bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deleted in Malignant Brain Tumors 1 is Present in the Vascular Extracellular Matrix and Promotes Angiogenesis
Authors: Müller Hanna , Hu Jiong , Popp Rüdiger , Schmidt Mirko H.H. , Müller-Decker Karin , Mollenhauer Jan , Fisslthaler Beate , Eble Johannes A. , Fleming Ingrid 
Published: November 2011

Objective—
Deleted in malignant brain tumors 1 (DMBT1) belongs to the scavenger receptor cysteine-rich superfamily of proteins and is implicated in innate immunity, cell polarity, and differentiation. Here we studied the role of DMBT1 in endothelial cells.

Methods and Results—

DMBT1 was secreted into the extracellular matrix (ECM) by endothelial cells in vitro and in situ and the presence of DMBT1 in the ECM increased endothelial cell adherence. Endothelial cell-derived DMBT1 associated with galectin-3 (coprecipitation), and human recombinant DMBT1 bound EGF, vascular endothelial growth factor and Delta-like (Dll) 4 (specific ELISAs). Compared to cells from wild-type mice, endothelial cells from DMBT1
−/−
mice demonstrated reduced migration, proliferation, and tube formation. In vivo recovery from hindlimb ischemia was attenuated in DMBT1
−/−
animals as was vascular endothelial growth factor -induced endothelial sprouting from isolated aortic rings; the latter response could be rescued by the addition of recombinant DMBT1. The Notch pathway is involved in multiple aspects of vascular development, including arterial-venous differentiation and we found that endothelial cells from DMBT1
−/−
mice expressed more EphrinB2 than cells from wild-type mice. Levels of Dll1, Dll4, Hes1, Hey1, and EphB4, on the other hand, were decreased.

Conclusion—
Taken together, the results of this study indicate that DMBT1 functions as an important endothelium-derived ECM protein that is able to bind angiogenic factors and promote adhesion, migration, proliferation, and angiogenesis as well as vascular repair. Mechanistically, DMBT1 interacts with galectin-3 and modulates the Notch signaling pathway as well as the differential expression of ephrin-B2 and EphB4.
Cost-Effectiveness Analysis of Continuous-Flow Left Ventricular Assist Devices as Destination Therapy
Authors: Rogers Joseph G. , Bostic Robin R. , Tong Kuo B. , Adamson Rob , Russo Mark , Slaughter Mark S. 
Published: November 2011

Background—
Continuous-flow left ventricular assist devices (LVADs) have become the dominant devices for mechanical circulatory support, but their cost-effectiveness is undetermined. This study assessed the cost-effectiveness of continuous-flow devices for destination therapy versus optimal medical management in advanced heart failure and compared the results with previous estimates for pulsatile devices.

Methods and Results—
A Markov model was developed to assess cost-effectiveness. Survival, hospitalization rates, quality of life, and cost data were obtained for advanced heart failure patients treated medically or with a continuous-flow LVAD. Rates of clinical outcomes for all patients were obtained from clinical trial databases. Medicare prospective payments were used to estimate the cost of heart failure admissions. The cost of LVAD implantation was obtained prospectively from hospital claims within a clinical trial. Compared with medically managed patients, continuous-flow LVAD patients had higher 5-year costs ($360 407 versus $62 856), quality-adjusted life years (1.87 versus 0.37), and life years (2.42 versus 0.64). The incremental cost-effectiveness ratio of the continuous-flow device was $198 184 per quality-adjusted life year and $167 208 per life year. This equates to a 75% reduction in incremental cost-effectiveness ratio compared with the $802 700 per quality-adjusted life year for the pulsatile-flow device. The results were most sensitive to the cost of device implantation, long-term survival, cost per rehospitalization, and utility associated with patients' functional status.

Conclusions—
The cost-effectiveness associated with continuous-flow LVADs for destination therapy has improved significantly relative to the pulsatile flow devices. This change is explained by significant improvements in survival and functional status and reduction in implantation costs.
Ninety-Day Outcome Rates of a Prospective Cohort of Consecutive Patients With Mild Ischemic Stroke
Authors: Khatri Pooja , Conaway Mark R. , Johnston Karen C. ,   for the Acute Stroke Accurate Prediction Study (ASAP) Investigators
Published: November 2011

Background and Purpose—
Prior studies have shown that patients with mild ischemic stroke have substantial disability rates at hospital discharge. We sought to determine disability rates at 90 days among patients not treated with thrombolytic therapy and explore the role of early neurological worsening.

Methods—
We reviewed a prospective cohort of 136 consecutive patients with mild deficits (National Institutes of Health Stroke Scale score ≤5) presenting within 24 hours of onset and no baseline disability. Baseline MRIs were performed on all subjects. Five-day MRIs were performed on a prespecified subcohort.

Results—

Among 136 patients, 40 (29%; 95% CI, 22%–38%) had poor outcomes (modified Rankin Scale score 2–6) at 90 days. Early worsening (4-point National Institutes of Health Stroke Scale increase; 25% versus 1%,
P
<0.001) and acute infarct growth (>10% on MRI–diffusion-weighted imaging; 79% versus 53%,
P
=0.02) from baseline to 5 days were more common among those with poor outcome.

Conclusions—
Patients with mild ischemic stroke have substantial rates (29%) of disability at 90 days.
Stroke and Long-Term Exposure to Outdoor Air Pollution From Nitrogen Dioxide
Authors: Andersen Zorana J. , Kristiansen Luise C. , Andersen Klaus K. , Olsen Tom S. , Hvidberg Martin , Jensen Steen S. , Ketzel Matthias , Loft Steffen , Sørensen Mette , Tjønneland Anne , Overvad Kim , Raaschou-Nielsen Ole 
Published: November 2011

Background and Purpose—
Years of exposure to tobacco smoke substantially increase the risk for stroke. Whether long-term exposure to outdoor air pollution can lead to stroke is not yet established. We examined the association between long-term exposure to traffic-related air pollution and incident and fatal stroke in a prospective cohort study.

Methods—
We followed 57 053 participants of the Danish Diet, Cancer and Health cohort in the Hospital Discharge Register for the first-ever hospital admission for stroke (incident stroke) between baseline (1993–1997) and 2006 and defined fatal strokes as death within 30 days of admission. We associated the estimated mean levels of nitrogen dioxide at residential addresses since 1971 to incident and fatal stroke by Cox regression analyses and examined the effects by stroke subtypes: ischemic, hemorrhagic, and nonspecified stroke.

Results—
Over a mean follow-up of 9.8 years of 52 215 eligible subjects, there were 1984 (3.8%) first-ever (incident) hospital admissions for stroke of whom 142 (7.2%) died within 30 days. We detected borderline significant associations between mean nitrogen dioxide levels at residence since 1971 and incident stroke (hazard ratio, 1.05; 95% CI, 0.99–1.11, per interquartile range increase) and stroke hospitalization followed by death within 30 days (1.22; 1.00–1.50). The associations were strongest for nonspecified and ischemic strokes, whereas no association was detected with hemorrhagic stroke.

Conclusions—
Long-term exposure to traffic-related air pollution may contribute to the development of ischemic but not hemorrhagic stroke, especially severe ischemic strokes leading to death within 30 days.
Exaggerated Postural Blood Pressure Rise Is Related to a Favorable Outcome in Patients With Acute Ischemic Stroke
Authors: Aries Marcel J.H. , Bakker Desiree C. , Stewart Roy E. , De Keyser Jacques , Elting Jan Willem J. , Thien Theo , Vroomen Patrick C.A.J. 
Published: November 2011

Background and Purpose—
The effects of early upright positioning in the acute phase of ischemic stroke on both blood pressure and functional outcome have not been previously examined.

Methods—
Prospective investigation of mean arterial pressure, heart rate, and peripheral oxygen saturation in the supine, sitting, and (if achievable) active standing position 1, 2, and 3 days after an acute stroke was performed. Also investigated was the presence of a significant postural blood pressure rise and fall using orthostatic definitions and the relation to functional outcome after 3 months.

Results—

One hundred sixty-seven patients were included (mean age, 68.5±15.2 years; median National Institutes of Health Stroke Scale, 7). Approximately 60% of the patients were able to stand. On average the mean arterial pressure increased when patients moved from the supine to sitting (Day 1: Δ 3.9 mm Hg;
P
<0.001) and from sitting to an active standing position (Day 1: Δ 4.6 mm Hg;
P
<0.001). Changes were most pronounced within the first 24 hours after a stroke. Blood pressure decreased significantly (fall) on standing in 13% of patients and increased significantly (rise) in 20% of the patients. The latter was independently associated with a favorable outcome (
P
=0.003). Moving to the standing position was accompanied by an increase of heart rate. No difference in oxygen saturation was observed in the various positions over the period of investigation.

Conclusions—
We found that a significant blood pressure rise during early upright positioning in patients with acute stroke was independently associated with a favorable outcome. No contraindication to early mobilization was found in this study.
Effects of Public Education by Television on Knowledge of Early Stroke Symptoms Among a Japanese Population Aged 40 to 74 Years
Authors: Miyamatsu Naomi , Kimura Kazumi , Okamura Tomonori , Iguchi Yasuyuki , Nakayama Hirofumi , Toyota Akihiro , Watanabe Makoto , Morimoto Akiko , Morinaga Miho , Yamaguchi Takenori 
Published: November 2011

Background and Purpose—
An educational campaign by mass media has been associated with great increases in the knowledge about early symptoms of stroke. However, few studies were conducted with a controlled community intervention study.

Methods—
To clarify the effects of a 1-year television campaign for the whole population on improvement of knowledge about stroke symptoms in 2 cities, a campaign area and a control area in Japan were selected. Before and after the campaign, 1960 randomly selected residents aged 40 to 74 years answered a telephone survey regarding knowledge of early stroke symptoms. We calculated the percentage and 95% CIs of participants who correctly chose all 5 early symptoms of stroke in each area and in each year.

Results—
Before the campaign, 53% of participants (95% CI, 50%–55%) in the campaign area and 46% (95% CI, 44%–49%) in the control area correctly chose 5 early symptoms. After the 1-year television campaign, knowledge was significantly improved only in the campaign area (campaign area, 63%; 95% CI, 60%–66%; control area, 51%; 95% CI, 48%–54%). After sex stratification, only women showed improved knowledge of early symptoms. The audience rate for the campaign television programs was found to be higher in women than in men.

Conclusions–
A 1-year stroke educational television campaign effectively improved knowledge about early stroke symptoms among Japanese women aged 40 to 74 years. No impact was found among men in this age group. Future studies should examine the impact of this approach on stroke knowledge among younger individuals and whether there are any behavioral changes that contribute to earlier presentation for treatment.
How Does Number of Risk Factors Affect Prognosis in Young Patients With Ischemic Stroke?
Authors: Putaala Jukka , Haapaniemi Elena , Kaste Markku , Tatlisumak Turgut 
Published: November 2011

Background and Purpose—
We aimed to explore clinical features of young patients with ischemic stroke with no traditional vascular risk factors and to assess the impact of risk factor counts on outcomes.

Methods—
We included 990 patients aged 15 to 49 years with first-ever ischemic stroke followed for a mean of 9.0±3.8 years (survivors). Risk factors were categorized as well-documented and less well-documented. Outcome measures were unfavorable functional outcome (3-month modified Rankin Scale 2–6); recurrent ischemic stroke; myocardial infarction or other arterial noncerebrovascular event; and death from any cause.

Results—

Compared with those with at least 1 well-documented risk factor, the 127 (12.8%) patients without risk factors were younger (median age, 37 versus 44 years;
P
<0.001), likely to be females (54.3% versus 34.9%;
P
<0.001), and they had more frequently a low-risk source of cardioembolism (21.3% versus 8.1%;
P
<0.001), internal carotid artery dissection (12.6% versus 6.4%;
P
=0.011), or vertebral artery dissection (17.3% versus 7.2%;
P
<0.001). The groups had similar 3-month functional outcomes. Patients without well-documented risk factors had less frequently recurrent ischemic strokes (4.7% versus 13.6%; log rank
P
=0.014), noncerebrovascular arterial events (0% versus 6.1%;
P
=0.008), and lower long-term mortality (3.4% versus 14.3%;
P
=0.003) than did those with at least 1 risk factor. Adjusted for demographics and stroke etiology, the number of well-documented risk factors was associated with higher risk for noncerebrovascular events. Increasing count of less well-documented risk factors was, in turn, independently associated with higher long-term mortality.

Conclusions—
In young adults with first-ever ischemic stroke, risk factor counts added independent prognostic information regarding noncerebrovascular events and mortality.
Time Course of Vascular Reactivity Using Repeated Phase-Contrast MR Angiography in Patients With Carotid Artery Stenosis
Authors: Hartkamp Nolan S. , Hendrikse Jeroen , van der Worp H. Bart , de Borst Gert J. , Bokkers Reinoud P.H. 
Published: November 2011

Background and Purpose—
Cerebral vascular reactivity assessment is typically performed with 2 perfusion measurements before and after a vasodilatory challenge. The aim of this study was to assess the time course of the vasodilatory effect in the brain-feeding arteries after a challenge with acetazolamide in patients with a stenosis of the internal carotid artery (ICA).

Methods—
Twenty-one patients with a symptomatic ICA stenosis and 18 healthy control subjects underwent 2-dimensional phase-contrast MR angiography to repeatedly measure the blood flow (mL/min) in both ICAs at baseline and in 5-minute intervals for 30 minutes after intravenous administration of acetazolamide.

Results—

At baseline, the blood flow was significantly lower in the stenosed ICAs of patients (155±17 mL/min) than in the contralateral ICAs (237±21 mL/min,
P
<0.05) and the ICAs of healthy control subjects (249±15 mL/min,
P
<0.05) and remained lower throughout the time course. The maximum vasodilatory effect in the stenosed ICAs was observed after 15.3±0.9 minutes, which was significantly later than in the contralateral ICAs (within 12.9±0.7 minutes,
P
<0.05) and healthy ICAs (within 12.8±0.8 minutes,
P
<0.05).

Conclusions—
The onset of the maximum vasodilatory effect after administration of acetazolamide is delayed in patients with a symptomatic ICA stenosis.
Why Analyze Mental Models of Local Climate Change? A Case from Southern Mozambique
Authors: Shaffer L. Jen , Naiene Leocadia 
Published: November 2011

AbstractPeople construct mental models of local climate change based on their observations and experiences of past climate events and changes. These mental models offer critical insight into locally important factors that trigger responses to new climate conditions and can be used to ground-truth regional climate models. In this paper, the authors explore mental models of changes to local climate patterns and climate-associated environmental changes over the past 45 years (1963–2008) in two rural communities in Matutúine District, Mozambique. Interview results are compared to data from a regional weather station. Residents discuss temperature increases, short-term and long-term precipitation changes, and altered seasonal timing. Measurable climate change in this region includes increasing temperatures and more erratic rainfall leading to drought and altered season timing. The climate-associated environmental changes residents observed draw attention to links between local livelihood practices and climate, as well as emphasize changes that would not necessarily appear in regional climate models. Such changes include reduced crop and wild fruit production, fewer cattle, variable forest size, increased wildfires and elephant conflict, drying up of water sources, poor health, and cultural change. Differences between adjacent communities highlight the potential interaction of landscape and vegetation variability, gender, and livelihoods in observations and experiences of climate change and demonstrate how mental models can provide insight into local ecological patterns and processes.
‘In Our Voice’: Lessons learned from a cardiovascular disease curriculum for American Indian students
Authors: Sprague D , Burgoyne K , Vallie D La , Buchwald D 
Published: November 2011

Background: American Indian children and adolescents are at risk for obesity, type 2 diabetes, hypertension, elevated cholesterol, and smoking, all of which are risk factors for cardiovascular disease. Objective: To address these health issues, we developed, implemented, and evaluated a culturally appropriate cardiovascular disease curriculum called ‘In Our Voice’ for American Indian students in grades 7 through 12. The curriculum consisted of 16 modules lasting 50 minutes each, and it was implemented as a pilot test at five sites in two western states. Results: We faced many challenges to success, including competing demands for instructional time and classrooms, which prevented two schools from completing the curriculum. Two notable findings emerged: students preferred a multicultural focus over a culturally tailored focus, and they desired more interactive educational materials. Conclusion: Recommendations for successfully implementing an innovative curriculum include ensuring the ongoing presence of researchers at school sites, funding an internal curriculum champion at every site, and maintaining student advisory boards to communicate student feedback to researchers.
Localization of Small Parathyroid Adenomas Using Modified 4‐Dimensional Computed Tomography/Ultrasound
Authors: Stucken Emily Z. , Kutler David I. , Moquete Rachel , Kazam Elias , Kuhel William I. 
Published: November 2011

ObjectiveTo investigate whether parathyroid gland weight has an impact on the accuracy of preoperative localization of parathyroid adenomas with modified 4 dimensional computed tomography/ultrasound. And to determine if the weight of parathyroid adenomas can be calculated accurately based on the dimensions of the gland on the CT images.Study DesignCase series with chart review.SettingTertiary care hospital.Subjects and MethodsOne hundred forty‐two patients who had a preoperative modified 4‐dimensional computed tomography/ultrasound and underwent parathyroidectomy for hyperparathyroidism due to a parathyroid adenoma between 1998 and 2009. Charts were reviewed to identify (1) the sensitivity and specificity for localization of parathyroid adenomas according to gland weight and (2) correlation between preoperative estimate of parathyroid weight and the surgical weight of the parathyroid gland.ResultsModified 4‐dimensional computed tomography/ultrasound displayed 92% sensitivity for localizing adenomas weighing <150 mg to the correct side of the neck (95% confidence interval [CI], 65%‐99%), 100% sensitivity for glands weighing 150 to 500 mg (95%‐100%), and 98% sensitivity for glands weighing >500 mg (92%‐100%). For localization to the correct quadrant of the neck, sensitivity was 75% (95% CI, 47%‐91%) for glands weighing <150 mg, 89% (79%‐95%) for those weighing 150 to 500 mg, and 94% (85%‐97%) for glands weighing >500 mg. A positive correlation was seen between the preoperative weight estimate based on imaging and the operative weight of the gland, with a Pearson correlation coefficient of 0.96.ConclusionModified 4‐dimensional computed tomography/ultrasound can closely predict the weight of parathyroid glands preoperatively and has good sensitivity for localization of adenomas, even in glands weighing less than 150 mg.
Face and Content Validation of a Virtual Reality Temporal Bone Simulator
Authors: Arora Asit , Khemani Sam , Tolley Neil , Singh Arvind , Budge James , Varela David A. Diaz Voss , Francis Howard W. , Darzi Ara , Bhatti Nasir I. 
Published: November 2011

ObjectiveTo validate the VOXEL‐MAN TempoSurg simulator for temporal bone dissection.Study DesignProspective international study.SettingOtolaryngology departments of 2 academic health care institutions in the United Kingdom and United States.Subjects and MethodsEighty‐five subjects were recruited consisting of an experienced and referent group. Participants performed a standardized familiarization session and temporal bone dissection task. Realism, training effectiveness, and global impressions were evaluated across 21 domains using a 5‐point Likert‐type scale. A score of 4 was the minimum threshold for acceptability.ResultsThe experienced group comprised 25 otolaryngology trainers who had performed 150 mastoid operations. The referent group comprised 60 trainees (mean otolaryngology experience of 2.9 years). Familiarization took longer in the experienced group (P =. 01). User‐friendliness was positively rated (mean score 4.1). Seventy percent of participants rated anatomical appearance as acceptable. Trainers rated drill ergonomics worse than did trainees (P =. 01). Simulation temporal bone training scored highly (mean score 4.3). Surgical anatomy, drill navigation, and hand‐eye coordination accounted for this. Trainees were more likely to recommend temporal bone simulation to a colleague than were trainers (P =. 01). Transferability of skills to the operating room was undecided (mean score 3.5).ConclusionRealism of the VOXEL‐MAN virtual reality temporal bone simulator is suboptimal in its current version. Nonetheless, it represents a useful adjunct to existing training methods and is particularly beneficial for novice surgeons before performing cadaveric temporal bone dissection. Improvements in realism, specifically drill ergonomics and visual‐spatial perception during deeper temporal bone dissection, are warranted.
Potential role of IL-13 in neuroprotection and cortical excitability regulation in multiple sclerosis
Authors: Rossi S , Mancino R , Bergami A , Mori F , Castelli M , De Chiara V , Studer V , Mataluni G , Sancesario G , Parisi V , Kusayanagi H , Bernardi G , Nucci C , Bernardini S , Martino G , Furlan R , Centonze D 
Published: November 2011

Background: Inflammation triggers secondary neurodegeneration in multiple sclerosis (MS). Objectives: It is unclear whether classical anti-inflammatory cytokines have the potential to interfere with synaptic transmission and neuronal survival in MS. Methods: Correlation analyses between cerebrospinal fluid (CSF) contents of anti-inflammatory cytokines and molecular, imaging, clinical, and neurophysiological measures of neuronal alterations were performed. Results: Our data suggest that interleukin-13 (IL-13) plays a neuroprotective role in MS brains. We found, in fact, that the levels of IL-13 in the CSF of MS patients were correlated with the contents of amyloid-β1-42. Correlations were also found between IL-13 and imaging indexes of axonal and neuronal integrity, such as the retinal nerve fibre layer thickness and the macular volume evaluated by optical coherence tomography. Furthermore, the levels of IL-13 were related to better performance in the low-contrast acuity test and Multiple Sclerosis Functional Composite scoring. Finally, by means of transcranial magnetic stimulation, we have shown that GABAA-mediated cortical inhibition was more pronounced in patients with high IL-13 levels in the CSF, as expected for a neuroprotective, anti-excitotoxic effect. Conclusions: The present correlation study provides some evidence for the involvement of IL-13 in the modulation of neuronal integrity and synaptic function in patients with MS.