bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of rituximab regime on time to relapse in aquaporin-4 antibody positive neuromyelitis spectrum disorder
Authors: Nasir Moneeb , Hone Luke , Palace Jacqueline , Tallantyre Emma , Kelly Patricia , Isabel Leite M , Robertson Neil , Bestwick Jonathan , Huda Saif , Dobson Ruth 
Published: August 2022

BackgroundAquaporin-4 (AQP4) antibody associated neuromyelitis optica spectrum disorder (NMOSD) requires long-term immunomodulation. In refractory cases rituximab can be used, however the optimal regime is not established.MethodsWe retrospectively examined different rituximab regimes in AQP4-NMOSD. Standard mono- therapy (SM; 6 monthly infusions), SM plus oral steroids (SM+S), extended interval dosing (EID; with retreat- ment at CD19 >1%) and EID with oral steroids (EID+S) were compared. The primary outcome was time to first clinical relapse. Potential confounders including age, gender, number of previous relapses, and onset phenotype were included.Results77 patients were included: 67 females, mean age 34.6, median DSS at rituximab initiation 5.0. 40 were on SM+S, 19 on SM, 8 on EID, and 10 on EID+S, with mean follow-up 38.5 months. 25/77 patients relapsed on rituximab. Median time to first relapse was 39 months (SM+S), 46 months (SM), 54 months (EID) and 42 months (EID+S). Adjusted Cox proportional hazard model revealed no significant difference between rituximab regimes (SM+S as reference; hazard ratio for SM 1.39, 95%CI 0.49–4.1, p=0.55; hazard ratio for EID 0.70, 95%CI 0.15–3.3, p=0.65; hazard ratio for EID+S 1.63, 95%CI 0.48–5.5, p=0.43). 9 significant infections were recorded, 3 in the SM group and 6 in SM+S.ConclusionsThis provides initial evidence that EID could be used for long term treatment of NMOSD. This may improve patient experience and consolidate use of hospital resources.
The Scottish Epilepsy Deaths Study Score (SEDS Score): a risk prediction model for epilepsy-related deaths
Authors: Mbizvo Gashirai , Schnier Christian , Simpson Colin , Chin Richard , Duncan Susan 
Published: August 2022

PurposeDevelop a risk prediction model for epilepsy-related death.MethodsIn this age/sex-matched case-control study, we compared adults (aged ≥16 years) suffering epilepsy-related death between 2009-2016 to living adults with epilepsy in Scotland. Cases were captured from national mortality records, and controls from a research database or epilepsy clinics. Medical record data were used in univariable and multivariable conditional logistic regression to develop a risk predic- tion model consisting of four variables chosen a priori. A sum of the factors present was taken to create a risk index – the SEDS Score. Odds ratios (OR) with 95% CIs were estimated.Results224 cases and 224 controls were compared (mean age 48 years). Univariables predicting epi- lepsy-related death were recent epilepsy-related A&E attendance (OR 5.1, CI 3.2–8.3), living in deprived areas (OR 2.5, CI 1.6–4.0), developmental epilepsy (OR 3.1, CI 1.7–5.7), alcohol abuse (OR 4.4, CI 2.2–9.2), absent recent neurology review (OR 3.8, CI 2.4–6.1), generalised epilepsy (OR 1.9, CI 1.2–3.0), and mental health problems (OR 1.6, CI 1.0–2.6). SEDS Score model variables consisted of the first three listed above, alongside the number of comorbidities (adjusting variable). Compared to having a SEDS Score of 0, those with a SEDS Score of 1, 2, and 3, had 3.6x (CI 1.9–6.8), 17.2x (CI 7.4–39.6), and 19.8x (CI 5.1–76.6) increased odds of death, respectively.ConclusionSEDS Scoring may help predict epilepsy-related death and requires external validation.
003 A case of SARS-CoV-2 Omicron variant associated acute encephalomyelitis
Authors: Dsouza Michelle , Lichtblau Nicole , Siddiqui Sarah , Harikrishnan Sreedharan , Abukhayzaran Nidal , Moses Samuel , Lauckaite Kristina 
Published: August 2022

With the ongoing pandemic of SARS-CoV-2 many neurological complications in relation to COVID-19 infection as well as immune-mediated and vaccine-associated phenomena have been described. To our knowledge, there has been no publication of a case of SARS-CoV-2 Omicron variant associated acute encephalomyelitis.We present a case of a 73-year-old woman with no relevant background history who is otherwise fit and well and fully vaccinated. She suffered from mild COVID symptoms and had a positive PCR test with presumptive Omicron variant on day 2. Five days into her respiratory illness she developed in quick suc- cession sensory disturbances of hands and feet, bilateral asymmetric flaccid leg weakness, and mild arm weakness. She had absent deep tendon reflexes in the legs and diminished deep tendon reflexes in the right arm. MRI of brain and spine showed signal changes in the brainstem, cervical and low thoracic cord in keeping with acute encephalomyelitis. Her CSF showed an inflammatory picture with raised protein of 1.27g/L and no cells. At the time of abstract submission, the patient received treatment with five days of intravenous steroids followed by ongoing plasma exchange and no comment on treatment response can be made at this stage.
005 A case of xanthomatous hypophysitis presenting as recurrent pituitary adenoma
Authors: Nazeer Kabir Khan , Jacob Saiju 
Published: August 2022

Xanthomatous hypophysitis is a rare inflammatory disorder of the pituitary gland which can present as a recurrent pituitary adenoma.We present a case of 58 year old lady initially presented over two decades ago with symptoms of pan- hypopituitarism with extreme lethargy. She has a background history of bacterial meningitis aged 30. MRI brain for the hypopituitarism showed a pituitary adenoma. As she had deterioration in the visual acuity a resection surgery of the presumed pituitary adenoma was done which improved her vision. Histopathology, however did not show features of adenoma but showed cellular infiltrates representing macrophages, admixed with small amount of plasma cells and foamy histocytes, a few B-cells and small number of IgG4 cells. The IgG4-cells were insufficient to make a diagnosis of IgG4 disease.Over the next year, her vision deteriorated requiring a re-do pituitary debridement again showing foamy macrophages and necrosis with a positive CD68 immunohistochemistry this raised a possibility of xan- thomatous hypophysitis or necrotising hypophysitis.She had further visual deterioration over the next 6 months for which she was given a course of IVMP which improved her vision significantly without a need for surgery. A follow up MRI with contrast showed reduction in the size of the lesion with no relapse.
008 Is primary new daily persistent headache de novo chronic migraine and chronic tension-type headache?
Authors: Cheema Sanjay , Stubberud Anker , Rantell Khadija , Nachev Parashkev , Tronvik Erling , Matharu Manjit 
Published: August 2022

ObjectiveTo compare the clinical characteristics and treatment responses of primary new daily persis- tent headache (NDPH) to transformed chronic daily headache (T-CDH, encompassing chronic migraine and chronic tension-type headache).MethodsAnalysis of prospectively collected clinical data in consecutive patients seen in a headache clinic between 2007 and 2019.ResultsInclusion criteria were met by 366 patients with NDPH and 696 with T-CDH. There was a lower female preponderance in NDPH than T-CDH (62.6% vs. 73.3%, p <0.001).Nausea, vomiting, photophobia, phonophobia, motion sensitivity, vertigo, and cranial autonomic symptoms were all less common in NDPH than T-CDH (all p<0.001). Most T-CDH patients (85%) met ICHD-3 criteria for chronic migraine, whereas fewer NDPH patients did (64%).Acute treatments were less effective in NDPH, and medication overuse was less common (16% vs. 42%, p<0.001). Response to most classes of oral preventive treatments was poor. The most effective treatment in NDPH was doselupin in 45.7% patients (95% CI 34.8-56.5%). OnabotulinumtoxinA was less likely to be effective in NDPH than T-CDH (34% vs. 49%, p=0.003).ConclusionsWhilst there is overlap in the phenotype and response to treatment of NDPH and T-CDH; NDPH appears to be less symptomatically diverse, and less responsive to treatment.
052 SKYLINE study design efficacy and safety of gantenerumab in participants at-risk for Alzheimer’s disease
Authors: Bullain Szofia , Delmar Paul , Sperling Reisa , Reiman Eric M , Aisen Paul , Wojtowicz Jakub , Bittner Tobias , Ashford Elizabeth , Doody Rachelle S , Ostrowitzki Susanne 
Published: August 2022

The anti-amyloid beta (Aβ) monoclonal antibody gantenerumab is in late-phase clinical development for early (prodromal-to-mild) Alzheimer’s disease (AD). SKYLINE is an upcoming Phase III multicentre, ran- domised, parallel-group, double-blind, placebo-controlled secondary prevention study, evaluating the efficacy and safety of subcutaneous gantenerumab in participants at risk for, or in the earliest stages of, AD.SKYLINE will enrol ~1,200 cognitively unimpaired participants, aged 60–80, with confirmed Aβ pathology (cerebrospinal fluid or positron emission tomography).Participants will be randomised 1:1 to 211 weeks’ subcutaneous gantenerumab (titrated to 1,020 mg monthly dosage) or placebo treatment administered weekly or every other week. Any participant confirmed as progressing to mild cognitive impairment or AD dementia during the study will undergo a blinded post-progression dose escalation, during which participants on placebo switch to gantenerumab. All parties will remain blinded to the assigned treatment at randomisation.The primary endpoint is change from baseline to Year 4 in the Preclinical Alzheimer’s Cognitive Composite-5 score. Secondary and exploratory objectives include further efficacy assessments (e.g. clinical progression); safety; pharmacodynamic biomarkers; pharmacokinetics; and identification of additional biomarkers.SKYLINE will be the first secondary prevention study of subcutaneous gantenerumab in cognitively unim- paired participants at risk for, or in the earliest stages of, AD.
Real-world bleeding in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) and prescribed different combinations of dual antiplatelet therapy (DAPT) in England: a population-based cohort study emulating a ‘target trial’
Authors: Pufulete Maria , Harris Jessica , Pouwels Koen , Reeves Barney C , Lasserson Daniel , Loke Yoon K , Mumford Andrew , Mahadevan Kalaivani , Johnson Thomas W 
Published: August 2022

ObjectiveTo estimate the incidence and HRs for bleeding for different dual antiplatelet therapies (DAPT) in a real-world population with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) in England.DesignA retrospective, population-based cohort study emulating a target randomised controlled trial (tRCT).Data sourcesLinked Clinical Practice Research Datalink (CPRD) and Hospital Episode Statistics (HES).SettingPrimary and secondary care.ParticipantsPatients ≥18 years old with ACS undergoing emergency PCI.InterventionsAspirin and clopidogrel (AC, reference) versus aspirin and prasugrel (AP) or aspirin and ticagrelor (AT); AP evaluated only in patients with ST-elevation myocardial infarction (STEMI).Main outcome measuresPrimary: any bleeding up to 12 months after the index event (HES- or CPRD- recorded). Secondary: HES-recorded bleeding, CPRD-recorded bleeding, all-cause and cardiovascular mortality, mortality from bleeding, myocardial infarction, stroke, additional coronary intervention and major adverse cardiovascular and cerebrovascular events (MACCE).ResultsIn ACS, the rates of any bleeding for AC and AT were 89 per 1000 person years and 134 per 1000 person years, respectively. In STEMI, rates for AC, AP and AT were 93 per 1000 person years, 138 per 1000 person years and 143 per 100 person years, respectively. In ACS, compared with AC, AT increased the hazard of any bleeding (HR: 1.47, 95% CI 1.19 to 1.82) but did not reduce MACCE (HR: 1.06, 95% CI 0.89 to 1.27). In STEMI, compared with AC, AP and AT increased the hazard of any bleeding (HR: 1.77, 95% CI 1.21 to 2.59 and HR: 1.50, 95% CI 1.10 to 2.05, respectively) but did not reduce MACCE (HR: 1.10, 95% CI 0.80 to 1.51 and HR: 1.21, 95% CI 0.94 to 1.51, respectively). Non-adherence to the prescribed DAPT regimen was 28% in AC (29% in STEMI only), 31% in AP (STEMI only) and 33% in AT (32% in STEMI only).ConclusionsIn a real-world population with ACS, DAPT with ticagrelor or prasugrel are associated with increased bleeding compared with DAPT with clopidogrel.Trial registration numberISRCTN76607611.
Individualised left anterior oblique projection for lead implantation into interventricular septum
Authors: Narumi Taro , Naruse Yoshihisa , Kaneko Yutaro , Sakakibara Tomoaki , Sano Makoto , Mogi Satoshi , Suwa Kenichiro , Ohtani Hayato , Urushida Tsuyoshi , Saotome Masao , Maekawa Yuichiro 
Published: August 2022

ObjectiveWe sought to investigate whether it is possible to obtain individualised left anterior oblique (LAO) by preprocedural electrocardiographic parameters and, if so, whether these parameters can help to improve the success rate of right ventricular (RV) lead implantation into the interventricular septum.MethodsIn this observational study, we assessed the relationship between preoperative electrocardiographic parameters and the angle of the interventricular septum obtained using thoracic CT. The participants were divided into two groups: a retrospective derivation cohort to derive the optimal formula for the individual septum axis, and a prospective internal validation cohort to which we applied the optimal formula and implanted using the new method.ResultsIn the retrospective derivation cohort (n=39), the mean angle of individualised LAO assessed by thoracic CT was 53.1°±8.9°, and the preoperative ECG QRS axis was strongly correlated with the interventricular septum axis (R2=0.490). LAO projection derived from the preoperative ECG QRS axis confirmed that the RV lead was placed in the interventricular septum during the pacemaker procedure in the prospective internal validation group (n=30). The success rate for placing the RV lead into the interventricular septum was significantly improved in the internal validation cohort (93% vs 64%, p<0.05). In addition, the N-terminal pro-brain natriuretic peptide level decreased significantly after surgery in the interventricular septal indwelling group.ConclusionsIndividualised LAO angle derived from the preoperative ECG QRS axis is a new useful and simple method for RV lead implantation into the interventricular septum.Trial registration numberUMIN000045741.
Indications for Left Atrial Appendage Occlusion in the United States and Associated In-Hospital Outcomes: Results From the NCDR LAAO Registry
Authors: Daimee Usama A. , Wang Yongfei , Masoudi Frederick A. , Varosy Paul D. , Friedman Daniel J. , Du Chengan , Koutras Cristina , Reddy Vivek Y. , Saw Jacqueline , Price Matthew J. , Kusumoto Fred M. , Curtis Jeptha P. , Freeman James V. 
Published: August 2022

Background:
The Food and Drug Administration approved left atrial appendage occlusion with the Watchman device for patients who are at increased stroke risk and are suitable for oral anticoagulation but who have an appropriate reason to seek a nondrug alternative. These broad criteria raise the question of their interpretation in clinical practice. There is a lack of studies comprehensively evaluating the indications for Watchman implantation among a large series of patients from contemporary, real-world practice in the United States.

Methods:
We used the National Cardiovascular Data Registry Left Atrial Appendage Occlusion Registry to identify Watchman procedures performed between 2016 and 2018. We assessed procedural indications for Watchman implantation in the United States and evaluated the association between procedural indications and in-hospital adverse events.

Results:

A total of 38 314 procedures were included. The mean patient age was 76.1±8.1 years, and 58.9% were men. The mean CHA
2
DS
2
-VASc score was 4.8±1.5, whereas the mean hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol (HAS-BLED) score was 3.0±1.1. Prior stroke or transient ischemic attack was reported in 40.2% and prior bleeding in 70.1%, with gastrointestinal bleeding being most common (41.9%). The most common site-reported procedural indications for Watchman implantation were increased thromboembolic risk (64.8%) and history of major bleed (64.3%), followed by high fall risk (35.5%). Most (71.9%) had ≥2 procedural indications. Patients with high fall risk had increased risk of in-hospital adverse events (adjusted OR, 1.12;
P
=0.025), but no other differences were found in the risk of in-hospital adverse events by procedural indication.

Conclusions:
Among patients in the National Cardiovascular Data Registry Left Atrial Appendage Occlusion Registry, the most common procedural indications for Watchman implantation were increased thromboembolic risk, history of major bleed, and high fall risk. A majority of patients had multiple procedural indications. High fall risk conferred a modestly increased risk of in-hospital adverse events.
Differential Impact of Stroke on Cognitive Impairment in Mexican Americans and Non-Hispanic White Americans
Authors: Becker Christopher J. , Heeringa Steven G. , Chang Wen , Briceño Emily M. , Mehdipanah Roshanak , Levine Deborah A. , Langa Kenneth M. , Gonzales Xavier F. , Garcia Nelda , Longoria Ruth , Springer Mellanie V. , Zahuranec Darin B. , Morgenstern Lewis B. 
Published: August 2022

Background:
The association between stroke and dementia is well established. Less is known about this association in underrepresented ethnic groups. In a large ethnically diverse cohort, we examined whether history of stroke was associated with cognitive impairment, and whether this relationship differed by ethnicity (Mexican American [MA] versus non-Hispanic White).

Methods:
This was a population-based cohort study conducted in Nueces County, TX, a biethnic community with a large and primarily nonimmigrant MA population. Residents aged ≥65 were recruited door-to-door or by telephone between May 2018 and December 2021. The primary exposure was history of stroke, obtained by self-report. Demographic, medical, and educational histories were also obtained. The primary outcome was the Montreal Cognitive Assessment (MoCA), a scale that evaluates multiple domains of cognitive performance. Scores were divided into 3 ordinal categories, roughly corresponding to normal cognition (MoCA 26–30), mild cognitive impairment (MoCA 20–25), or probable dementia (MoCA 0–19).

Results:

One thousand eight hundred one participants completed MoCA screening (55% female; 50% MA, 44% Non-Hispanic White, 6% other), of whom 12.4% reported history of stroke. Stroke prevalence was similar across ethnicities (X
2
2.1;
P
=0.34). In a multivariable cumulative logit regression model for the ordinal cognition outcome, a stroke by ethnicity interaction was observed (
P
=0.01). Models stratified by ethnicity revealed that stroke was associated with cognitive impairment across ethnicities, but had greater impact on cognition in non-Hispanic Whites (cumulative odds ratio=3.81 [95% CI, 2.37–6.12]) than in MAs (cumulative odds ratio=1.58 [95% CI, 1.04–2.41]). Increased age and lower educational attainment were also associated with cognitive impairment, regardless of ethnicity.

Conclusions:
History of stroke was associated with increased odds of cognitive impairment after controlling for other factors in both MA and Non-Hispanic White participants. The magnitude of the impact of stroke on cognition was less in MA than in Non-Hispanic White participants.
Large-Scale Coherent Turbulence Structures in the Atmospheric Boundary Layer over Flat Terrain
Authors: Alcayaga Leonardo , Larsen Gunner Chr. , Kelly Mark , Mann Jakob 
Published: August 2022

Abstract
We investigate characteristics of large-scale coherent motions in the atmospheric boundary layer using field measurements made with two long-range scanning wind lidars. The joint scans provide quasi-instantaneous wind fields over a domain of ∼50 km2, at two heights above flat but partially forested terrain. Along with the two-dimensional wind fields, two-point statistics and spectra are used to identify and characterize the scales, shape, and anisotropy of coherent structures—as well as their influence on wind field homogeneity. For moderate to high wind speeds in near-neutral conditions, most of the observed structures correspond to narrow streaks of low streamwise momentum near the surface, extending several hundred meters in the streamwise direction; these are associated with positive vertical velocity ejections. For unstable conditions and moderate winds, these structures become large-scale rolls, with longitudinal extent exceeding the measuring domain (>∼5 km); they dominate the conventional surface-layer structures in terms of both physical scale and relative size of velocity-component variances, appearing as quasi-two-dimensional structures throughout the entire boundary layer. The observations shown here are consistent with numerical simulations of atmospheric flows, field observations, and laboratory experiments under similar conditions.

Significance Statement
Coherent structures have attracted the interest of researchers for decades, being viewed as the closest to “order” that we can find within the chaos of turbulence. In the turbulent atmospheric boundary layer, micro- and mesoscale coherent structures come in many shapes and sizes, such as convective cells, rolls, or streaks. In this study we used dual lidars (remote sensing measurements), developing analysis of their tandem usage to characterize in detail some of the large-scale coherent structures generated over flat terrain. This allowed us to better understand the mechanisms that generate such structures and describe their influence on the morphology of the turbulent atmospheric boundary layer across a good deal of its depth.
Cost of Illness Analysis of Common Mental Disorders: A Study from an Indian Academic Tertiary Care Hospital
Authors: Kondapura Manjunatha B. , Manjunatha Narayana , Nagaraj Anil Kumar Mysore , Praharaj Samir Kumar , Kumar Channaveeraachari Naveen , Math Suresh Bada , Rao Girish N. 
Published: August 2022

Background: The cost of illness (COI) for common mental disorders (CMDs) that include depression, anxiety, and somatoform disorder is less studied in India. Hence, we studied the COI and disability of CMDs and their relationship in patients with depression, anxiety, and somatoform disorders. Methods: In this cross-sectional study, we recruited 220 patients (110 with depression, 58 with anxiety disorders, and 52 with somatoform disorders) and evaluated disability using the Sheehan Disability Scale (SDS). The schedule for the cost of illness (S-COI) was used for evaluating COI for the last year. Results: The annual COI of CMDs from the patient perspective was ₹21,620 (interquartile range [IQR], ₹47,761; ≈US$290). The median annual direct COI was ₹4,907 (IQR ₹7,502), and indirect COI was ₹12,900 (IQR ₹37744). The direct COI was 18%, whereas the indirect COI was 82%. The direct and indirect COI in the three groups were similar. In all three groups with ongoing treatment, the mean scores indicated a mild level of disability. Total and indirect COI, but not the direct COI, correlated positively with the severity of illness and disability. Conclusion: All the CMDs with ongoing treatment are associated with a mild level of disability and are a significant financial burden, with higher indirect costs.