bluuebunny/crossref_metadata_2025_split huggingface dataset:
Faint Stars in a Faint Galaxy. II. The Low-mass Stellar Initial Mass Function of the Boötes I Ultrafaint Dwarf Spheroidal Galaxy
Authors: Filion Carrie , Platais Imants , Wyse Rosemary F. G. , Kozhurina-Platais Vera 
Published: November 2022

Abstract
This paper presents improved constraints on the low-mass stellar initial mass function (IMF) of the Boötes I (Boo I) ultrafaint dwarf galaxy, based on our analysis of recent deep imaging from the Hubble Space Telescope. The identification of candidate stellar members of Boo I in the photometric catalog produced from these data was achieved using a Bayesian approach, informed by complementary archival imaging data for the Hubble Ultra Deep Field. Additionally, the existence of earlier-epoch data for the fields in Boo I allowed us to derive proper motions for a subset of the sources and thus identify and remove likely Milky Way stars. We were also able to determine the absolute proper motion of Boo I, and our result is in agreement with, but completely independent of, the measurement(s) by Gaia. The best-fitting parameter values of three different forms of the low-mass IMF were then obtained through forward modeling of the color–magnitude data for likely Boo I member stars within an approximate Bayesian computation Markov Chain Monte Carlo algorithm. The best-fitting single power-law IMF slope is

α
=
−

1.95

−
0.28

+
0.32

, while the best-fitting broken power-law slopes are

α

1

=
−

1.67

−
0.57

+
0.48

and

α

2

=
−

2.57

−
1.04

+
0.93

. The best-fitting lognormal characteristic mass and width parameters are

M

c

=

0.17

−
0.11

+
0.05



⊙

and

σ
=

0.49

−
0.20

+
0.13

. These broken power-law and lognormal IMF parameters for Boo I are consistent with published results for the stars within the Milky Way, and thus it is plausible that Boötes I and the Milky Way are populated by the same stellar IMF.
Echocardiographic Prediction of Successful Weaning From Venoarterial Extracorporeal Membrane Oxygenation
Authors: Alonso-Fernandez-Gatta Marta , Merchan-Gomez Soraya , Gonzalez-Cebrian Miryam , Diego-Nieto Alejandro , Gonzalez-Martin Javier , Toranzo-Nieto Ines , Barrio Alfredo , Martin-Herrero Francisco , Sanchez Pedro L. 
Published: November 2022

Background
Weaning from venoarterial extracorporeal membrane oxygenation (VA-ECMO) support fails in 30% to 70% of patients.

Objective
To explore the utility of echocardiographic parameters in predicting successful disconnection from VA-ECMO.

Methods
Patients receiving VA-ECMO in a referral hospital were included. The relationships between echocardiographic parameters during the weaning trial and weaning success (survival &gt; 24 hours after VA-ECMO explant and no death from cardiogenic shock, heart failure, or cardiac arrest during the hospital stay) and survival were evaluated.

Results
Of 85 patients included, 61% had successful weaning. Parameters significantly related to weaning success were higher left ventricular ejection fraction (LVEF; 40% in patients with weaning success vs 30% in patients with weaning failure, P = .01), left ventricular outflow tract velocity time integral (15 cm vs 11 cm, P = .01), aortic valve opening in every cycle (98% vs 91% of patients, P = .01), and normal qualitative right ventricular function (60% vs 42% of patients, P = .02). The LVEF remained as an independent predictor of weaning success (hazard ratio, 0.938; 95% CI, 0.888-0.991; P = .02). An LVEF &gt;33.4% was the optimal cutoff value to discriminate patients with successful weaning (area under the curve, 0.808; sensitivity, 93%; specificity, 72%) and was related to higher survival at discharge (60% vs 20%, P &lt; .001).

Conclusion
Among weaning trial echocardiographic parameters, LVEF was the only independent predictor of successful VA-ECMO weaning. An LVEF &gt;33.4% was the optimal cutoff value to discriminate patients with successful weaning and was related to final survival.
Use of Fluoxetine to Augment the Inter-Ictal Hypercapnic Ventilatory Response in Patients with Epilepsy
Authors: Sainju Rup K , Dragon Deidre N , Winnike Harold B , Eyck Patrick Ten , Granner Mark A , Gehlbach Brian K , Richerson George B 
Published: November 2022

Background:
Severe peri-ictal respiratory dysfunction is a potential biomarker for high SUDEP risk and correlates with an attenuated hypercapnic ventilatory response (HCVR). Prior studies suggest a potential role for selective serotonergic reuptake inhibitors in modifying the HCVR, but this approach has not been studied in the epilepsy population.

Objectives:
To assess the feasibility of using fluoxetine to augment HCVR in epilepsy patients.

Methods and Material:
An inter-ictal HCVR was measured using a CO2 rebreathing technique in patients with epilepsy aged 18–75 years. Eligible participants were randomized to fluoxetine or placebo, and the HCVR was repeated at the end of week 4. Primary outcomes were recruitment and retention rate.

Results:
Of the 30 subjects enrolled, 22 were randomized (mean: 3.8 subjects/3 months), with a retention rate of 100% in fluoxetine and 95% in placebo.

Conclusions:
Our results demonstrate feasibility for a larger definitive future study to assess the efficacy of fluoxetine in augmenting HCVR.
A Rare Triad of Lateral Rectus Palsy, Sylvain Fissure Bleed, and Bilateral SDH Shrouding a Benign Pathology
Authors: Meena Rajesh Kumar , Doddamani Ramesh S , Kanasani Suresh , Sawarkar Dattaraj P , Singh Pankaj Kumar , Chandra P Sarat 
Published: November 2022

Background:Arachnoid cysts are benign extra-cerebral congenital lesions that are thought to arise from the splitting of the arachnoid membrane. Although most arachnoid cysts remain static with advancing age, occasionally they can become symptomatic due to cyst enlargement or hemorrhage. Hemorrhage into the arachnoid cysts (intra-cystic hemorrhage) with or without associated subdural hematoma is of rare occurrence.Case Discussion:A 23-year-old male presented with a history of sudden onset severe headache while sleeping. The patient also noticed double vision, especially when looking towards the left side. Non-contrast computed tomography (NCCT) scan of the head showed left temporal pole hematoma with left Sylvian fissure bleed and bilateral fronto-temporoparietal (FTP) subacute SDH.Conclusion:Every patient with incidentally detected AC, especially in the middle cranial fossa, should be counseled regarding the risk of possible complications including hemorrhage and regular follow-up.
Basilar Artery Thrombectomy Between Evidence-Based Medicine and the Real-World Practice
Authors: El Malky Islam , Hendi Ali Mo , Abdelkhalek Hazem Mo 
Published: November 2022

Background and Aim:Basilar artery occlusion (BAO) is known for its catastrophic outcomes, whether death or disability, in approximately 70% of patients. Mechanical thrombectomy (MT) has been approved as an intervention in large vessel occlusion of anterior circulation, based on multiple randomized controlled trials (RCTs) and meta-analyses. Even though two RCTs appeared recently, there is still uncertainty about the effect of MT in BAO. Our study aims to report the outcome of MT in BAO and the variables affecting good outcomes and mortality rate.Materials and Methods:We retrospectively collected the clinical and radiological data of 30 BAO patients treated in our center by MT between July 2016 and July 2021. A favorable clinical outcome was considered if mRS was ≤2. A favorable radiological result was considered if modified Thrombolysis in Cerebral Infarction (mTICI) was ≥2b at the end of the intervention. Multiple variables were tested for their effects on favorable clinical outcomes and mortality.Results:The mean age of the 30 patients was 61.23 ± 16.81 years; 20/30 (66.7%) were male. A favorable functional outcome was achieved in 40.7%. Successful revascularization was achieved in 26 patients (86.7%). Mortality at 90 days was observed in 11 patients (36.7%). The presenting National Institute of Health and Stroke Scale (NIHSS) was the only predictor of mortality, and the optimal cut-off value for death was 15 with area under the curve (AUC) = 0.758 (sensitivity 91% and specificity 59%) andPvalue = 0.02.Conclusion:Thrombectomy is an effective procedure in BAO which has naturally a bad outcome. The presenting NIHSS might be the only predictor of mortality in our study.
Complexities in Genetic Counseling and Testing of Huntington's Disease
Authors: Ratna Nikhil , Pasupulati Swathi Lakshmi , Nadella Ravi K. , Purushottam Meera , Jain Sanjeev 
Published: November 2022

Background:Huntington's Disease (HD) is an autosomal dominant, progressive neuropsychiatric illness caused by CAG repeat expansion. The high penetrance of the mutation and limited treatment options make it challenging for patients and caretakers. Proper counseling enables families to cope better and make informed life choices.Objective:To explore some complex issues in genetic counseling and testing (GCAT) in HD.Materials and Methods:Vignettes of patients who underwent genetic testing along with pre and post-test counseling at our GCAT clinic.Results:Case 1: Diagnosis of juvenile HD meant that the healthy parent was an obligate carrier of the mutation. Case 2: Consanguinity resulted in a dense prevalence of HD and >50% risk for the progeny. Case 3: Predictive testing in youth with healthy parents but affected uncles and aunts revealed a HD expansion.Conclusions:HD can present with complex inheritance patterns and proper counseling is necessary for better outcomes.
COVID-19 and Stroke Trends in A Tertiary Care Center from South India -Our Monsoon Experience
Authors: Ramachandran Dileep , George Githin Benoy , Panicker Praveen , Aravind R , Suresh MK , Iype Thomas 
Published: November 2022

Introduction:The unprecedented challenges during the COVID pandemic and the subsequent lockdown had resulted in a delay in treatment metrics for acute stroke. There is a rising concern that COVID-19 co-infection can adversely affect stroke outcome. We aim to investigate the impact of COVID-19 in the management of stroke patients. We also compared the differences in stroke manifestations, etiological pattern, treatment course, and outcome of acute stroke patients in COVID-19 confirmed cases.Methodology:A single-center retrospective study was done at the Stroke Unit, Government Medical College, Thiruvananthapuram. Consecutive patients of acute stroke confirmed by imaging, presenting within 24 hours of the onset of symptoms in May to July 2020 and May to July 2019, were included. The primary data variables included baseline demographics, risk factors, admission NIHSS, stroke timings, thrombolysis rate, TOAST etiology, mRS at discharge, and in-hospital mortality.Results:Strokes with higher NIHSS, arrival blood sugar and blood pressure, and delays in door-to-CT and door-to-needle time were more during the pandemic. Intravenous thrombolysis was less and mortality was higher in COVID-19 strokes during the pandemic. COVID-19-positive stroke patients had more hemorrhagic strokes, more severe strokes with low CT ASPECTS, more hemorrhagic transformation, high in-hospital mortality, and poor functional outcome at discharge and 3 months.Conclusion:Our study was a hypothesis-generating study with a limited number of patients. This study has reconfirmed the higher severity of the stroke, with a higher mRS score and mortality during the pandemic, especially among COVID-19-positive stroke patients.
Atypical Optic Neuritis
Authors: Ojha Pawan T , Barvalia Prachi P , Singh Rakesh , Soni Girish , Kadam Nikhil , Nagendra Shashank , Aglave Vikram , Jagiasi Kamlesh 
Published: November 2022

Background:
Many potential causes of optic nerve inflammation exist, including typical and atypical causes, which require different management strategies.

Objective:
The objective of this study is to identify red flags that help differentiate typical from atypical optic neuritis (ON).

Materials and Methods:
This prospective study included 66 patients (100 eyes) with immune-mediated ON from January 2016 to June 2019, carefully excluding the nonimmune causes. The clinico-radiological features, investigations, therapy, and outcome were analyzed.

Results:
We evaluated 33 cases each of typical and atypical ON. The typical group included 29 idiopathic ON and four associated with multiple sclerosis. Atypical ON included 19 neuromyelitis optica (NMO), seven MOG-associated ON (MOG-ON), and others due to Sjogren's syndrome, granulomatous polyangiitis, sarcoidosis, and IgG4 disease. Atypical ON occurred significantly and more frequently with extremes of ages (<10 or >70 years), bilateral simultaneous or severe vision loss with early disc pallor, multiple attacks, symptoms/neuro-imaging indicating non-MS disease e.g., long segment ON/myelitis, large confluent lesions, the involvement of optic tract, chiasma, area postrema or diencephalon, and (pachy) meningitis. Systemic involvement and poor outcomes despite steroids and second-line immunosuppression were observed more often in the atypical ON.

Conclusions:
The red flags indicating atypical ON are onset at extremes of age, multiple attacks, bilateral simultaneous or severe to very severe vision loss, early disc pallor, neurological symptoms, or imaging abnormalities suggesting non-MS disease, systemic involvement, and poor steroid responsiveness. The awareness might help the clinician promptly identify and escalate therapy to ensure a better outcome.
Cardiovascular Autonomic Assessment in Guillain–Barré Syndrome
Authors: Tan Cheng-Yin , Shahrizaila Nortina , Tan Hui-Ting , Goh Khean-Jin , Tan Maw-Pin 
Published: November 2022

Background:
Severe dysautonomia is typically seen during acute phase of Guillain–Barré syndrome (GBS).

Objective:
To investigate the relationship of cardiovascular autonomic dysfunction with motor recovery in GBS.

Materials and Methods:
Consecutive GBS patients presented to our hospital were recruited. Clinical assessment was evaluated with the Medical Research Council (MRC) sum score and GBS disability score (GDS). All patients had series of autonomic testing on admission and after treatment at 6 and 24 weeks. Both computation-dependent tests (heart rate variability [HRV] and baroreflex sensitivity [BRS]) and autonomic maneuvers were performed. Age- and gender-matched healthy controls (HC) were recruited. The data obtained at admission, 6 weeks and 24 weeks were compared within groups for statistical difference.

Results:
Six patients (4 men; mean age 39.5 ± 14.3 years) were recruited over one year. Five had GBS and one Miller Fisher syndrome. The mean MRC sum score and GDS on admission were 52.3 ± 4.3 and 3.5 ± 0.8 respectively. During admission, time-domain average RR interval (AVNN) and BRS were significantly poorer among cases compared to HC. Active standing 30:15 ratio and cold pressor test at admission were also significantly abnormal when compared with HC. All the autonomic parameters had normalized by 6 weeks and these were significant for the high frequency-HRV, BRS, and active standing 30:15 ratio. For MRC and GDS, there were significant improvements in the scoring over a period of 24 weeks.

Conclusions:
Dysautonomia in GBS improved gradually and in keeping with motor and disability recovery.
Effect of Age, Stage, and Type of Surgical Revascularization on Clinical and Angiographic Outcome in Moyamoya Disease – Experience from a Case Series of 175 Revascularization Procedures
Authors: Sreenivasan Sanjeev A , Suri Ashish , Raheja Amol , Phuyal Subhash , Singh Manmohan , Mishra Shashwat , Tandon Vivek , Devarajan1 Leve J , Kalaivani M , Poodipedi Sarat C , Kale Shashank S 
Published: November 2022

Background:There is dearth of literature on impact of age – pediatric versus adult, Suzuki staging – early versus late, and revascularization type – indirect versus direct on clinical and angiographic outcome in moyamoya disease (MMD). Hence, we intend to comprehensively evaluate factors influencing outcome in MMD following surgical revascularization.Methods:MMD patients operated at our institute from January 2011 to August 2018 were followed for an average 24 months. Primary outcomes were modified Rankin score (mRS) and stroke risk reduction. Secondary outcome was angiographic outcome score (AOS).Results:A total of 133 patients including 37.6% adults (>18 years;n= 50) underwent 175 revascularizations – 89 direct (DR) and 86 indirect (IR) subgroups. Mean mRS scores improved in pediatric DR (P< 0.001), IR (P< 0.001), adult IR (P= 0.10), and DR (P= 0.25) subgroups. Recurrent stroke rate was similar in pediatric-DR (2.7%) and IR (7.6%,P= 0.61), and adult-DR (0%) and IR (4.1%) subgroups (P= 1.00). AOS scores improved in pediatric DR (P= 0.002) and IR (P= 0.01), and adult-DR (P= 0.02) and IR (P= 0.06) subgroups. Late-stage MMD (Suzuki IV–VI) showed better improvement in mRS scores than early-stage-Suzuki (I–III;P< 0.001). Recurrent stroke rates were similar (P= 0.26) and AOS scores improved significantly in early- and late-stage MMD (P< 0.001).Conclusions:In pediatrics, clinical and angiographic outcome significantly improved after revascularization procedure, and in adults, angiographic improvement was more evident than clinical recovery. Late-stage Suzuki MMD patients demonstrated significantly better clinical improvement than early stage. The angiographic improvement was equivalent to early stage, irrespective of age and type of revascularization.
Serum Trace Elements in Children with Well-Controlled and Drug Refractory Epilepsy Compared to Controls
Authors: Chakrabarty Biswaroop , Dogra Ankush Singh , Toteja G S , Pandey R M , Paul Vinod K , Gulati Sheffali 
Published: November 2022

Background:Trace elements have been implicated in pathogenesis of epilepsy. Studies till date have shown altered levels of serum trace elements in children with epilepsy.Objective:The objective of the current was to estimate serum levels of trace elements in children with well-controlled and drug refractory epilepsy and compare it with controls.Methodology:In a tertiary care teaching hospital of North India, serum selenium, copper, zinc, and iron were estimated in well-controlled and drug refractory epileptic children aged 2–12 years and compared with age and gender matched controls.Results:A total of 106 children with epilepsy (55 drug refractory and 51 well controlled) and 52 age and gender matched controls were included in the study. Serum selenium and copper were significantly decreased in cases compared to controls. After classifying epilepsy into well-controlled and drug refractory cases, only in the latter the significant difference for serum selenium and copper levels remained compared to controls. Additionally, in the drug refractory cases, serum iron levels were significantly reduced compared to controls.Conclusions:Serum trace elements are altered in children with epilepsy (more so in the drug refractory group) compared to controls. Monitoring of serum trace elements in children with epilepsy should be considered. Up to one-third of epilepsy is drug refractory of which only another third are amenable to surgery. It is worth investigating the therapeutic potential of altered micronutrient status in these patients.
Nicardipine versus Labetalol for Hypertension during Acute Stroke
Authors: Hao Fang , Yin Suna , Tang Lina , Zhang Xueguang , Zhang Shubao 
Published: November 2022

Background and Objective:Current recommendations prescribe either nicardipine or labetalol as the first-line treatment for acute hypertension due to ease of use, availability, and low price. However, it is unclear if these drugs have different effectiveness and safety profiles. This systematic review and meta-analysis aimed to compare the efficacy and safety of labetalol and nicardipine in patients with acute stroke.Materials and Methods:MEDLINE via PubMed, Scopus, Embase, and Google Scholar databases were electronically searched for the eligible publications from inception until March 2022. All full-text journal papers in English which compared the efficacy of nicardipine with that of labetalol on lowering blood pressure (BP; or treating hypertension) in all subtypes of acute stroke were included. The Cochrane Collaboration tool was used to assess the risk of bias. Data were analyzed using specific statistical methods.Results:Following the abstract and full-text screening, this meta-analysis included five retrospective cohorts and one prospective pseudorandomized cohort. Nicardipine's effect on time at goal BP was significantly superior to that of labetalol in patients with acute stroke (0.275 standardized mean difference [SMD], 95% confidence interval [CI]: 0.112–0.438,P= 0.001). The incidence of adverse events was significantly higher in the nicardipine group than that in the labetalol group. The pooled odds ratio (OR) was 1.509 (95% CI: 1.077–2.113,I2= 0.00%,P= 0.757). The quality of included studies was found to be low.Conclusion:More prospective, comparative trials are needed to investigate the efficacy of BP management as well as clinical outcomes in acute stroke patients receiving continuous labetalol and nicardipine infusions.
A Practice Pilot Survey on the Current Use of Corticosteroid Therapy in Brain Tumor Patients
Authors: Panda Pankaj K , Gupta Tejpal , Jalali Rakesh 
Published: November 2022

Background:
This pilot survey aims to provide an insight into the variations of corticosteroid prescription among health care professionals across the Indian subcontinent and serve as a prerequisite for the future development of corticosteroid therapy guidelines in brain tumor patients.

Materials and Methods:
Participants of this anonymized online questionnaire-based survey included health care professionals involved in treating brain tumor patients. Unique links were electronically mailed to health care professionals from a database populated from professional associations. Descriptive statistical analysis, Chi-square test, and/or exact test were used for data analysis.

Results:
Seventy-three percent of the respondents were radiation oncologists followed by neurosurgeons (23%), medical oncologists (2%), and other specialties (2%). Raised intracranial pressure (90%) was the commonest indication for prescribing corticosteroids. Fifty percent of neurosurgeons preferred corticosteroids to be given routinely for all patients undergoing surgery for brain tumors while 64% of the radiation oncologists would prescribe based on imaging findings and/or on appearance of neurologic symptoms. Most of the respondents (90%) used a flat dosage pattern for determining the starting dose of corticosteroids. Emerging data about the long-term use of corticosteroids having a negative impact on the survival of brain tumor patients were not known by 52% of the respondents. The majority of the practitioners (94%) agreed regarding the formulation of evidence-based guidelines for prescribing corticosteroids in brain tumor patients.

Conclusion:
In view of the wide variations of corticosteroid therapy practices among health care professionals across various parts of the world, our pilot survey provides significant information which can act as a suitable benchmark to form uniform practice guidelines.