bluuebunny/crossref_metadata_2025_split huggingface dataset:
Women's alcohol consumption and risk for alcohol‐exposed pregnancies in Russia
Authors: Balachova Tatiana , Bonner Barbara , Chaffin Mark , Bard David , Isurina Galina , Tsvetkova Larissa , Volkova Elena 
Published: July 2011

ABSTRACTAims  Alcohol‐exposed pregnancies (AEP) are the direct cause of fetal alcohol spectrum disorders (FASD). This study examines drinking patterns among pregnant and non‐pregnant women of childbearing age in Russia, a country with one of the highest levels of alcohol consumption in the world.Design  Cross‐sectional survey.Setting  Seven public women's clinics in two locations: St Petersburg (SPB) and the Nizhny Novgorod region (NNR).Participants  A total of 648 pregnant and non‐pregnant childbearing‐age women.Measurements  A face‐to‐face structured interview assessed alcohol consumption, pregnancy status/possibility of becoming pregnant and consumption before and after pregnancy recognition.Findings  Eighty‐nine per cent of non‐pregnant women reported consuming alcohol and 65% reported binge drinking in the past 3 months; 47% in NNR and 28% in SPB reported binges at least monthly. Women who might become pregnant consumed alcohol similarly to women who were not likely to become pregnant, and 32% of women in SPB and 54% in NNR were categorized as at risk for AEP. There was a significant decline in drinking after pregnancy identification. Twenty per cent of pregnant women reported consuming alcohol and 6% in SBP (none in NNR) reported binge drinking; however, a high prevalence of binge drinking was found among women who might become pregnant or who were trying to conceive.Conclusions  Russian women substantially reduce drinking after pregnancy recognition compared to pre‐pregnancy levels. No reductions were found prior to pregnancy recognition, either when a woman might become pregnant or when she was trying to conceive. The pre‐conception period presents a risk window and, therefore, a prevention opportunity.
Bilingual teaching in nursing education in China: Evolution, status, and future directions
Authors: He Wei , Xu Yu , Zhu Jianhua 
Published: July 2011

AbstractBased on Chinese published literature and personal observations, this article reviews the history of bilingual teaching in nursing education in China, describes its current status and challenges, and predicts its future directions. Bilingual teaching in nursing education enjoys increasing popularity in China. The major factors that affect bilingual teaching are bilingual educators, students' English‐language levels, bilingual teaching materials, and teaching models. Based on surveys of nursing schools, the English‐language proficiency of the nursing educators varies greatly. The main issues with the teaching methods lie in over‐translation, cramming, and limited interaction between the students and the teachers. Despite relatively inadequate English‐language proficiency among Chinese nursing students, their interest can be strengthened greatly if international exchanges are available and promoted. Bilingual textbooks are more suitable in China's national context because of pricing and relevance. Although immersive bilingual teaching is the ideal, it is more feasible to begin with infiltrative bilingual teaching and move progressively towards increased English‐language penetration. Future directions for improving bilingual teaching include training teaching faculty members, strengthening international exchanges, providing better bilingual study atmospheres, and gradually implementing bilingual textbooks.
O-018 Long-term anatomical results after endovascular treatment of ruptured intracranial aneurysms with GDC and Matrix coils: analysis of the CLARITY series
Authors: Cognard C , Pierot L , Ricolfi F , Anxionnat R 
Published: July 2011

PurposeCLARITY is a prospective, multicenter, consecutive series including patients treated with GDC or Matrix coils for ruptured aneurysms. Long-term anatomical results are presented.Materials and MethodsPostoperative and long-term anatomical results were evaluated anonymously and independently by two experienced neuroradiologists using the 3-point Modified Montreal scale.ResultsPost-operative and long-term anatomical results were evaluated in 517/649 patients (79.7%). In the long-term follow-up, complete occlusion was reported in 95/276 aneurysms (34.4%) in the GDC group and 80/241 aneurysms (33.2%) in the Matrix group, neck remnant in 127/276 aneurysms (46.0%) in the GDC group and 118/241 aneurysms (49.0%) in the Matrix group, and aneurysm remnant in 54/276 aneurysms (19.6%) in the GDC group and 43/241 aneurysms (17.8%) in the Matrix group (p=0.780). Direct comparison of long-term vs immediate post-operative aneurysm occlusion showed improvement in 35/272 aneurysms (12.9%) in the GDC group and 27/239 aneurysms (11.3%) in the Matrix group, stable situation in 98/272 aneurysms (36.0%) in the GDC group and 97/239 aneurysms (40.6%) in the Matrix group, and worsening in 139/272 aneurysms (51.1%) in the GDC group and 115/239 aneurysms (48.1%) in the Matrix group (p=0.555). During the follow-up period, a total of 32/517 patients were retreated: 9/276 (3.3%) in the GDC group and 23/241 (9.5%) in the Matrix group (p=0.003).Conclusions1-year anatomical results are not different in patients with ruptured aneurysms treated with GDC or Matrix coils. Similarly, the evolution of aneurysm occlusion is not different in patients treated with GDC or Matrix coils.
O-021 Hospitalization costs for endovascular and surgical treatment of unruptured cerebral aneurysms in the USA are substantially higher than medicare payments
Authors: Brinjikji W , Kallmes D , Lanzino G , Cloft H 
Published: July 2011

Background and PurposeEndovascular and surgical options are both available for the treatment of unruptured cerebral aneurysms. Knowledge of the costs for hospitalization of these patients is important to understanding economic impact of these patients on hospitals.MethodsUsing the National Inpatient Sample, hospitalizations for clipping and coiling of unruptured cerebral aneurysms from 2001 to 2008 were identified by cross-matching ICD-9 codes for diagnosis of unruptured aneurysm with procedure codes for clipping or coiling of cerebral aneurysms, and excluding all patients with diagnosis of subarachnoid hemorrhage and intracerebral hemorrhage. Hospital costs for 2008 were correlated with age, gender, and discharge status, and compared to Medicare payments.ResultsCosts of both clipping and coiling have increased from 2001 to 2008. The median 2008 hospital costs were US$23 574 (IQR 18233–29941) for clipping and US$25 734 (IQR 17436–35846) for coiling without complication, which were higher than the average Medicare payment of US$12 599. The median hospital costs were US$36 188 (IQR 21831–55308) for clipping and US$40 502 (IQR 24289–50108) for coiling treatments complicated by major morbidity, and US$68 165 (IQR 32972–100211) for clipping and US$56 020 (IQR 00000–00000) for coiling treatments complicated by mortality, which were higher than the average Medicare payments for patients with major complications and comorbidities of US$22 946. In multivariate analysis, female gender was associated with higher costs for coiling (p=0.02), and poor discharge status was associated with higher costs for both clipping (p<0.001) and coiling (p<0.001).ConclusionsHospitalization costs for patients undergoing clipping and coiling of unruptured cerebral aneurysms are substantially higher than Medicare payments.
O-029 Hemorrhagic complications following the endovascular treatment of brain AVMs
Authors: Baharvahdat H , Blanc R , Pistocchi S , Bartolini B , Piotin M 
Published: July 2011

PurposeThe intracranial hemorrhage is the most important complication during or after embolization of brain arteriovenous malformations (AVM). This study was designed to identify the possible risk factors related to intracranial bleeding during and after embolization of brain AVMs.Material and MethodsThe 474 consecutive embolization procedures of AVMs, performed in Neurointerventional service of Rothschild Foundation, Paris, France, were studied retrospectively .The clinical and morphological characteristics of them were reviewed and analyzed.ResultsThe mean age of patients was 32.2 years±13.8 (SD). The AVMs were located cortically in 70%, deep in 20%, and infratentorial in 10%. The most common clinical presentations were hemorrhage in 46% of cases and seizure in 23%. The procedural complications were intracranial bleeding (12%), catheter-related problems (10%), and ischemia (3.7%). The Onyx volume injected in procedures with hemorrhagic complications was more than the ones without hemorrhagic complications (p=0.020). The intracranial bleeding was not related to the patients' age (p=0.2), nidus size (p=0.59), hemorrhagic presentation of AVM (p=0.54), the spetzler-Martin grade of AVM (p=0.75), and location of AVM (deep-infratentorial vs cortical, p=0.28). The hemorrhagic complication was not different between the procedures used detachable microcatheter and the procedures used nondetachable microcatheter (p=0.61).ConclusionsAccording to results of this study, in neuroendovascular treatment of AVMs, the onyx volume injected during the procedure can affect the development of intracranial bleeding.
O-033 Radiation savings in pediatric angiographic procedures by incorporation of extra-low dose settings into procedure time-out
Authors: Morris P 
Published: July 2011

BackgroundWith the introduction of the Artis Zee Siemens biplane neuroangiographic suite into our department, radiation exposure and skin-dose estimates were collected prospectively on all pediatric procedures using ultra-low exposure settings beyond those recommended by the manufacturer. Pediatric “Minus” settings for fluoroscopy were set at 3 fps and 18 nGy/p (default 7.5–10 fps and 23 nGy/p). Setting this low-dose protocol was incorporated into our pre-procedure “Timeout” to assure compliance.MethodsEstimates of radiation dose were reviewed for 10 consecutive diagnostic and 10 interventional pediatric procedures. These results were compared with exposure parameters recorded using fluoroscopy and DSA with an adult size phantom using our pediatric low dose, the manufacturer's recommended pediatric settings, our adult low dose protocol, and the manufacturer's default adult settings.ResultsEstimated skin dose per case varied from 45.1 to 1888 mGy and Dose-Area-Product (DAP) varied from 27.2 to 5426 microGym2. The lower tier of exposures were all diagnostic procedures. For diagnostic procedures fluoroscopy related DAP readings accounted for 1.7–11.5% of the total DAP reading, and fluoroscopy accounted for 1–17% of the total estimated skin dose. For embolization procedures fluoroscopy accounted for 19–55.6% of DAP readings, and for 20–58% of estimated skin dose. Phantom DAP readings and estimated skin dose using a gamut of protocols suggest that fluoroscopy radiation readings using our pediatric minus protocol represent a dose savings of up to 88% compared with using an adult manufacturer's default setting at 7.5 fps at similar magnification. Phantom runs of DSA using Pediatric and Adult settings estimated a radiation dose reduction of at least 75% in DAP readings and 65% in skin dose compared with manufacturer adult default settings.ConclusionPhysician compliance with use of lower-dose pediatric radiation protocols for neuroangiographic procedures has the potential to result in substantial reduction of patient dose compared with likely doses accrued through inadvertent conduct of the case in default or adult settings. Fluorocopy settings are proportionately a larger component of the total dose during interventional procedures, underscoring the importance of compliance with manual fixing of protocol settings at the beginning of each case.
P-004 Endovascular management of acute ischemic stroke based on perfusion studies: a single center experience
Authors: Sharma J , Shams T , Blackham K , Hsu D , Tarr R , Sunshine J 
Published: July 2011

BackgroundCT Perfusion or MR perfusion studies are often used to evaluate patients who presents with Acute Ischemic Stroke (AIS). Little published data are available regarding the real-time use of perfusion imaging to guide endovascular management.ObjectiveTo evaluate the role of perfusion imaging in selection and decisions for endovascular management in AIS patients.MethodsRetrospective chart review was performed from prospectively collected database of patients with AIS who were treated with endovascular therapy from April 2010 to December 2010. Patients were divided into two groups: Group 1: included 23 patients who had initial perfusion study performed to decide endovascular management by exclusion of candidates with large matched defects, 10 males and 13 females with mean age of 68.13 (range 39–86), mean NIHSS 16.4 (range 6–26) and Group 2: included 21 patients who were treated with endovascular management without perfusion imaging screening, 10 males and 11 females with mean age 64.86 (range 34–89), mean NIHSS 15.7 (range 0–42). The primary outcome measures following the intervention were intracranial hemorrhage rate and mortality rate.ResultsGroup 1: All patients had lesions in the anterior circulation. Four patients received a combination of IV and IA tPA. Two received intravenous tPA, two received intra-arterial tPA. MERCI was used in seven patients and Penumbra device was used in seven patients. Post procedure hemorrhage was 13% (n=3). The mortality rate was 4.3% (n=1). Group 2: 15 patients had lesions in the anterior circulation and six patients in posterior circulation. Four patients received a combination of IV and IA tPA. Three received intravenous tPA, six received intra-arterial tPA. MERCI was used in eight patients and Penumbra device was used in 14 patients. Post procedure hemorrhage was 30% (n=6). The mortality rate was 24% (n=5).ConclusionsAlthough not a matched population, we note a trend toward a lower rate of symptomatic hemorrhage and mortality in patients who were selected based on perfusion study for endovascular therapy. Further prospective trials are warranted to evaluate role of perfusion based studies in selecting patients for endovascular management.
P-011 Preliminary results with a new volumetric-filling platinum coil, the penumbra coil 400
Authors: Woo H , Fiorella D , Han P 
Published: July 2011

PurposeThe FDA has recently approved the Penumbra Coil 400 for embolization of cerebral aneurysms. It is differentiated from existing platinum coils by virtue of its 0.020″ outer diameter, which results in increased filling per coil and intrinsic softness. We report the preliminary results of peri-procedural efficacy and safety of this new coil platform at two centers.Methods and MaterialsThis study is a retrospective case review of 7* consecutive patients at two centers treated with the Penumbra Coil. Adjunctive devices were used in 5 cases. The number of coils used to treat the aneurysm, the degree of occlusion and the final estimated packing density were recorded. Peri-procedural device related and clinical adverse events were recorded.ResultsThere were no device-related or clinical adverse events. An average of 4.4 coils (range 2–7) were deployed per aneurysm. The average final estimated packing density was 35.7% (range 15.1–48). 5 out of 7 aneurysms were completely occluded at the end of the procedure.ConclusionsThe Penumbra Coil 400 can be successfully used to treat a wide range of aneurysm types and sizes with acceptable complete occlusion rates, final packing densities, and peri-procedural complications. It appears that fewer coils can be used to achieve these results than would be normally expected with conventional size coils. The effect on procedure time, flouro time, economics, and long term stability will require further study.
P-025 Measurement of ionizing radiation exposure over the gravid uterus during endovascular treatment of intracranial aneurysm
Authors: Cho A , Pakbaz R , Green D 
Published: July 2011

IntroductionIntracranial hemorrhage during pregnacy can have catastrophic outcomes for both mother and fetus with high mortality rates (estimated 63% and 27% respectively) in untreated ruptured aneurysms. One of the most commonly expressed concerns about angiography during pregnancy is the potential risk of fetal abnormalities resulting from radiation exposure. We report direct measurement of ionizing radiation exposure over of the gravid uterus during cerebral arteriography.Materials and methodsDose over the gravid uterus using a TLD was measured during endovascular treatment of an intracranial aneurysm. The patient's abdomen was shielded using lead aprons place anterior and posterior, and strategies for dose reduction implemented. Pubmed search using mesh terms pregnancy, radiation dose, endovascular therapy and CT was performed for literature review.ResultsDose measured over the gravid uterus was 11 MREM. In comparison to findings reported in the literature this level is significantly less than esposure over the uterus during CT of the abdomen to exclude appendicitis/nephrolithiasis and CT of the chest to exclude pulmonary embolism in pregnancy. The dose is similar to head CT exposure. Risk to benifit analysis for treatment of ruptured aneurysms favors treatment during pregnancy.ConclusionRadiation exposure to the gravid uterus and fetus during cerebral angiography and endovascular procedures are within standard radiation exposure in pregnancy guidelines and comparible with other imaging modalities used during pregnancy. Diagnostic cerebral angiography and endovascular procedures can be safely performed during pregnancy while implementing radiation dose reduction strategies.
P-029 Usefulness of 3D time-of-flight magnetic resonance angiography (MRA) and contrast-enhanced MRA following coil embolization with the Enterprise stent for cerebral aneurysm
Authors: Takayama K , Miyouchin K , Sakamoto M , Taoka T , Wada T , Nakagawa H , Kichikawa K , Kurokawa S 
Published: July 2011

PurposeThe aim of this study was to determine the feasibility and usefulness of contrast-enhanced MR angiography (CE-MRA) and 3D time-of-flight (TOF) MRA for the follow-up of intracranial aneurysms treated with the Enterprise stent and detachable coils, by comparing with digital subtraction angiography (DSA).MethodsWe retrospectively analyzed five consecutive patients with five aneurysms were treated by coiling with Enterprise stent assistance and were followed-up by CE-MRA, TOF MRA, and DSA. All patients from 2 months to 6 months after endovascular treatment using Enterprise stent were included. Depictions of the internal and neck portions of the parent artery and aneurysm with TOF MRA and CE-MRA were compared with those of DSA, assumed to be the gold standard.ResultsThere was an important artifact with signal loss at the level of the stent in all cases on 3D TOF MRA; it was impossible to evaluate the parent artery lumen and aneurysm neck in all cases (100%). CE-MRA demonstrated the parent artery lumen and aneurysm neck and was comparable to DSA in all cases (100%). For 3 cases of neck remnant or residual aneurysm, there was no difference in decisions regarding further therapy between CE-MRA and DSA.ConclusionFor the follow-up after coil embolization using an Enterprise stent, evaluation with 3D TOF MRA is difficult, CE-MRA contrast-enhanced MRA is necessary.
P-030 A self-expanding wingspan stent-assisted recanalization for acute middle cerebral artery occlusion in case of failure or contraindication to intravenous thrombolysis
Authors: Sung S , Lee T 
Published: July 2011

BackgroundEarly recanalization of occluded intracranial arteries in acute ischemic stroke is one of the most important factors for better clinical outcome. Recanalization with a self-expanding Wingspan stent, which can be deployed rapidly and safely, is an option for treating acute ischemic stroke when intravenous thrombolysis has failed or is contraindicated. We present the feasibility, efficacy and safety of recanalization with a wingspan stent for acute middle cerebral artery (MCA) occlusion.MethodsWe collected 10 patients with acute MCA occlusion in whom recanalization was not achieved with a standard intravenous thrombolysis, or who were ineligible for intravenous thrombolysis or who presented after 3 h of symptom onset and the stenting could be completed within 8 h from stroke symptom onset. All 10 patients were treated with a self-expanding Wingspan stent. Recanalization results were assessed by thrombolysis in cerebral infarction (TICI) score of the target vessel after stenting. Neurological status was measured before and 7 days after stenting using the National Institutes of Health Stroke Scale (NIHSS). Procedure-related complications were assessed by a Vascular Neurologist. Functional outcome was evaluated at discharge according to the modified Rankin Scale (mRS).ResultsSuccessful stent deployment and recanalization were achieved in all patients (TICI 2a:1, TICI 2b:3, TICI 3:6). The patients' mean NIHSS score on admission was 12.7 points with SD of 6.3 points (range 4–21). In all 10 patients, the occlusion site were located in the 1st segment of the MCA (M1, n=7, left:2, right:5) and 2nd segment of the MCA (M2, n=3, all: right). The mean time interval from stroke symptom onset to stenting was 34.8–76.3 min. No vessel perforations or dissections occurred in any patient. None of the patients had intracranial hemorrhage visible on follow-up CT. Nine patients improved on the NIHSS at 7 days after stenting. One patient did not change the NIHSS score even though the occluded artery was completely recanalized. At 7 days after recanalization, NIHSS score of all patients was 4.4–4.7 (median 4, range 0–13). At discharge, an mRS of three was achieved in all 10 patients and an mRS of two was achieved in seven patients (70%). No further ischemic events occurred within 90 days after stenting.ConclusionsThis case series demonstrated that the self-expanding Wingspan stent can be used safely for acute MCA occlusion and can have a good clinical outcome if standard treatments are unavailable. Further, randomized trials will be needed to determine if stenting is associated with improved outcome.