bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Collaterals on Successful Revascularization in Solitaire FR With the Intention for Thrombectomy
Authors: Liebeskind David S. , Jahan Reza , Nogueira Raul G. , Zaidat Osama O. , Saver Jeffrey L. 
Published: May 2014

Background and Purpose—
Collaterals at angiography before endovascular therapy were analyzed to ascertain the effect on a novel end point of successful revascularization without symptomatic hemorrhage in the Solitaire FR With the Intention for Thrombectomy (SWIFT) study.

Methods—
Collateral grade (American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology) on baseline angiography was independently assessed, blind to other data, with statistical analyses delineating the relationship with clinical, laboratory, and imaging parameters.

Results—

Angiographic data on collaterals were available in 119 of 144 subjects (mean age, 67±12 years; 52% woman; median National Institutes of Health Stroke Scale, 18 [range, 8–28]). Worse collaterals were noted in subjects with elevated baseline blood glucose (
P
=0.013) and those with elevated baseline systolic blood pressure (
P
=0.039). Multivariate predictors of partial or worse collaterals included absence of prior hypertension (odds ratio, 4.049,
P
=0.012), smoking history (odds ratio, 3.822;
P
=0.013), and higher blood glucose (odds ratio, 1.017;
P
=0.022). Collaterals were strongly related to Alberta Stroke Program Early CT Score (ASPECTS) at baseline (0–1: median 8 [3–10]; 2–9 [5–10]; 3–9 [7–10]; 4–9 [8–10];
P
<0.001) and 24 hours (0–1: median 1 [0–5]; 2–6 [0–10]; 3–8 [0–10]; 4–8 [4–8];
P
<0.001). Better collaterals were linked with Thrombolysis in Cerebral Infarction 2b/3 reperfusion (
P
=0.019), better median National Institutes of Health Stroke Scale at day 7/discharge (
P
<0.001), and better day 90 modified Rankin Scale (
P
<0.001). Better collateral grade was associated with successful revascularization without symptomatic hemorrhage, mean 2.3 (95% confidence interval, 2.1–2.5) versus 1.9 (95% confidence interval, 1.7–2.2),
P
=0.021.

Conclusions—
Better collaterals were associated with lower glucose, lower blood pressure, smaller baseline infarcts in SWIFT, and greater likelihood of successful revascularization without hemorrhage and good clinical outcomes.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01054560.
Association of Kidney Disease Measures With Ischemic Versus Hemorrhagic Strokes
Authors: Mahmoodi Bakhtawar K. , Yatsuya Hiroshi , Matsushita Kunihiro , Sang Yinying , Gottesman Rebecca F. , Astor Brad C. , Woodward Mark , Longstreth W.T. , Psaty Bruce M. , Shlipak Michael G. , Folsom Aaron R. , Gansevoort Ron T. , Coresh Josef 
Published: May 2014

Background and purpose—
Although low glomerular filtration rate (GFR) and albuminuria are associated with increased risk of stroke, few studies compared their contribution to risk of ischemic versus hemorrhagic stroke separately. We contrasted the association of these kidney measures with ischemic versus hemorrhagic stroke.

Methods—
We pooled individual participant data from 4 community-based cohorts: 3 from the United States and 1 from The Netherlands. GFR was estimated using both creatinine and cystatin C, and albuminuria was quantified by urinary albumin-to-creatinine ratio (ACR). Associations of estimated GFR and ACR were compared for each stroke type (ischemic versus intraparenchymal hemorrhagic) using study-stratified Cox regression.

Results—

Among 29 595 participants (mean age, 61 [SD 12.5] years; 46% men; 17% black), 1261 developed stroke (12% hemorrhagic) during 280 549 person-years. Low estimated GFR was significantly associated with increased risk of ischemic stroke, but not hemorrhagic stroke, whereas high ACR was associated with both stroke types. Adjusted hazard ratios for ischemic and hemorrhagic stroke at estimated GFR of 45 (versus 95) mL/min per 1.73 m
2
were 1.30 (95% confidence interval, 1.01–1.68) and 0.92 (0.47–1.81), respectively. In contrast, the corresponding hazard ratios for ACR of 300 (versus 5) mg/g were 1.62 (1.27–2.07) for ischemic and 2.57 (1.37–4.83) for hemorrhagic stroke, with significantly stronger association with hemorrhagic stroke (
P
=0.04). For hemorrhagic stroke, the association of elevated ACR was of similar magnitude as that of elevated systolic blood pressure.

Conclusions—
Whereas albuminuria showed significant association with both stroke types, the association of decreased estimated GFR was only significant for ischemic stroke. The strong association of albuminuria with both stroke types warrants clinical attention and further investigations.
Inhibition of Serotonin Reuptake by Antidepressants and Cerebral Microbleeds in the General Population
Authors: Aarts Nikkie , Akoudad Saloua , Noordam Raymond , Hofman Albert , Ikram M. Arfan , Stricker Bruno H. , Visser Loes E. , Vernooij Meike W. 
Published: May 2014

Background and Purpose—
Serotonin reuptake inhibiting antidepressants decrease platelet aggregation. This may cause an increased risk of intracerebral hemorrhage. However, the risk of subclinical microbleeds, which are highly prevalent in middle-aged and elderly people, is unknown. We studied whether serotonin reuptake inhibiting antidepressants increase the frequency of cerebral microbleeds and secondarily whether they lower the presence of ischemic vascular damage.

Methods—
Within the population-based Rotterdam Study, information on antidepressant use was obtained from continuously monitored pharmacy records. Brain MRI was available in 4945 participants (55% women, mean age 64 years) between 2005 and 2011. We categorized antidepressants based on affinity for the serotonin transporter: high, intermediate, or low. Microbleeds (presence and location) and ischemic lesions (lacunes, white matter lesions) were rated on MRI. Logistic and linear regression, adjusted for age, sex, depressive symptoms, and cardiovascular risk were used to study the association of antidepressants with microbleeds and ischemic vascular lesions.

Results—
Antidepressant use with strong serotonin reuptake inhibition was not associated with microbleed presence (odds ratio compared with nonuse, 1.03; confidence interval, 0.75–1.39) irrespective of microbleed location in the brain. Exclusion of antithrombotic users or persons with cortical infarcts did not change our results. Furthermore, serotonin reuptake inhibition was not related to ischemic vascular brain damage.

Conclusions—
In the general population, use of serotonin reuptake inhibiting antidepressants is not related to presence of cerebral microbleeds. This strengthens the idea that the platelet inhibitor effects of antidepressant drugs with affinity for serotonin are minimal and further supports the safety of selective serotonin reuptake inhibitors for nongastrointestinal bleedings.
Hospital-Directed Feedback to Emergency Medical Services Improves Prehospital Performance
Authors: Choi Bryan , Tsai Devin , McGillivray Celia Gomes , Amedee Caryn , Sarafin Jo-Ann , Silver Brian 
Published: May 2014

Background and Purpose—
A potential way to improve prehospital stroke care and patient handoff is hospital-directed feedback for emergency medical service (EMS) providers. We evaluated whether a hospital-directed EMS stroke follow-up tool improved documentation of adherence to the Rhode Island state prehospital stroke protocol for EMS providers.

Methods—
A standardized, 10-item feedback tool was developed in 2012 and sent to EMS directors for every transported patient with a discharge diagnosis of ischemic stroke. We reviewed patient charts meeting these criteria between January 2008 and December 2013. Performance on the tool was compared between the preintervention (January 2008 through January 2012) and postintervention (February 2012 through December 2013) periods.

Results—

We identified 1176 patients with ischemic stroke who arrived by EMS in the study period: 668 in the preintervention period and 508 in the postintervention period. The overall score for the preintervention group was 5.31 and for the postintervention group 6.42 (
P
<0.001). Each of the 10 items, except checking blood glucose, showed statistically significant improvement in the postintervention period compared with the preintervention period.

Conclusions—
Hospital-directed feedback to EMS was associated with improved overall compliance with state protocols and documentation of 9 out of 10 individual items. Future confirmatory studies in different locales and studies on the impact of this intervention on actual tissue-type plasminogen activator administration rates and EMS personnel knowledge and behavior are needed.
Pathophysiology of hypnic headache
Authors: Holle Dagny , Naegel Steffen , Obermann Mark 
Published: May 2014

Background Hypnic headache (HH) is a rare primary headache disorder that is characterized by strictly sleep related headache attacks. Purpose The underlying pathophysiology of HH is mainly enigmatic but some clinical characteristics such as circadian rhythmicity and caffeine responsiveness may point toward possible underlying mechanisms. Method Current studies that deal with the pathophysiology of HH are summarized. Data on cerebral imaging, sleep, electrophysiology studies, effectiveness of drugs, and symptomatic headache types are discussed to illuminate underlying pathophysiologic mechanisms. Conclusion HH can be clearly differentiated by its clinical presentation as well as imaging and electrophysiological study results from other primary headaches such as migraine or cluster headache. The underlying pathophysiology is still enigmatic but a hypothalamic involvement seems to be likely.
Arthroscopic Hip Revision Surgery for Residual Femoroacetabular Impingement (FAI)
Authors: Larson Christopher M. , Giveans M. Russell , Samuelson Kathryn M. , Stone Rebecca M. , Bedi Asheesh 
Published: May 2014

Background: There are limited data reporting outcomes after revision arthroscopic surgery for residual femoroacetabular impingement (FAI). Hypothesis: (1) Revision arthroscopic FAI correction results in improved outcomes, but they are inferior to those of primary arthroscopic FAI correction. (2) Improved postrevision radiographic parameters are predictive of better outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent arthroscopic hip revision for residual FAI were reviewed. Pathomorphological findings, intraoperative findings, and preoperative and postoperative modified Harris Hip Score (MHHS), Short Form–12 (SF-12), and pain on a visual analog scale (VAS) values were evaluated. Outcomes after revision arthroscopic FAI correction were compared with outcomes of a matched cohort who underwent primary arthroscopic FAI correction. Results: A total of 79 patients (85 hips) with a mean age of 29.5 years underwent arthroscopic revision FAI correction (mean follow-up, 26 months). The labrum was debrided (27 hips), repaired (49 hips), or reconstructed (7 hips). Two labrums were stable and required no treatment. The results of revision arthroscopic FAI correction were compared with those of 220 age- and sex-matched patients (237 hips) who underwent primary arthroscopic FAI correction (mean follow-up, 23 months). The mean improvement in outcome scores after revision FAI correction was 17.8 (MHHS), 12.5 (SF-12), and 1.4 (VAS) points compared with 23.4 (MHHS), 19.7 (SF-12), and 4.6 (VAS) points after primary arthroscopic FAI correction. The mean improvement was significantly better in the primary cohort compared with the revision cohort ( P < .01 for MHHS, SF-12, and VAS values). Good/excellent results were achieved in 81.7% of the primary cohort and 62.7% of the revision cohort ( P < .01). Greater postoperative head-neck offset ( P = .024), subspine/anterior inferior iliac spine (AIIS) decompression ( P = .014), labral repair/reconstruction ( P = .009), and capsular plication ( P = .032) were significant predictors for better outcomes after revision surgery. Conclusion: Arthroscopic hip revision surgery for residual FAI yielded significantly improved outcome measures, but these were inferior to those after primary arthroscopic FAI corrective surgery. Improved femoral head-neck offset after cam decompression, identification and treatment of subspine/AIIS impingement, labral preservation/reconstruction, and capsular preservation/plication may be paramount to achieve satisfactory outcomes.
The correlation between carotid artery atherosclerosis and clinical ischemic heart disease in lupus patients
Authors: Eder L , Gladman DD , Ibañez D , Urowitz MB 
Published: May 2014

Aim The extent of subclinical atherosclerosis can be assessed by ultrasound measurement of carotid intima-media thickness (cIMT) and total plaque area (TPA). We aimed to investigate the correlation between measures of atherosclerosis as documented on imaging studies of the carotid vasculature and clinical coronary artery disease (CAD) in systemic lupus erythematosus (SLE). Methods The study patients were recruited from the University of Toronto prospective cohort of SLE patients. Patients who had a history of CAD were compared to those without CAD. TPA and cIMT were measured using high-resolution optimized ultrasound systems. Logistic regression models were used to investigate the strength of association between ultrasound measures of atherosclerosis and CAD. The strength of association as expressed by odds ratio (OR) was compared between TPA and cIMT. Results A total of 103 SLE patients were analyzed (27 patients with a history of CAD). Carotid IMT correlated only moderately with TPA ( r = 0.43, p < 0.001). Both measures were significantly associated with the presence of CAD. However, TPA showed a stronger association than cIMT (OR 9.55 vs. 2.02, respectively). TPA was also more strongly associated with dyslipidemia and hypertension compared to cIMT. Conclusions In SLE patients, cIMT correlates only moderately with TPA, suggesting that they measure different phenotypes of atherosclerosis. Carotid TPA correlated better than cIMT with cardiovascular risk factors and CAD, suggesting that it may serve as a better tool for the investigation of atherosclerosis in SLE.
Formulation for beginners
Authors: Selzer Rob , Ellen Steven 
Published: May 2014

Objective: Developing a formulation is an important method of understanding the people we treat. Writing a formulation need not be seen as burdensome or difficult. Our objective is to provide a framework for the formulation process to make it more accessible for beginners. Conclusion: We describe a method that beginners can adopt easily and then build upon as their experience and knowledge broadens.
Major Bleeding With Dabigatran and Rivaroxaban in Patients With Atrial Fibrillation
Authors: Fontaine Gabriel V , Mathews Katy D , Woller Scott C , Stevens Scott M , Lloyd James F , Evans R Scott 
Published: May 2014

Background: Although the rate of bleeding among patients with atrial fibrillation (AF) taking novel oral anticoagulants in randomized controlled trials is described, the rate of bleeding with “real-world” use is uncertain. Methods: We conducted a retrospective electronic medical record interrogation and subsequent chart review among patients within Intermountain Healthcare between October 2010 and November 2012. Patients were included if they had a diagnosis of AF and were receiving either dabigatran or rivaroxaban. Rates of major bleeding were calculated. Results: Among 2579 patients, 13 (0.5%) experienced major bleeding (95% confidence interval [CI] 0.23-0.77), 5 (0.19%) experienced intracranial hemorrhage (95% CI 0.02-0.36), and 2 (0.08%) experienced fatal bleeding. Of the 13 patients experiencing a major bleed, 8 (61.5%) would have been excluded from the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) and Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) clinical trials. Conclusion: We observed a rate of major bleeding similar to that reported in randomized clinical trials among patients with AF prescribed dabigatran or rivaroxaban.
A nurse-run clinic for patients with incidentally discovered small abdominal aortic aneurysms is feasible and cost-effective
Authors: Griffin JL , Clarke GA , Roake JA , Lewis DR 
Published: May 2014

Introduction Patients with incidentally discovered small abdominal aortic aneurysms (AAA) require assessment by a vascular surgery department for possible enrollment in a surveillance programme. Our unit implemented a vascular nurse-run AAA clinic in October 2010. The aim of this study was to assess the feasibility of a specialist nurse-run small AAA clinic. Methods Demographic and clinical data were collected prospectively for all patients seen in the new vascular nurse clinic between October 2010 and November 2012. A validated AAA operative mortality score was used to aid decision making by the vascular nurse. Results Some 250 patients were seen in the clinic. 198 (79.2%) patients were enrolled in surveillance, 40 (16%) declined enrollment and 12 (4.8%) were referred to a consultant clinic for further assessment. The majority of patients were male and the mean age was 73.7 years. Co-morbidities included hypertension, a history of cardiovascular disease, and hyperlipidaemia. The majority of referrals were considered to be low operative risk. No aneurysms ruptured whilst under surveillance. Conclusions A nurse-run clinic that assesses patients with incidentally discovered small AAAs for inclusion in AAA surveillance is a feasible alternative to assessment of these patients in a consultant-run clinic.
Glycemic Variability in Nondiabetic Morbidly Obese Persons
Authors: Salkind Sara J. , Huizenga Robert , Fonda Stephanie J. , Walker M. Susan , Vigersky Robert A. 
Published: May 2014

Background: Glycemic variability (GV) is correlated with oxidative stress which may lead to increased cardiovascular risk and poor clinical outcomes in people with prediabetes and diabetes. We sought to understand whether morbidly obese persons without diabetes by standard criteria have dysglycemia as measured by GV. Methods: We performed an observational study of GV metrics and carotid intima media thickness (CIMT) in 21 morbidly obese normoglycemic and 15 morbidly obese prediabetic applicants to The Biggest Loser television show. The results were compared to previously published studies in normoglycemic nonobese and obese individuals. Glucose was measured with a masked continuous glucose monitor (CGM) over 3 to 8 days and carotid intima media thickness (CIMT) was determined by ultrasound. CGM-derived GV metrics for GV were coefficient of variation (CV), standard deviation (SD), mean amplitude of glycemic excursions (MAGE), continuous overall net glycemic action–1 hour (CONGA1), and mean of daily differences (MODD). Results: We found that morbidly obese subjects (n = 21) who were normoglycemic by standard criteria had higher GV (CV = 22%, SD = 24.2 mg/dl and MAGE = 48.6 mg/dl) than previous reports of normoglycemic, nonobese individuals (CV = 12-18%, SD = 11.5-15.0 mg/dl, and MAGE = 26.3-28.3 mg/dl). Morbidly obese prediabetic subjects (n = 15) had GV metrics indistinguishable from those morbidly obese subjects who were normoglycemic. CIMT was higher in both morbidly obese groups compared with historical age- and sex-matched controls. Conclusions: Normoglycemic and prediabetic morbidly obese individuals have higher GV compared with normal weight, nondiabetic individuals. We speculate that this may increase the risk for macrovascular disease through excessive oxidative stress.
Treatment of acute pancreatitis with protease inhibitors administered through intravenous infusion: an updated systematic review and meta-analysis
Authors: Seta Takeshi , Noguchi Yoshinori , Shikata Satoru , Nakayama Takeo 
Published: May 2014

AbstractBackgroundThe intravenous use of protease inhibitors in patients with acute pancreatitis is still controversial. The purpose of this study was to evaluate the effectiveness of protease inhibitors intravenously administered to prevent pancreatitis-associated complications.MethodsWe updated our previous meta-analysis with articles of randomized controlled trials published from January 1965 to March 2013 on the effectiveness of protease inhibitors for acute pancreatitis. A systematic search of PubMed, EMBASE, the Cochrane Library, and Japana Centra Revuo Medicina was conducted. In addition, Internet-based registries (ClinicalTrials.gov, controlled-trials.com, UMIN, JMACCT, and JAPIC) were used to search for on-going clinical trials. Furthermore, references of review articles and previously published meta-analyses were handsearched. The main outcome of interest was the overall mortality rate from acute pancreatitis.ResultsSeventeen trials were selected for analysis. Overall, protease inhibitors did not achieve a significant risk reduction in mortality (pooled risk difference [RD], -0.02; 95% Confidence Interval [CI], -0.05 to 0.01; number needed to treat [NNT], 74.8) with low heterogeneity. A subgroup analysis in moderate to severe pancreatitis (defined by control mortality rate [CMR] >0.10) did not show a significant effect of protease inhibitors to prevent death (pooled RD, -0.03; 95% CI, -0.07 to 0.01; NNT, 1603.9) with low heterogeneity. An additional subgroup analysis of two trials with CMR >0.20 (i.e., low quality) revealed a significant risk reduction.ConclusionThe present meta-analysis re-confirmed that there is no solid evidence that supports the intravenous use of protease inhibitors to prevent death due to acute pancreatitis.
Examination of historical paintings by state-of-the-art hyperspectral imaging methods: from scanning infra-red spectroscopy to computed X-ray laminography
Authors: Legrand Stijn , Vanmeert Frederik , Van der Snickt Geert , Alfeld Matthias , De Nolf Wout , Dik Joris , Janssens Koen 
Published: May 2014

Abstract
The development of advanced methods for non-destructive selective imaging of painted works of art at the macroscopic level based on radiation in the X-ray and infrared range of the electromagnetic spectrum are concisely reviewed. Such methods allow to either record depth-selective, element-selective or species-selective images of entire paintings. Camera-based ‘full field’ methods (that record the image data in parallel) can be discerned next to scanning methods (that build up distributions in a sequential manner by scanning a beam of radiation over the surface of an artefact). Six methods are discussed: on the one hand, macroscopic X-ray fluorescence and X-ray diffraction imaging and X-ray laminography and on the other hand macroscopic Mid and Near Infrared hyper- and full spectral imaging and Optical Coherence Tomography. These methods can be considered to be improved versions of the well-established imaging methods employed worldwide for examination of paintings, i.e., X-ray radiography and Infrared reflectography. Possibilities and limitations of these new imaging techniques are outlined.
PEG-ing down (and preventing?) the cause of pegloticase failure
Authors: Abeles Aryeh M 
Published: May 2014

AbstractPegloticase is a powerful but underutilized weapon in the rheumatologist’s armamentarium. The drug’s immunogenicity leads to neutralizing antibody formation and rapid loss of efficacy in roughly one-half of all patients, which remains an impediment to broader use. New data, however, suggest that drug survival might improve with concomitant immunosuppressive agent (s), which merits further study. Efficacy appears to be unchanged when pegloticase is infused at 3-week (rather than 2-week) intervals. Stretching the time between infusions may also improve patient adherence and allow for earlier identification of transient responders.