bluuebunny/crossref_metadata_2025_split huggingface dataset:
Superficial Femoral Artery Plaque, the Ankle-Brachial Index, and Leg Symptoms in Peripheral Arterial Disease
Authors: McDermott Mary M. , Liu Kiang , Carr James , Criqui Michael H. , Tian Lu , Li Debiao , Ferrucci Luigi , Guralnik Jack M. , Kramer Christopher M. , Yuan Chun , Kibbe Melina , Pearce William H. , Berry Jarett , McCarthy Walter , Liao Yihua , Xu Dongxiang , Orozco Jennifer , Carroll Timothy J. 
Published: March 2011

Background—
The clinical significance of magnetic resonance–imaged plaque characteristics in the superficial femoral artery (SFA) is not well established. We studied associations of the ankle-brachial index (ABI) and leg symptoms with MRI-measured plaque area and percent lumen area in the SFA in participants with and without lower-extremity peripheral arterial disease (PAD).

Methods and Results—

Four hundred twenty-seven participants (393 with PAD) underwent plaque imaging of the first 30 mm of the SFA. Twelve 2.5-mm cross-sectional images of the SFA were obtained. Outcomes were normalized plaque area, adjusted for artery size (0 to 1 scale, 1=greatest plaque), and lumen area, expressed as a percent of the total artery area. Adjusting for age, sex, race, smoking, statins, cholesterol, and other covariates, lower ABI values were associated with higher normalized mean plaque area (ABI <0.50:0.79; ABI 0.50 to 0.69:0.73; ABI 0.70 to 0.89:0.65; ABI 0.90 to 0.99:0.62; ABI 1.00 to 1.09:0.48; ABI 1.10 to 1.30:0.47 (
P
trend <0.001)) and smaller mean percent lumen area (
P
trend <0.001). Compared with PAD participants with intermittent claudication, asymptomatic PAD participants had lower normalized mean plaque area (0.72 versus 0.65,
P
=0.005) and larger mean percent lumen area (0.30 versus 0.36,
P
=0.01), adjusting for the ABI and other confounders.

Conclusions—
Lower ABI values are associated with greater MRI-measured plaque burden and smaller lumen area in the first 30 mm of the SFA. Compared with PAD participants with claudication, asymptomatic PAD participants have smaller plaque area and larger lumen area in the SFA.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00520312.
Diffusion Tensor MRI Reveals Chronic Alterations in White Matter Despite the Absence of a Visible Ischemic Lesion on Conventional MRI
Authors: Bihel Ebeline , Roussel Simon , Toutain Jérôme , Bernaudin Myriam , Touzani Omar 
Published: March 2011

Background and Purpose—
The impact of stroke on white matter is poorly described in preclinical investigations mainly based on rodents with a low white (WM)/gray matter ratio. Using diffusion tensor imaging, we evaluated WM alterations and correlated them with sensorimotor deficits after stroke in the marmoset, a nonhuman primate that displays a WM/gray matter ratio close to that of humans.

Methods—
Marmosets underwent a transient brain ischemia (3-hour). Eight serial MRI examinations were made during ischemia and up to 45 days after reperfusion. The sensorimotor deficits were evaluated weekly over 45 days. To assess WM alterations, the SD of the angle of the first eigenvector projection was calculated in the cortex and in the internal and external capsules. The fiber-tracking approach was used to measure the number and the length of bundles.

Results—
Changes in the apparent diffusion coefficient and the fractional anisotropy values were similar during the temporal evolution of the lesion in the marmoset model of ischemia to that reported in patients with stroke. Despite an absence of visible lesions on T2-MRI and diffusion tensor imaging at the chronic stage, diffusion tensor MRI evidenced alterations in WM by the increase in the standard deviation of the angle of the first eigenvector projection in the cortex, internal and external capsules, and the decrease in the number of bundles of fibers tracked. The disruption of WM was strongly correlated with the chronic sensorimotor deficits.

Conclusions—
Despite an absence of a visible ischemic lesion at the chronic stage, diffusion tensor MRI revealed disorganization of WM, which probably underlies the persistence of functional deficits.
Cerebral Perfusion Pressure Thresholds for Brain Tissue Hypoxia and Metabolic Crisis After Poor-Grade Subarachnoid Hemorrhage
Authors: Schmidt J. Michael , Ko Sang-Bae , Helbok Raimund , Kurtz Pedro , Stuart R. Morgan , Presciutti Mary , Fernandez Luis , Lee Kiwon , Badjatia Neeraj , Connolly E. Sander , Claassen Jan , Mayer Stephan A. 
Published: March 2011

Background and Purpose—
To identify a minimally acceptable cerebral perfusion pressure threshold above which the risks of brain tissue hypoxia (BTH) and oxidative metabolic crisis are reduced for patients with subarachnoid hemorrhage (SAH).

Methods—

We studied 30 poor-grade SAH patients who underwent brain multimodality monitoring (3042 hours). Physiological measures were averaged over 60 minutes for each collected microdialysis sample. Metabolic crisis was defined as a lactate/pyruvate ratio >40 with a brain glucose concentration ≤0.7 mmol/L. BTH was defined as P
bt
O
2
<20 mm Hg. Outcome was assessed at 3 months with the Modified Rankin Scale.

Results—

Multivariable analyses adjusting for admission Hunt-Hess grade, intraventricular hemorrhage, systemic glucose, and end-tidal CO
2
revealed that cerebral perfusion pressure ≤70 mm Hg was significantly associated with an increased risk of BTH (OR, 2.0; 95% CI, 1.2–3.3;
P
=0.007) and metabolic crisis (OR, 2.1; 95% CI, 1.2–3.7;
P
=0.007). Death or severe disability at 3 months was significantly associated with metabolic crisis (OR, 5.4; 95% CI, 1.8–16;
P
=0.002) and BTH (OR, 5.1; 95% CI, 1.2–23;
P
=0.03) after adjusting for admission Hunt-Hess grade.

Conclusions—
Metabolic crisis and BTH are associated with mortality and poor functional recovery after SAH. Cerebral perfusion pressure levels <70 mm Hg was associated with metabolic crisis and BTH, and may increase the risk of secondary brain injury in poor-grade SAH patients.
Self-Reported Long-Term Needs After Stroke
Authors: McKevitt Christopher , Fudge Nina , Redfern Judith , Sheldenkar Anita , Crichton Siobhan , Rudd Anthony R. , Forster Ann , Young John , Nazareth Irwin , Silver Louise E. , Rothwell Peter M. , Wolfe Charles D.A. 
Published: March 2011

Background and Purpose—
Development of interventions to manage patients with stroke after discharge from the hospital requires estimates of need. This study estimates the prevalence of self-reported need in community-dwelling stroke survivors across the United Kingdom.

Methods—

We conducted a survey of stroke survivors 1 to 5 years poststroke recruited through Medical Research Council General Practice Research Framework general practices and 2 population-based stroke registers. Levels and type of need were calculated with comparisons among sociodemographic groups, disability level, and cognitive status using the χ
2
test or Fisher exact test, as appropriate.

Results—

From 1251 participants, response rates were 60% (national sample) and 78% (population registers sample) with few differences in levels of reported need between the 2 samples. Over half (51%) reported no unmet needs; among the remainder, the median number of unmet needs was 3 (range, 1 to 13). Proportions reporting unmet clinical needs ranged from 15% to 59%; 54% reported an unmet need for stroke information; 52% reported reduction in or loss of work activities, significantly more from black ethnic groups (
P
=0.006); 18% reported a loss in income and 31% an increase in expenses with differences by age, ethnic group, and deprivation score. In multivariable analysis, ethnicity (
P
=0.032) and disability (
P
=0.014) were associated with total number of unmet needs.

Conclusions—
Multiple long-term clinical and social needs remain unmet long after incident stroke. Higher levels of unmet need were reported by people with disabilities, from ethnic minority groups, and from those living in the most deprived areas. Development and testing of novel methods to meet unmet needs are required.
Outcomes of Mechanical Endovascular Therapy for Acute Ischemic Stroke
Authors: Rouchaud Aymeric , Mazighi Mikael , Labreuche Julien , Meseguer Elena , Serfaty Jean-Michel , Laissy Jean-Pierre , Lavallée Philippa C. , Cabrejo Lucie , Guidoux Céline , Lapergue Bertrand , Klein Isabelle F. , Olivot Jean-Marc , Abboud Halim , Simon Olivier , Schouman-Claeys Elisabeth , Amarenco Pierre 
Published: March 2011

Background and Purpose—
Recanalization is a powerful predictor of stroke outcome in patients with arterial occlusion. Intravenous recombinant tissue plasminogen activator is limited by its recanalization rate, which may be improved with mechanical endovascular therapy (MET). However, the benefit and safety of MET remain to be determined. The aim of this study was to give reliable estimates of efficacy and safety outcomes of MET.

Methods—
We analyzed data from our prospective clinical registry and conducted a systematic review of all previous studies using MET published between January 1966 and November 2009.

Results—
From April 2007 to November 2009, 47 patients with acute stroke were treated with MET at Bichat Hospital. The literature search identified 31 previous studies involving a total of 1066 subjects. In the meta-analysis, including our registry data, the overall recanalization rate was 79% (95% CI, 73–84). Meta-analysis of clinical outcomes showed a pooled estimate of 40% (95% CI, 34–46; 27 studies) for favorable outcome, 28% (95% CI, 23–33; 28 studies) for mortality, and 8% (95% CI, 6–10; 27 studies) for symptomatic intracranial hemorrhage. The likelihood of a favorable outcome increased with the use of thrombolysis (OR, 1.99; 95% CI, 1.23–3.22) and with proportion of patients with isolated middle cerebral artery occlusion (OR per 10% increase, 1.14; 95% CI, 1.04–1.25).

Conclusions—
MET is associated with acceptable safety and efficacy in stroke patients, and it may be a therapeutic option in those presenting with isolated middle cerebral artery occlusion.
Helicopter Transport of Stroke Patients and Its Influence on Thrombolysis Rates
Authors: Reiner-Deitemyer Veronika , Teuschl Yvonne , Matz Karl , Reiter Martina , Eckhardt Raoul , Seyfang Leonhard , Tatschl Claudia , Brainin Michael ,   for the Austrian Stroke Unit Registry Collaborators
Published: March 2011

Background and Purpose—
Acute stroke management requires minimization of prehospital time. This study addresses the value of helicopter transport compared with other means of transportation to a stroke unit and compares their rates of thrombolysis on a nationwide basis.

Methods—
Prospective data collection and prespecified evaluation of data from 32 stroke units between 2003 and 2009 were used. We distinguished between patients transported either directly to a stroke unit or transferred indirectly via a peripheral hospital. Thus, there were 6 transport groups: helicopter emergency service (HEMS) direct and indirect, ambulance accompanied by an emergency physician direct and indirect, and ambulance without physician direct and indirect. Demographic and clinical factors, time delays, and rates of thrombolysis of patients transported by helicopter were compared with factors of patients transported otherwise.

Results—
Of 21 712 ischemic stroke patients, 905 patients (4.1%) were transported by helicopter. Of these, 752 patients (3.4%) were transported by direct HEMS, and 153 patients (0.7%) were transported by indirect HEMS. Thrombolysis rates were highest for HEMS (24% direct, 29% indirect) transport, followed by ambulance accompanied by an emergency physician (18% direct, 15% indirect). The probability of receiving thrombolysis was highest for indirect HEMS transport (OR 3.6, 2.2–6.0), followed by indirect ambulance accompanied by an emergency physician transport (OR 1.5, 1.1–1.9). The shortest times, 90 minutes or less from stroke onset to hospital arrival, were achieved with direct AMBP and direct HEMS transport.

Conclusions—
The shortest hospital arrival times and highest thrombolysis rates were seen in ischemic stroke patients transported by helicopter.
Effect of Age on Outcomes of Treatment of Unruptured Cerebral Aneurysms
Authors: Brinjikji Waleed , Rabinstein Alejandro A. , Lanzino Giuseppe , Kallmes David F. , Cloft Harry J. 
Published: March 2011

Background and Purpose—
Age might differentially affect outcomes in patients treated for unruptured cerebral aneurysms with surgical clipping versus endovascular coil therapy. We evaluated a large administrative database to determine the effect of age on outcomes in patients treated for unruptured cerebral aneurysm.

Methods—
Using the National Inpatient Sample, we evaluated morbidity (discharge to long-term facility) and mortality of patients undergoing clipping or coiling of unruptured cerebral aneurysms in the United States between 2001 and 2008. Outcomes were evaluated in relation to four age strata: younger than 50 years; 50 to 64 years; 65 to 79 years; and patients 80 years or older.

Results—

Patients younger than 50 years old undergoing coiling had significantly lower morbidity rates when compared to patients who underwent clipping (3.5% versus 8.1%;
P
<0.0001), but no difference in mortality (0.6% versus 0.6%;
P
=0.72). Patients between 50 and 64 years old undergoing coiling had significantly decreased morbidity (4.0% versus 13.7%;
P
<0.0001) and mortality (0.5% versus 1.1%;
P
<0.0001) when compared to patients who underwent clipping. Coiled patients 65 to 79 years old had lower morbidity (6.9% versus 26.8%;
P
<0.0001) and mortality (0.8% versus 2.0%;
P
<0.0001) compared to patients who underwent clipping. Patients aged 80 years or older undergoing coiling also had lower morbidity (9.8% versus 33.5%;
P
<0.0001) and mortality (2.4% versus 21.4%;
P
<0.0001) when compared to patients who have undergone clipping.

Conclusions—
Patients treated with endovascular coiling have significantly less morbidity and mortality than those treated with surgical clipping, and these differences become more pronounced with age.
Evaluation of the MindMatters buddy support scheme in southwest Sydney: Strategies, achievements and challenges
Authors: Khan Raquiba J , Bedford Karen , Williams Mandy 
Published: March 2011

Objective: Assessing the strategies, achievements and challenges of implementing MindMatters and the views of partner schools towards the buddy support scheme. Design: The MindMatters buddy support scheme (2007–2008) was designed to increase the capacity of secondary schools to adopt a whole-school approach to improving health and well-being of the school community. Fourteen schools received support from health workers and funding. Setting: Secondary schools in southwest Sydney. Method: The scheme was evaluated qualitatively through face-to-face interviews with a representative from each school and thematic analysis of the information. Results: Participants believed that external support is needed to run additional programmes, as schools have competing priorities. They understood the link between the well-being of students and staff and good mental health. The achievements identified included less bullying and more student participation, connectedness, networking with outside agencies and increased confidence in showcasing their programmes. The challenges included: engaging culturally and linguistically diverse and indigenous communities; resources; support from the school executive; and staff transitions, time, skills and motivation. Factors that enabled schools to achieve positive outcomes were: partnership with the health service; MindMatters training; a positive staff attitude; and support from within the school. Conclusion: The partnership scheme contributed to strengthening staff confidence in implementing MindMatters. Health workers helped to bridge the gap between schools and state representatives. The capability of schools, the significance of the scheme and the usefulness of MindMatters training collectively contributed to the main achievements of incorporating a student voice, engaging community and building relationships with other agencies.
Adolescent boys’ grooming product use and perceived health risks: An exploration of parental influence
Authors: Yoo Jeong-Ju , Jacob John , Baier Margaret 
Published: March 2011

Objective: To investigate parental influence on adolescent boys’ use and risk-perceptions of using appearance-related products. Design: Using appearance-enhancing products can present a health threat to adolescents, as these products are not only applied to the body, but can also be ingested. Adolescents may look to their parents for information about products, or they may make inferences based on observing their parents’ appearance management behaviours. Setting: The results of this research suggest future studies to assist in developing intervention strategies to guide parents in promoting healthy appearance management for their sons. Method: The data were collected from 155 adolescent boys in the United States (US). Their ages ranged from 11-18 years, with an average age of 14.3 years. The frequencies of product use and risk-perceptions were compared using a Chi-square test, based on the sum of the parental influence scales. Results: Adolescent boys used a variety of appearance-related products, and their risk-perceptions coincided with their frequency of product use. Parental normative influence was significant for acne treatment, diet pills, and fragrance/body-spray products, although parental informative influence was not significantly related to product use. Parental influence was not related to their perceptions of the relative healthfulness of the same products. Conclusion: Parental influence is either directed toward encouraging or discouraging product use, rather than educating adolescents on the healthfulness of these products.
Profile and Outcome of Patients With Liver Cirrhosis Requiring Mechanical Ventilation
Authors: Juneja Deven , Gopal Palepu B , Kapoor Dharmesh , Raya Ravichandra , Sathyanarayanan Mohan 
Published: March 2011

Objective: Few studies have addressed the outcome of patients with cirrhosis requiring mechanical ventilation (MV). We aimed to investigate the short-term outcome of such patients. Methods: Retrospective review of data of 73 consecutive patients with cirrhosis requiring MV over a 2-year period (2006-2008). Data on patient’s characteristics, reason for MV, the presence of other organ failure, and first day Acute Physiology Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), Child-Pugh (CP), and Model for End-Stage Liver Disease (MELD) scores were collected, with 30-day mortality being the primary outcome measure. Results: Observed mortality in ICU and at 30 days was 75.3% and 87.7%, respectively. Area under curve was 0.77 (95% CI, 0.65-0.86) for APACHE II, 0.94 (95% CI, 0.85-0.98) for SOFA, 0.83 (95% CI, 0.7-0.96) for CP, and 0.93 (95% CI, 0.85-0.98) for MELD ( P = .096) in predicting 30-day mortality. By univariate analysis, indication for intubation ( P = .001), need for vasopressor support ( P = .002), the presence of renal failure ( P < .03), and duration of MV ( P < .001) were significantly associated with mortality. On multivariate analysis, only duration of MV (adjusted odds ratio 0.63, 95% CI: 0.42-0.95, P = .03) was the independent predictor of mortality with a majority of patients, 51/64 (79.7%), dying in the first 48 hours of intubation. Conclusions: Patients with cirrhosis requiring MV have a dismal prognosis. Such patients and their families should be informed about the overall outcome to assist their decisions about life support and intensive care, outside the transplant setting. Prognostic scores, especially SOFA and MELD, may aid in determining which patients may benefit from aggressive therapy.
Intravenous Ibandronate Acutely Reduces Bone Hyperresorption in Chronic Critical Illness
Authors: Via Michael A. , Potenza Matthew V. , Hollander Jason , Liu Xuan , Peng Yuanzhen , Li Jianhua , Sun Li , Zaidi Mone , Mechanick Jeffrey I. 
Published: March 2011

Objective: Patients who remain critically ill for prolonged periods and require tracheotomy, defined as chronic critical illness (CCI), display elevated levels of bone resorption. The measurement of bone turnover markers reveals that osteoclastic bone resorption is not only enhanced but also uncoupled from osteoblastic bone formation. We examine the effect of ibandronate on bone turnover in patients with CCI. Methods: This study is a prospective, double-blind, placebo-controlled trial, in which 20 postmenopausal female participants with CCI were followed for an 11-day period after the administration of a single intravenous dose of ibandronate (3 mg). All participants were treated with ergocalciferol (2000 IU daily), calcium carbonate (1250 mg daily), and calcitriol (0.25 μg daily). Results: The ibandronate group showed a 34% decrease in serum C-telopeptide (CTX) levels (a marker of osteoclastic activity) on day 6, while the placebo group showed a 13% increase ( P = .01). By day 11, CTX levels in ibandronate group were not significantly different than baseline or from the placebo group. Osteocalcin (OCN) levels (a marker of osteoblast activity) increased by 78% compared to baseline in the ibandronate group ( P = .01) and by 42% in the placebo group ( P = .05). There were no significant differences in OCN between the 2 groups throughout the study. Parathyroid hormone levels remained constant throughout the study. No adverse events were observed. Conclusion: A single dose of intravenous ibandronate causes a significant but transient reduction in osteoclast activity in patients with CCI, which persists over a 6-day period.
Relative kidney hyperfiltration in primary aldosteronism: a meta-analysis
Authors: Kuo Chin-Chi , Wu Vin-Cent , Tsai Ching-Wei , Wu Kwan-Dun ,   The Taiwan Primary Aldosteronism Investigation (TAIPAI) Study Group)
Published: March 2011

Introduction: Since the phenomenon of hyperfiltration in primary aldosteronism (PA) was first noted in 1996, subsequent clinical studies have produced conflicting results. To determine the development of relative hyperfiltration in PA, we performed a meta-analysis. Methods: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched through to July 2009. Reference sections of original articles, meta-analyses, and reviews on hyperfiltration in PA were reviewed. Hypertensive patients provided the controlled data for hyperfiltration. Two authors independently extracted the data. Results: A total of seven studies were included. One study was from the data of the TAIPAI group. Overall, there was strong evidence that relative kidney hyperfiltration existed in PA (fixed-effects model: standardised mean difference (SMD), 0.13; 95% confidence interval (CI), 0.03—0.22, p = 0.007; random-effects model: SMD, 0.35; 95% CI, -0.01—0.71, p = 0.05), though with a significant heterogeneity ( p < 0.0001). In the secondary meta-analysis with five top-quality studies, the relative kidney hyperfiltration was more significant. Mean age in each enrolled study was the only factor significantly associated with the existence of heterogeneity among the selected studies in the meta-regression analysis. Conclusions: Current evidence suggests that relative kidney hyperfiltration is the hallmark in PA and the phenomenon is beyond the effect of hypertension of PA. Clinicians should be aware of the possibility of occult renal damage in patients with PA.