bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morphological and clinical risk factors for the rupture of anterior communicating artery aneurysms
Authors: Matsukawa Hidetoshi , Uemura Akihiro , Fujii Motoharu , Kamo Minobu , Takahashi Osamu , Sumiyoshi Sosuke 
Published: December 2012

Object
Patients with ruptured anterior communicating artery (ACoA) aneurysms have historically been observed to have poor neuropsychological outcomes, and ACoA aneurysms have accounted for a higher proportion of ruptured than unruptured aneurysms. Authors of this study aimed to investigate the morphological and clinical characteristics predisposing to ACoA aneurysm rupture.

Methods
Data from 140 consecutive patients with ACoA aneurysms managed at the authors' facility between July 2003 and November 2011 were retrospectively reviewed. Patients with (78) and without (62) aneurysm rupture were divided into groups, and morphological and clinical characteristics were compared. Morphological characteristics were evaluated based on 3D CT angiography and included aneurysm location, dominance of the A1 portion of the anterior cerebral artery, direction of the aneurysm dome around the ACoA, aneurysm bleb(s), size of the aneurysm and its neck, aneurysm–parent artery angle, and existence of other intracranial unruptured aneurysms.

Results
Patients with ruptured ACoA aneurysms were significantly younger (a higher proportion were younger than 60 years of age) than those with unruptured lesions, and a significantly smaller proportion had hypercholesterolemia. A significantly larger proportion of patients with ruptured aneurysms showed an anterior direction of the aneurysm dome around the ACoA, had a bleb(s), and/or had an aneurysm size ≥ 5 mm. Multivariate logistic regression analysis showed that an anterior direction of the aneurysm dome around the ACoA (OR 6.0, p = 0.0012), the presence of a bleb(s) (OR 22, p < 0.0001), and an aneurysm size ≥ 5 mm (OR 3.16, p = 0.035) were significantly associated with ACoA aneurysm rupture.

Conclusions
Findings in the present study demonstrated that the anterior projection of an ACoA aneurysm may be related to rupturing. The authors would perhaps recommend treatment to patients with unruptured ACoA aneurysms that have an anterior dome projection, a bleb(s), and a size ≥ 5 mm.
Limbic system surgery for treatment-refractory obsessive-compulsive disorder: a prospective long-term follow-up of 64 patients
Authors: Sheth Sameer A. , Neal Jonathan , Tangherlini Frances , Mian Matthew K. , Gentil Andre , Cosgrove G. Rees , Eskandar Emad N. , Dougherty Darin D. 
Published: December 2012

Object
Obsessive-compulsive disorder (OCD) is a common and disabling psychiatric illness, and in a significant proportion of patients with OCD the disease is refractory to conventional pharmacotherapy and psychotherapy. For more than half a century, patients with severe, treatment-resistant OCD have been treated with stereotactic limbic system lesions, including dorsal anterior cingulotomy. The authors present their results describing the efficacy and durability of limbic system surgery for OCD, characterizing a large cohort of patients treated at a single institution with a mean follow-up of more than 5 years.

Methods
The authors identified 64 consecutive patients undergoing cingulotomy for refractory OCD at the Massachusetts General Hospital between 1989 and 2009. Changes in OCD and major depressive disorder symptom severity were assessed at both the initial and most recent postoperative follow-up by using the Yale-Brown Obsessive Compulsive Scale and the Beck Depression Inventory, respectively. Full and partial OCD symptom responses were defined as Yale-Brown Obsessive Compulsive Scale score reductions of ≥ 35% and 25%–34%, respectively.

Results
Regarding OCD symptom improvement, at the first postoperative follow-up (mean 10.7 months), 35% of patients demonstrated a full response and 7% were partial responders. Thirty patients had a subsequent procedure (repeat cingulotomy or subcaudate tractotomy). By the most recent follow-up (mean 63.8 months), rates climbed to 47% and 22% for full and partial responses, respectively. Of the 24 patients with at least a partial response at initial follow-up, 20 (83%) retained at least a partial response at final follow-up. Comorbid major depressive disorder severity decreased by 17% at the most recent follow-up.

Conclusions
Limbic system surgery based on initial cingulotomy offers a durable and effective treatment option for appropriately selected patients with severe OCD who have not responded to conventional pharmacotherapy or psychotherapy.
Communicating hydrocephalus caused by an unruptured perimedullary arteriovenous fistula in the lumbar region of an infant
Authors: Wilson Mitchell P. , Aronyk Keith E. , Yeo Thomas , Chow Michael , Pugh Jeffrey A. 
Published: December 2012

Spinal arteriovenous malformations are rare in children, although perimedullary arteriovenous fistulas (PMAVFs) may account for up to 24% of spinal arteriovenous malformations in this age group. Reported presentations of PMAVFs have included progressive or acute myelopathic symptoms, pain, hematomyelia, and subarachnoid hemorrhage. No known reports of an unruptured PMAVF causing communicating hydrocephalus have been previously published.
A 17-month-old girl presented to the authors' clinic with a 6-month history of back and leg pain, gait regression, constipation, and marked lumbar hyperlordosis due to a PMAVF. A brain MRI study also demonstrated advanced hydrocephalus. The patient underwent embolization with Onyx of 2 feeding arteries from the right L-1 and 1 feeding artery from the left L-1 lumbar arteries. Postembolization follow-up imaging demonstrated a reduction in size of the L-1 pedicles and no residual supply of the fistula. Three-year clinical follow-up showed normal bowel and bladder function with significant improvements in the patient's back pain, gait, and hyperlordosis. The patient's ventricular enlargement improved without direct management of her hydrocephalus.
To the authors' knowledge, this is the first reported case of communicating hydrocephalus caused by an unruptured PMAVF. The authors postulate that the origin of hydrocephalus was either central venous hypertension caused by the high-flow fistula or a change in fluid dynamics reducing CSF resorption through arachnoid granulations in the lumbar region of the spinal cord. The exact role that spinal arachnoid granulations play in CSF resorption is not currently known. Regardless of pathogenesis, initial treatment should focus on management of the fistula with additional hydrocephalus management only when necessary.
Central sleep apnea and associated Chiari malformation in children with syndromic craniosynostosis: treatment and outcome data from a supraregional national craniofacial center
Authors: Addo Nii K. , Javadpour Sheila , Kandasamy Jothy , Sillifant Paul , May Paul , Sinha Ajay 
Published: December 2012

Object
The association of Chiari malformation Type I (CM-I) with syndromic craniosynostosis (SC) in children is well established. Central sleep apnea (CSA) may subsequently occur. However, sleep studies performed in these patients have been focused mainly on assessing the severity of obstructive sleep apnea. Therefore, the incidence and management of CSA in these patients remains poorly defined. Authors of this study aimed to assess the efficacy of foramen magnum decompression (FMD) in resolving CSA, initially detected incidentally, in a small cohort of patients with CM-I and SC.

Methods
The clinical data for 5 children who underwent FMD for CSA at Alder Hey Children's Hospital between December 2007 and December 2009 were retrospectively analyzed. Outcomes were evaluated with respect to FMDs by utilizing pre- and postdecompression sleep studies. Of the 5 patients, 2 had Crouzon syndrome and 3 had Pfeiffer syndrome.

Results
Patient age at the time of surgery ranged from 1.1 to 12.6 years (median 4.1 years). The median postoperative follow-up was 3.6 years. Sleep studies revealed that 2 children experienced a > 80% reduction in CSAs at 1.5 and 21 months after decompression. The remaining 3 children experienced a > 60% reduction in CSAs when reevaluated between 2 and 10 months after decompression. The associated central apnea index improved for all patients.

Conclusions
Findings suggested that FMD is an effective treatment modality for improving CSA in patients with SC and associated CM-I. The use of multimodal polysomnography technology may improve the evaluation and management of these patients.
Divergence in CD19-Mediated Signaling Unfolds Intraclonal Diversity in Chronic Lymphocytic Leukemia, Which Correlates with Disease Progression
Authors: Herishanu Yair , Kay Sigi , Dezorella Nili , Baron Shoshana , Hazan-Halevy Inbal , Porat Ziv , Trestman Svetlana , Perry Chava , Braunstein Rony , Deutsch Varda , Polliack Aaron , Naparstek Elizabeth , Katz Ben-Zion 
Published: December 2012

AbstractEmerging data on intraclonal diversity imply that this phenomenon may play a role in the clinical outcome of patients with chronic lymphocytic leukemia (CLL), where subsets of the CLL clone responding more robustly to external stimuli may gain a growth and survival advantage. In this study, we report intraclonal diversity resolved by responses to CD19 engagement in CLL cells, which can be classified into CD19-responsive (CD19-R) and -nonresponive subpopulations. Engagement of CD19 by anti-CD19 Ab rapidly induced cellular aggregation in the CD19-R CLL cells. The CD19-R CLL cells expressed higher surface levels of CD19 and c-myc mRNA, exhibited distinct morphological features, and were preferentially abolished in rituximab-treated patients. Both subpopulations reacted to sIgM stimulation in a similar manner and exhibited similar levels of Akt and Erk phosphorylation, pointing to functional signaling divergence within the BCR. CD19 unresponsiveness was partially reversible, where nonresponding CD19 cells spontaneously recover their signaling capacity following incubation in vitro, pointing to possible in vivo CD19–signaling attenuating mechanisms. This concept was supported by the lower CD19-R occurrence in bone marrow–derived samples compared with cells derived from the peripheral blood of the same patients. CLL patients with &gt;15.25% of the CD19-R cell fraction had a shorter median time to treatment compared with patients with &lt;15.25% of CD19-R cell fraction. In conclusion, divergence in CD19-mediated signaling unfolds both interpatient and intraclonal diversity in CLL. This signaling diversity is associated with physiological implications, including the location of the cells, their responses to anti-CLL therapeutics, and disease progression.
IL-6 Controls the Innate Immune Response against Listeria monocytogenes via Classical IL-6 Signaling
Authors: Hoge Judith , Yan Isabell , Jänner Nathalie , Schumacher Valéa , Chalaris Athena , Steinmetz Oliver M. , Engel Daniel R. , Scheller Jürgen , Rose-John Stefan , Mittrücker Hans-Willi 
Published: December 2012

Abstract
The cytokine IL-6 plays a protective role in immune responses against bacterial infections. However, the mechanisms of IL-6–mediated protection are only partially understood. IL-6 can signal via the IL-6R complex composed of membrane-bound IL-6Rα (mIL-6Rα) and gp130. Owing to the restricted expression of mIL-6Rα, classical IL-6 signaling occurs only in a limited number of cells such as hepatocytes and certain leukocyte subsets. IL-6 also interacts with soluble IL-6Rα proteins and these IL-6/soluble IL-6Rα complexes can subsequently bind to membrane-bound gp130 proteins and induce signaling. Because gp130 is ubiquitously expressed, this IL-6 trans-signaling substantially increases the spectrum of cells responding to IL-6. In this study, we analyze the role of classical IL-6 signaling and IL-6 trans-signaling in the innate immune response of mice against Listeria monocytogenes infection. We demonstrate that L. monocytogenes infection causes profound systemic IL-6 production and rapid loss of IL-6Rα surface expression on neutrophils, inflammatory monocytes, and different lymphocyte subsets. IL-6–deficient mice or mice treated with neutralizing anti–IL-6 mAb displayed impaired control of L. monocytogenes infection accompanied by alterations in the expression of inflammatory cytokines and chemokines, as well as in the recruitment of inflammatory cells. In contrast, restricted blockade of IL-6 trans-signaling by application or transgenic expression of a soluble gp130 protein did not restrain the control of infection. In summary, our results demonstrate that IL-6Rα surface expression is highly dynamic during the innate response against L. monocytogenes and that the protective IL-6 function is dependent on classical IL-6 signaling via mIL-6Rα.
Cell-Specific TLR9 Trafficking in Primary APCs of Transgenic TLR9-GFP Mice
Authors: Avalos Ana M. , Kirak Oktay , Oelkers J. Margit , Pils Marina C. , Kim You-Me , Ottinger Matthias , Jaenisch Rudolf , Ploegh Hidde L. , Brinkmann Melanie M. 
Published: December 2012

Abstract
Recognition of nucleic acids by TLR9 requires its trafficking from the endoplasmic reticulum to endolysosomal compartments and its subsequent proteolytic processing. Both processes depend on interactions of TLR9 with the polytopic endoplasmic reticulum–resident protein UNC93B1. To examine the intracellular behavior of TLR9 in primary APCs, we generated transgenic mice expressing a TLR9-GFP fusion. The TLR9-GFP transgene is functional and is proteolytically processed in resting bone marrow–derived macrophages (BMDMs), dendritic cells, and B cells. Inhibition of cleavage impairs TLR9-dependent responses in all primary APCs analyzed. The kinetics of TLR9-GFP processing in BMDMs and B cells differs: in B cells, proteolysis occurs at a faster rate, consistent with an almost exclusive localization to endolysosomes at the resting state. In contrast to the joint requirement for cathepsins L and S for TLR9 cleavage in macrophages, TLR9-GFP cleavage depends on cathepsin L activity in B cells. As expected, in BMDMs and B cells from UNC93B1 (3d) mutant mice, cleavage of TLR9-GFP is essentially blocked, and the expression level of UNC93B1 appears tightly correlated with TLR9-GFP cleavage. We conclude that proteolysis is a universal requirement for TLR9 activation in the primary cell types tested, however the cathepsin requirement, rate of cleavage, and intracellular behavior of TLR9 varies. The observed differences in trafficking indicate the possibility of distinct modes of endosomal content sampling to facilitate initiation of TLR-driven responses in APCs.
The Depletion of NK Cells Prevents T Cell Exhaustion to Efficiently Control Disseminating Virus Infection
Authors: Cook Kevin D. , Whitmire Jason K. 
Published: December 2012

AbstractNK cells have well-established functions in immune defense against virus infections and cancer through their cytolytic activity and production of cytokines. In this study, we examined the frequency of NK cells and their influence on T cell responses in mice given variants of lymphocytic choriomeningitis virus that cause acute or persisting infection. We found increased frequencies of circulating NK cells during disseminating infection compared with uninfected or acutely infected mice. Consistent with recent reports, we observed that the depletion of NK cells in mice with disseminated infection increased peak numbers of virus-specific cytokine producing CD8+ T cells and resulted in the rapid resolution of disseminated infection. Additionally, we show that NK cell depletion sustained T cell responses across time and protected against T cell exhaustion. The positive effects of NK cell depletion on T cell responses only occurred when NK cells were depleted within the first 2 d of infection. We find that the improved CD8+ T cell response correlated with an enhanced ability of APCs from NK cell–depleted mice to stimulate T cell proliferation, independently of the effects of NK cells on CD4+ T cells. These results indicate that NK cells play an integral role in limiting the CD8 T cell response and contribute to T cell exhaustion by diminishing APC function during persisting virus infection.
Inappropriateness of fresh frozen plasma for abnormal coagulation tests
Authors: S Pybus  , MacCormac A , Houghton A , Martlew V , Thachil J 
Published: December 2012

Background: There is increasing evidence to suggest that the use of fresh frozen plasma (FFP) as a prophylaxis to bleeding is ineffective. However, a high proportion of FFP transfusions still occur in non-bleeding patients despite the high risk of adverse events. The aim of the study was to assess compliance with current prophylactic FFP guidelines at a large tertiary centre. Methods: Data were collected retrospectively over a 16-month period from May 2010 to August 2011. Information collected included patient characteristics, indications for and details of FFP use, and the ordering of coagulation screens before and after transfusion. Results: Over this period, FFP was used in a total of 573 transfusion episodes, 88 of which were prophylactic. This use deviated from the British Committee for Standards in Haematology guidelines in three main areas: indications for FFP use (89%), dose prescribed (49%) and the measurement of prothrombin time (PT) and activated partial thromboplastin time (APTT) after transfusion (66%). Conclusions: There were no significant differences in compliance with guidelines between different hospital departments, suggesting a culture of widespread inappropriate FFP use and a general lack of understanding among clinicians. Physician training and increased enforcement of existing guidelines could reduce FFP usage and expenditure.
Perspectives of Speech-Language Pathologists on the Use of Telepractice in Schools: Quantitative Survey Results
Authors: Tucker Janice K. 
Published: December 2012

This research surveyed 170 school-based speech-language pathologists (SLPs) in one northeastern state, with only 1.8% reporting telepractice use in school-settings. These results were consistent with two ASHA surveys (2002; 2011) that reported limited use of telepractice for school-based speech-language pathology. In the present study, willingness to use telepractice was inversely related to age, perhaps because younger members of the profession are more accustomed to using technology. Overall, respondents were concerned about the validity of assessments administered via telepractice; whether clinicians can adequately establish rapport with clients via telepractice; and if therapy conducted via telepractice can be as effective as in-person speech-language therapy. Most respondents indicated the need to establish procedures and guidelines for school-based telepractice programs.
The Multi-faceted Implementation of Telepractice to Service Individuals with Autism
Authors: Boisvert Michelle , Hall Nerissa , Andrianopoulos Mary , Chaclas Jeanne 
Published: December 2012

Telepractice is a method of service delivery in which professionals provide intervention, assessment and consultation services to individuals through the use of telecommunication technologies. In response to the nationwide school-based shortage of speech-language pathologists, telepractice has emerged as a viable way to reach underserved clients. Telepractice has the potential to extend to populations in need of services, including those diagnosed with autism. This paper examines an evidence-based clinical model for the delivery of telepractice services and describes the policies and procedures required for assessing individual need, confidentiality, technology, training and documentation within a telepractice program. Two clinical case studies involving individuals diagnosed with autism are described and provide initial evidence for the use of telepractice as a practical method for direct and consultative service delivery. Results indicated that both the student receiving direct services, and the treating clinician receiving consultative services via telepractice, demonstrated an increased skill level in target domains.
Oligo(∊-caprolactone)-Based Polymer Networks Prepared by Photocrosslinking in Solution
Authors: Friess Fabian , Wischke Christian , Behl Marc , Lendlein Andreas 
Published: December 2012

Purpose Polymer networks with adjustable properties prepared from endgroup-functionalized oligoesters by UV-crosslinking in melt have evolved into versatile multifunctional biomaterials. In addition to the molecular weight or architecture of precursors, the reaction conditions for crosslinking are pivotal for the polymer network properties. Crosslinking of precursors in solution may facilitate low-temperature processes and are compared here to networks synthesized in melt. Methods Oligo(∊-caprolactone)-(z)methacrylate (oCL-(z)IEMA) precursors with a linear (z = di) or a four-armed star-shaped (z = tetra) architecture were crosslinked by radical polymerization in melt or in solution with UV irradiation. The thermal, mechanical, and swelling properties of the polymer networks obtained were characterized. Results Crosslinking in solution resulted in materials with lower Young's moduli (E), lower maximum stress (σmax), and higher elongation at break (∊B) as determined at 70 °C. Polymer networks from 8 kDa star-shaped precursors exhibited poor elasticity when synthesized in the melt, but can be established as stretchable materials with a semi-crystalline morphology, a high gel- content, and a high elongation at break when prepared in solution. Conclusions The crosslinking condition of methacrylate functionalized precursors significantly affected network properties. For some types of precursors such as star-shaped telechelics, synthesis in solution provided semi-crystalline elastic materials that were not accessible from crosslinking in melt.
The Interpersonal Process in Tissue Donation Requests with “Undecided” Next of Kin
Authors: Dorflinger Lindsey , Auerbach Stephen M. , Siminoff Laura A. 
Published: December 2012

Context Although recent studies have demonstrated that tissue requesters' behavior during conversations about tissue donation affects consent rates, the link between requesters' behavior and consent rates remains unclear. Objective To examine whether positive/collaborative requester behaviors elicit complementary behaviors from next of kin who were initially undecided about their willingness to donate their deceased family member's tissues. Design Audio recordings of requests were coded to assess for interpersonal behavior of each interactant. Setting Audio recordings were gathered from a national sample of tissue banks. Participants One hundred and two requester–next-of-kin dyads, consisting of 102 relatives and 53 requesters. Main Outcome Measures Tissue requester and next-of-kin affiliation and interpersonal control were assessed. Tissue requesters' persuasion, confirmation (eg, approval, empathy, reassurance) and disapproval, as well as next-of-kin approval and disapproval, were examined. Results Tissue requesters and next of kin tended to match one another on affiliation and complement one another on interpersonal control. “Key topics,” which may affect the next of kin's decision, are discussed in only about one-third of requests. Next of kin were less affiliative and more disapproving when requesters were also more disapproving. Interpersonal behavior of the tissue requester, such as affiliation, statements of disapproval, and persuasion, as well as discussion of key topics, was a significant predictor of the interpersonal behavior of the next of kin. Conclusions Positive requester behaviors elicited a positive response from undecided next of kin. Because many next of kin have limited knowledge about tissue donation before the request, the communication process may affect the next of kin's perceptions of donation and thus affect the likelihood of consent. Findings could potentially inform communication skills training for tissue requesters; future research could examine effects of such training on consent rates.