bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Predictors of High Posttreatment Platelet Reactivity to Clopidogrel in Koreans
Authors: Park Kyung Woo , Park Jin Joo , Jeon Ki‐Hyun , Kang Si‐Hyuk , Oh Il‐Young , Yang Han‐Mo , Cho Hyun‐Jai , Lee Hae‐Young , Kang Hyun‐Jae , Koo Bon‐Kwon , Oh Byung‐Hee , Park Young‐Bae , Kim Hyo‐Soo 
Published: December 2010

SUMMARYIntroduction: High posttreatment platelet reactivity to clopidogrel (HPPR) is associated with major adverse cardiac events. However, the clinical predictors of HPPR in Asians have not been studied previously.Aims: We sought to determine clinical predictors of HPPR in Koreans.Results: We measured platelet reactivity with the VerifyNow P2Y12 assay in 1431 consecutive patients undergoing coronary angiography. We used the cut‐off value of greater than 275 P2Y12 Reaction Unit (PRU) to define patients with HPPR. The clinical characteristics were compared between patients with HPPR (36.3%) and those without HPPR (63.7%).The mean age (65.4 ± 9.1 vs. 62.2 ± 9.7 years) was higher, hypertension (68.5% vs. 62.0%), diabetes mellitus (35.4% vs. 28.5%), chronic kidney disease (36.3% vs. 22.5%), renal replacement treatment (1.2% vs. 0.2%), and congestive heart failure (1.3% vs. 0.3%) were more common among patients with HPPR, while male gender (72.6% vs. 54.8%) and smoking (19.9% vs. 13.1%) were more common among non‐HPPR patients. Mean glomerular filtration rate (63.5 ± 18.6 vs. 69.7 ± 16.1 mL/min/1.73 m3) was lower and C‐reactive protein (hs‐CRP) (6.6 ± 20.5 mg/L vs. 4.2 ± 12.1 mg/L) level was higher among those with HPPR. Independent predictors of HPPR were female gender (OR 1.90, P≤ 0.001), chronic kidney disease (OR 1.51, 0 = 0.004), diabetes mellitus (OR 1.35, P= 0.024), hs‐CRP ≥ 2.0 mg/L (OR 1.31, P= 0.005), and age increase in decades (OR 1.21, P= 0.002), while smoking was negative risk factor (OR 0.63, P= 0.015). The number of risk factors was linearly associated with the risk of HPPR, with most patients having one or two predictors.Conclusion: In Korean population, independent clinical predictors of HPPR included diabetes mellitus, increased age, female gender, chronic kidney disease, and hs‐CRP ≥ 2.0 mg/L, while cigarette smoking was associated with better responsiveness. Mean platelet reactivity and HPPR prevalence steadily increased with the number of clinical predictors.
Subcutaneous Dirofilariosis in South‐East Serbia‐Case Report
Authors: Tasić S. , Stoiljković N. , Miladinović‐Tasić N. , Tasić A. , Mihailović D. , Rossi L. , Gabrielli S. , Cancrini G. 
Published: December 2010

SummaryHuman dirofilariosis is a relatively rare infection caused by filarial worms of the genus Dirofilaria. We herein report the first case of human subcutaneous dirofilariosis in the southeastern part of Serbia. A complete alive nematode was removed from a nodule in the periorbital region of a 50‐year‐old woman. The nematode was morphologically identified as a D. repens‐like immature female. The diagnosis was confirmed with molecular methods. The patient was probably infected in the South‐East Serbia as she had not travelled abroad, nor in other parts of Serbia such as Vojvodina, recently identified as a hyperendemic area for D. repens infection of dogs.
SECOND NATURE AND SPIRIT: HEGEL ON THE ROLE OF HABIT IN THE APPEARANCE OF PERCEPTUAL CONSCIOUSNESS
Authors: Forman David 
Published: December 2010

abstractHegel's discussion of the concept of “habit” appears at a crucial point in his Encyclopedia system, namely, in the transition from the topic of “nature” to the topic of “spirit” (Geist): it is through habit that the subject both distinguishes itself from its various sensory states as an absolute unity (the I) and, at the same time, preserves those sensory states as the content of sensory consciousness. By calling habit a “second nature,” Hegel highlights the fact that incipient spirit retains a “moment” of the natural that marks a limitation compared to “pure thought” but that also makes perceptual consciousness possible. This makes Hegel's account analogous in important respects to John McDowell's “naturalism of second nature.” But Hegel's account of habit can be seen as a version of a Kantian synthesis of the productive imagination—and hence presupposes a given material that can become one's own by means of habit. This does not mean that Hegel falls into the Myth of the Given, but it does suggest that an appropriate account of second nature might be committed to something McDowell wants to deny: that nonconceptual states of consciousness play a role (even if not a justificatory role) in perception.
WANDERING AMONG SHADOWS: THE DISCORDANCE OF TIME IN LEVINAS AND BERGSON
Authors: Durie Robin 
Published: December 2010

abstractOne of the earliest examples of articulating the “discordance of time”—a theme that serves as a guiding thread woven throughout much of the re‐engagement with time that is characteristic of continental philosophy—can be found in a series of essays written by Levinas in the aftermath of World War II. I show how these essays derive from a set of key texts by Bergson and how Bergson already anticipated the distinctive ways of conceptualizing the movement of time that are advanced by Levinas in his early essays. Nevertheless, as I will show, Levinas chooses not to acknowledge this Bergsonian anticipation of his theory of time, despite his recognition, repeated throughout many texts and interviews, of the influence of Bergson on the formation of his own thought. I conclude by reflecting on the complexity of the Bergsonian inheritance in Levinas's philosophy of time.
P-001 Quantification of parametric color coded digital subtraction angiography
Authors: Powers C , Aagaard-Kienitz B , Pulfer K , Royalty K , Arat A , Niemann D , Strother C 
Published: December 2010

PurposeColor coding of digital subtraction angiography (DSA) is a temporal and intensity post-processing color coded algorithm that generates a single composite image containing all information contained in a standard DSA acquisition. The composite image enhances the conspicuity of findings on DSA images done before and after therapeutic interventions. To date, analysis of images processed with this algorithm has been entirely qualitative. In a series of patients, we sought to add quantification to the color coded images.Materials and methodsAngiographic acquisitions were obtained by a single operator using the same volume of contrast medium injected through a catheter at the same location before and after treatment. Using the time to peak parameter, the effect of neuroendovascular treatment of cerebral artery vasospasm and intracranial stenosis was quantified in three patients. A time contrast concentration curve was generated from a group of pixels in the extracranial segment of the vertebral artery or internal carotid artery (proximal to the area of pathology) to confirm that delivery of the contrast bolus was equivalent before and after treatment. Next, a time contrast concentration curve from a group of pixels in a vessel distal to the lesion was used to quantify the treatment effect. Quantitative analysis was obtained by directly comparing the time to peak before and after treatment at these two locations.ResultsColor coded DSA was quantified in two patients treated for vasospasm and in one with an intracranial stenosis. In all cases, composite color images were generated with the only variable between pretreatment and post-treatment images being the treatment itself. In all cases, time–concentration curves distal to the lesion demonstrated quantifiable changes in time to peak following treatment. Overall, there was a 1–1.25 s decrease in time to peak after verapamil infusion for vasospasm. There was a 0.5 s decrease in time to peak after angioplasty for intracranial stenosis.ConclusionsColor coded DSA not only presents all the information from a standard acquisition as a composite qualitative image but also contains readily quantifiable parametric data. The full usefulness of these data remains to be determined and is the topic of ongoing investigations. Furthermore, animal experiments on the effects of varying stenosis on quantitative data proximal and distal to the stenosis are ongoing and will be presented.
O-018 A new hemodynamic parameter: energy loss to anticipate aneurysm rupture
Authors: Takao H , Murayama Y , Qian Y , Mohamed A , Matsuda W , Umezu M , Abe T 
Published: December 2010

PurposeDifferent hemodynamic models have been studied for the need to estimate the rupture risk of cerebral aneurysms with variable success. We postulated that the transfer of energy by the interaction of the hemodynamic forces with the aneurysmal wall can be related to the risk of rupture. For that reason we introduced a new hemodynamic parameter called energy loss (EL).Methods40 side wall, medium sized aneurysms were selected from our aneurysm database from 2003 to 2009. Four incidentally found internal carotid posterior communicating artery aneurysms ruptured during their period of conservative observation (ruptured-IA). 36 stable unruptured aneurysms (stable-IA) with the same location and similar size were examined with EL.EL is created by separation and turbulence of the flow. We subtracted without aneurysm energy from with aneurysm energy in our model. To avoid the influence from size of aneurysms, the EL was divided by the aneurismal volume.ResultsThe flow inside the ruptured IAs appeared more complex, and it crashed strongly into aneurysm surfaces. In contrast, the flow inside of stable-IAs passed smoothly through the aneurysms.The EL in ruptured-IAs was about five times higher than that of stable-IAs.ConclusionThe research indicated that there is a more complex flow pattern with significant turbulence inside of ruptured-IA. The EL created by aneurysms was clearly different between ruptured-IA and stable-IA. The results indicate that the EL may be an important parameter to estimate the risk of aneurysm rupture and that potentially can be developed into clinical application.Abstract O-018 Figure 1Flow visualization at systolic peak. The blood flow in a case before rupture had a more complex flow pattern.
O-002 Acute stroke treatment: without time limitations
Authors: Turk A , Turner R , Chaudry I 
Published: December 2010

BackgroundMany new stroke trials are evaluating the utility of perfusion imaging for patient selection within certain time constraints. There is evidence that patients with a delayed (>12 h) clinical–diffusion mismatch have poor clinical outcomes. We present our experience utilizing perfusion imaging to triage patients for endovascular therapy irrespective of time constraints.Methods53 patients were treated over the past 2 years utilizing presenting National Institutes of Health Stroke Scale (NIHSS), anatomic imaging and perfusion information. Patients were excluded if they had a hemorrhage or significant completed stroke (>1/3 middle cerebral artery territory volume) on CT or cerebral blood volume maps. If perfusion imaging was limited, as in some basilar occlusion cases, then the clinical examination (NIHSS) was used. The median time to treatment from symptom onset of the patient cohort was then determined and patients were divided into two groups. Clinical outcomes were then documented and subgroup analysis was performed.ResultsThe mean time to treatment was 10.36 h and the median was 6.13 h (range 1.75–72 h), suggesting several patients were treated far beyond 6 h. Utilizing a 6 h time point to identify two separate groups yielded 26 patients treated before 6 h and 27 patients treated more than 6 h from symptom onset. Angiographically, TIMI2 or better flow was restored 96% of the time. Patient outcomes in those treated less than 6 h compared with more than 6 h showed modified Rankin Score (mRS) of 0–2 in 36% and 37%, respectively, and mRS 0–3 in 56% and 52%, respectively.ConclusionUtilization of perfusion based techniques is a viable clinical strategy for identifying acute stroke patients for endovascular therapy. Clinical outcomes can be obtained that are similar to those of clinical trials, irrespective of time constraints in appropriately selected patients.
O-028 Effect of baseline CT scan appearance and time to recanalization on clinical outcomes in endovascular thrombolysis of acute ischemic strokes
Authors: Goyal M , Menon B , Hill M , Coutts S , Demchuk A 
Published: December 2010

PurposeThe Penumbra Pivotal Stroke Trial reported a 25% good outcome rate (modified Rankin Scale (mRS) ≤2) despite 81% recanalization rate. We evaluated whether a good initial non-contrast CT (Alberta Stroke Programe Early CT Score (ASPECTS) >7) and a short time to recanalization predicted good clinical outcome in this trial.Materials and methodsData were from the Penumbra Pivotal Stroke Trial. Baseline scans were evaluated by two experienced readers blinded to clinical outcomes using an ASPECTS scoring system. ASPECTS was dichotomized into >7 and ≤7 for the primary analysis. Data on the degree of recanalization based on TIMI scores, stroke onset to recanalization time and CT to recanalization time were obtained. The primary clinical outcome was mRS ≤2 at 3 months.ResultsMedian baseline NIHSS was 18 (range 8–34) and median baseline ASPECTS was 6 (range 0–10). 81.2% achieved recanalization (TIMI 2–3) and 27.1% good clinical outcome. There was no difference in baseline characteristics between the groups with ASPECTS >7 and ≤7 except in history of hypertension (more common in the >7 group, p=0.01). No difference in TIMI 2–3 recanalization (83.9% vs 79.6%; p=0.8), onset to recanalization (390 vs 359 min; p=0.6) or CT to recanalization time (223.8 vs 208 min; p=0.6) was noted between these two groups. Good clinical outcome however was significantly higher in the >7 group compared with the ≤7 group (50% vs 15%, risk ratio 3.3, 95% CI 1.6 to 6.8; p=0.0001). No patient with an ASPECTS score ≤4 (n=28) or without recanalization (TIMI 0–1) (n=16) had good clinical outcome. There was evidence of an interaction between baseline ASPECTS (dichotomized as >7 and ≤7) and onset to recanalization time (dichotomized as ≤300 min and >300 min) in predicting good clinical outcome (p=0.06).ConclusionPatients with a low baseline CT (ASPECTS ≤4) do not benefit from recanalization at any time point. Patients who do not recanalize do not benefit at all. Fast recanalization may benefit even patients with evident damage on the CT scan (ASPECTS >4). Only patients with very favorable scans (ASPECTS >7) benefit when recanalization is late. Patients benefit the most when they are recanalized rapidly and have a favorable baseline CT scans (ASPECTS>7).
O-029 Oral contraceptive and hormone replacement therapy in women with cerebral aneurysms
Authors: Feldman L , Goldstein L , Ouyang B , Chen M 
Published: December 2010

Background and purposeAlthough ruptured cerebral aneurysms are more common in postmenopausal women than in premenopausal women, or men, the putative hormonal role that underlies this disparity is poorly understood. Prior clinical and laboratory studies suggest that estrogen, via multiple mechanisms, is critical in maintaining arterial vascular integrity and tone. Use of oral contraceptives (OCP) and hormone replacement therapy (HRT) attenuates the sudden physiologic drops in estrogen seen during the normal menstrual cycle and at menopause. The goal of this study was to compare the rate of exogenous estrogen modifying agent use in a cohort of women with cerebral aneurysms with large sample national averages.MethodsWith IRB approval, a retrospective, case control study was performed via trained telephone interviews at a US urban tertiary center. Female patients with cerebral aneurysms under the care of a single physician (MC) from over a 2 year period were compared with a publically available data set from 4682 random female controls in the US, also interviewed via telephone using random digit dialing (Ann Epidemiol2002;12:213–22). The questions asked of both groups were similar with regard to gynecologic history and the use and duration of estrogen modifying medications. Variables included age of menarche, parity, age at birth of first child, use of oral contraceptives and duration if any, use of HRT and duration if any, and age at menopause. Univariate and multivariate analyses were performed.ResultsBetween 2008 and 2009, 49 cases were successfully interviewed with an age range between 31 and 80 years. χ2tests of independence were performed to examine the relationship between OCPs or HRTs in cases compared with controls. The lower rate of OCP (χ2(1,N=)=0, p<0.0001) and HRT (χ2(1,N=)=0, p=0.0292) use among cases was statistically significant. Furthermore, an independent samples t test showed a statistically significant lower mean duration of OCP among cases compared with controls (p=0.0041).ConclusionsWomen with cerebral aneurysms not only used OCP and HRT less frequently than the general population but if they did it was of shorter duration. These results support the hypothesis that physiologic drops in estrogen that occur during the menstrual cycle and particularly at menopause may explain why cerebral aneurysms are more frequently found in women, particularly during menopause. A protective role for pharmacologic estrogen stabilization in women who are at risk for cerebral aneurysm formation warrants further study.Abstract O-029 Table 1Cases (n=49)Control n=4682Age years (years) (mean (SD))56 (13)49 (8.3)BMI (mean (SD))26.97 (6.9)25 (5.9)Age menarche (years) (mean (SD))12.8 (1.8)12.4 (1.6)Age first pregnancy (years) (mean (SD))20 (SD 8.3)22.9 (5.3)No of term pregnancies (mean (SD))2.47 (1.9)2.3 (1.7)Any or current use of OCP (%)5178Median duration of OCP use (years)2.65.2Any or current use of HRT (%)2441
E-010 Triple coaxial catheter technique for coil embolization of cerebral aneurysms
Authors: Uemura A , Fujii M , Yamamoto D , Matsukawa H , Kobayashi N , Numaguchi Y 
Published: December 2010

IntroductionKeeping microcatheters stable in anterior cerebral artery (ACA) or middle cerebral artery (MCA) aneurysms during coil embolization is crucial in the success of the treatment. We currently use a triple coaxial catheter system by using long 4 French or 5 French Cerulean G catheters (Medikit, Tokyo, Japan) as second guiding catheter to support microcatheters in cases of distal cerebral aneurysms. The purpose of this retrospective study is to evaluate the efficacy of the triple coaxial system in the treatment of distal cerebral aneurysms.Materials and methodsWe retrospectively reviewed eight cases (five men and three women; aged 47–90 years; mean 68.1 years) of ACA and MCA ruptured aneurysms treated by endovascular coil embolization by using the triple coaxial system between April 2009 and February 2010. The location of the aneurysms included the anterior communicating artery (n=6), distal ACA (n=1) and distal MCA (n=1). A 5 French guiding sheath (n=4) or 6 French guiding catheter (n=4) was used as the primary guiding catheter. A 4 French or 5 French Cerulean G catheter was introduced up to the petrous portion of the internal carotid artery as a second guiding catheter. Evaluated subjects included success of microcatheter navigation, stability of microcatheter during the procedure and other technical issues.ResultsIn all cases, a microcatheter was navigated into the aneurysms successfully. Microcatheters were kept stable inside the aneurysms during the procedure. However, to advance preshaped SL-10 microcatheters (Boston Scientific, Natick, Massachusetts, USA) inside 4 French Cerulean G catheter in two cases was so difficult that we had to exchange the microcatheter to another one. There was no complication associated with the technique. Contrast injection through the guiding catheter during the procedure was slightly hard when 6 French guiding catheters were used as the primary guiding catheter.ConclusionTriple coaxial system for ACA and MCA aneurysms is a safe and feasible technique. However there are several technical issues that we have to take into account.
E-011 Safety and efficacy of combined mechanical and pharmacological intervention in acute stroke patients with atrial fibrillation
Authors: Sharma J , Nanda A , Mehta S , Joshi A , Hsu D 
Published: December 2010

ObjectiveWe report on the use of combined mechanical and pharmacological intra-arterial interventions in patients with atrial fibrillation in acute stroke settings.BackgroundCardioembolic source is a major cause of ischemic stroke. However, there is limited experience regarding the use of combined mechanical and chemical intra-arterial therapy in acute stroke patients with atrial fibrillation.Design and methodsRetrospective chart review was performed on 45 patients with atrial fibrillation who underwent interventional acute stroke treatment from January 2006 to October 2009. The study included 29 men and 16 women, with a mean age of 72 years. The mean National Institutes of Health Stroke Scale was 17 at presentation. The primary outcome measures included for analysis following the intervention were intracranial hemorrhage (ICH), mortality and recanalization rates as well as modified Ranking Score (mRS).ResultsThe mean time from onset of symptoms to beginning of the angiographic procedure was within 3–6 h. 20 patients received 0.9 mg/kg intravenous tissue plasminogen activator (tPA) for 40 min as a bridging therapy prior to any endovascular management. Large vessel occlusions were noted in more than 73% of the patients (n=33) Thirty patients received intra-arterial tPA and a mechanical device was used in 16 patients during endovascular intervention. Mechanical thrombectomy devices utilized were MERCI and Penumbra in 12 and four patients, respectively. Rate of postprocedure symptomatic ICH was 15% (n=7). Nine patients died during the hospital stay (20%). Partial to complete recanalization (TIMI 2 or 3) was achieved in 25 patients (55%). mRS ≤3 was achieved in 23 patients (51%) at the time of discharge.ConclusionsCombined mechanical and pharmacological therapies during acute stroke interventions can be safe and effective in achieving revascularization in patients with atrial fibrillation.
E-014 Effect of carotid artery stenting on cognitive function in patients with carotid artery stenosis: one year outcomes
Authors: Turk A , Pulfer K , Turski P , Niemann D , Aagaard-Kienitz B , Rowley H 
Published: December 2010

BackgroundCarotid artery stenosis may be a cause of reduced cognitive performance. We have previously demonstrated that stent revascularization resulted in short term improvement in cognitive testing. The goal of this study was to demonstrate the long term durability of improved cognitive performance 1 year after carotid stenting.MethodsPatients referred for stenting of a unilateral carotid artery stenosis were enrolled in the study. Neuropsychological testing was performed with a Mini-Mental Status Examination, an extended mental status examination, a subjective cognitive status measure and a psychomotor performance speed test. The severity of stenosis was measured on angiography performed prior to stenting. One year after stenting, CT angiography was performed to ensure no restenosis had occurred and neuropsychological testing was repeated. Differences in neuropsychological test scores pre- and post-stenting were calculated and tested for significance with a Student t test.Result13 patients with a single unilateral greater than 50% carotid stenosis completed the study. The stenosis of the carotid artery averaged 84% prior to treatment and 9% after treatment. Post-stenting, the extended mental status examination was significantly improved. There was also significant improvement in delayed memory at 1 year that was not present at the 3 month follow-up. The subjective cognitive status measure also improved. No significant change was noted in the Mini-Mental Status Examination or in the speed of psychomotor performance.ConclusionCarotid artery stenting in patients with a unilateral carotid artery stenosis resulted in significant long term improvements in cognitive test scores, most notably delayed memory.