bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temporal Changes in Periprocedural Events in the Carotid Revascularization Endarterectomy Versus Stenting Trial
Authors: Howard George , Hopkins L. Nelson , Moore Wesley S. , Katzen Barry T. , Chakhtoura Elie , Morrish William F. , Ferguson Robert D. , Hye Robert J. , Shawl Fayaz A. , Harrigan Mark R. , Voeks Jenifer H. , Howard Virginia J. , Lal Brajesh K. , Meschia James F. , Brott Thomas G. 
Published: July 2015

Background and Purpose—
Post-hoc, we hypothesized that over the recruitment period of the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST), increasing experience and improved patient selection with carotid stenting, and to a lesser extent, carotid endarterectomy would contribute to lower periprocedural event rates.

Methods—
Three study periods with approximately the same number of patients were defined to span recruitment. Composite and individual rates of periprocedural stroke, myocardial infarction, and death rate were calculated separately by treatment assignment (carotid stenting/carotid endarterectomy). Temporal changes in unadjusted event rates, and rates after adjustment for temporal changes in patient characteristics, were assessed.

Results—

For patients randomized to carotid stenting, there was no significant temporal change in the unadjusted composite rates that declined from 6.2% in the first period, to 4.9% in the second, and 4.6% in the third (
P
=0.28). Adjustment for patient characteristics attenuated the rates to 6.0%, 5.9%, and 5.6% (
P
=0.85). For carotid endarterectomy–randomized patients, both the composite and the combined stroke and death outcome decreased between periods 1 and 2 and then increased in period 3.

Conclusions—
The hypothesized temporal reduction of stroke+death events for carotid stenting–treated patients was not observed. Further adjustment for changes in patient characteristics between periods, including the addition of asymptomatic patients and a >50% decrease in proportion of octogenarians enrolled, resulted in practically identical rates.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00004732.
White Matter Hyperintensities Relate to Clinical Progression in Subjective Cognitive Decline
Authors: Benedictus Marije R. , van Harten Argonde C. , Leeuwis Annebet E. , Koene Teddy , Scheltens Philip , Barkhof Frederik , Prins Niels D. , van der Flier Wiesje M. 
Published: July 2015

Background and Purpose—
In patients with subjective cognitive decline, we assessed whether small vessel disease was associated with clinical progression and cognitive decline.

Methods—
We included 334 patients with subjective cognitive decline. Follow-up was 3±2 years.

Results—
Fifty-three (16%) patients progressed clinically to mild cognitive impairment or dementia. White matter hyperintensities were associated with clinical progression and with annual decline on memory, attention, executive functioning, and global cognition. Microbleeds and lacunes were not associated with clinical progression or cognitive decline.

Conclusions—
In patients with subjective cognitive decline, patients with white matter hyperintensities are at increased risk of clinical progression and cognitive decline.
Effects of Electrical Stimulation in Spastic Muscles After Stroke
Authors: Stein Cinara , Fritsch Carolina Gassen , Robinson Caroline , Sbruzzi Graciele , Plentz Rodrigo Della Méa 
Published: July 2015

Background and Purpose—
Neuromuscular electric stimulation (NMES) has been used to reduce spasticity and improve range of motion in patients with stroke. However, contradictory results have been reported by clinical trials. A systematic review of randomized clinical trials was conducted to assess the effect of treatment with NMES with or without association to another therapy on spastic muscles after stroke compared with placebo or another intervention.

Methods—
We searched the following electronic databases (from inception to February 2015): Medline (PubMed), EMBASE, Cochrane Central Register of Controlled Trials and Physiotherapy Evidence Database (PEDro). Two independent reviewers assessed the eligibility of studies based on predefined inclusion criteria (application of electric stimulation on the lower or upper extremities, regardless of NMES dosage, and comparison with a control group which was not exposed to electric stimulation), excluding studies with <3 days of intervention. The primary outcome extracted was spasticity, assessed by the Modified Ashworth Scale, and the secondary outcome extracted was range of motion, assessed by Goniometer.

Results—
Of the total of 5066 titles, 29 randomized clinical trials were included with 940 subjects. NMES provided reductions in spasticity (−0.30 [95% confidence interval, −0.58 to −0.03], n=14 randomized clinical trials) and increase in range of motion when compared with control group (2.87 [95% confidence interval, 1.18–4.56], n=13 randomized clinical trials) after stroke.

Conclusions—
NMES combined with other intervention modalities can be considered as a treatment option that provides improvements in spasticity and range of motion in patients after stroke.

Clinical Trial Registration Information—

URL:
http://www.crd.york.ac.uk/PROSPERO
. Unique identifier: CRD42014008946.
Hypotension During Endovascular Treatment of Ischemic Stroke Is a Risk Factor for Poor Neurological Outcome
Authors: Löwhagen Hendén Pia , Rentzos Alexandros , Karlsson Jan-Erik , Rosengren Lars , Sundeman Henrik , Reinsfelt Björn , Ricksten Sven-Erik 
Published: July 2015

Background and Purpose—
In retrospective studies, patients receiving general anesthesia for endovascular treatment for acute ischemic stroke have worse neurological outcome compared with patients receiving conscious sedation. It has been suggested that this is caused by general anesthesia–associated hypotension. We investigated the effect of intraprocedural hypotension on neurological outcome.

Methods—
One hundred eight patients with acute ischemic stroke, who underwent endovascular treatment in general anesthesia between 2007 and 2012, were included. Analyzed predictors of neurological outcome were age, sex, comorbidities, baseline National Institutes of Health Stroke Scale, intraprocedural relative changes in mean arterial blood pressure from baseline, blood glucose, modified Thrombolysis in Cerebral Infarction score, and elapsed time from stroke to computed tomography, groin puncture, and recanalization/end of procedure.

Results—

A fall in mean arterial blood pressure of >40% was an independent predictor for poor neurological outcome (
P
=0.032), as were higher admission National Institutes of Health Stroke Scale score (
P
=0.008) and lack of recanalization (
P
=0.003).

Conclusions—
Profound intraprocedural hypotension is an independent predictor for poor neurological outcome in patients with acute ischemic stroke undergoing endovascular therapy in general anesthesia.
Safety of Statin Pretreatment in Intravenous Thrombolysis for Acute Ischemic Stroke
Authors: Tsivgoulis Georgios , Kadlecová Pavla , Kobayashi Adam , Czlonkowska Anna , Brozman Miroslav , Švigelj Viktor , Csiba Laszlo , Kõrv Janika , Demarin Vida , Vilionskis Aleksandras , Jatuzis Dalius , Katsanos Aristeidis H. , Rudolf Jobst , Krespi Yakup , Mikulik Robert 
Published: July 2015

Background and Purpose—
A recent meta-analysis investigating the association between statins and early outcomes in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT) indicated that prestroke statin treatment was associated with increased risk of 90-day mortality and symptomatic intracranial hemorrhage. We investigated the potential association of statin pretreatment with early outcomes in a large, international registry of AIS patients treated with IVT.

Methods—

We analyzed prospectively collected data from the Safe Implementation of Treatments in Stroke-East registry (SITS-EAST) registry on consecutive AIS patients treated with IVT during an 8-year period. Early clinical recovery within 24 hours was defined as reduction in baseline
National Institutes of Health Stroke Scale
score of ≥10 points. Favorable functional outcome at 3 months was defined as modified Rankin Scale scores of 0 to 1. Symptomatic intracranial hemorrhage was diagnosed using National Institute of Neurological Disorders and Stroke, European-Australasian Acute Stroke Study-II and SITS definitions.

Results—

A total of 1660 AIS patients treated with IVT fulfilled our inclusion criteria. Patients with statin pretreatment (23%) had higher baseline stroke severity compared with cases who had not received any statin at symptom onset. After adjusting for potential confounders, statin pretreatment was not associated with a higher likelihood of symptomatic intracranial hemorrhage defined by any of the 3 definitions. Statin pretreatment was not related to 3-month all-cause mortality (odds ratio, 0.92; 95% confidence interval, 0.57–1.49;
P
=0.741) or 3-month favorable functional outcome (odds ratio, 0.81; 95% confidence interval, 0.52–1.27;
P
=0.364). Statin pretreatment was independently associated with a higher odds of early clinical recovery (odds ratio, 1.91; 95% confidence interval, 1.25–2.92;
P
=0.003).

Conclusions—
Statin pretreatment seems not to be associated with adverse outcomes in AIS patients treated with IVT. The effect of statin pretreatment on early functional outcomes in thrombolysed AIS patients deserves further investigation.
An annotated list of the type specimens of Tortricidae (Lepidoptera) in <br />the collection of Zoological Institute, St. Petersburg, Russia. 1. Types of species described by O. Bremer, A. M. Djakonov, N. G. Erschoff, and A. M. Gerasimov
Authors: NEDOSHIVINA SVETLANA V. 
Published: July 2015

The primary types of 15 tortricid species described by O. Bremer, A. M. Djakonov, N. G. Erschoff, and A. M. Gerasimov deposited in the collection of Zoological Institute in St. Petersburg, Russia (ZISP) are listed and discussed. Lectotypes are designated for eight of these: Lazotaenia [sic.] aurichalcana Bremer, 1864; Ptycholoma plumbeolana Bremer, 1864; Tortrix euxina Djakonov, 1929; Diceratura rhodograpta Djakonov, 1929; Penthina enervana Erschoff, 1877; Tortrix (Idiographis) excentricana Erschoff, 1877; Conchylis nomadana Erschoff, 1874; Cochylis pistrinana Erschoff, 1877. Descriptions of the labels and photographs of adults are given for each species. Type specimens of two other species presumed to be deposited in ZISP, Bactra griseana Djakonov, 1929 and Lazotaenia [sic.] quinquemaculana Bremer, 1864, were not found in the collection and presumably are lost.
The Role of Moisture in Summertime Low-Level Jet Formation and Associated Rainfall over the East Asian Monsoon Region
Authors: Chen Ruidan , Tomassini Lorenzo 
Published: July 2015

Abstract
The southwesterly low-level jet (LLJ) located to the east of the Tibetan Plateau in southern China plays an important role in summertime convective initiation over north China. This study adopts a novel perspective and uses hindcast experiments in order to investigate the role of moisture in LLJ and associated heavy rainfall formation, employing a global atmospheric general circulation model (AGCM). In the sensitivity experiments, an increase of humidity in the inflow region leads to a weaker LLJ but stronger diurnal wind oscillations. The weaker LLJ is due to a decreased lower-tropospheric east–west pressure gradient resulting from a low pressure anomaly over southeastern China induced by deep convection and related condensational heating. On the other hand, the stronger diurnal variation of the LLJ originates from stronger day-and-night thermal differences over the sloping terrain, which is related to drier conditions over the mountain range. Moreover, the increased humidity and decreased LLJ counteract one another to impact precipitation in the outflow region. The change of precipitation is mainly determined by the altered moisture flux divergence. If the increase in humidity dominates, then the moisture flux convergence is enhanced and favors more precipitation over north China. Otherwise, if the decreased LLJ dominates, then the moisture flux convergence is reduced, which constrains precipitation. It is highlighted that the moist diabatic and dynamic processes are intimately coupled, and that a correct simulation of moisture flux convergence is vital for AGCMs to reproduce the LLJ-related precipitation, particularly the nocturnal precipitation peak, which is a deficiency in many current models.
Occupational choice of youth in a disadvantaged community
Authors: Gallagher MaryBeth , Pettigrew Judith , Muldoon Orla 
Published: July 2015

Introduction The ability to make daily autonomous occupational choices has been identified as a human right and positively linked to wellbeing. Those marginalized from choice are considered at risk of occupational injustice. Disadvantaged young people are one group who may be marginalized from making such choices. Occupational choice is largely assumed to be an internal, individual process based on abilities and motivation, within environmental boundaries. From an external, contextual standpoint, this process has been scantly explored. This research, underpinned by an occupational justice perspective, sought understanding of disadvantaged young peoples’ daily choices. Method Qualitative and participative methods were used. Nine young people, aged 11–14 participated in Photovoice and photo elicitation interviews. Data were analysed thematically. Findings Occupational choices are contextually informed and constrained, as illustrated by three themes: a limited perception of choices, choices informed by a need to stay connected to others and choices as a vehicle for social positioning. Conclusion Occupational choices do not appear to emanate from internal interests and abilities but rather from necessitated and mandated actions based on socio-cultural expectations. This suggests that occupational therapists must pay closer attention to the social context that informs choices to improve wellbeing of at-risk young people.
Model-Based Comparison of the Normal and Fontan Circulatory Systems—Part II
Authors: Chin Alvin J. , Watrous Raymond L. 
Published: July 2015

Background: In the absence of an accessible chronic animal model of the Fontan circulation, computational modeling can provide insights into this unique circulatory arrangement, especially how differently it behaves from the normal mammalian circulation. Many groups have focused on refining a single element of the entire Fontan circulation—the total cavopulmonary connection (TCPC). Yet, only modest improvements in transplant-free survival have resulted. From an engineering perspective, optimizing the performance of a complex, multiparameter system requires an understanding of how the performance is affected by the full set of system parameters. Methods: We evaluated the hemodynamic impact of nine physiological perturbations in the two-year-old (yo) patient with hypoplastic left heart syndrome having a Fontan rearrangement (using our previously described lumped-parameter multicompartment model of both pulmonary and systemic circulations). In cases where comparison is appropriate, we evaluated the hemodynamic impact of analogous pathophysiologies in the normal two-year-olds. We operated the model in open-loop mode in order to expose the magnitude of the impact of uncompensated physiological perturbations. Results: Without the benefit of compensatory mechanisms, a valvar regurgitant fraction of 50% is sufficient to drop the cardiac index (CI) to 2.0 L/min/m2 or less. Aortopulmonary collateral flow of 0.6 L/min (1.1 L/min/m2) or 0.5 L/min (0.9 L/min/m2), sufficient to raise the ratio of pulmonary flow to systemic flow (Qp/Qs) to no higher than 1.2 or 1.5 (fenestration present or absent, respectively), is the maximum which could be tolerated (CI = 2.0 L/min/m2) without the help of compensatory mechanisms. Ventricular end-diastolic elastance (stiffness) changes have dramatic effects on CI in a Fontan circulatory arrangement. Conclusions: Several components of the Fontan circulation other than the TCPC actually have equal, or greater, impact on CI under certain conditions.
Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease
Authors: Piggott Kurt D. , Soni Meshal , Decampli William M. , Ramirez Jorge A. , Holbein Dianna , Fakioglu Harun , Blanco Carlos J. , Pourmoghadam Kamal K. 
Published: July 2015

Background: Acute kidney injury (AKI) and fluid overload have been shown to increase morbidity and mortality. The reported incidence of AKI in pediatric patients following surgery for congenital heart disease is between 15% and 59%. Limited data exist looking at risk factors and outcomes of AKI or fluid overload in neonates undergoing surgery for congenital heart disease. Methods: Neonates aged 6 to 29 days who underwent surgery for congenital heart disease and who were without preoperative kidney disease were included in the study. The AKI was determined utilizing the Acute Kidney Injury Network criteria. Results: Ninety-five neonates were included in the study. The incidence of neonatal AKI was 45% (n = 43), of which 86% had stage 1 AKI. Risk factors for AKI included cardiopulmonary bypass time, selective cerebral perfusion, preoperative aminoglycoside use, small kidneys by renal ultrasound, and risk adjustment for congenital heart surgery category. There were eight mortalities (five from stage 1 AKI group, three from stage 2, and zero from stage 3). Fluid overload and AKI both increased hospital length of stay and postoperative ventilator days. Conclusion: To avoid increased risk of morbidity and possibly mortality, every attempt should be made to identify and intervene on those risk factors, which may be modifiable or identifiable preoperatively, such as small kidneys by renal ultrasound.
Subaortic Area at Risk for Development of Obstruction After Surgical Repair of Atrioventricular Septal Defect
Authors: Pontailler Margaux , Capderou André , Lebret Emmanuel , Vergnat Mathieu , Ly Mohammed , Roussin Régine , Belli Emré 
Published: July 2015

Background: Morphology of the left ventricular outflow tract (LVOT) in atrioventricular septal defects (AVSDs) has been reported to be at risk for development of obstruction. The purpose of the present study was to identify the incidence, the risk factors, and the surgical outcomes of subaortic stenosis in repaired AVSDs. Methods: Records of 427 consecutive patients who underwent anatomical repair for all types of AVSDs from January 2000 to December 2012 were reviewed. Outcomes, independent risk factors, reoperation, and death were analyzed. Results: In a median follow-up of five years (range: 17 months-11.8 years), eight patients required nine reoperations for subaortic stenosis. Study group (n = 11) included three additional patients for whom repair was performed in a different institution. Median delay for reoperation was 11.9 years (range: 1.3-19.4 years). Surgical relief of subaortic stenosis was obtained by means of the enlargement of the LVOT: resection of fibrous structures in all reoperated patients and associated with septal myectomy in four. Two patients required a modified Konno procedure. Five reoperations were associated with left atrioventricular valve repair or replacement. Statistical analysis didn’t reveal any morphologic or demographic risk factors. No early or late death occurred. Conclusion: The development of subaortic stenosis after repair of AVSD remains a rare complication in midterm follow-up (incidence: 1.9%). The performance of preventive gesture during repair seemed to be unjustified. The surgical management of this reoperation consists of a simple and safe procedure.
Achieving Benchmark Results for Neonatal Palliation of Hypoplastic Left Heart Syndrome and Related Anomalies in an Emerging Program
Authors: Dodge-Khatami Ali , Chancellor William Z. , Gupta Bhawna , Seals Samantha R. , Ebeid Makram R. , Batlivala Sarosh P. , Taylor Mary B. , Salazar Jorge D. 
Published: July 2015

Background: Results of surgical management of hypoplastic left heart syndrome (HLHS) and related anomalies are often compared to published benchmark data which reflect the use of a variety of surgical and hybrid protocols. We report encouraging results achieved in an emerging program, despite a learning curve at all care levels. Rather than relying on a single preferred protocol, surgical management was based on matching surgical strategy to individual patient factors. Methods: From 2010 to 2014, a total of 47 consecutive patients with HLHS or related anomalies with ductal-dependent systemic circulation underwent initial surgical palliation, including 30 Norwood stage I, 8 hybrid stage I, and 9 salvage-to-Norwood procedures. True hybrid procedures entailed bilateral pulmonary artery banding and ductal stenting. In the salvage-to-Norwood strategy, ductal stenting was withheld in favor of continued prostaglandin infusion in anticipation of a deferred Norwood procedure. Cardiac comorbidities (obstructed pulmonary venous return, poor ventricular function, and atrioventricular valve regurgitation) and noncardiac comorbidities influenced the choice of treatment strategies and were analyzed as potential risk factors for extracorporeal membrane oxygenation (ECMO) support or in-hospital mortality. Results: Overall hospital survival was 81% (Norwood 83.3%, hybrid 88%, “salvage” 67%; P = .4942). Extracorporeal membrane oxygenation support was used for eight (17%) patients with two survivors. For cases with obstructed pulmonary venous return (n = 10, 21%), management choices favored a hybrid or salvage strategy ( P = .0026). Aortic atresia (n = 22, 47%) was treated by a Norwood or salvage-to-Norwood. No cardiac, noncardiac, or genetic comorbidities were identified as independent risk factors for ECMO or discharge mortality in a multivariable analysis. Conclusions: Our emerging program achieved outcomes that compare favorably to published benchmark data with respect to hospital survival. These results reflect rigorous interdisciplinary teamwork and a flexible approach to surgical palliation based on matching surgical strategy to patient factors. With major associated cardiac/noncardiac comorbidity and antegrade coronary flow, a true hybrid with ductal stenting was our preferred strategy. For high-risk situations such as aortic atresia with obstructed pulmonary venous return, the salvage hybrid-bridge-to-Norwood strategy may help achieve survival albeit with increased resource utilization.