bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy and Safety of MAP0004, Orally Inhaled DHE in Treating Migraines With and Without Allodynia
Authors: Tepper Stewart J. , Kori Shashidhar H. , Borland Scott W. , Wang Min H. , Hu Bin , Mathew Ninan T. , Silberstein Stephen D. 
Published: November 2011

Background.— Central sensitization develops once migraine attacks become established and can be clinically detected by the development of cutaneous allodynia. The efficacy of triptans for migraine resolution has been shown to be markedly reduced when administered in patients with established cutaneous allodynia.Objective.— The study aimed to evaluate the efficacy and safety of MAP0004, a novel, orally inhaled, form of dihydroergotamine, in patients with and without cutaneous allodynia at the time of treatment.Methods.— This evaluation was a post hoc subanalysis of a randomized, double‐blind, placebo‐controlled, 2‐arm, phase 3, multicenter study. The presence or absence of baseline cutaneous allodynia at the time of drug administration was based on the response to a standard questionnaire. Treatment efficacy at 2 hours posttreatment was compared in patients with and without baseline allodynia.Results.— At the time of treatment, allodynia was present in 216 patients treated with MAP0004 and 202 patients treated with placebo. MAP0004 treatment efficacy was superior to placebo, as measured by 2‐hour pain relief for patients with and without allodynia (P < .0001) and as measured by 2‐hour pain freedom for patients with (P < .0001) and without (P < .0002) allodynia. No significant within‐treatment differences after treatment with MAP0004 in patients with and without allodynia at baseline were observed. Patients were more likely to be allodynia‐free after treatment with MAP0004 compared with placebo (73% vs 66%, P = .0013). Furthermore, treatment with MAP0004 prevented the development of allodynia in patients not experiencing allodynia at baseline (P = .0057). MAP0004 was generally well tolerated.Conclusions.— This post hoc subanalysis shows that MAP0004 was similarly effective in patients whether or not allodynia was present at treatment baseline. Patients were also more likely to be allodynia‐free following treatment of a migraine with MAP0004.
Investigation of Nonmechanical Findings during Spinal Movement Screening for Identifying and/or Ruling Out Metastatic Cancer
Authors: Cook Chad , Ross Michael D. , Isaacs Robert , Hegedus Eric 
Published: November 2011

AbstractStudy design:  Retrospective cohort study.Objective:  To investigate the diagnostic accuracy of lumbar movement restrictions and pain in patients with metastatic bone cancer.Background:  When evaluating patients with low back pain, physical therapists have used the presence of nonmechanical findings during a spinal movement screen as 1 factor in determining whether physician referral is necessary. There are no studies that have investigated the accuracy of this strategy in a situation of diagnostic uncertainty.Methods:  This study included 1,109 patients (655 women) with low back pain (mean age = 54.8 ± 16.3 years) seen at a spine surgery center who received a clinical movement screen and an imaging‐supported diagnosis by an orthopedic surgeon. No report of pain during movement and no limitation of movement were considered the 2 targeted findings as these are associated with nonmechanical findings.Results:  Sixty‐six patients were diagnosed with metastatic cancer, 61 with metastatic bone cancer and concomitant diagnoses. Pain‐free lumbar movements in all directions for patients with metastatic bone cancer without concomitant diagnoses were associated with a posttest probability of 0.00 (+likelihood ratio = 2.4; −likelihood ratio = 0.0), which may be useful in ruling out spinal cancer. In situations where a concomitant diagnosis was present with cancer, the value of a movement screen was poor.Conclusion:  Nonmechanical findings during a traditional movement screen are not specific to sinister conditions such as metastatic spinal cancer. Clinicians should expect concomitant conditions to exhibit painful or limited findings in patients with and without cancer.
A Review of Opioid Prescribing Practices and Associations with Repeat Opioid Prescriptions in a Contemporary Outpatient HIV Clinic
Authors: Önen Nur F. , Barrette Ernie‐Paul , Shacham Enbal , Taniguchi Toshibumi , Donovan Michael , Overton Edgar T. 
Published: November 2011

AbstractObjectives:  Among persons in current HIV outpatient care, data on opioid prescribing are lacking. This study aims to evaluate predictors of repeat opioid prescribing and to characterize outpatient opioid prescribing practices.Methods:  Retrospective cross‐sectional study of persons ≥ 18 years in HIV outpatient care who completed an annual behavioral assessment between June 2008 and June 2009. Persons were grouped by ≤ 1 and ≥ 2 opioid prescriptions (no‐repeat‐opioid and repeat‐opioids, respectively). Independent predictors for repeat‐opioids were evaluated. Opioid prescribing practices were characterized in a sub‐study of persons prescribed any opioid.Results:  Overall, 659 persons were included, median age 43 years, 70% men, and 68% African American. Independent predictors of repeat‐opioids (88 [13%] persons) included opportunistic illnesses (both current and previous), depression, peripheral neuropathy, and hepatitis C coinfection (P < 0.05). In the subgroup, 140 persons received any opioid prescription (96% short‐acting, 33% tramadol). Indications for opioid prescribing were obtained in 101 (72%) persons, with 97% for noncancer‐related pain symptoms. Therapeutic response was documented on follow‐up in 67 (48%) persons, with no subjective relief of symptoms in 63%. Urine drug screens were requested in 6 (4%) persons, and all performed were positive for illicit drugs.Conclusions:  Advanced HIV disease and greater medical and neuropsychiatric comorbidity predict repeat opioid prescribing, and these findings reflect the underlying complexities in managing pain symptoms in this population. We also highlight multiple deficiencies in opioid prescribing practices and nonadherence to guidelines, which are of concern as effective and safe pain management for our HIV‐infected population is an optimal goal.
Relationship between erythropoietin resistance index and left ventricular mass and function and cardiovascular events in patients on chronic hemodialysis
Authors: Chung Sungjin , Song Ho Cheol , Shin Seok Joon , Ihm Sang‐Hyun , Park Chan Seok , Kim Hee‐Yeol , Yang Chul Woo , Kim Yong‐Soo , Choi Euy Jin , Kim Yong Kyun 
Published: November 2011

AbstractThe response to erythropoietin (EPO) treatment varies considerably in individual patients on chronic hemodialysis. The EPO resistance index (ERI) has been considered useful to assess the EPO resistance and can be easily calculated in the clinic. The aim of this study was to investigate the association between ERI and left ventricular mass (LVM) and function and to determine whether ERI was associated with cardiovascular events in patients on hemodialysis. This study was designed prospectively. Clinical, laboratory, and echocardiographic variables were assessed in 72 patients on hemodialysis. The ERI was determined as the weekly weight‐adjusted dose of EPO (U/kg/week) divided by hemoglobin concentration (g/dL). Patients were divided into three groups by tertiles of ERI. Patients with higher tertiles of ERI had a higher LVM index and lower LV ejection fraction compared with those with lower tertiles of ERI (P = 0.019 and P = 0.030, respectively). The median follow‐up period was 53 months. The Kaplan–Meier plot showed increased frequency of cardiovascular events in patients with higher tertiles of ERI, compared with those with lower tertiles of ERI (P = 0.011, log‐rank test). The multivariate Cox proportional hazard models showed that the ERI was the significant independent predictor of cardiovascular events (HR 3.00, 95% CI, 1.04–8.62, P = 0.042). Our data show that ERI was related with LVM index, LV systolic function and cardiovascular events in patients with hemodialysis. By monitoring of ERI, early identification of the EPO resistance may be helpful to predict the cardiovascular risk in hemodialysis patients.
Field melanin mapping of the hairless scalp
Authors: Piérard Gérald E. , Piérard‐Franchimont Claudine , Quatresooz Pascale 
Published: November 2011

BackgroundMottled subclinical melanoderma (MSM) is frequently seen on facial skin using the ultraviolet light enhanced visualization (ULEV) method. The corresponding aspect on the hairless scalp remains unknown.ObjectiveTo explore the field distribution of melanin on the scalp of fair‐skinned Caucasian subjects.MethodThe scalp was examined in 43 men with androgenic alopecia. The Visioscan® camera provided the ULEV pictures. Another optical (Visioface® Quick) device was used under white light illumination followed by colour contrast enhancement. This was reached after specific computer filtration of the cyan hue wavelengths.ResultsUnder white light illumination, the scalp looked normal. MSM patterns were disclosed by both optical procedures as evenly scattered discrete patchy fields of hypermelanosis. The smaller rounded spots were restricted to the lips of the hair infundibula. Larger irregularly shaped spots predominated in the interfollicular areas. A few hypomelanotic spots were scattered over the scalp.ConclusionThe present observations based on dual optical methods possibly provide information about a patterned pathobiology of melanocytes on the scalp. The spotty MSM pattern looked similar to the reported aspects on the face. It somewhat resembled the widespread PUVA‐induced lentiginosis.
The first resolved imaging of milliarcsecond-scale jets in Circinus X-1
Authors: Miller-Jones J. C. A. , Moin A. , Tingay S. J. , Reynolds C. , Phillips C. J. , Tzioumis A. K. , Fender R. P. , McCallum J. N. , Nicolson G. D. , Tudose V. 
Published: November 2011

Abstract
We present the first resolved imaging of the milliarcsecond-scale jets in the neutron star X-ray binary Circinus X-1, made using the Australian Long Baseline Array. The angular extent of the resolved jets is ∼20 mas, corresponding to a physical scale of ∼150 au at the assumed distance of 7.8 kpc. The jet position angle is relatively consistent with previous arcsecond-scale imaging with the Australia Telescope Compact Array. The radio emission is symmetric about the peak, and is unresolved along the minor axis, constraining the opening angle to be &lt;20°. We observe evidence for outward motion of the components between the two halves of the observation. Constraints on the proper motion of the radio-emitting components suggest that they are only mildly relativistic, although we cannot definitively rule out the presence of the unseen, ultrarelativistic (Γ &gt; 15) flow previously inferred to exist in this system.
Underuse of Antithrombotic Therapy Caused High Incidence of Ischemic Stroke in Patients with Atrial Fibrillation
Authors: Yu Hsiu-Chin , Tsai Yun-Fang , Chen Min-Chi , Yeh Chi-Hsiao 
Published: November 2011

Background Atrial fibrillation is one of the most important causes of ischemic stroke. The purposes of this study were to recognize the incidence of ischemic stroke, the use of antithrombotic agents, the predictors of ischemic stroke, and prescription of warfarin during the three-years after atrial fibrillation was diagnosed. Methods This was a descriptive design and chart review study, comprised of 1211 subjects at two hospitals in Northern Taiwan who were aged ≥60 at their first diagnosis of atrial fibrillation. Chi-square and logistic regression were used for data analysis. Results The incidence of ischemic stroke was 46·2% during the three-years after atrial fibrillation was diagnosed, with 86·3% of those occurring in the first year. The prescription rate was 53·3% in antithrombotic therapy, which included 42·5% antiplatelet agents and 10·8% warfarin. The positive predictors of ischemic stroke were age ≥75 (odds ratio = 1·48) and a history of ischemic stroke (odds ratio = 3·19); the negative predictors were continued use of warfarin (odds ratio = 0·01), transient use of warfarin (odds ratio = 0·25), alternating use of warfarin and antiplatelet agents (odds ratio = 0·04), and use of antiplatelet agents alone (odds ratio = 0·13). The positive predictors of prescribing warfarin were a history of ischemic stroke (odds ratio = 2·32), thromboembolism (odds ratio = 31·06), mitral stenosis (odds ratio = 10·02), and mechanical valve replacement (odds ratio = 136·02). The negative predictor of prescribing warfarin was age ≥75 (odds ratio = 0·62). Conclusions It is important in prevention of ischemic stroke to give antithrombotic therapy to newly diagnosed atrial fibrillation patients. Underuse of antithrombotic therapy and warfarin were more severe in our study than in Western countries.
Clinical Utility of the AlphaFIM® Instrument in Stroke Rehabilitation
Authors: Lo Alexander , Tahair Nicola , Sharp Shelley , Bayley Mark T. 
Published: November 2011

Background The AlphaFIM instrument is an assessment tool designed to facilitate discharge planning of stroke patients from acute care, by extrapolating overall functional status from performance in six key Functional Independence Measure (FIM) instrument items. Aim To determine whether acute care AlphaFIM rating is correlated to stroke rehabilitation outcomes. Methods In this prospective observational study, data were analyzed from 891 patients referred for inpatient stroke rehabilitation through an Internet-based referral system. Simple linear and stepwise regression models determined correlations between rehabilitation-ready AlphaFIM rating and rehabilitation outcomes (admission and discharge FIM ratings, FIM gain, FIM efficiency, and length of stay). Covariates including demographic data, stroke characteristics, medical history, cognitive deficits, and activity tolerance were included in the stepwise regressions. Results The AlphaFIM instrument was significant in predicting admission and discharge FIM ratings at rehabilitation (adjusted R2 0·40 and 0·28, respectively; P < 0·0001) and was weakly correlated with FIM gain and length of stay (adjusted R2 0·04 and 0·09, respectively; P < 0·0001), but not FIM efficiency. AlphaFIM rating was inversely related to FIM gain. Age, bowel incontinence, left hemiparesis, and previous infarcts were negative predictors of discharge FIM rating on stepwise regression. Intact executive function and physical activity tolerance of 30 to 60 mins were predictors of FIM gain. Conclusions The AlphaFIM instrument is a valuable tool for triaging stroke patients from acute care to rehabilitation and predicts functional status at discharge from rehabilitation. Patients with low AlphaFIM ratings have the potential to make significant functional gains and should not be denied admission to inpatient rehabilitation programs.
Too Good to Treat? Outcomes in Patients Not Receiving Thrombolysis Due to Mild Deficits or Rapidly Improving Symptoms
Authors: Willey Joshua Z. , Stillman Joshua , Rivolta Juan A. , Vieira Julio , Doyle Margaret M. , Linares Guillermo , Marchidann Adrian , Elkind Mitchell S. V. , Boden-Albala Bernadette , Marshall Randolph S. 
Published: November 2011

Introduction Among ischemic stroke patients arriving within the treatment window, rapidly improving symptoms or having a mild deficit (i.e. too good to treat) is a common reason for exclusion. Several studies have reported poor outcomes in this group. We addressed the question of early neurological deterioration in too good to treat patients in a larger prospective cohort study. Methods Admission and discharge information were collected prospectively in acute stroke patients who presented to the emergency room within three-hours from onset. The primary outcome measure was change in the National Institutes of Health Stroke Scale from baseline to discharge. Secondary outcomes were discharge National Institutes of Health Stroke Scale #>4, not being discharged home, and discharge modified Rankin scale. Results Of 355 patients who presented within three-hours, 127 (35.8%) had too good to treat listed as the only reason for not receiving thrombolysis, with median admission National Institutes of Health Stroke Scale = 1 (range = 0 to 19). At discharge, seven (5.5%) showed a worsening of National Institutes of Health Stroke Scale ≥1, and nine (7.1%) had a National Institutes of Health Stroke Scale #>4. When excluding prior stroke (remaining n = 97), discharge status was even more benign: only five (5.2%) had a discharge National Institutes of Health Stroke Scale #>4, and two (2.1%) patients were not discharged home. Conclusion We found that a small proportion of patients deemed too good to treat will have early neurological deterioration, in contrast to other studies. Decisions about whether to treat mild stroke patients depend on the outcome measure chosen, particularly when considering discharge disposition among patients who have had prior stroke. The decision to thrombolyze may ultimately rest on the nature of the presentation and deficit.
Stroke Patients Do Not Need to be Inactive in the First Two-Weeks after Stroke: Results from a Stroke Unit Focused on Early Rehabilitation
Authors: Askim Torunn , Bernhardt Julie , Løge Anne Dahle , Indredavik Bent 
Published: November 2011

Background Although stroke unit care with early rehabilitation is recommended for most stroke patients, the content of the treatment given to acute stroke patients differs a lot. Aim The primary aim of this study was to describe the activity patterns of acute stroke patients managed in a stroke unit focused on early rehabilitation. Methods Patients admitted to the stroke unit at St. Olavs Hospital, Trondheim, with the diagnosis of stroke were asked to participate. Patients were eligible if they were less than 14 days post stroke and did not receive palliative care. Patients were observed every 10 mins from 8:00 am to 5:00 pm, and activity, location, and who helped them were recorded. Results A total of 117 patients (mean age 78·7 years; 56% male) were included. In total, patients spent 30·3% of time in bed, 46·4% of time in sitting out of bed, and 19·9% of time in higher motor activities such as transferring, standing, walking, or climbing stairs. Patients with mild, moderate, and severe stroke spent 79·5%, 59·2%, and 31·0% of observed time sitting out of bed or engaged in higher motor activities, respectively. Conclusion This study shows that it is possible for acute stroke patients to spend most of the active day out of bed and to engage in higher motor activities up to 20% of the time. It also shows that it is feasible for severely affected stroke patients to stay out of bed in the early phase after stroke.
Prevalence and Antimicrobial Susceptibility ofCampylobacterin Broiler Flocks in Japan
Authors: Haruna M. , Sasaki Y. , Murakami M. , Ikeda A. , Kusukawa M. , Tsujiyama Y. , Ito K. , Asai T. , Yamada Y. 
Published: November 2011

SummaryCampylobacter was isolated from 67 (47.2%) of 142 broiler flocks between September 2009 and February 2010. The prevalence ofCampylobacterin broiler flocks was significantly lower during January and February than it was from September to December.Campylobactercolonization was more common in flocks that were not provided with a disinfected water supply, which was consistent with the findings of a previous study. The prevalence of antimicrobial drug‐resistantCampylobacterspp. was investigated, and the minimum inhibitory concentrations of eight antimicrobial agents were determined for 122Campylobacter jejuniisolates and 46Campylobacter coliisolates from broiler flocks between 2007 and 2010. In this study, 29.5% (36/122) ofC. jejuniisolates and 41.3% (19/46) ofC. coliisolates were resistant to enrofloxacin (ERFX), whereas all isolates were susceptible to erythromycin. Furthermore, the ERFX‐resistant isolates were tested for susceptibility to other classes of antimicrobial agents, and 55.6% (20/36) of ERFX‐resistantC. jejuniisolates and 47.4% (9/19) of ERFX‐resistantC. coliisolates were resistant to at least one of aminobenzyl penicillin, dihydrostreptomycin and oxytetracycline. To avoid an impact of antimicrobial drug‐resistantCampylobacterspp. on the efficacy of antimicrobial treatment for human campylobacteriosis, prudent use of antimicrobial agents is a requisite. The use of antimicrobial agents should be accompanied by various approaches such as prevention ofCampylobactercolonization in broiler flocks with the aim of lowering the occurrence ofCampylobacterinfection in humans.
Rapamycin combined with donor immature dendritic cells promotes liver allograft survival in association with CD4+CD25+Foxp3+ regulatory T cell expansion
Authors: Wang Guo‐Ying , Yang Yang , Li Hua , Zhang Jian , Li Min‐Ru , Zhang Qi , Chen Gui‐Hua 
Published: November 2011

Aim:  To determine whether donor immature dendritic cells (imDCs) combined with a short postoperative course of rapamycin (Rapa) has the ability to expand the CD4+CD25+Foxp3+ regulatory T (Treg) cells and prolong liver allograft survival.Methods:  Orthotopic liver transplantation (OLT) was performed from Lewis rats to Brown Norway recipients. Three days before transplantation, animals were injected intravenously with 2 × 106 donor bone marrow‐derived imDCs. Recipient rats (the combined treated group) also received Rapa for 7 d after liver transplantation. Additional groups received either imDCs alone, Rapa alone, or saline alone. Every six recipients from each group were killed at 14 days, 28 days after OLT. The changes of CD4+CD25+Foxp3+ Treg cells in peripheral blood and spleen, histological changes of liver grafts, and serum cytokine levels were investigated. The other six recipients were left in each group to observe the animal survival.Results:  Donor imDCs followed by a short postoperative course of Rapa induced long‐term allograft survival. The percentage of CD4+CD25+Foxp3+ Treg cells in CD4+ T cells in the combination treatment group were significantly higher compared with the acute rejection group. Moreover, within the CD4+CD25+ T cell population the combination treatment recipients maintained a higher incidence of Foxp3+ T cells compared with the other groups. Despite the lower serum levels of interleukin (IL)‐2, IL‐12, and interferon‐γ in the combined treated group, the cytokine levels in the combined treated group at 7 days after OLT was nearly twice that at 3 days after OLT but decreased significantly compared with the other groups at 28 days after OLT. Serum IL‐10 level in the combined treated group was higher than the other groups.Conclusions:  A single imDC infusion followed by a short postoperative course of Rapa prolongs liver allograft survival and enhances the expansion of Treg cells. This optimal protocol may be a promising administration protocol for the peritransplant tolerance induction.