bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-058 The ultimate sacrifice of a recalcitrant common carotid pseudoaneurysm after carotid endarterectomy
Authors: Nduku V , Veznedaroglu E , Liebman K 
Published: July 2012

Common Carotid Artery (CCA) pseudoaneurysms are uncommon vascular lesions. They are most likely to occur as a sequelae of previous neck surgery (CEA incidence <1%), blunt or penetrating injuries to the neck, cancer with radiation necrosis, iatrogenic, mycotic and fibromuscular dysplasia than spontaneously. Formation of CCA pseudoaneurysm post CEA can occur anytime from 2 days to 22 years and is attributed to wound dehiscence, suture failure, and arterial wall breakdown resulting from infection and the quality of the graft. We report the case of a neurologically asymptomatic 75-year-old male who developed an impressive, pulsatile pseudoaneurysm of the Right CCA 1 year after having bilateral CEA. There was less deliberation in his management options for he was referred to us by his General Vascular Surgeon. Angiograms revealed a 20.3 mm × 27.8 mm RCCA pseudoaneurysm that was rendered impotent using selective catherization with stent and coil embolization. Two weeks after discharge, he returned with a ruptured RCCA pseudoaneurysm and extravasations of blood through his previous incision site (CEA). New angiograms not only confirmed the stability of the 2 week old coils and stent construct but revealed a patent flow area inferior to the coils and posterior to the stent. This was again managed endovascularly using more coiling. Complete control of the pseudoaneurysm without any hemodynamic compromise was achieved and the patient was discharged home neurologically intact with no signs of infection. After 1 week, he returned with active pulsatile recalcitrant hemorrhage. This life threatening exsanguination was controlled by sacrificing the Right CCA (Parent Artery Sacrifice) after performing a Balloon Test Occlusion. This case brings to light an uncommon pathology, the complexity of its management, endovascular vs open surgical options, and the futile but systemic attempt to spare the parent artery.Competing interestsNone.Abstract E-058 Figure 1Abstract E-058 Figure 2
E-060 Dural arterio-venous fistula presenting with acute encephalopathy
Authors: Al Wafai A , Afshani M , Kazemi S 
Published: July 2012

BackgroundDural Arterio-venous fistulas (DAF) comprise 10%–15% of all intracranial vascular lesions. These are mostly acquired lesions. The DAF can be asymptomatic or they can present with nonaggressive symptoms (eg, tinnitus) or aggressive symptoms (eg, hemorrhage or neurological deficits).Case reportWe are reporting a case with DAF, who presented with acute encephalopathy. The patient is a 62-year-old male who presented with 4 days history of headache and progressive confusion. About 2 months prior to this admission, the patient was diagnosed with DVT in lower extremity and also superior and lateral sinus thrombosis. He was fully anti-coagulated and his INR on this presentation was 2. MRI of head showed multiple engorged cerebral veins. Four vessels cerebral arteriogram showed DAF with several arterial feeders from middle meningeal arteries, occipital arteries and also bilateral vertebral arteries. Partial embolization of the fistula was achieved with ONYX immediately post procedure patient's mental status improved and on last follow-up patient came back to his baseline.ConclusionDAF can present with acute encephalopathy due to venous hypertension.Competing interestsNone.
E-069 Restenosis after carotid artery stenting using the carotid wallstent: frequency of restenosis and effect of cilostazol in preventing restenosis
Authors: Takayama K , Taoka T , Myouchin K , Wada T , Nakagawa H , Kichikawa K , Kurokawa S 
Published: July 2012

Background and PurposeRestenosis after carotid artery stenting (CAS) is a postoperative problem, with a reported frequency around 2%–8%. However differences in stent design, procedure, and the antiplatelet agent appear affect the incidence of restenosis. We assessed the frequency of restenosis and the effect of the antiplatelet agent cilostazol (CLZ) in preventing restenosis after CAS by the standard procedure using the Carotid Wallstent (CWS).Materials and MethodsBetween May 2010 and October 2011, 62 lesions in 60 consecutive patients of CAS using the CWS were performed and all patients were followed clinically and assessed by ultrasonography, 3D-CTA or angiography at 3 and 6 months postoperatively. Restenosis was defined as ≥50% stenosis, The incidences of restenosis and differences in the incidence of restenosis by the difference in type of antiplatelet agent between the CLZ group (n=30; aspirin 100 mg and CLZ 200 mg) and the non-CLZ group (n=32; aspirin 100 mg and clopidogrel 75 mg (n=29) or ticlopidine 100 mg (n=2), 200 mg (n=1)) were retrospectively investigated. Two antiplatelet agents were given starting 1 week preoperatively until at least 3 months postoperatively.ResultsRestenosis occurred in five patients (8.3%), but all were cases of asymptomatic lesions in the follow-up period. All five patients of restenosis were in the non-CLZ group, with no cases of restenosis in the CLZ group; the difference was significant (p=0.0239).ConclusionThe restenosis rate after CAS using CWS was 8.3%. CLZ was associated with significant inhibition of restenosis.Competing interestsNone.
E-074 Intravenous thrombolysis and endovascular therapy for acute ischemic stroke with internal carotid artery occlusion: a systematic review of clinical outcomes
Authors: Mokin M , Kass-Hout T , Kass-Hout O , Dumont T , Kan P , Snyder K , Siddiqui A , Levy E 
Published: July 2012

Background and PurposeStrokes secondary to acute internal carotid artery (ICA) occlusion are associated with extremely poor prognosis. Best treatment approach to acute stroke in this setting is unknown. We sought to determine clinical outcomes in patients with acute ischemic stroke due to ICA occlusion treated with intravenous (IV) systemic thrombolysis or intraarterial (IA) endovascular therapy.MethodsUsing the PubMed database we searched for studies that included patients with acute ischemic stroke due to ICA occlusion who had received treatment with IV thrombolysis or IA endovascular interventions. Studies that provided data on functional outcomes beyond 30 days, mortality and symptomatic intracerebral hemorrhage (sICH) rates were included in our analysis.ResultsWe identified 28 studies with a total of 385 patients in the IV thrombolysis group and 584 patients in the endovascular group. Rates of favorable outcomes and sICH were significantly higher in the endovascular group than in the IV thrombolysis-only group (33.6% vs 24.9%, p=0.004 and 11.1% vs 4.9%, p=0.001, respectively). No significant difference in mortality rates was found between the two groups (27.3% in the IV thrombolysis group vs 32.0% in the endovascular group, p=0.12).ConclusionsAccording to our systematic review, endovascular treatment of acute ICA occlusion results in improved clinical outcomes. A higher rate of sICH following endovascular treatment does not result in an increased overall mortality rate. Randomized trials comparing systemic thrombolysis vs endovascular treatment are needed to determine the best treatment strategy in patients with acute ICA occlusion.Competing interestsM Mokin: None. T Kass-Hout: Genentech. O Kass-Hout: None. T Dumont: None. P Kan: None. K Snyder: Toshiba and ev3. A Siddiqui: NINDS 1R01NS064592-01A1, University at Buffalo. Shurtleff, Inc., Concentric Medical, ev3/Covidien Vascular Therapies, GuidePoint Global Consulting, Penumbra. Codman & Shurtleff, Inc, Genentech. Hotspur, Intratech Medical, StimSox, Valor Medical. Abbott Vascular, American Association of Neurological Surgeons, Neocure Group LLC, an Emergency Medicine Conference, Abbott Vascular. E Levy: Codman & Shurtleff, Inc.,ev3/Covidien Vascular Therapies, Boston Scientific. TheraSyn Sensors, Inc. Medical Ltd., Mynx/Access Closure.
E-075 Recanalization with wingspan stent for secondary division of middle cerebral artery occlusion in failure or contraindication to intravenous thrombolysis
Authors: Sung S , Lee T 
Published: July 2012

Background and PurposeRecanalization with the Wingspan stent, which can be deployed rapidly and safely, is an option for treating acute middle cerebral artery (MCA) secondary division (M2) occlusion when intravenous thrombolysis has failed or is contraindicated. The purpose of this study was to evaluated feasibility, efficacy, and safety of recanalization for acute MCA M2 occlusion using the Wingspan stent.MethodsWe report 10 patients with acute MCA M2 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 symptom onset. We analyzed angiographic and clinical results.ResultsSuccessful recanalization with the Wingspan stent were achieved in all patients. The mean NIHSS score on admission was 13.8 points (range 6–23). The occlusion site were located in the superior division (n=4, left:3, right:1), the middle division (n=1, right) and the inferior division (n=5, all: right) of MCA. The mean time interval from stroke symptom onset to stenting was 348.9±90.4 min. No intracranial hemorrhage, vessel perforations or dissections occurred in any patient. One patient developed acute thrombosis in distal ICA of a stented side at 4 days after placement and was managed well with mechanical thrombectomy. All patients improved on the NIHSS (mean amount: 8.8) and to an NIHSS score of 5±4.6 (median 4.5, range 0–15) at 7 days. At discharge, an mRS of ≤3 was achieved in 8 patients (80%) and an mRS of ≤2 was achieved in six patients (60%).ConclusionsThis case series demonstrated the feasibility of using a Wingspan stent safely and effectively for acute MCA M2 occlusions when intravenous thrombolysis failed or was contraindicated.Competing interestsNone.
E-077 Manual aspiration thrombectomy through balloon-tipped guide catheter for rapid clot burden reduction in endovascular therapy for ICA L/T occlusion: Abstract E-077 Figure 1
Authors: Eesa M , Almekhlafi M , Mitha A , Wong J , Goyal M 
Published: July 2012

PurposeTimely recanalization during endovascular procedures for acute ischemic stroke can be challenging in cases with large clot burden as those encountered in the terminal internal carotid, T- or L-type occlusion.MethodsA novel but simple technique to achieve fast reduction in clot burden in stroke patients with occlusion of the internal carotid artery termination is described where manual suction using a 60 ml syringe applied through an 8-French Balloon guide catheter positioned in the cervical carotid vasculature with proximal flow arrest allows subsequent revascularization of the residual middle cerebral artery clot.ResultsThe use of manual suction through balloon-tipped guide catheter in ICA L- or T-type occlusion is illustrated. This resulted in significant reduction of the clot burden and facilitated further interventions leading to full recanalization.ConclusionManual suction using 60 ml syringe through balloon guide catheter is a useful and feasible technique that facilitates thrombectomy of large burden cerebral clots.Competing interestsNone.Abstract E-077 Figure 1
Oral contraception and energy intake in women: Impact on substrate oxidation during exercise
Authors: Isacco Laurie , Thivel David , Pelle Anne Meddahi , Zouhal Hassane , Duclos Martine , Duche Pascale , Boisseau Nathalie 
Published: July 2012

Oral contraception (OC) and energy intake may play a role in fuel selection during exercise. The aim of this study was to investigate the effect of OCs (OC+ vs. OC–) in fed and fasting conditions on substrate oxidation and metabolic and hormonal responses in women during exercise. Substrate oxidation (respiratory exchange ratio and lipid and carbohydrates oxidation rates), metabolic (glycerol, free fatty acids (FFA), and glucose), and hormonal (insulin, adrenaline, and noradrenaline) responses were determined in 21 women: 10 regularly menstruating women (OC–) and 11 women using OCs (OC+: low-dose monophasic pill; ethinyl estradiol ≤ 30 µg) during 45 min at 65% of maximal oxygen consumption in fasting and postprandial states. At rest, OC+ presented higher low-density lipoprotein cholesterol, total cholesterol, and triglyceride plasma concentrations as compared with OC–. OC status had no influence on substrate oxidation and metabolic and hormonal responses during exercise. In the fasting state, whatever the OC status, women exhibited greater reliance on fat than in postprandial condition. This occurred in the presence of lower plasma insulin concentrations and higher plasma FFA and glycerol levels. The results indicated that the use of low-dose monophasic combined with OCs did not modify fuel selection and metabolic and hormonal responses during exercise in women. The fasting condition, compared with the fed condition, decreased carbohydrate oxidation during exercise, leading to a greater lipid mobilization and utilization whatever the OC status. Thus, in women, the realization of an exercise in either the fed or fasting conditions had a greater impact on substrate oxidation than OC status.
An exploratory study of sodium, potassium, and fluid nutrition status of tube-fed nonambulatory children with severe cerebral palsy
Authors: McGowan Joan Elizabeth , Fenton Tanis R. , Wade Andrew William , Branton Jodi Lynn , Robertson Marli 
Published: July 2012

Children with severe cerebral palsy (CP) often have lower mineral intakes than healthy children. It is unknown if their lower nutrient intakes are adequate to meet their needs. The objective of this study was to examine the sodium, potassium, phosphate, and fluid status of primarily tube-fed nonambulatory children with severe CP. The design consisted of a cross-sectional exploratory study and a clinical trial of sodium supplementation. Nutritional status was determined among primarily tube-fed children (aged 2 to 17 years) with CP based on blood and urine samples, anthropometry, and 3-day food records. Mineral and fluid status was evaluated by a nephrologist blind to nutrient intakes. Twenty children supplied food records, blood samples, and anthropometric measurements, and 16 supplied urine samples. Six (37.5%) of those who provided urine samples were considered possibly dehydrated, as urine osmolality was >600 mmol·kg–1. Six (60%) of the 10 children with satisfactory fluid status (low urine osmolality) were considered to have a possible dietary sodium deficiency based on a very low urine sodium concentration (<20 mmol·L–1). Those considered to have a possible dietary sodium deficiency had a significantly lower sodium intake (48% ± 15% Adequate Intake (AI)) compared with those considered sodium sufficient (73% ± 20% AI) (p = 0.031). One child was considered possibly phosphorus deficient, but none was assessed as likely potassium deficient. The conclusion was that sodium deficiencies were likely prevalent among the children. The findings from this small observational study suggest that sodium intakes for tube-fed children with CP should be maintained near the AI for their age. Hydration status of children receiving hypercaloric formulas should be monitored.
Sasanquasaponin up-regulates anion exchanger 3 expression and elicits cardioprotection via NO/RAS/ERK1/2 pathway
Authors: Chen He-Ping , He Ming , Mei Zhu-Jun , Huang Qi-Ren , Huang Min 
Published: July 2012

We have shown recently that sasanquasaponin (SQS) can inhibit ischemia/reperfusion-induced elevation of intracellular Cl–concentration ([Cl–]i) and elicit cardioprotection by up-regulating anion exchanger 3 (AE3) expression. In the present study, we futher analysed the intracellular signal transduction pathways by which SQS up-regulates AE3expression and elicits cardioprotection. Cardiomyocytes were incubated for 24 h with or without 10 µmol/L SQS, followed by simulated ischemia/reperfusion (sI/R). NO formation, Ras activity, and extracellular-regulated kinase 1/2 (ERK1/2) phosphorylation were measured appropriately. We showed that SQS pretreatment efficiently attenuated viability loss and lactate dehydrogenase leakage induced by sI/R in cardiomyocytes. Moreover, SQS induced NO production and promoted Ras activation, which futher promoted extracellular-regulated kinase 1/2 (ERK1/2) phosphorylation. These effects were paralleled by an increase in AE3expression. However, when the cardiomyocytes were treated with 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-l-oxyl-3-oxide (c-PTIO; an NO scavenger), S-trans-trans-farnesylthiosalicylic acid (FTS) (a Ras inhibitor), U0126 (an ERK1/2 inhibitor), respectively, the increase in AE3expression occurring during SQS pretreatment was almost completely abolished and, as a result, SQS-induced cardioprotection was prevented. Our findings indicate that SQS might up-regulate AE3expression through NO/Ras/ERK1/2 signal pathway to elicit cardioprotection in cultured cardiomyocytes.
A study about drug combination therapy of Schisandra sphenanthera extract and Rapamycin in healthy subjects
Authors: Li Ruidong , Guo Wenyuan , Fu Zhiren , Ding Guoshan , Wang Zhengxin , Fu Hong 
Published: July 2012

To assess the effect of the drug combination of Schisandra sphenanthera extract (SchE) and Rapamycin (RAPA), 18 healthy subjects were given oral treatments of RAPA alone and with SchE. Pharmacokinetic investigations and indexes of hepatic and renal functions, as well as other indices of oral RAPA administration (2 mg), were performed both before and after the SchE treatment period. Whole-blood RAPA concentrations were determined by enzyme-linked immunosorbent assay. The research found that the mean whole-blood RAPA AUC0–∞, Cmax, and tmax increased almost 2-, 2.1-, and 1.3-fold, respectively, and CL/F (–38.0%) decreased almost 1.6-fold in these subjects when RAPA was administered with SchE compared with oral RAPA administered alone. The results of this study proved that SchE can increase the oral bioavailability of RAPA and will add important information to the interaction area between drugs and herbal products.
A GENERALIZATION OF HAUSDORFF DIMENSION APPLIED TO HILBERT CUBES AND WASSERSTEIN SPACES
Authors: KLOECKNER BENOÎT 
Published: July 2012

A Wasserstein space is a metric space of sufficiently concentrated probability measures over a general metric space. The main goal of this paper is to estimate the largeness of Wasserstein spaces, in a sense to be made precise.In the first part, we generalize the Hausdorff dimension by defining a family of bi-Lipschitz invariants, called critical parameters, that measure largeness for infinite-dimensional metric spaces. Basic properties of these invariants are given, and they are estimated for a natural set of spaces generalizing the usual Hilbert cube. These invariants are very similar to concepts initiated by Rogers, but our variant is specifically suited to tackle Lipschitz comparison.In the second part, we estimate the value of these new invariants in the case of some Wasserstein spaces, as well as the dynamical complexity of push-forward maps. The lower bounds rely on several embedding results; for example we provide uniform bi-Lipschitz embeddings of all powers of any space inside its Wasserstein space and we prove that the Wasserstein space of a d-manifold has "power-exponential" critical parameter equal to d. These arguments are very easily adapted to study the space of closed subsets of a compact metric space, partly generalizing results of Boardman, Goodey and McClure.
Long-term efficacy of Boswellia serrata in four patients with chronic cluster headache
Authors: Lampl Christian , Haider Bernhard , Schweiger Christine 
Published: July 2012

Background: Cluster headache is an extremely severe and debilitating trigemino-autonomic pain syndrome. About 10% of patients with cluster headache manifest a chronic form (CCH).The present case series study aims to evaluate the long-term efficacy of Boswellia serrata (Sallaki H15) on headaches and disturbed sleep in patients with CCH. Case results: In an open-label study, four patients with CCH and disturbed sleep received oral B. serrata. Conclusion: The results provide Class IV evidence that oral B. serrata reduces the intensity and frequency of headaches in patients with CCH.
Magnetic resonance spectroscopy in migraine: What have we learned so far?
Authors: Reyngoudt Harmen , Achten Eric , Paemeleire Koen 
Published: July 2012

Objective: To summarize and evaluate proton (1H) and phosphorus (31P) magnetic resonance spectroscopy (MRS) findings in migraine. Methods: A thorough review of 1H and/or 31P-MRS studies in any form of migraine published up to September 2011. Results: Some findings were consistent in all studies, such as a lack of ictal/interictal brain pH change and a disturbed energy metabolism, the latter of which is reflected in a drop in phosphocreatine content, both in the resting brain and in muscle following exercise. In a recent interictal study ATP was found to be significantly decreased in the occipital lobe of migraine with aura patients, reinforcing the concept of a mitochondrial component to the migraine threshold, at least in a subgroup of patients. In several studies a correlation between the extent of the energy disturbance and the clinical phenotype severity was apparent. Less consistent but still congruent with a disturbed energy metabolism is an observed lactate increase in the occipital cortex of several migraine subtypes (MwA, migraine with prolonged aura). No increases in brain glutamate levels were found. Conclusion: The combined abnormalities found in MRS studies imply a mitochondrial component in migraine neurobiology. This could be due to a primary mitochondrial dysfunction or be secondary to, for example, alterations in brain excitability. The extent of variation in the data can be attributed to both the variable clinical inclusion criteria used and the variation in applied methodology. Therefore it is necessary to continue to optimize MRS methodology to gain further insights, especially concerning lactate and glutamate.
Social Integration and Diabetes Management Among Rural Older Adults
Authors: Arcury Thomas A. , Grzywacz Joseph G. , Ip Edward H. , Saldana Santiago , Nguyen Ha T. , Bell Ronny A. , Kirk Julienne K. , Quandt Sara A. 
Published: July 2012

Objectives: To describe diabetes management behaviors and social integration among older adults, and delineate the associations of social integration with diabetes management behaviors. Method: Interview data from 563 African American, American Indian, and White participants (age 60+) from eight south central North Carolina counties selected using a site-based procedure. Statistical analysis comprises descriptive statistics, bivariate analysis, and multivariate analysis. Results: Participants had high levels of social integration and largely adhered to diabetes management behaviors (glucose monitoring, checking feet, maintaining diet, formal exercise program, health provider monitoring A1C and examining feet). Social integration was associated with several behaviors; social network size, particularly other relatives seen and spoken with on the telephone, was associated with provider A1C monitoring and foot examinations. Discussion: Social integration had small but significant associations with diabetes management behaviors. This analysis suggests specific mechanisms for how social integration influences the effect of disease on disability.