bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sildenafil Potentiates Bone Morphogenetic Protein Signaling in Pulmonary Arterial Smooth Muscle Cells and in Experimental Pulmonary Hypertension
Authors: Yang Jun , Li Xiaohui , Al-Lamki Rafia S. , Wu Changxin , Weiss Astrid , Berk Joachim , Schermuly Ralph T. , Morrell Nicholas W. 
Published: November 2012

Objective—
Mutations in the bone morphogenetic protein type II receptor (BMPR-II) are responsible for the majority of cases of heritable pulmonary arterial hypertension (PAH), and BMPR-II deficiency contributes to idiopathic and experimental forms of PAH. Sildenafil, a potent type-5 nucleotide-dependent phosphodiesterase inhibitor, is an established treatment for PAH, but whether sildenafil affects bone morphogenetic protein (BMP) signaling in the pulmonary circulation remains unknown.

Methods and Results—
Studies were undertaken in human pulmonary arterial smooth muscle cells (PASMCs) and in vivo in the monocrotaline rat model of PAH. In PASMCs, sildenafil enhanced BMP4-induced phosphorylation of Smad1/5, Smad nuclear localization, and Inhibitor of DNA binding protein 1 gene and protein expression. This effect was mimicked by 8-bromo-cyclic GMP. Pharmacological inhibition or small interfering RNA knockdown of cyclic GMP-dependent protein kinase I inhibited the effect of sildenafil on BMP signaling. In functional studies, we observed that sildenafil potentiated the antiproliferative effects of BMP4 on PASMC proliferation. Furthermore, sildenafil restored the antiproliferative response to BMP4 in PASMCs harboring mutations in BMPR-II. In the monocrotaline rat model of PAH, which is characterized by BMPR-II deficiency, sildenafil prevented the development of pulmonary hypertension and vascular remodeling, and partly restored Smad1/5 phosphorylation and Inhibitor of DNA binding protein 1 gene expression in vivo in monocrotaline exposed rat lungs.

Conclusion—
Sildenafil enhances canonical BMP signaling via cyclic GMP and cyclic GMP-dependent protein kinase I in vitro and in vivo, and partly restores deficient BMP signaling in BMPR-II mutant PASMCs. Our findings demonstrate a novel mechanism of action of sildenafil in the treatment of PAH and suggest that targeting BMP signaling may be beneficial in this disease.
Comprehensive Annular and Subvalvular Repair of Chronic Ischemic Mitral Regurgitation Improves Long-Term Results With the Least Ventricular Remodeling
Authors: Szymanski Catherine , Bel Alain , Cohen Iris , Touchot Bernard , Handschumacher Mark D. , Desnos Michel , Carpentier Alain , Menasché Philippe , Hagège Albert A. , Levine Robert A. , Messas Emmanuel 
Published: November 2012

Background—
Undersized ring annuloplasty for ischemic mitral regurgitation (MR) is associated with variable results and >30% MR recurrence. We tested whether subvalvular repair by severing second-order mitral chordae can improve annuloplasty by reducing papillary muscle tethering.

Methods and Results—

Posterolateral myocardial infarction known to produce chronic remodeling and MR was created in 28 sheep. At 3 months, sheep were randomized to sham surgery versus isolated undersized annuloplasty versus isolated bileaflet chordal cutting versus the combined therapy (n=7 each). At baseline, chronic myocardial infarction (3 months), and euthanasia (6.6 months), we measured left ventricular (LV) volumes and ejection fraction, wall motion score index, MR regurgitation fraction and vena contracta, mitral annulus area, and posterior leaflet restriction angle (posterior leaflet to mitral annulus area) by 2-dimensional and 3-dimensional echocardiography. All groups were comparable at baseline and chronic myocardial infarction, with mild to moderate MR (MR vena contracta, 4.6±0.1 mm; MR regurgitation fraction, 24.2±2.9%) and mitral annulus dilatation (
P
<0.01). At euthanasia, MR progressed to moderate to severe in controls but decreased to trace with ring plus chordal cutting versus trace to mild with chordal cutting alone versus mild to moderate with ring alone (MR vena contracta, 5.9±1.1 mm in controls, 0.5±0.08 with both, 1.0±0.3 with chordal cutting alone, 2.0±0.4 with ring alone;
P
<0.01). In addition, LV end-systolic volume increased by 108% in controls versus 28% with ring plus chordal cutting, less than with each intervention alone (
P
<0.01). In multivariate analysis, LV end-systolic volume and mitral annulus area most strongly predicted MR (
r
2
=0.82,
P
<0.01).

Conclusions—
Comprehensive annular and subvalvular repair improves long-term reduction of both chronic ischemic MR and LV remodeling without decreasing global or segmental LV function at follow-up.
Reducing Door-to-Needle Times Using Toyota’s Lean Manufacturing Principles and Value Stream Analysis
Authors: Ford Andria L. , Williams Jennifer A. , Spencer Mary , McCammon Craig , Khoury Naim , Sampson Tomoko R. , Panagos Peter , Lee Jin-Moo 
Published: November 2012

Background and Purpose—
Earlier tissue-type plasminogen activator (tPA) treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times. We used lean process improvement methodology to develop a streamlined intravenous tPA protocol.

Methods—
In early 2011, a multidisciplinary team analyzed the steps required to treat patients with acute ischemic stroke with intravenous tPA using value stream analysis (VSA). We directly compared the tPA-treated patients in the “pre-VSA” epoch with the “post-VSA” epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes.

Results—

The VSA revealed several tPA protocol inefficiencies: routing of patients to room, then to CT, then back to the room; serial processing of workflow; and delays in waiting for laboratory results. On March 1, 2011, a new protocol incorporated changes to minimize delays: routing patients directly to head CT before the patient room, using parallel process workflow, and implementing point-of-care laboratories. In the pre and post-VSA epochs, 132 and 87 patients were treated with intravenous tPA, respectively. Compared with pre-VSA, door-to-needle times and percent of patients treated ≤60 minutes from hospital arrival were improved in the post-VSA epoch: 60 minutes versus 39 minutes (
P
<0.0001) and 52% versus 78% (
P
<0.0001), respectively, with no change in symptomatic hemorrhage rate.

Conclusions—
Lean process improvement methodology can expedite time-dependent stroke care without compromising safety.
Telephone Assessment of Cognition After Transient Ischemic Attack and Stroke
Authors: Pendlebury Sarah T. , Welch Sarah J.V. , Cuthbertson Fiona C. , Mariz Jose , Mehta Ziyah , Rothwell Peter M. 
Published: November 2012

Background and Purpose—
Face-to-face cognitive testing is not always possible in large studies. Therefore, we assessed the telephone Montreal Cognitive Assessment (T-MoCA: MoCA items not requiring pencil and paper or visual stimulus) and the modified Telephone Interview of Cognitive Status (TICSm) against face-to-face cognitive tests in patients with transient ischemic attack (TIA) or stroke.

Methods—
In a population-based study, consecutive community-dwelling patients underwent the MoCA and neuropsychological battery >1 year after TIA or stroke, followed by T-MoCA (22 points) and TICSm (39 points) at least 1 month later. Mild cognitive impairment (MCI) was diagnosed using modified Petersen criteria and the area under the receiver-operating characteristic curve (AUC) determined for T-MoCA and TICSm.

Results—

Ninety-one nondemented subjects completed neuropsychological testing (mean±SD age, 72.9±11.6 years; 54 males; stroke 49%) and 73 had telephone follow-up. MoCA subtest scores for repetition, abstraction, and verbal fluency were significantly worse (
P
<0.02) by telephone than during face-to-face testing. Reliability of diagnosis for MCI (AUC) were T-MoCA of 0.75 (95% confidence interval [CI], 0.63–0.87) and TICSm of 0.79 (95% CI, 0.68–0.90) vs face-to-face MoCA of 0.85 (95% CI, 0.76–0.94). Optimal cutoffs were 18 to 19 for T-MoCA and 24 to 25 for TICSm. Reliability of diagnosis for MCI (AUC) was greater when only multi-domain impairment was considered (T-MoCA=0.85; 95% CI, 0.75–0.96 and TICSm=0.83, 95% CI, 0.70–0.96) vs face-to-face MoCA=0.87; 95% CI, 0.76–0.97).

Conclusions—
Both T-MoCA and TICSm are feasible and valid telephone tests of cognition after TIA and stroke but perform better in detecting multi-domain vs single-domain impairment. However, T-MoCA is limited in its ability to assess visuoexecutive and complex language tasks compared with face-to-face MoCA.
Early Change in Ferumoxytol-Enhanced Magnetic Resonance Imaging Signal Suggests Unstable Human Cerebral Aneurysm
Authors: Hasan David , Chalouhi Nohra , Jabbour Pascal , Dumont Aaron S. , Kung David K. , Magnotta Vincent A. , Young William L. , Hashimoto Tomoki , Winn H. Richard , Heistad Donald 
Published: November 2012

Background and Purpose—
The clinical significance of early (ie, within the first 24 hours) uptake of ferumoxytol by macrophages in the wall of human cerebral aneurysms is not clear. The purpose of this study was to determine whether early uptake of ferumoxytol suggests unstable cerebral aneurysm.

Methods—
Thirty unruptured aneurysms in 22 patients were imaged with magnetic resonance imaging 24 hours after infusion of ferumoxytol. Eighteen aneurysms were also imaged 72 hours after infusion of ferumoxytol. Aneurysm dome tissue was collected from 4 patients with early magnetic resonance imaging signal changes, 5 patients with late signal changes, and 5 other patients with ruptured aneurysms. The tissue was immunostained for expression of cyclooxygenase-1, cyclooxygenase-2, microsomal prostaglandin E2 synthase-1, and macrophages.

Results—
In 23% (7/30) of aneurysms, there was pronounced early uptake of ferumoxytol. Four aneurysms were clipped. The remaining 3 aneurysms were managed conservatively; all 3 ruptured within 6 months. In 53% (16 of 30) of aneurysms, there was pronounced uptake of ferumoxytol at 72 hours. Eight aneurysms were surgically clipped, and 8 were managed conservatively; none ruptured or increased in size after 6 months. Expression of cyclooxygenase-2, microsomal prostaglandin E2 synthase-1, and macrophages was similar in unruptured aneurysms with early uptake of ferumoxytol and ruptured aneurysms. Expression of these inflammatory molecules was significantly higher in aneurysms with early uptake of ferumoxytol versus aneurysms with late uptake.

Conclusions—
Uptake of ferumoxytol in aneurysm walls within the first 24 hours strongly suggests aneurysm instability and probability of rupture within 6 months, and may warrant urgent intervention.
School physical education: The effectiveness of health-related interventions and recommendations for health-promotion practice
Authors: Quitério Ana Luísa Dias 
Published: November 2012

Objective: To assess the effectiveness of physical education (PE) interventions designed to foster health features among school-aged children, and to present a qualitative perspective of the different approaches that are most effective in promoting health among youth. Design: Systematic review. Method: An extensive electronic literature search was carried out of published trials on interventions targeted to alter health features using school PE. The systematic searches across PE programmes and different health features were conducted using Medline and Web of Science databases. Following screening for scope and relevance, the studies included were compared based on the type of PE programme: augmented PE programme, non-augmented PE programme and multi-component programme. Results: A number of positive outcomes have been reached. Improvements were reported in both self-reported and objectively measured physical activity (PA), student activity levels during PE, physical fitness, blood profile, fundamental movement skills, cardiovascular disease risk, health-knowledge and dietary profiles. A considerable number of PE-interventions failed to decrease body mass index (BMI), adiposity measures and percent body fat (% BF). Modest effects were also observed for bone mass acquisition. Conclusion: Evidence revealed positive and consistent results across different health features. Nevertheless, the findings regarding body composition were inconsistent and sparse. Few considerations and recommendations were raised toward the PE role in the promotion of healthy lifestyles, and a number of implications for health promotion practice have been stressed.
A culturally specific dietary plan to manage weight gain among African American breast cancer survivors
Authors: Griffith Kathleen A , Royak-Schaler Renee , Nesbitt Kim , Zhan Min , Kozlovsky Adriane , Hurley Kristen , Pelser Colleen , Tkaczuk Katherine H Rak , Ryan Alice S 
Published: November 2012

Breast cancer survival rates are lower in African Americans (AAs) than in Caucasians, owing in part to a higher prevalence of obesity in the former, which increases the risk of recurrence and mortality. The Women’s Intervention Nutrition Study (WINS) found that Caucasian women who followed a low-fat eating plan experienced a lower rate of cancer recurrence than women who maintained their usual diets. The purpose of this study was to test the feasibility of a WINS plan tailored to the cultural needs of AA breast cancer survivors. This feasibility pilot study was conducted at a university National Cancer Institute-designated comprehensive cancer center outpatient clinic with AA breast cancer survivors. The culturally specific WINS (WINS-c) plan included eight individual counseling sessions, five educational group meetings, and follow-up telephone calls over a 1-year period. Outcome measures included dietary fat, triglyceride, insulin and glucose levels, and fruit and vegetable intake. Participants ( n = 8) had a mean age of 61.1 years (standard error of the mean (SEM) 3.1 years) and a mean BMI of 32 kg/m2 (SEM 4.25 kg/m)2. Baseline daily fat consumption decreased from 64.6 g (range 36.8–119.6g) to 44.0 g (21.6–73.4g) at 52 weeks ( p = 0.07). Mean daily consumption of fruits and vegetables increased by 36% and 15%, respectively. Mean triglyceride levels decreased at 12 months ( p < 0.05). Sustained hyperinsulinemia was noted in most participants, including those without diabetes. Mean calcium and vitamin D consumption decreased over the 1-year study period. In AA breast cancer survivors, the WINS-c program resulted in a trend toward reduced fat consumption and may represent a sustainable approach in this population for improvement of diet quality after breast cancer.
Clavicular Bone Tunnel Malposition Leads to Early Failures in Coracoclavicular Ligament Reconstructions
Authors: Cook Jay B. , Shaha James S. , Rowles Douglas J. , Bottoni Craig R. , Shaha Steven H. , Tokish John M. 
Published: November 2012

Background: Modern techniques for the treatment of acromioclavicular (AC) joint dislocations have largely centered on free tendon graft reconstructions. Recent biomechanical studies have demonstrated that an anatomic reconstruction with 2 clavicular bone tunnels more closely matches the properties of native coracoclavicular (CC) ligaments than more traditional techniques. No study has analyzed tunnel position in regard to risk of early failure. Purpose: To evaluate the effect of clavicular tunnel position in CC ligament reconstruction as a risk of early failure. Study Design: Case series; Level of evidence, 4. Methods: A retrospective review was performed of a consecutive series of CC ligament reconstructions performed with 2 clavicular bone tunnels and a free tendon graft. The population was largely a young, active-duty military group of patients. Radiographs were analyzed for the maintenance of reduction and location of clavicular bone tunnels using a picture archiving and communication system. The distance from the lateral border of the clavicle to the center of each bone tunnel was divided by the total clavicular length to establish a ratio. Medical records were reviewed for operative details and functional outcome. Failure was defined as loss of intraoperative reduction. Results: The overall failure rate was 28.6% (8/28) at an average of 7.4 weeks postoperatively. Comparison of bone tunnel position showed that medialized bone tunnels were a significant predictor for early loss of reduction for the conoid (a ratio of 0.292 vs 0.248; P = .012) and trapezoid bone tunnels (a ratio of 0.171 vs 0.128; P = .004); this correlated to an average of 7 to 9 mm more medial in the reconstructions that failed. Reconstructions performed with a conoid ratio of ≥0.30 were significantly more likely to fail (5/5, 100%) than were those performed lateral to a ratio of 0.30 (3/23, 13.0%) ( P < .01). There were no failures when the conoid ratio was <0.25 (0/10, 0%). Conoid tunnel placement was also statistically significant for predicting return to duty in our active-duty population. Conclusion: Medial tunnel placement is a significant factor in risk for early failures when performing anatomic CC ligament reconstructions. Preoperative templating is recommended to evaluate optimal placement of the clavicular bone tunnels. Placement of the conoid tunnel at 25% of the clavicular length from the lateral border of the clavicle is associated with a lower rate of lost reduction and a higher rate of return to military duty.
Characterization of alkali-treated kenaf fibre-reinforced recycled polypropylene composites
Authors: Islam Muhammad Remanul , Beg Mohammad Dalour H , Gupta Arun 
Published: November 2012

In this study, composites were produced using alkali-treated kenaf fibre and recycled polypropylene to improve the interfacial bonding between them. Maleic anhydride grafted polypropylene was used at a ratio of 1:10 to the fibre as a coupling agent. Blends are mixed together by means of a twin screw extruder and test specimens for mechanical testing were prepared through injection moulding machine. Fibre density, tensile property, elemental analysis, structural and morphological changes due to treatment was observed and their effects on the properties of the formulated composites were analyzed. Characterization of the composites was done by the tensile, flexural, impact and melt flow index tests. Thermogravimetric analysis and differential scanning calorimetry analysis were carried out to evaluate the thermal properties of the composites. Experiment showed that best tensile strength (TS) was found at 40% loading of fibre and alkali treatment of fibre enhanced the TS by 57%. Activation energies were calculated through Broido’s equation. It was also found that recycled polypropylene degrades at one stage, while composites degrade at two stages. Incorporating fibres decrease the activation energies of the composites but both coupling agent and treatment of fibres in that case enhance activation energies by 11 kJ mol−1 and 29 kJ mol−1, respectively, in the second stage. Field emission scanning electron microscope of the fractured surface showed that treatment of fibre improves the interfacial bonding between fibres and matrix. Density and water uptake of the composites were also studied in this study.
Preparation and characterization of PVAc–NMA–MMT
Authors: Fang Qun , Cui Hui-Wang , Du Guan-Ben 
Published: November 2012

To further improve and enhance the performances and properties of polyvinyl acetate (PVAc), montmorillonite (MMT) and N-hydroxymethyl acrylamide (NMA) were introduced together to polymerize with vinyl acetate (VAc). The exfoliated nanocomposite of PVAc–NMA–MMT was prepared through different synthesis precursors. Linear macromolecular chains of PVAc–NMA were formed in MMT layers. MMT was exfoliated into layers or sheets of nanoparticles and dispersed randomly in PVAc–NMA matrix. Both PVAc–NMA and MMT had small particles with a diameter of 50–100 nm. They dispersed together randomly. PVAc–NMA–MMT was a pseudo-plastic non-Newtonian fluid and possessed the normal stress effect (or Weissenberg effect from the pole-climbing phenomenon. With the change of different synthesis precursors and the increase of NMA content and MMT content in the synthesis system, the molecular weight of PVAc–NMA–MMT increased. PVAc–NMA–MMT had good dispersion, excellent storage stability and high static tensile at 6.47–6.85 MPa.
Increased iron accumulation occurs in the earliest stages of demyelinating disease: an ultra-high field susceptibility mapping study in Clinically Isolated Syndrome
Authors: Al-Radaideh Ali M , Wharton Samuel J , Lim Su-Yin , Tench Christopher R , Morgan Paul S , Bowtell Richard W , Constantinescu Cris S , Gowland Penny A 
Published: November 2012

Objective: To determine, using ultra-high field magnetic resonance imaging (MRI), whether changes in iron content occur in the earliest phases of demyelinating disease, by quantifying the magnetic susceptibility of deep grey matter structures in patients with Clinically Isolated Syndrome (CIS) that is suggestive of multiple sclerosis (MS), as compared with age-matched healthy subjects. Methods: We compared 19 CIS patients to 20 age-matched, healthy controls. Scanning of the study subjects was performed on a 7T Philips Achieva system, using a 3-dimensional, T2*-weighted gradient echo acquisition. Phase data were first high-pass filtered, using a dipole fitting method, and then inverted to produce magnetic susceptibility maps. Region of interest (ROI) analysis was used to estimate magnetic susceptibility values for deep grey matter structures (caudate nucleus, putamen, globus pallidus, the thalamus and its pulvinar). Results: Significantly increased relative susceptibilities were found in the CIS group, compared with controls, for the caudate nucleus ( p = < 0.01), putamen ( p < 0.01), globus pallidus ( p < 0.01) and pulvinar ( p < 0.05). We found no significant nor consistent trends in the relationship between susceptibility and age for either the study controls or CIS patients, in any ROI ( r2 < 0.5; p > 0.05). In CIS patients, the time elapsed since the clinical event and the Expanded Disability Status Scale (EDSS) scores were not correlated with iron levels in any ROI ( r2 < 0.5; p > 0.05); however, a moderate correlation ( r2 = 0.3; p < 0.01) was found between the T1 lesion load and the mean susceptibility of the caudate nucleus. Conclusion: CIS patients showed an increased iron accumulation, as measured using susceptibility mapping of the deep grey matter, suggesting that iron changes did occur at the earlier stages of CIS disease.
Successful repair of an isolated osteochondral fracture of the patella presenting with locking of the knee
Authors: Khan SK , Dowen D , Asaad SS 
Published: November 2012

A 15-year-old boy presented with a locked knee after a football injury. Sudden valgus impact to the planted right leg caused a patellar osteochondral fracture diagnosed by magnetic resonance imaging. The 2.5-cm fragment had avulsed off the medial facet without damage to the medial retinaculum or the medial patellofemoral ligament. The fracture was stabilised with headless compression screws. It had healed at 8 weeks, with the patient being able to bear full weight, and with a full range of active knee movement. At 4 months, he had returned to playing football for his school team. Normally, such a fracture occurs due to sheering force on the patella against the femur during the relocation phase of an acute patellar dislocation. In this case, the patella may have subluxed and then reduced spontaneously, without causing a true dislocation or damage to the medial soft tissue restraints. The energy dissipated at contact with the femur would however be sufficient to sheer the fragment off the patella. We believe this is the first report of successful repair of an osteochondral patellar fracture sustained by this mechanism.