bluuebunny/crossref_metadata_2025_split huggingface dataset:
Step Test Scores Are Related to Measures of Activity and Participation in the First 6 Months After Stroke
Authors: Mercer Vicki Stemmons , Freburger Janet Kues , Chang Shuo-Hsiu , Purser Jama L. 
Published: August 2009

Background: The Step Test (ST) is a measure of dynamic standing balance and paretic–lower-extremity motor control in patients with stroke. Little is known about the extent to which impairments assessed by the ST relate to activity and participation during stroke recovery.Objective: The purpose of this study was to determine relationships between ST scores and measures of activity and participation during the first 6 months after stroke.Design: This was a prospective cohort study.Methods: Thirty-three individuals (18 men, 15 women) with a diagnosis of a single, unilateral stroke participated in the study. Participants were tested one time per month from 1 to 6 months poststroke. The ST was considered an impairment-level measure. Self-selected gait speed and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) Physical Function Index (PFI) were used to assess physical function. Three domains (mobility, basic and instrumental activities of daily living, participation) of the Stroke Impact Scale were used to assess self-reported disability. Regression analyses were conducted to examine the bivariate associations between ST scores and each physical function and disability measure at each time point (1–6 months).Results: The ST scores were positively associated with both physical function measures. The associations were stronger for self-selected gait speeds (R2=.60–.79) than for the PFI scores (R2=.32–.60). During the first 6 months after stroke, each additional step with the paretic lower extremity on the ST corresponded to a 0.07-m/s to 0.09-m/s increase in gait speed, and each additional step with the nonparetic lower extremity was associated with a 0.07-m/s to 0.08-m/s gait speed increase. The impairment-disability associations were weaker than the impairment-physical function associations.Limitations: Limitations of the study include a relatively small sample size and lack of examiner blinding with regard to participant characteristics.Conclusions: Impairments in balance and paretic–lower-extremity motor control, as measured by the ST, relate to physical function and disability during the first 6 months following stroke.
Management of direct carotid-cavernous sinus fistulas with the use of ethylene-vinyl alcohol (Onyx) only: preliminary results
Authors: Zenteno Marco , Santos-Franco Jorge , Rodríguez-Parra Vladimir , Balderrama Jorge , Aburto-Murrieta Yolanda , Vega-Montesinos Susana , Lee Ángel 
Published: August 2009

Object
So-called direct carotid-cavernous fistulas (CCFs) are commonly treated by detachable balloons or coils to occlude the shunt while sparing the carotid artery. Liquid embolic agents have been rarely used, and in particular, to the authors' knowledge, the use of Onyx as the sole agent has never been reported in an indexed publication.

Methods
The authors describe a case series of 5 patients with posttraumatic CCF in whom embolization with Onyx was prospectively used as the sole strategy of management.

Results
Complete occlusion was obtained at the end of the procedure in 4 cases, and the lesion in the remaining patient subsequently occluded at the 6-month follow-up evaluation.

Conclusions
As endovascular techniques for treatment of direct CCFs continue to evolve, this novel approach with Onyx as the sole embolic material seems promising in treating these lesions.
Monitoring intracranial pressure in patients with malignant middle cerebral artery infarction: is it useful?
Authors: Poca Maria Antonia , Benejam Bessy , Sahuquillo Juan , Riveiro Marilyn , Frascheri Laura , Merino Maria Angels , Delgado Pilar , Alvarez-Sabin Jose 
Published: August 2009

Object
Intracranial pressure (ICP) monitoring is increasingly used in the treatment of patients with malignant middle cerebral artery (MCA) infarction. However, neurological deterioration may exist independent from intracranial hypertension. This study aimed to present the findings of continuous ICP monitoring in a cohort of patients with malignant MCA infarction and to correlate these findings with clinical and radiological features.

Methods
The authors studied a prospective cohort of 25 patients with malignant MCA infarction consecutively admitted to the neurotrauma intensive care unit of the Vall d'Hebron University Hospital between March 2002 and September 2006. The patients were treated using a combined protocol of initial moderate hypothermia and hemicraniectomy. The latter was performed when patients showed a midline shift (MLS) ≥ 5 mm or ICP > 20 mm Hg. Six patients had an MLS ≥ 5 mm on the first CT scan and underwent surgery without prior ICP monitoring. This study focuses on the subgroup of 19 patients who underwent intraparenchymatous ICP monitoring before surgery.

Results
Intracranial pressure readings were evaluated and correlated with pupillary abnormalities, MLS, and ischemic tissue volume. In 12 of the 19 patients, ICP values were always ≤ 20 mm Hg, despite a mean (± SD) MLS of 6.7 ± 2 mm and a mean ischemic tissue volume of 241.3 ± 83 cm3. In 2 patients with anisocoria, ICP values were also normal.

Conclusions
In patients with a malignant MCA infarction, pupillary abnormalities and severe brainstem compression may be present despite normal ICP values. Therefore, continuous ICP monitoring cannot substitute for close clinical and radiological follow-up in the management of these patients.
Three-dimensional volume-rendering technique in the angiographic follow-up of intracranial aneurysms embolized with coils
Authors: Zhou Bing , Li Ming-Hua , Wang Wu , Xu Hao-Wen , Cheng Yong-De , Wang Jue 
Published: August 2009

Object
The authors conducted a study to evaluate the advantages of a 3D volume-rendering technique (VRT) in follow-up digital subtraction (DS) angiography of coil-embolized intracranial aneurysms.

Methods
One hundred nine patients with 121 intracranial aneurysms underwent endovascular coil embolization and at least 1 follow-up DS angiography session at the authors' institution. Two neuroradiologists independently evaluated the conventional 2D DS angiograms, rotational angiograms, and 3D VRT images obtained at the interventional procedures and DS angiography follow-up. If multiple follow-up sessions were performed, the final follow-up was mainly considered. The authors compared the 3 techniques for their ability to detect aneurysm remnants (including aneurysm neck and sac remnants) and parent artery stenosis based on the angiographic follow-up. The Kruskal-Wallis test was used for group comparisons, and the kappa test was used to measure interobserver agreement. Statistical analyses were performed using commercially available software.

Results
There was a high statistical significance among 2D DS angiography, rotational angiography, and 3D VRT results (X2 = 9.9613, p = 0.0069) when detecting an aneurysm remnant. Further comparisons disclosed a statistical significance between 3D VRT and rotational angiography (X2 = 4.9754, p = 0.0257); a high statistical significance between 3D VRT and 2D DS angiography (X2 = 8.9169, p = 0.0028); and no significant difference between rotational angiography and 2D DS angiography (X2 = 0.5648, p = 0.4523). There was no statistical significance among the 3 techniques when detecting parent artery stenosis (X2 = 2.5164, p = 0.2842). One case, in which parent artery stenosis was diagnosed by 2D DS angiography and rotational angiography, was excluded by 3D VRT following observations of multiple views. The kappa test showed good agreement between the 2 observers.

Conclusions
The 3D VRT is more sensitive in detecting aneurysm remnants than 2D DS angiography and rotational angiography and is helpful for identifying parent artery stenosis. The authors recommend this technique for the angiographic follow-up of patients with coil-embolized aneurysms.
Application of a flexible CO2 laser fiber for neurosurgery: laser-tissue interactions
Authors: Ryan Robert W. , Wolf Tamir , Spetzler Robert F. , Coons Stephen W. , Fink Yoel , Preul Mark C. 
Published: August 2009

Object
The CO2 laser has an excellent profile for use in neurosurgery. Its high absorption in water results in low thermal spread, sparing adjacent tissue. Use of this laser has been limited to line-of-sight applications because no solid fiber optic cables could transmit its wavelength. Flexible photonic bandgap fiber technology enables delivery of CO2 laser energy through a flexible fiber easily manipulated in a handheld device. The authors examined and compared the first use of this CO2 laser fiber to conventional methods for incising neural tissue.

Methods
Carbon dioxide laser energy was delivered in pulsed or continuous wave settings for different power settings, exposure times, and distances to cortical tissue of 6 anesthetized swine. Effects of CO2 energy on the tissue were compared with bipolar cautery using a standard pial incision technique, and with scalpel incisions without cautery. Tissue was processed for histological analysis (using H & E, silver staining, and glial fibrillary acidic protein immunohistochemistry) and scanning electron microscopy, and lesion measurements were made.

Results
Light microscopy and scanning electron microscopy revealed laser incisions of consistent shape, with central craters surrounded by limited zones of desiccated and edematous tissue. Increased laser power resulted in deeper but not significantly wider incisions. Bipolar cautery lesions showed desiccated and edematous zones but did not incise the pia, and width increased more than depth with higher power. Incisions made without using cautery produced hemorrhage but minimal adjacent tissue damage.

Conclusions
The photonic bandgap fiber CO2 laser produced reliable cortical incisions, adjustable over a range of settings, with minimal adjacent thermal tissue damage. Ease of application under the microscope suggests this laser system has reached true practicality for neurosurgery.
A method for placing Heschl gyrus depth electrodes
Authors: Reddy Chandan G. , Dahdaleh Nader S. , Albert Gregory , Chen Fangxiang , Hansen Daniel , Nourski Kirill , Kawasaki Hiroto , Oya Hiroyuki , Howard Matthew A. 
Published: August 2009

A wide range of devices is used to obtain intracranial electrocorticography recordings in patients with medically refractory epilepsy, including subdural strip and grid electrodes and depth electrodes. Penetrating depth electrodes are required to access some brain regions, and 1 target site that presents a particular technical challenge is the first transverse temporal gyrus, or Heschl gyrus (HG). The HG is located within the supratemporal plane and has an oblique orientation relative to the sagittal and coronal planes. Large and small branches of the middle cerebral artery abut the pial surface of the HG and must be avoided when planning the electrode trajectory.
Auditory cortex is located within the HG, and there are functional connections between this dorsal temporal lobe region and medial sites commonly implicated in the pathophysiology of temporal lobe epilepsy. At some surgical centers, depth electrodes are routinely placed within the supratemporal plane, and the HG, in patients who require intracranial electrocorticography monitoring for presumed temporal lobe epilepsy. Information from these recordings is reported to facilitate the identification of seizure patterns in patients with or without auditory auras.
To date, only one implantation method has been reported to be safe and effective for placing HG electrodes in a large series of patients undergoing epilepsy surgery. This well-established approach involves inserting the electrodes from a lateral trajectory while using stereoscopic stereotactic angiography to avoid vascular injury. In this report, the authors describe an alternative method for implantation. They use frameless stereotaxy and an oblique insertion trajectory that does not require angiography and allows for the simultaneous placement of subdural grid arrays. Results in 19 patients demonstrate the safety and efficacy of the method.
Magnetic resonance neurography for the evaluation of peripheral nerve, brachial plexus, and nerve root disorders
Authors: Du Rose , Auguste Kurtis I. , Chin Cynthia T. , Engstrom John W. , Weinstein Philip R. 
Published: August 2009

Object
Treatment of spinal and peripheral nerve lesions relies on localization of the pathology by the use of neurological examination, spinal MR imaging and electromyography (EMG)/nerve conduction studies (NCSs). Magnetic resonance neurography (MRN) is a novel imaging technique recently developed for direct imaging of spinal and peripheral nerves. In this study, the authors analyzed the role of MRN in the evaluation of spinal and peripheral nerve lesions.

Methods
Imaging studies, medical records, and EMG/NCS results were analyzed retrospectively in a consecutive series of 191 patients who underwent MRN for spinal and peripheral nerve disorders at the University of California, San Francisco between March 1999 and February 2005. Ninety-one (47.6%) of these patients also underwent EMG/NCS studies.

Results
In those who underwent both MRN and EMG/NCS, MRN provided the same or additional diagnostic information 32 and 45% of patients, respectively. Magnetic resonance neurograms were obtained at a median of 12 months after the onset of symptoms. The utility of MRN correlated with the interval between the onset of symptoms to MRN. Twelve patients underwent repeated MRN for serial evaluation. The decrease in abnormal signal detected on subsequent MRN correlated with time from onset of symptoms and the time interval between MRN, but not with resolution of symptoms. Twenty-one patients underwent MRN postoperatively to assess persistent, recurrent, or new symptoms; of these 3 (14.3%) required a subsequent surgery.

Conclusions
Magnetic resonance neurography is a valuable adjunct to conventional MR imaging and EMG/NCS in the evaluation and localization of nerve root, brachial plexus, and peripheral nerve lesions. The authors found that MRN is indicated in patients: 1) in whom EMG and traditional MR imaging are inconclusive; 2) who present with brachial plexopathy who have previously received radiation therapy to the brachial plexus region; 3) who present with brachial plexopathy and have systemic tumors; and 4) in patients under consideration for surgery for peripheral nerve lesions or after trauma. Magnetic resonance neurography is limited by the size of the nerve trunk imaged and the timing of the study.
Routine review of ascites fluid from patients with cirrhosis or hepatocellular carcinoma is a low-yield procedure: An observational study
Authors: Thrall Michael J. , Giampoli Ellen J. 
Published: August 2009

Background:
Patients with cirrhosis develop ascites for physiologic reasons that are unrelated to malignant progression. However, physicians performing paracentesis in these patients, often send fluid to the cytology laboratory, sometimes specifically looking for hepatocellular carcinoma (HCC). We have investigated the diagnostic yield of these specimens.

Materials and Methods:
A computerized pathology database search for all ascites fluid cases submitted to the cytology laboratory at a major liver transplant center between November 2004 and April 2008 was performed. Clinical history was obtained for each case. Patients with cirrhosis, with or without HCC, were included in the study. Cytologic diagnoses were compiled and follow-up information was obtained for cases with non-negative findings.

Results:
A total of 167 specimens from 133 patients ranging from 29 to 85 years of age (mean 56 years) were submitted over the said time period. The causes of cirrhosis included: alcohol - 44; Hepatitis C - 30; Hepatitis B - 6; non-alcoholic steatohepatitis - 7; cryptogenic - 18; other single causes - 6; and multifactorial (alcohol and hepatitis viruses) - 22. Hepatocellular carcinoma (HCC) was present or strongly suspected in 17 patients and had been previously resected in two others. The status of fifteen patients was post liver transplant, with recurrent liver failure. Human immunodeficiency virus was present in seven patients and eight patients had a history of non hepatic malignancies. Among the specimens, 162 were negative, two had atypical lymphocytes worked up for lymphoma, and three had atypical epithelioid cells; none was positive for HCC. Immunohistochemistry demonstrated a mesothelial origin for the atypical epithelioid cells in two cases; in the third case, the patient died shortly after the specimen was collected, with no radiological evidence of HCC.

Conclusion:
Ascites fluid cytology specimens in patients with cirrhosis, even those known or suspected to have HCC, are almost always negative. Atypical cells seen in such specimens should be treated with skepticism since the likelihood that they represent peritoneal spread of HCC is low..
Fabrication of Microbeads with a Controllable Hollow Interior and Porous Wall Using a Capillary Fluidic Device
Authors: Choi Sung‐Wook , Zhang Yu , Xia Younan 
Published: August 2009

AbstractPoly(D,L‐lactide‐co‐glycolide) (PLGA) microbeads with a hollow interior and porous wall are prepared using a simple fluidic device fabricated with PVC tubes, glass capillaries, and a needle. Using the fluidic device with three flow channels, uniform water‐in‐oil‐in‐water (W‐O‐W) emulsions with a single inner water droplet can be achieved with controllable dimensions by varying the flow rate of each phase. The resultant W‐O‐W emulsions evolve into PLGA microbeads with a hollow interior and porous wall after the organic solvent in the middle oil phase evaporates. Two approaches are employed for developing a porous structure in the wall: emulsion templating and fast solvent evaporation. For emulsion templating, a homogenized, water‐in‐oil (W/O) emulsion is introduced as the middle phase instead of the pure oil phase. Low‐molecular‐weight fluorescein isothiocyanate (FITC) and high‐molecular‐weight fluorescein isothiocyanate–dextran conjugate (FITC–DEX) is added to the inner water phase to elucidate both the pore size and their interconnectivity in the wall of the microbeads. From optical fluorescence microscopy and scanning electron microscopy images, it is confirmed that the emulsion‐templated microbeads (W‐W/O‐W) have larger and better interconnected pores than the W‐O‐W microbeads. These microstructured microbeads can potentially be employed for cell encapsulation and tissue engineering, as well as protection of active agents.
Mortality of older construction and craft workers employed at department of energy (DOE) nuclear sites
Authors: Dement John M. , Ringen Knut , Welch Laura S. , Bingham Eula , Quinn Patricia 
Published: August 2009

AbstractBackgroundThe U.S. Department of Energy (DOE) established medical screening programs at the Hanford Nuclear Reservation, Oak Ridge Reservation, the Savannah River Site, and the Amchitka site starting in 1996. Workers participating in these programs have been followed to determine their vital status and mortality experience through December 31, 2004.MethodsA cohort of 8,976 former construction workers from Hanford, Savannah River, Oak Ridge, and Amchitka was followed using the National Death Index through December 31, 2004, to ascertain vital status and causes of death. Cause‐specific standardized mortality ratios (SMRs) were calculated based on US death rates.ResultsSix hundred and seventy‐four deaths occurred in this cohort and overall mortality was slightly less than expected (SMR = 0.93, 95% CI = 0.86–1.01), indicating a “healthy worker effect.” However, significantly excess mortality was observed for all cancers (SMR = 1.28, 95% CI = 1.13–1.45), lung cancer (SMR = 1.54, 95% CI = 1.24–1.87), mesothelioma (SMR = 5.93, 95% CI = 2.56–11.68), and asbestosis (SMR = 33.89, 95% CI = 18.03–57.95). Non‐Hodgkin's lymphoma was in excess at Oak Ridge and multiple myeloma was in excess at Hanford. Chronic obstructive pulmonary disease (COPD) was significantly elevated among workers at the Savannah River Site (SMR = 1.92, 95% CI = 1.02–3.29).ConclusionsDOE construction workers at these four sites were found to have significantly excess risk for combined cancer sites included in the Department of Labor' Energy Employees Occupational Illness Compensation Program (EEOCIPA). Asbestos‐related cancers were significantly elevated. Am. J. Ind. Med. 52:671–682, 2009. © 2009 Wiley‐Liss, Inc.
Self‐presentation and the value of information in Q&A websites
Authors: Raban Daphne Ruth 
Published: August 2009

AbstractPrior research has shown that social interaction is important for continuation of question‐and‐answer (Q&A) activity online and that it also leads to monetary rewards. The present research focuses on the link between social interaction and the value of information. Expressions of self‐presentation in the interaction between askers and answerers online are studied as antecedents for answer feedback which represents the value of the answer to the asker. This relationship is examined in a Q&A site, specifically, in Google Answers (GA). The results of content analysis performed on sets of questions and answers show that both explicit and implicit social cues are used by the site's participants; however, only implicit expressions of self‐presentation are related to the provision of social and monetary feedback, ratings, and tips. This finding highlights the importance of implicit cues in textual communication and lends support to the notion of social capital where both monetary and social forms of feedback are the result of interaction online.
Application of immobilized bovine enterokinase in repetitive fusion protein cleavage for the production of mucin 1
Authors: Kubitzki Tina , Minör Daniel , Mackfeld Ursula , Oldiges Marco , Noll Thomas , Lütz Stephan 
Published: August 2009

AbstractBovine enterokinase is a serine protease that catalyzes the hydrolysis of peptide bonds and plays a key role in mammalian metabolism. Because of its high specificity towards the amino acid sequence (Asp)4‐Lys, enterokinase is a potential tool for the cleavage of fusion proteins, which are gaining more importance in biopharmaceutical production. A candidate for adaptive cancer immunotherapy is mucin 1, which is produced recombinantly as a fusion protein in CHO cells. Here, we present the first repetitive application of immobilized enterokinase for the cleavage of the mucin fusion protein. The immobilization enables a facile biocatalytic process due to simplified separation of the biocatalyst and the target protein. Immobilized enterokinase was applied in a maximum of 18 repetitive reactions. The enzyme utilization (total turnover number) was increased significantly 419‐fold compared to unbound enzyme by both immobilization and optimization of process conditions. Slight enzyme inactivation throughout the reaction cycles was observed, but was compensated by adjusting the process time accordingly. Thus, complete fusion protein cleavage was achieved. Furthermore, we obtained isolated mucin 1 with a purity of more than 90% by applying a simple and efficient purification process. The presented results demonstrate enterokinase to be an attractive tool for fusion protein cleavage.