bluuebunny/crossref_metadata_2025_split huggingface dataset:
E-002 Reversible cerebral vasoconstriction syndrome treated with intra-arterial vasodilator therapy: a case report
Authors: Chowdhry S , Blackham K 
Published: July 2011

BackgroundReversible vasoconstriction syndrome has been described as an important cause of cerebral arteriopathy and/or vasoconstriction, with non-aneurysmal SAH recently being noted as a more common presentation that previously recognized. No standardized treatment exists and serious complications such as ischemic stroke have been reported. Although distal segmental narrowing is typical, proximal vessel occlusions have been reported.Case ReportA 43-year-old female marathon runner presented to an outside hospital following a thunderclap headache with initial negative head CT and lumbar puncture. 1 week later after worsening headache and nausea, a repeat head CT revealed right frontal intraparenchymal hematoma. A CT angiogram revealed right carotid terminus occlusion and scattered diffuse segmental narrowings. She was treated with steroids and nimodipine. Following progression of symptoms including left hemi-inattention, she was transferred to our facility and found to have a large right parietal infarct, subarachnoid hemorrhage along the right frontal cortex and multifocal moderate to severe segmental stenoses. Her NIH stroke scale was 16. Based on our experience with intra-arterial verapamil for the treatment of aneurysmal subarachnoid hemorrhage, she was taken to angiography where confirmation of multifocal proximal and distal segmental vascular narrowing was made and intra-arterial verapamil was given: 5 mg in the right internal carotid artery, 20 mg in the left internal carotid artery and 10 mg in the left vertebral artery. Immediate clinical improvement was appreciated despite modest angiographic changes. Daily transcranial Doppler studies were performed, along with induced hypertension and monitoring of central venous pressure. Systemic verapamil and high dose steroids were also administered. She returned to the angiography suite four times in the next 5 days week for clinical symptoms (left arm weakness, agitation and confusion) or elevated transcranial Doppler studies and was found to have a similar and recurrent pattern of vasospasm. She received similar intra-arterial treatment at each angiogram, again with clinical and angiographic improvement. At the time of discharge, the patient's left sided weakness and cognitive deficits had resolved but she suffered from residual left hemi-inattention.ConclusionWe describe a patient with severe, medical-treatment refractory RCVS who demonstrated clinical and radiographic response to repeated treatment with intra-arterial vasodilator therapy.
E-009 Treatment of ruptured cerebral aneurysms is increasingly occurring in high volume centers in the USA
Authors: Leake C , Brinjikji W , Kallmes D , Cloft H 
Published: July 2011

PurposeAlthough there is no formal system for regionalization of care for subarachnoid hemorrhage, evidence of better outcomes at higher volume centers might be expected to result in more of these patients being referred to high volume centers. The purpose of this study was to evaluate the US National Inpatient Sample (NIS) from 2001 to 2008 for trends in patient admissions for treatment of ruptured aneurysms at high and low volume centers.MethodsWe evaluated the numbers of ruptured aneurysms treated with clipping and coiling annually at low (≤20 patients/year) and high volume (>20 patients/year) centers, and also counted the number of high and low volume centers for each treatment. Hospitalizations for clipping or coiling of ruptured aneurysms were identified by cross-matching International Classification of Disease Codes for diagnosis of ruptured aneurysm (430.0) with procedure codes for clipping (39.51) or coiling (39.52, 39.79, or 39.72) of cerebral aneurysms.Results(Abstract E-009 figure 1) In 2001, 31% (435/1392) of patients clipped and 0% (0/122) of patients coiled were treated at high volume centers, whereas in 2008 these numbers increased to 62% (627/1016) of patients clipped and 68% (917/1351) of patients coiled, respectively. For clipping, the number of low volume centers significantly declined from 177 centers in 2001 to 85 centers in 2008, while the number of high volume centers has remained constant at 13 to 15. For coiling procedures, the number of low volume centers decreased from 62 centers in 2001 to 54 centers in 2008, while the number of high volume centers substantially increased from 0 centers in 2001 to 16 centers in 2005 and remained constant thereafter.Abstract E-009 Figure 1ConclusionTreatment of ruptured cerebral aneurysms is increasingly occurring in high volume centers in the USA. This is a favorable trend in that better outcomes are associated with care for these patients at a high volume center.
E-011 Merci retrievers as access adjuncts for reperfusion catheters: the grappling hook technique
Authors: Hui F , Hussain M , Spiotta A , Bhalla T , Toth G , Moskowitz S , Elgabaly M , Sivapatham T , Jafari N , Rasmussen P 
Published: July 2011

Objective and ImportanceExpeditious and stable access in the setting of acute ischemic stroke is foundational to mechanical revascularization of large vessel occlusions of the cerebral vasculature, particular when using an aspiration based system. Proximal vascular tortuousity and unfavorable anatomic variability may impede vascular access necessary for revascularization. In particular, the ophthalmic segment often proves difficult for large caliber aspiration catheters to navigate. We describe an approach using the Merci Retriever system as an adjunct to gain stable catheter access for aspiration.Clinical PresentationsThree patients presenting with acute ischemic stroke were treated via mechanical thrombectomy using the Penumbra 054 system. However, due to anatomical configurations, access to the M1 segment was challenging, with difficulty traversing the ophthalmic segment of the internal carotid artery ipsilateral to the respective M1 segment occlusion.InterventionAspiration catheter access into the distal middle cerebral artery was achieved via advancement of an 18L microcatheter followed by deployment of an appropriately sized Merci Retriever into the M1 segment. Gentle tension on the Retriever was applied, altering the angle at which the Aspiration catheter navigated the ophthalmic segment, affording accelerated access past the ophthalmic artery origin and into the ipsilateral M1 segment and clot. Retraction of the retriever into the 18L was followed by removal of the 18L in each case, which was in turn followed by aspiration using the Penumbra Aspiration catheter.ConclusionTime is of the essence in treating acute ischemic stroke, and, upon occasion, tortuous proximal anatomy may impede access to the occluded vessel. By making use of the apposition of a Merci retriever against the wall of a vessel, increased tension and straightening along the core wire changes the angle at which the large profile catheter makes with the vessel. As such, in unfavorable ophthalmic segment anatomy, this technique may be employed to advance an aspiration catheter to treat the offending embolus in the setting of an acute ischemic stroke.
E-013 Comparison of initial results following dual aneurysm embolization with the new penumbra coil 400 and 10-size coils in a single patient treated by the same operator
Authors: Gaughen J 
Published: July 2011

PurposeThe recently available Penumbra Coil 400 has 400% the volume per unit length of a 10-size coil due to its 0.020″ primary diameter, double that of conventional 10-coils. The Penumbra Coil 400 also purports to be softer than an equivalent 10-coil due to the larger primary diameter. This case report investigates these claims through two aneurysms treated in the same patient with two different coil systems.Methods and MaterialsA 53-year-old female presented with acute onset left 3rd nerve palsy. Her history was notable for clipping of a right posterior communicating artery aneurysm 18 years prior. She was found to have a 7.4×5.0×5.0 mm (97 mm3) basilar artery bifurcation aneurysm and a 12.7×11.2×10.8 mm (804 mm3) anterior communicating artery (Acomm) aneurysm. The basilartip aneurysm was accessed with an Eschelon-10 microcatheter (Covidien, Dublin, Ireland) and embolized with five GDC-10 coils (Stryker, Kalamazoo, Michigan, USA):5 mm×15 cm, 4 mm×6 cm, 3 mm×8 cm, 2 mm×6 cm and 2 mm×4 cm. The coiling endpoint was catheter kick-out. 7 days later, the Acomm aneurysm was accessed with a PX400 microcatheter (Penumbra, Inc., Alameda, California, USA) and embolized with eight Penumbra coils: 10 mm ×40 cm, 8 mm×20 cm and 5 mm×10 cm complex standard, 4 mm×8 cm and 3 mm×10 cm complex soft, 3 mm×6 cm, 2 mm×3 cm and 2 mm×2 cm helical extra soft. The coiling endpoint was catheter kickout.ResultsProcedure results for both aneurysms are shown below. There were no technical or clinical complications with either procedure.ConclusionsThe Penumbra Coil 400 filled a large aneurysm to adequate packing density in about the same overall time and use of fluoroscopy as a smaller aneurysm treated with 10-size coils, despite the Penumbra-treated aneurysm being 8.3 times larger by volume. Follow-up will be required to assess the durability of occlusion in both aneurysms.Abstract E-013 Table 1Basilar tip aneurysmAcomm aneurysmAneurysm volume97 mm3804 mm3Coil type usedGDC-10Penumbra coil 400# of coils58Total coil length39 cm99 cmFinal packing density22.0%(Angiosuite iPhone App)24.9%(Angiosuite iPhone App)Total fluoro time (min)34.5 min31.3 minTotal procedure time (min)101 min118 min
E-015 Mechanical and chemical angioplasty for sah induced cerebral vasospasm: experience at the university of Michigan 1997–2005
Authors: Pandey A , Bunney A , Singh R , Thompson B , Chaudhary N , Fletcher J , Rajajee K , Gemmete J 
Published: July 2011

ObjectiveTo evaluate the safety and efficacy of chemical and mechanical angioplasty in the treatment of medically refractory cerebral vasospasm toward the goal of identifying factors predicting clinical outcome.MethodsAll patients undergoing endovascular management of medically refractory cerebral vasospasm at the University of Michigan between 1997 and 2005 were included. Clinical and angiographic data were collected retrospectively with the review of clinical charts as well radiographic images once institutional review board approval was gained.Results28 patients underwent mechanical/chemical angioplasty during this time period. Demographic data included: mean age 51.8 years, 21% male, 79% female, and 89% Caucasians. Anterior circulation aneurysm comprised 52% of this patient population and 80% of the patients presented with a Hunt Hess III/IV grade SAH while 96% had a Fisher IV bleeding pattern. The mean aneurismal neck size was 3.7 mm while the dome size was 7.4 mm. 59% of the patient population had undergone microsurgery for aneurismal protection as opposed to endovascular treatment. 56% of the patients were tobacco users and 39% had a history of hypertension. 78% of the patients had presented 5–12 days post SAH. There were no vessel dissections, ruptures, or thrombosis associated with the mechanical procedure. Only 38% of patients required angioplasty involving the posterior circulation vasculature. Modified Rankin score improved from the time of vasospasm to the time of discharge with statistical significance (14% independent at time of symptoms as opposed to 53% independent at time of discharge).ConclusionSAH associated cerebral vasospasm leads to significant morbidity and mortality. Mechanical and chemical angioplasty are safe and effective methods of preventing DIND associated with medically refractory cerebral vasospasm.
E-016 Intracranial endoluminal waveform analysis to understand the underlying pathophysiology and quantify treatment effect: case illustration involving venous sinus stenosis
Authors: Spiotta A , Rasmussen P , Moskowitz S 
Published: July 2011

IntroductionExtracranial waveform analysis of both arterial and venous intravascular compartments is common. Any catheter with a fluid-filled lumen that is of sufficient inner diameter to support transducing a pressure waveform can provide information from the intravascular compartment from which it is derived. This methodology, when applied to the intracranial vasculature, may provide useful insights into a patient's specific pathophysiology. Additionally, such waveform analysis could provide feedback to assess the efficacy of a targeted intervention. We present our preliminary experience with a strategy of assessing the intracranial, endoluminal waveforms during a neurointervention.MethodologyA 21-year-old female presented with rapid neurological decline progressing to obtundation secondary to intracranial hypertension. Angiography demonstrated left transverse sinus (TS) occlusion with stenosis of the contralateral TS. Under roadmap visualization, an Echelon microcatheter was crossed over a microwire proximal (“upstream”) to the stenosis involving the right TS. Waveform analysis was performed at this starting point and as it was pulled back to a location distal to the stenosis (“downstream”). Waveforms were captured with the Bedmaster software package (Excel Medical Solutions) which we have customized to integrate data acquisition from the angiography suite.ResultsICP was monitored with an intraparenchymal monitor (Camino, Integra Neurosciences, Plainsboro, New Jersey, USA) and measured 54–59 mm Hg, while mean arterial pressure (MAP) measured by an arterial line in the radial artery measured 93–94 mm Hg. Proximal to the stenosis, pressure readings of 68 mm Hg with a waveform that mirrored an attenuated ICP waveform. Distal to the stenosis, the waveform dampened and mirrored the central venous pressure measured at 3 mm Hg. Angioplasty alone did not result in a sustained improvement, at which point a balloon mounted stent was used at the stenosis. Following treatment of the lesion the waveform analysis was repeated at the same locations along the TS which had been previously monitored. Treatment of the lesion resulted in a decrease in ICP to 36–37 mm Hg. The pressure along the TS was now 44 mm Hg along the treated TS with resolution of the pressure gradient.ConclusionA significant pressure gradient was identified across the stenotic lesion in the TS, verifying the pathophysiologic process to be venous hypertension from venous outlet obstruction. ICP significant improved following treatment of the lesion and elimination of the pressure gradient across the lesion, again verifying venous outlet obstruction to be the underlying etiology.Abstract E-016 Figure 1
E-018 Intracranial stenting of a persistent primitive hypoglossal artery in a patient presenting with acute bilateral posterior circulation infarcts
Authors: Polo M , Chiu D , Klucznik R , Diaz-Daza O 
Published: July 2011

PurposeWe discuss the endovascular technique used in treating a critical stenosis of a persistent hypoglossal artery with angioplasty and stenting, as well as the anatomy of this rare variant using CT, MRA, biplanar and 3D DSA, and DynaCT.Case ReportA 63-year-old Hispanic male presented to the E.R. with a chief complaint of blurred vision and dizziness for 2 days. Past medical history was significant for hypertension, diabetes and hyperlipidemia.Imaging FindingsCT and MRI showed multiple areas of acute ischemia involving both occipital lobes and the right cerebellar hemisphere. The CT also showed an enlarged right hypoglossal canal. MRA and DSA revealed an anomalous vessel, arising extracranially from the cervical segment of the internal carotid artery, entering the intracranial compartment through the hypoglossal canal and supplying the basilar artery. The distal portion of this vessel, just below the basilar junction, had a critical stenosis. This critical stenosis was treated endovascularly with angioplasty and stenting, using a 3×15 mm Gateway balloon and a 4×15 mm Wingspan stent.SummaryA persistent hypoglossal artery is one of four primitive embryologic connections between the internal carotid artery and the vertebrobasilar circulation. Atherosclerotic disease of the common or the proximal internal carotid artery, or of the hypoglossal artery itself, may present with symptoms of vertebrobasilar insufficiency, or lead to infarction in the posterior circulation. To our knowledge, this represents the first case report of intracranial stenting through a persistent hypoglossal artery. The technical aspects of the endovascular treatment are addressed. We also discuss the anatomy of the persistent hypoglossal artery, using CT, MRI, MRA, biplanar and 3D DSA, and Dyna CT correlation.Abstract E-018 Figure 1
The Islamic Headscarf Problem before Secular Legal Systems: Factual and Legal Developments in Turkish, French and European Human Rights Laws
Authors: Ulusoy Ali 
Published: July 2011

AbstractThe Islamic headscarf problem is bound to form a risk of clash of civilizations between Western and Muslim cultures. In Turkey, the Islamic headscarf constitutes a significant symbol or cause of battle between a powerful ultra-secularist Kemalist bureaucracy and moderate but also opportunist Islamist politics. In France, despite previous judicial solution, the legal headscarves ban in (merely public) schools seems to be a political message to the conservative and nationalist electorate in the name of Republicanism. The European Court of Human Rights' legalization of headscarves bans tends to be a legal coup de main for the contenders against Islamist radicalism. Dealing with this problem responsibly following rational legal standard – as described and proposed in this article – could surprisingly demonstrate that a consensus is possible concerning such a big problem between two cultures.
Composite membranes of poly(lactic acid) with zinc-added bioactive glass as a guiding matrix for osteogenic differentiation of bone marrow mesenchymal stem cells
Authors: Oh Sun-Ae , Won Jong-Eun , Kim Hae-Won 
Published: July 2011

This study aims to produce a degradable and bone-bioactive membrane for guiding bone regeneration by combining a degradable polymer, poly(lactic acid) (PLA), with a bioactive inorganic zinc-containing bioactive glass (ZnBG). The in vitro osteogenic development of rat bone marrow mesenchymal stem cells (rBMSCs) upon different membrane substrates (pure PLA control, PLA–BG, and PLA–ZnBG) was investigated in terms of bone cell phenotype syntheses and mineralization. Results showed significantly stimulated production of alkaline phosphatase and osteocalcin at days 14 and 21 in the membranes containing BG and ZnBG, with more in the samples containing ZnBG. The addition of ZnBG in PLA allowed the rBMSCs to express a high level of bone sialoprotein as confirmed by immunostaining. Cellular mineralization of the secreted extracellular matrix showed a significantly higher Ca level on the BG- and ZnBG-added membrane than on the PLA, and the more so in the ZnBG-added one. Based on the in vitro assessments using rBMSCs, the ZnBG-added PLA is considered to be of potential use in guiding active bone regeneration within the periodontal pocket.
Genome-wide evidence for positive selection and recombination in Actinobacillus pleuropneumoniae
Authors: Xu Zhuofei , Chen Huanchun , Zhou Rui 
Published: July 2011

Abstract

Background

Actinobacillus pleuropneumoniae is an economically important animal pathogen that causes contagious pleuropneumonia in pigs. Currently, the molecular evolutionary trajectories for this pathogenic bacterium remain to require a better elucidation under the help of comparative genomics data. For this reason, we employed a comparative phylogenomic approach to obtain a comprehensive understanding of roles of natural selective pressure and homologous recombination during adaptation of this pathogen to its swine host.

Results
In this study, 12 A. pleuropneumoniae genomes were used to carry out a phylogenomic analyses. We identified 1,587 orthologous core genes as an initial data set for the estimation of genetic recombination and positive selection. Based on the analyses of four recombination tests, 23% of the core genome of A. pleuropneumoniae showed strong signals for intragenic homologous recombination. Furthermore, the selection analyses indicated that 57 genes were undergoing significant positive selection. Extensive function properties underlying these positively selected genes demonstrated that genes coding for products relevant to bacterial surface structures and pathogenesis are prone to natural selective pressure, presumably due to their potential roles in the avoidance of the porcine immune system.

Conclusions
Overall, substantial genetic evidence was shown to indicate that recombination and positive selection indeed play a crucial role in the adaptive evolution of A. pleuropneumoniae. The genome-wide profile of positively selected genes and/or amino acid residues will provide valuable targets for further research into the mechanisms of immune evasion and host-pathogen interactions for this serious swine pathogen.
Differences in integrin expression and signaling within human breast cancer cells
Authors: Taherian Aliakbar , Li Xinlei , Liu Yongqing , Haas Thomas A 
Published: July 2011

Abstract

Background
Integrins are used as prognostic indicators in breast cancer. Following engagement with extracellular matrix proteins, their signaling influences numerous cellular processes including migration, proliferation, and death. Integrin signaling varies between cell types through differential expression of integrin subunits, and changes within a given cell upon exposure to a cell agonist or through changes in its surroundings. These variations in signaling can profoundly affect the phenotypic, tumorogenecity and metastatic properties of cancer cells. In the present study, we investigated if there were differences in the expression of integrins, integrin structures, and integrin co-receptors within three breast cancer cells and if these differences effected integrin signaling.

Methods
Expression of integrins, urokinase receptor and vascular endothelial cell growth factor receptor (VEGFR) in metastatic MDA-MB-435 and MDA-MB-231, non-metastatic MCF7 and non-breast cancer Hek-293 cells was measured by flow cytometry. Cell adhesion was assessed using collagen, fibrinogen, fibronectin and vitronectin coated plates. Changes in kinase levels following PMA stimulation, and cell adhesion-induced activation of kinases were determined by western blot analysis. Distribution of actin stress fibers and focal adhesions was assessed by immunocytochemistry.

Results
All cells expressed αv integrins, while high β5 and αvβ5 expression was restricted to the cancer cells and high β3 and αvβ3 expression was restricted to MDA-MB-435 cells. The two metastatic cells were the least adhesive, but all cells adhered well to most proteins in the absence of PMA. All proliferating cells expressed activated pSrc, but only proliferating metastatic cells expressed high pMEK levels. PMA treatment resulted in time-dependent changes in activated kinase levels, and only MDA-MB-231 cells constitutively expressed high levels of activated pMEK. MDA-MB-435 cells formed more stress fibers and focal adhesions and only exhibited adhesion-induced activation of pMEK and pFAK. All cells expressed the urokinase receptor, but MCF7 cells had markedly higher VEGFR expression. Adhesion induced differential expression of pFAK, pMEK and pERK.

Conclusions
This study demonstrates that breast cancers vary in their expression of integrins, their capacity to form focal adhesion and to signal through integrins. These differences likely contribute to phenotypic variations between cancer lines and account for some of the heterogeneity of breast cancer.