bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intranasal delivery of insulin via the olfactory nerve pathway
Authors: Renner Dan B , Svitak Aleta L , Gallus Nathan J , Ericson Marna E , Frey William H , Hanson Leah R 
Published: July 2012

Abstract

Objectives
Intranasal delivery has been shown to target peptide therapeutics to the central nervous system (CNS) of animal models and induce specific neurological responses. In an investigation into the pathways by which intranasal administration delivers insulin to the CNS, this study has focused on the direct delivery of insulin from the olfactory mucosa to the olfactory bulbs via the olfactory nerve pathway.

Methods
Nasal and olfactory tissues of mice were imaged with fluorescent and electron microscopy 30 min following intranasal administration.

Key findings
Macroscopic analysis confirmed delivery to the anterior regions of the olfactory bulbs. Confocal microscopy captured delivery along the olfactory nerve bundles exiting the nasal mucosa, traversing the cribriform plate and entering the bulbs. With electron microscopy, insulin was found within cells of the olfactory nerve layer and glomerular layer of the olfactory bulbs.

Conclusions
These results demonstrated that intranasal administration of labelled insulin targeted the CNS through the olfactory nerve pathway in mice.
Isolation, modification and cytotoxic evaluation of flavonoids from Rhododendron hainanense
Authors: Zhao Jie , Ding Huan-Xing , Zhao Deng-Gao , Wang Chun-Ming , Gao Kun 
Published: July 2012

Abstract

Objectives
The aim of this study was to search for antitumour activity of flavonoid compounds. The cytotoxic activity of these compounds in vitro was evaluated against the human leukaemia (HL-60) and human hepatoma (SMMC-7721) cell lines.

Methods
Eight natural flavonoids (1–8) were isolated from the aerial parts of Rhododendron hainanense and a series of modified flavonoid derivatives (9–18) were obtained from the natural product matteucinol (1), using simple synthetic methods. Antitumour inhibitory activity of these flavonoids was assessed using the sulforhodamine B method.

Key findings
Most of the compounds exhibited good pharmacological activity and the preliminary structure–activity relationships were described. Within the series of flavonoid derivatives in this study, compounds 3 (2,3-dihydro-5-hydroxy-7-methoxy-2-(4-methoxyphenyl)-6,8-dimethyl-4H-1-benzopyran-4-one) and 16 (5-hydroxy-7, 4′-dimethoxy-6, 8-dimethylflavan) exhibited strong inhibitory activity against the HL-60 cell line with IC50 values (the drug concentration that resulted in a 50% reduction in cell viability or inhibition of the biological activity) of 15.2 and 13.2 µm, respectively.

Conclusions
Renewed attention to flavonoid derivatives revealed the possibility that compounds 3 and 16 could be considered as lead compounds for the development of new antitumour agents. Our results have not only enriched the family of active flavonoids from natural sources, but have encouraged the synthesis of flavonoid analogues for improving cytotoxic activity.
Role of fetuin-A in atherosclerosis associated with diabetic patients
Authors: Singh Monika , Sharma Pramod Kumar , Garg Vipin Kumar , Mondal Shambhu Charan , Singh Avnesh Kumar , Kumar Nikhlesh 
Published: July 2012

Abstract

Objectives
Fetuin-A is a circulating glycoprotein, formed in the liver. It regulates bone remodelling and calcium metabolism. Fetuin-A has adipogenic properties, so fat accumulation in the liver may be associated with higher levels of fetuin-A. Fetuin-A is an inhibitor of the phosphorylation of the insulin receptor tyrosine kinase.

Key findings
High concentrations of fetuin-A in humans causes insulin resistance. Insulin sensitivity is also found to be increased in fetuin-A knockout mice. Fetuin-A has been shown to cause insulin resistivity in type-2 diabetes mellitus and worsens the pro-atherogenic milieu.

Summary
Fetuin-A should be considered as a hepatic bio-marker. Vascular diseases like atherosclerosis are major causes of disability in patients with diabetes mellitus.
Calculating the need for intensive care beds
Authors: Pearson Gale A , Reynolds Fiona , Stickley John 
Published: July 2012

AimPrompted by high refused admission rates, we sought to model demand for our 20 bed paediatric intensive care unit.MethodsWe analysed activity (admissions) and demand (admissions plus refused admissions). The recommended method for calculating the required number of intensive care beds assumes a Poisson distribution based upon the size of the local catchment population, the incidence of intensive care admission and the average length of stay. We compared it to the Monte Carlo method which would also include supra-regional referrals not otherwise accounted for but which, due to their complexity, tend to have a longer stay than average. For the new method we assigned data from randomly selected emergency admissions to the refused admissions. We then compared occupancy scenarios obtained by random sampling from the data with replacement.ResultsThere was an increase in demand for intensive care over time. Therefore, in order to provide an up-to-date model, we restricted the final analysis to data from the two most recent years (2327 admissions and 324 refused admissions). The conventional method suggested 27 beds covers 95% of the year. The Monte Carlo method showed 95% compliance with 34 beds, with seasonal variation quantified as 30 beds needed in the summer and 38 in the winter.ConclusionBoth approaches suggest that the high refused admission rate is due to insufficient capacity. The Monte Carlo analysis is based upon the total workload (including supra-regional referrals) and predicts a greater bed requirement than the current recommended approach.
Opportunistic adolescent health screening of surgical inpatients
Authors: Wilson Hayden , Bostock Nancy , Phillip Nicola , Shannon Penny , Payne Donald , Kennedy Andrew 
Published: July 2012

PurposeOpportunistic health screening has long been promoted by advocates of adolescent health. However, there are few objective data documenting the outcomes in an inpatient setting.MethodsThe authors performed opportunistic health screening on 114 surgical inpatients, median age 14 (range 10–18) years, admitted to a general adolescent ward in a tertiary children's hospital. A four-page paper document with a formatted list of questions, based on the Home, Education, Activities, Drugs, Sexual Health, Suicide framework, was developed to standardise screening and documentation.ResultsAreas of concern requiring intervention were identified in 34 (30%) patients. Specific interventions included referrals to the Adolescent Medicine clinic (n=6), Hospital School Services (n=7) and Psychological Medicine (n=7).ConclusionsConsideration should be given to offer adolescent health screening to all surgical inpatients. Further research should involve the participation of young people and should focus on the outcomes, feasibility, acceptability and resource implications of such screening.
Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys
Authors: Millard Peter S , Bru Juan , Berger Christopher A 
Published: July 2012

BackgroundPoint-of-care electronic medical records (EMRs) are a key tool to manage chronic illness. Several EMRs have been developed for use in treating HIV and tuberculosis, but their applicability to primary care, technical requirements and clinical functionalities are largely unknown.ObjectivesThis study aimed to address the needs of clinicians from resource-limited settings without reliable internet access who are considering adopting an open-source EMR.Study eligibility criteriaOpen-source point-of-care EMRs suitable for use in areas without reliable internet access.Study appraisal and synthesis methodsThe authors conducted a comprehensive search of all open-source EMRs suitable for sites without reliable internet access. The authors surveyed clinician users and technical implementers from a single site and technical developers of each software product. The authors evaluated availability, cost and technical requirements.ResultsThe hardware and software for all six systems is easily available, but they vary considerably in proprietary components, installation requirements and customisability.LimitationsThis study relied solely on self-report from informants who developed and who actively use the included products.Conclusions and implications of key findingsClinical functionalities vary greatly among the systems, and none of the systems yet meet minimum requirements for effective implementation in a primary care resource-limited setting. The safe prescribing of medications is a particular concern with current tools. The dearth of fully functional EMR systems indicates a need for a greater emphasis by global funding agencies to move beyond disease-specific EMR systems and develop a universal open-source health informatics platform.
Cause-specific infant mortality in a population-based Swedish study of term and post-term births: the contribution of gestational age and birth weight
Authors: Altman Maria , Edstedt Bonamy Anna-Karin , Wikström Anna-Karin , Cnattingius Sven 
Published: July 2012

ObjectiveTo investigate infant mortality and causes of infant death in relation to gestational age (GA) and birth weight for GA in non-malformed term and post-term infants.DesignObservational, retrospective nationwide cohort study.SettingSweden 1983–2006.Participants2 152 738 singleton non-malformed infants born at 37 gestational weeks or later.Main outcome measuresInfant, neonatal and postneonatal mortality and causes of infant death.ResultsInfant mortality rate was 0.12% (n=2687). Compared with infants born at 40 weeks, risk of infant mortality was increased among early term infants (37 weeks, adjusted OR 1.70, 95% CI 1.43 to 2.02). Compared with infants with normal birth weight for GA, very small for gestational age (SGA; <3rd percentile) infants faced a doubled risk of infant mortality (adjusted OR 2.13, 95% CI 1.80 to 2.53), and corresponding risk was also increased among moderately SGA infants (3rd to <10th percentile; adjusted OR 1.46, 95% CI 1.26 to 1.68). Sudden infant death syndrome (SIDS) was the most common cause of death, accounting for 39% of all infant mortality. Compared with birth at 40 weeks, birth at 37 weeks was associated with increased risks of death by infections, cardiovascular disorders, SIDS and malignant neoplasms. Very and moderately SGA were associated with increased risks of death by neonatal respiratory disorders, infections, cardiovascular disorders, SIDS and neuromuscular disorders. High birth weight for GA was associated with increased risks of death by asphyxia and malignant neoplasms.ConclusionEarly term birth and very to moderately low birth weight for GA are independent risk factors for infant mortality among non-malformed term infants.
Medium term outcome in Bell's palsy in children
Authors: McNamara Roisin , Doyle Jennifer , Mc Kay Mary , Keenan Peter , Babl Franz E 
Published: July 2012

ObjectiveBell's palsy is a non-life threatening disorder with important functional and psychosocial effects. While recent research has shown significant benefit from treatment with steroids in adults, there have been no conclusive studies demonstrating benefit in children. This study set out to explore the medium term resolution of symptoms in Bell's palsy presenting to the emergency department (ED).Patients and MethodsThis was a retrospective cohort study of children attending an Irish paediatric ED with a diagnosis of Bell's palsy. Patients were identified via the ED database. The primary outcome measure was resolution at follow-up call (6–18 months after presentation). Secondary outcome measures were ED treatment, imaging and time to resolution of symptoms.ResultsThere were 48 presentations, involving 45 patients. Left and right-sided palsies were equally represented. Of these, 16 (33%) received prednisolone. MRI was performed in five cases (10%), four were normal and one did not change management. In follow-up telephone contact, of 35 presentations, 28 (80%, 95% CI 63% to 91%) had complete resolution, six (17%, 95% CI 7% to 34%) partial resolution to variable degrees and one patient showed no improvement. Of the 13 patients who had received prednisolone, nine (69%, 95% CI 39% to 91%) had complete resolution; of the 22 patients who were not treated with prednisolone 19 (86%, 95% CI 65% to 97%) had complete resolution (p=0.22).ConclusionsThe majority of children with Bell's palsy have complete resolution of the facial weakness. Steroid use is highly variable and warrants a placebo controlled randomised trial.
O-012 Long term angiographic follow-up of aneurysms treated with self-expandable stents
Authors: Nishido H , Piotin M , Bartolini B , Pistocchi S , Redjem H , Blanc R 
Published: July 2012

PurposeStent-assisted coiling of intracranial aneurysms has proved to promote aneurysm occlusion and to reduce aneurysm recurrence. First reports were promising but longer follow-up are needed to confirm the benefits of stenting over coiling without stents.Materials and MethodsOver the last 9 years, we treated selectively with coils 1621 aneurysms; 320 (including 38 in the setting of SAH) with stent-assistance, 1321 (628 in the setting of SAH) with coiling without stent-assistance, in 1253 patients. A retrospective review was conducted on patients that were followed at least for 18 months after endovascular treatment. Categorization was based on presence and type of stent assistance (none, single, X and Y-stenting). The rates of angiographic recanalization, rehemorrhage, and retreatment were analyzed.Results493 aneurysms were treated with coil embolization and 95 aneurysms with stent-assisted coiling (87 single-stent, 6 Y-stent, 2 X-stent). Mean angiographic follow-up was 34 months for stent-assisted coiled aneurysms, 38 months for coiled aneurysms (p=0.0542). Stent-assisted coiled aneurysms were larger (mean 7.7 mm) than coiled aneurysms (mean 6.6 mm) (p=0.0195). Stented aneurysms had significantly lower recanalization (12.6% vs 35.7%, p<0.0001). Retreatment rate was lower in the stented group (4.2%) (4/95) vs 8.9% (44/493) in the non-stented aneurysms (p=0.1527). Rehemorrhage occurred in two patients in the coiled group, whereas none were noted in the stented group (p=1). In multivariate analysis, larger aneurysms, non-stented aneurysms, and SAH at presentation were predictors of aneurysm recanalization.ConclusionLong-term follow-up demonstrate that stent-assisted coiled aneurysms have lower recurrence, retreatment, and rehemorrhage rates than aneurysms coiled without stent assistance.Competing interestsNone.
O-014 A new application of MRI fusion in angiographic percutaneous intervention for pediatric orbital lesions: Abstract O-014 Figure 1
Authors: Case D , Dion J , Wojno T , Tong F 
Published: July 2012

Introduction/PurposeMRI fusion is a recently developed image targeting technique that volumetrically overlays an MRI sequence onto a live fluoroscopic image updated in real time. The ability to utilize the superior soft tissue resolution of MRI for interventional lesion targeting without the practical constraints of an interventional MRI suite is potentially a powerful tool. Lesions that are well-visualized under MRI but possessing little fluoroscopic contrast are otherwise untreatable in the angio suite and ideally suited to this new technique. We present four consecutive cases involving small intraorbital masses in children where MRI-fusion volumetric overlay techniques were used to precisely target the lesions for the purposes of both percutaneous biopsy and venolymphatic malformation sclerotherapy.Materials/MethodsFour pediatric patients were referred for percutaneous biopsy (n=1) and sclerotherapy (n=3) for small intraorbital masses. The DICOM MRI data sequences that best demonstrated the target lesions were imported to a Philips Allura fluoroscopy system. General anesthesia was administered and an XperCT scan of the head was obtained in the angiography suite. A multimodality matching overlay of the imported MRI data with the obtained XperCT data was performed to facilitate procedure planning with the MRI target superimposed over the live fluoroscopic images. Direct puncture of the target lesion was performed with a 23- or 25-gauge needle. Percutaneous sclerotherapy intralesional needle tip confirmation was assessed with aspiration and contrast injection. The targeted sclerotherapy lesions were then slowly injected manually with a mixture of Bleomycin and contrast with intermittent fluoroscopic evaluation to ensure intralesional placement. The biopsy case specimen was aspirated with a 23 gauge needle and a cell smear and core sample were submitted to Pathology.ResultsThe treatment/biopsy needles were successfully placed in all four lesions in the angiographic suite using this technique. The needle was placed intralesional on the first pass in all four cases without complication with needle repositioning in the treatment cases as necessary for aspiration. No contrast extravasation or venous drainage was identified in the treatment group with intralesional contrast and Bleomycin/contrast injection. The biopsy patient had a diagnostic sample obtained while the sclerotherapy lesions were all decreased in size on follow-up imaging with resolution of their clinical symptoms. No sclerotherapy patient has required additional treatment.ConclusionMRI fusion with real-time fluoroscopic imaging allows for treatment of previously non-visualized lesions in the angiographic suite with sufficient soft tissue detail to perform precise percutaneous orbital interventions in a safe and therapeutic manner.Competing interestsNone.Abstract O-014 Figure 1
O-019 Infarct volume thresholds for prediction of independent functional outcomes after acute ischemic stroke: Abstract O-019 Figure 1
Authors: Nogueira R , Jovin T 
Published: July 2012

Background and PurposeThe main premise of reperfusion therapy in acute ischemic stroke (AIS) is to prevent the conversion of the salvable penumbra into irreversible infarct core thereby reducing the final stoke size. Indeed, previous studies have demonstrated a strong correlation between final infarct volumes and functional outcomes. We sought to establish the optimal final infarct thresholds that best correlate with independent functional outcomes.MethodsMulticenter retrospective analysis across five large academic centers. Consecutive patients meeting the following criteria were included: (1) anterior circulation stroke; (2) available final stroke imaging volumetric analysis; (3) available modified Rankin scale (mRS) score at 90 days. Receiver operating characteristic (ROC) curves were created to help defining the optimal final stroke volume points that discriminate a 90-day mRS ≤2.ResultsA total of 484 consecutive patients were identified. The mean age was 65.6±14.6 years. The mean baseline NIHSS was 14.2±7.1. The mean final stroke volume was 77.7±88.5 cc (median, 40.5 cc). A total of 201 out of the 484 (41.5%) of the patients achieved functional independence at 90 days. The ROC analysis demonstrated that final infarct volume (FIV) was a strong discriminator of independent outcomes with an area under the curve [AUC] of 0.778. The best cut-off point for discriminating 90-day mRS ≤2 was 35 cc of FIV (70% specificity; 70% sensitivity). The AUC could be improved by excluding older patients. In patient <65 years, the AUC was 0.844 with an optimal discriminating point at 53 cc (75% specificity; 75% sensitivity). The exclusion of patients >80 years yielded an AUC of 0.797 with an optimal FIV discriminating point at 40 cc (72% specificity; 72% sensitivity). In this population, FIV of 29 cc had 80% specificity and 62% sensitivity whereas FIV of 15 cc had 90% specificity but only 40% sensitivity for an independent functional outcome.ConclusionsFinal infarct volume is a strong surrogate for good outcomes after AIS. Our data suggest that the exclusion of patients with infarct volumes >35–40 cc on baseline imaging may enhance the chances of a positive confirmatory clinical trial of reperfusion in AIS.Competing interestsR Nogueira: Concentric Medical; ev3 Neurovascular; Coaxia. T Jovin: None.Abstract O-019 Figure 1Receiver operating characteristic (ROC) curves of Final Stroke Volume (cc) and Independent Functional Outcome (mRS ≤2) at 90 days.
O-028 The LUNA aneurysm embolization system for treatment of intracranial aneurysms
Authors: Piotin M , Sourour N , Biondi A , Mounayer C , Blanc R 
Published: July 2012

PurposeThe LUNA Aneurysm Embolization System (AES) is a self-expanding ovoid device that serves as an intra saccular flow diverter as well as a scaffold for endothelization across the neck. The objective of this prospective clinical study was to evaluate the ability of the AES to occlude intracranial aneurysms while maintaining patency of the parent artery.Materials and Methods15 patients with intracranial aneurysms were enrolled (intention to treat) in the study so far. Immediate post-implantation occlusion grade (complete (complete obliteration of the aneurysm including the neck), near-complete (persistence of any portion of the original defect of the arterial wall), or incomplete (any opacification of the sac) compared to baseline), and parent vessel compromise were evaluated. Patients underwent neurological and neurocognitive testing with the Modified Rankin Scale and the National Institute of Health Stroke Scale (NIHSS) at baseline and time of discharge. Follow-up included clinical assessment at 1 month and 3 months, clinical and angiographic follow-up at 6 months.Results15 patients (14 women, 1 man) with 14 unruptured and 1 ruptured saccular aneurysms (5 para-ophtalmic, 3 AcoA, 3 ICA-Pcom, 2 MCA, 1 ICA bifurcation, 1 A1; sizes from 5.0 to 6.7 mm) were enrolled to date in the study. In all but 1 aneurysm (1 failed procedure converted in coiling immediately after aneurysm dome perforation with the microcatheter of a recently ruptured aneurysm) 1 AES was deployed per aneurysm. In four cases, the AES embolization was carried out with balloon microcatheter assistance. In one case, the AES failed to detach and was exchanged for a second AES device that detached. In one case, AES placement led to aneurysm perforation that was controlled by temporary balloon occlusion and heparin reversion. In one case, thrombo-embolic complication was treated with i.a. injection of Abciximab. Immediate complete occlusion was obtained in one case, near complete occlusion was obtained in nine cases, no occlusion in four cases. Clinical follow-up was uneventful. To date, four patients with four aneurysms were followed with angiography at 6 months, showing complete occlusion in two cases, neck remnants in two cases. There was no parent artery stenosis or occlusion.ConclusionPreliminary results demonstrate good safety profile. The first short-term angiographic follow-up are promising. More and longer follow-up are pending.Competing interestsNone.