting for known risk factors for breast cancer, the ORs for a history of diagnostic chest X-rays, excluding those for tuberculosis or pneumonia, were 1.16 [95% confidence interval (CI), 0.64–2.11] for BRCA1 mutations carriers and 1.22 (95% CI, 0.62–2.42) for BRCA2 mutations carriers. The OR was statistically elevated for BRCA2 mutation carriers with three to five diagnostic chest X-rays (P = 0.01) but not for those with six or more chest X-rays. Few women reported chest fluoroscopy for tuberculosis or chest X-rays for pneumonia; the OR estimates were elevated, but not statistically significant, for BRCA1 mutation carriers.
Conclusions: Our findings do not support a positive association between diagnostic chest X-rays and breast cancer risk before the ages of 50 years for BRCA1 or BRCA2 mutation carriers.
Impact: Given the increasing use of diagnostic imaging involving higher ionizing radiation doses, further studies of genetically predisposed women are warranted. Cancer Epidemiol Biomarkers Prev; 22(9); 1547–56. ©2013 AACR.
Tobacco Smoke Exposure and the Risk of Childhood Acute Lymphoblastic and Myeloid Leukemias by Cytogenetic Subtype
Authors: Metayer Catherine , Zhang Luoping , Wiemels Joseph L. , Bartley Karen , Schiffman Joshua , Ma Xiaomei , Aldrich Melinda C. , Chang Jeffrey S. , Selvin Steve , Fu Cecilia H. , Ducore Jonathan , Smith Martyn T. , Buffler Patricia A. 
Published: July 2013

Abstract
Background: Tobacco smoke contains carcinogens known to damage somatic and germ cells. We investigated the effect of tobacco smoke on the risk of childhood acute lymphoblastic leukemia (ALL) and myeloid leukemia (AML), especially subtypes of prenatal origin such as ALL with translocation t(12;21) or high-hyperdiploidy (51–67 chromosomes).
Methods: We collected information on exposures to tobacco smoking before conception, during pregnancy, and after birth in 767 ALL cases, 135 AML cases, and 1,139 controls (1996–2008). Among cases, chromosome translocations, deletions, or aneuploidy were identified by conventional karyotype and fluorescence in situ hybridization.
Results: Multivariable regression analyses for ALL and AML overall showed no definite evidence of associations with self-reported (yes/no) parental prenatal active smoking and child's passive smoking. However, children with history of paternal prenatal smoking combined with postnatal passive smoking had a 1.5-fold increased risk of ALL [95% confidence interval (CI), 1.01–2.23], compared to those without smoking history (ORs for pre- or postnatal smoking only were close to one). This joint effect was seen for B-cell precursor ALL with t(12;21) (OR = 2.08; 95% CI, 1.04–4.16), but not high hyperdiploid B-cell ALL. Similarly, child's passive smoking was associated with an elevated risk of AML with chromosome structural changes (OR = 2.76; 95% CI, 1.01–7.58), but not aneuploidy.
Conclusions: Our data suggest that exposure to tobacco smoking was associated with increased risks of childhood ALL and AML; and risks varied by timing of exposure (before and/or after birth) and cytogenetic subtype, based on imprecise estimates.
Impact: Parents should limit exposures to tobacco smoke before and after the child's birth. Cancer Epidemiol Biomarkers Prev; 22(9); 1600–11. ©2013 AACR.
Angiogenin Mediates Androgen-Stimulated Prostate Cancer Growth and Enables Castration Resistance
Authors: Li Shuping , Hu Miaofen G. , Sun Yeqing , Yoshioka Norie , Ibaragi Soichiro , Sheng Jinghao , Sun Guangjie , Kishimoto Koji , Hu Guo-Fu 
Published: July 2013

Abstract
The androgen receptor (AR) is a critical effector of prostate cancer development and progression. Androgen-dependent prostate cancer is reliant on the function of AR for growth and progression. Most castration-resistant prostate cancer (CRPC) remains dependent on AR signaling for survival and growth. Ribosomal RNA (rRNA) is essential for both androgen-dependent and castration-resistant growth of prostate cancer cells. During androgen-dependent growth of prostate cells, androgen-AR signaling leads to the accumulation of rRNA. However, the mechanism by which AR regulates rRNA transcription is unknown. Here, investigation revealed that angiogenin (ANG), a member of the secreted ribonuclease superfamily, is upregulated in prostate cancer and mediates androgen-stimulated rRNA transcription in prostate cancer cells. Upon androgen stimulation, ANG undergoes nuclear translocation in androgen-dependent prostate cancer cells, where it binds to the rDNA promoter and stimulates rRNA transcription. ANG antagonists inhibit androgen-induced rRNA transcription and cell proliferation in androgen-dependent prostate cancer cells. Interestingly, ANG also mediates androgen-independent rRNA transcription through a mechanism that involves its constitutive nuclear translocation in androgen-insensitive prostate cancer cells, resulting in a constant rRNA overproduction and thereby stimulating cell proliferation. Critically, ANG overexpression in androgen-dependent prostate cancer cells enables castration-resistant growth of otherwise androgen-dependent cells. Thus, ANG-stimulated rRNA transcription is not only an essential component for androgen-dependent growth of prostate cancer but also contributes to the transition of prostate cancer from androgen-dependent to castration-resistant growth status.
Implications: The ability of angiogenin to regulate rRNA transcription and prostate cancer growth makes it a viable target for therapy. Mol Cancer Res; 11(10); 1203–14. ©2013 AACR.
Cheliensisin A Inhibits EGF-Induced Cell Transformation with Stabilization of p53 Protein Via a Hydrogen Peroxide/Chk1-Dependent Axis
Authors: Zhang Jingjie , Gao Guangxun , Chen Liang , Deng Xu , Li Jingxia , Yu Yonghui , Zhang Dongyun , Li Fei , Zhang Min , Zhao Qinshi , Huang Chuanshu 
Published: July 2013

Abstract
Cheliensisin A (Chel A), a novel styryl-lactone isolated from Goniothalamus cheliensis Hu, has been shown to induce apoptosis in human promyelocytic leukemia HL-60 cells with Bcl-2 downregulation. Yet, the potential chemopreventive effect of Chel A has not been explored. Here, we showed that Chel A treatment with various concentrations (0.5, 1.0, 2.0, and 4.0 μmol/L) for 3 weeks could dramatically inhibit EGF-induced cell transformation in Cl41 cells (IC50 ∼2.0 μmol/L). Also, coincubation of Cl41 cells with Chel A (2.0 and 4.0 μmol/L) for 48 hours could induce cell apoptosis in a caspase-3–dependent manner. Mechanically, Chel A treatment could result in increased p53 phosphorylation at Ser15 and elevated p53 total protein expression. Moreover, we found that p53 induction by Chel A was regulated at the protein degradation level, but not at either the transcription or the mRNA level. Further studies showed that p53 stabilization by Chel A was mediated via induction of phosphorylation and activation of Chk1 protein at Ser345. This notion was substantiated by the results that transfection of dominant negative mutant of Chk1 (GFP-Chk1 D130A) significantly attenuated the p53 protein expression, cell apoptosis, and inhibition of cell transformation by Chel A. Finally, increased hydrogen peroxide was found to mediate Chk1 phosphorylation at Ser345, p53 protein induction, cell apoptotic induction, and transformation inhibition following Chel A treatment. Taken together, our studies identify Chel A as a chemopreventive agent with the understanding of the molecular mechanisms involved. Cancer Prev Res; 6(9); 949–58. ©2013 AACR.