bluuebunny/crossref_metadata_2025_split huggingface dataset:
Abstract TP436: Precision Medicine Using Quantitative Electroencephalography for Blood Pressure Augmentation in Penumbral Salvage After Subarachnoid Hemorrhage
Authors: Sy Heustein , Kapinos Gregory , Shafeeq Hira 
Published: March 2022

Delayed cerebral ischemia (DCI) complicates aneurysmal subarachnoid hemorrhage (SAH) in 20 to 30 percent of cases. DCI is treated initially with hemodynamic augmentation to improve cerebral perfusion. AHA/ASA guidelines recommend induced hypertension in the treatment of DCI, but at the same time recognize that insufficient scientific data support this practice. There is little practical guidance on how to augment blood pressure - i.e. extent and duration of blood pressure augmentation. Oftentimes, intensivists determine blood pressure goals by serial neurologic exams, which may be limited in poor clinical grade SAH.
We assessed the hypothesis that quantitative electroencephalography (EEG) has an adjunctive value to the clinical exam that can be used to monitor response to blood pressure augmentation in SAH.
Three patients with aneurysmal SAH in the neurocritical care unit were connected to quantitative EEG. To detect a decline in neuronal activity, we measured the amount of EEG variability, reactivity, amplitude as well as the changes in alpha-delta ratio. Induced hypertension through fluid challenge and inotropic support was tailored to reach the clinical and/or electrographic ischemic threshold, i.e. blood pressure levels that ameliorated clinical examination or the EEG.
Induced hypertension tailored to quantitative EEG data was tolerated well. We observed that neurologic examination of the patient (i.e. wakefulness, alertness, mental status, motor strength) following blood pressure augmentation correlated with quantitative EEG data. Furthermore, quantitative EEG added value to clinical exam, allowing for more precise increments in hemodynamic augmentation. Tapering of inotropic support was also done more safely and in a timely manner with EEG changes that preceded mild clinical impairments.
In conclusion, we demonstrated in a case series that blood pressure augmentation can be guided by quantitative EEG data, which correlated with the neurologic exam. Further research can be done to determine if induced hypertension guided by quantitative EEG can reduce mortality and morbidity in patients with aneurysmal SAH.
Abstract TP444: Exploring Peripheral Mirnas as Biomarkers for Human Ischemic Stroke
Authors: Kelly Stephen , Wang Shu , Uhegwu Nnamdi , Porbeni Charles , Moussavi Mohammed , Kirmani Jawad , Gizzi Martin 
Published: March 2022

Introduction.
While genomic array studies have shown that cohorts of messenger RNA (mRNA) levels in blood can be used to delineate between stroke types, there are some drawbacks with this approach. Not least the relatively poor stability of mRNA in blood. We are exploring the utility of circulating microRNAs (miRNAs) as biomarkers of ischemic stroke. miRNAs are small (∼22 nt) evolutionarily conserved single-stranded, non-coding RNA species that function as potent regulators of gene expression. They suppress gene expression by hybridizing with the 3’ untranslated region (3’UTR) of target messenger RNAs (mRNAs) and trigger mRNA degradation and/or translational repression. miRNAs are contained within several cellular and non-cellular compartments in the blood and are more stable in the bloodstream than messenger RNAs.
Methods.
Fifteen patients diagnosed with acute ischemic stroke (initial National Institutes of Health Stroke Scale of 5 or greater) and six no-stroke controls were enrolled in this study. Three blood samples were drawn from each patient into PAXgene tubes. Sample 1 was drawn within 5 hours of stroke, before IV tissue plasminogen activator t-PA treatment. Sample 2 was drawn at 24 hours following stroke onset, after IV rt-PA, thrombectomy and IA rt-PA. Sample 3 was drawn at 7 days post-stroke. RNA quality and concentration was determined and cDNA libraries generated to perform deep sequencing analysis on a SOLiD Sequencer.
Results.
Our data strongly suggests that miRNA expression profiles in peripheral blood are significantly altered in patients with ischemic stroke compared with control patients. We found 23 miRNAs that are differentially expressing in ischemic patients versus controls. Fifteen of these miRNAs were significantly decreased in ischemic stroke, while 8 were significantly increased in ischemic stroke. Moreover, comparison of the miRNA expression levels in the blood of a patient presenting with signs of ischemic stroke, but who was diagnosed with a transient ischemic attack (TIA) and released without treatment, grouped with control patients upon analysis.
Conclusion.
We have convincing preliminary data showing that miRNA expression profiles in peripheral blood following ischemic stroke are significantly altered.
Abstract WMP77: Neurovascular Complications During Long-term Left Ventricular Assist Device (LVAD) Support: Single Center Experience
Authors: Izzy Saef , Renault Simone , Rubin Daniel , Vaitkevicius Henrikas , Smallwood Jennifer , Givertz Michael M , Feske Steven K 
Published: March 2022

Introduction:
Left ventricular assist devices (LVAD) have emerged as the standard of care for treating patients with advanced heart failure refractory to maximal medical therapy. Postoperative cerebrovascular complications are an important cause of morbidity and decreased quality of life. However, the literature contains little data on the incidence, predictors, and outcome of stroke.

Hypothesis:
We aimed to determine the incidence of cerebrovascular complications, their type, and association with stroke risk factors and anticoagulation therapy.

Methods:
Data were collected prospectively on all patients with LVADs implanted at BWH. Categorical variables were tested by Chi-square.

Results:
From 2007 to 2015, 151 patients (123 male; median age 57) underwent implantation of HeartMate II LVAD: 79 bridge to transplant, 62 destination therapy, and 10 bridge to candidacy.

Strokes occurred in 31 patients (21%). Risk of stroke did not correlate with sex (25 male, 6 female) or age (median at stroke onset 57). Seventeen acute ischemic strokes (AIS) occurred in 16 patients and 17 intracerebral hemorrhages (ICH) occurred in 15 patients. Four of the AIS were complicated by secondary hemorrhage. Events occurred at a mean of 362 days from implantation (range 5 days-6 years 8 months).
All patients except one were on warfarin at time of stroke (goal INR 2-3.5). Mean INR at AIS onset was 2.3 compared to 3.0 for ICH. Of the 15 ICH patients, 3 had supratherapeutic INR > 3.5. Eleven of the 16 AIS patients were also receiving ASA, 1 ASA + dipyridamole, 1 ASA + dipyridamole + bivalirudin. One received ASA only. All ICH patients and all those with AIS with secondary hemorrhage were on ASA.
Patients with COPD were more likely to have a stroke (p = 0.0006); 30 of the 151 patients had COPD and 13 of them (43%) had strokes. Risk of stroke did not correlate with DM, HTN, hyperlipidemia, CKD, PAD, AF, or prior stroke.
Nineteen of 31 patients with stroke versus 22 of 120 without stroke died (mortality 61 v 18 %; p << 0.001).

Conclusions:
Stroke is an important cause of major morbidity and mortality in patients on LVAD support. Patients with COPD are at an increased risk of stroke. Further studies addressing post-LVAD stroke risk, prevention, and treatment are warranted.
Abstract WP370: Differential Alternative Splicing of Leukocyte mRNAs After Intracerebral Hemorrhage and Ischemic Stroke of Different Etiologies
Authors: Dykstra-Aiello Cheryl J , Jickling Glen C , Ander Bradley P , Zhan Xinhua , Liu DaZhi , Hull Heather , Orantia Miles A , Ho Carolyn , Sharp Frank R , Stamova Boryana S 
Published: March 2022

Transcriptome studies have used 3’-biased microarrays to study regulated genes and pathways in the blood of ischemic stroke (IS) patients, missing a majority of transcript isoforms due to alternative splicing (AS). AS is implicated in many diseases but is unexplored with respect to IS and intracerebral hemorrhage (ICH). Thus, we hypothesized AS differs between 1) IS, ICH and vascular risk factor control (VRFC) subjects; 2) three main causes of IS (Cardioembolic, Large Vessel and Lacunar), ICH and VRFC.
For Aim1, differential alternative splicing (DAS) in whole blood of IS vs ICH vs VRFC males was studied on Affymetrix exon junction HTA 2.0 arrays (n=36, 12 per group). For Aim 2, we investigated DAS between Cardioembolic, Large Vessel and Lacunar IS etiologies, and ICH and VRFC using paired-end RNA-Seq (Illumina Solexa, 200M 2X100bp reads per sample) on 20 whole blood RNA samples (n=4 males per group). DAS was assessed with 1-way-ANOVA (FDR p<0.05). Significant differential exon-usage was calculated between each group (p<0.0005; fold change> |1.2|). Differential usage of 90 exons separated the IS, ICH and VRFC groups. Affected genes included HGF (hepatic growth factor), involved in thrombosis and angiogenesis, and NOS1 (nitric oxide synthase 1), implicated in stroke risk. DAS among ICH, three main causes of IS, and VRFC was displayed by 412 genes. Differential expression of 308 exons separated these 5 groups. Several genes with DAS belonged to NF-kB and PPAR signaling pathways, SRA1, steroid receptor RNA activator 1, and Akt1, all of which have been implicated in experimental ICH pathogenesis. ICH activates NF-kB transcription factor which perpetuates inflammation. PPAR-gamma, via inhibition of NF-kB and induction of antioxidative pathways, reduces inflammation and oxidative stress and stimulates phagocytosis-mediated hematoma cleanup. In conclusion, our results provide first evidence for DAS in whole blood in ICH vs IS, and vs different IS etiologies. These data indicate disease specific immune response and could yield biomarkers for ICH and various IS causes. Future studies in a larger cohort are needed to validate results.
Abstract WP391: Time out Process Prior to Administration of Tissue Plasminogen Activator for Acute Ischemic Stroke Treatment
Authors: Spahr Catherine , Linde Ruth , McKniff Sueanne , Deel Julie , Mingle John 
Published: March 2022

The goal to administer tissue plasminogen activator within 60 minutes of patient arrival to the Emergency Department is attainable through rigorous attention to a standardized process and interdisciplinary collaboration.
This pilot sought to enhance safety and improve reliability of administration for tissue plasminogen activator with implementation of a time out prior to administration.

An interdisciplinary team designed an improvement strategy related to the process reliability of tissue plasminogen activator administration. Four errors occurred in 12 months, a failure rate of 10¯
1
(failure of 1 in 10 administrations). Primary goal: design a process with a failure rate of <10¯
3
(failure of 1 in 1000 administrations). Secondary goal: ensure alignment with current work flow associated with bar code medication administration. The concept of a safety time out was adopted with 7 confirmatory elements: time last known well, blood glucose, anticoagulation status, blood pressure, contraindications, team consensus, and assurance of a patent intravenous catheter. The Informatics team designed a tool within the electronic health record. A standardized communication process was written. Participants in the time out included a physician and nurse at the patient’s bedside. All stakeholders received training. Prior to redesign, there was a failure rate of 10¯
1
with confirmation of all safety elements in 88% of tissue plasminogen activator recipients. The time out procedure was trialed in 5 patients with 100% compliance and an extrapolated failure rate of 10¯
3
. The average door to needle time was 60 minutes versus 69 minutes prior to the pilot. The time out process took less than 1 minute in all cases. In this group, the time-out successfully identified a missing element - a blood glucose result - the process was stopped until the result was available.

The redesigned process is safe. There was no negative impact to achieving the standard of care. The primary goal of 10¯
3
performance was achieved. Secondary goal: alignment with current medication administration process achieved. Unanticipated results: decrease door to needle time and greater satisfaction with a collaborative approach to medication administration.
Abstract WP63: Clinical Utility of Whole-brain 4D-CTA Using a 320-detector Row CT Scanner in the Evaluation of Spontaneous Lobar Intracerebral Hemorrhage
Authors: Tajiri Hiroyuki 
Published: March 2022

Purpose:
We performed a retrospective study on the capacity of 320-detector row computed tomography (CT) scanners to detect vascular lesions in spontaneous intracerebral hemorrhage, particularly using whole-brain four-dimensional CT angiography (4D-CTA).

Materials and methods:
Subjects were patients brought to our hospital emergency room between April 2011 and August 2015 who were diagnosed with spontaneous intracerebral hemorrhage by non-contrast CT. Contrast-enhanced CTA (including 4D-CTA) was performed for all patients with a 320-detector row CT scanner soon after confirming a hemorrhagic lesion. Patients with bleeding in common sites for subarachnoid hemorrhage, intraventricular hemorrhage, or hypertensive intracerebral hemorrhage (basal ganglia, thalamus, brain stem, or cerebellar dentate nucleus) were excluded. Evaluation items were:

-Hematoma size (estimated bleeding volume)
-Number and frequency (%) of cerebrovascular lesions detectable with 4D-CTA
-In patients who had cerebral angiography (CAG), the concordance rate between the detection rate and the Spetzler-Martin grade for AVMs or Cognard classification for dural arteriovenous fistulas (dAVFs) was calculated. Definitive diagnosis was made by consensus between two neuroradiologists.

Results:
Subjects were 125 patients diagnosed with spontaneous intracerebral hemorrhage during the study period (72 men (57.6%); mean age, 58.4±17.2 years; range, 20-88 years; mean estimated bleeding volume, 17.5±12.6 mL). A vascular lesion was detected as the source of bleeding with 4D-CTA in 10 of the 125 patients (8.0%), of whom 5 had AVM, 3 had dAVF, 1 had Moyamoya disease, and 1 had obstruction of the superior sagittal sinus. In patients who underwent CAG at a later date, 4D-CTA offered almost the same diagnostic power as CAG.

Conclusion:
Whole-brain 4D-CTA using a 320-detector row CT scanner was useful for diagnosing spontaneous intracerebral hemorrhage, particularly for detecting cerebrovascular lesions.
On the Emergence of the Iranian Apocalypse Between the Sixth and Seventh Centuries
Authors: Agostini Domenico 
Published: March 2022

The Iranian apocalyptic texts belong to the body of Pahlavi literature that was written in the ninth and tenth centuries. While most scholarship points to the early Islamic reworking and redaction of these apocalyptic accounts, which is clearly evident in the overlapping narratives, various late Sasanian historical and apocalyptic material still seems to be detectable.
This article reassesses the identification of some Iranian apocalyptic figures, in order to discuss the origin of some literary models that were likely shared with some coeval neighboring traditions. It will thereby situate the emergence of Iranian apocalyptic ideas between the end of the sixth to the first decades of the seventh century.
Immortality and Longevity through Yoga in the Tirumantiram
Authors: Wittich Agi 
Published: March 2022

Abstract
Tirumūlar yoga reveals the practices through which one may achieve longevity and immortality. Prolonging life aids the yogi to accomplish yoga’s final transcendent state of consciousness, samadhi, in which the yogi’s consciousness is absorbed into the god Śiva. Although a person’s lifespan is determined by the time of their conception, birth, and actions, life expectancy can be prolonged by certain yogic techniques. This is attested to in Tirumūlar’s seminal text Tirumantiram, in which he claims to have reached samadhi and to have lived for thousands of years. Tirumūlar details four yoga systems – Aṣṭāṅgayoga, Khecarīyoga, Candrayoga, and Paryaṅgayoga – that are meant to preserve life energy. These systems include practices designed to retain vital energies such as breath and semen retention, awaken and elevate the life force, and lead to immortality. The yoga’s final immortal state of samadhi resembles a deathlike state, which is said to be the ultimate blissful state of living.
The Triggers of Transformation
Authors: Kędzia Ilona 
Published: March 2022

Abstract
This article studies the comprehensive medico-alchemical Tamil text Six Hundred Verses by Siddhar Yākōpu. Through an analysis of selected sections of this text, the article explores the discourse on the preparation called cavukkāram. Cavukkāram seems to be crucial for the medico-alchemical system exposited in the book, where it is portrayed as a potent catalyst that enables both alchemical operations on inanimate matter and remarkable transformations of human beings. The article explores the recipes, powers, and further processing for cavukkāram, drawing out ambiguities and inconsistencies in the discourse on the substance and the equivocalness of the text. It concludes that Six Hundred Verses describes, among other things, several different methods of preparing a substance called cavukkāram; the vocabulary in the recipes is highly ambiguous, and certain ingredients are presented as rare and difficult to attain – all of which adds to the obscurity of the discourse.
Explorative Study of Indian Medicines in Singapore
Authors: Sébastia Brigitte 
Published: March 2022

Abstract
Compared to ayurveda, siddha medical practice and use outside India has hardly been investigated. Based on an ethnography of siddha and ayurveda clinics conducted in 2019 in Singapore, and secondarily, in southern Malaysia, this paper analyzes the development of these medicines in terms of adaptations, transformations, and the strategies or avoidance necessary to respond to clients/patients’ demands and to fit in with the regulations for traditional medicines. Whereas siddha medicine is well established in Malaysia, it is hardly discernible in Singapore, represented by only two clinics: a long-standing one reflecting the tradition, and a recent one, illustrating the process of modernization impelled by the institutionalization of medical knowledge. The practice of ayurveda, by contrast, has seen a significant expansion since the beginning of the twenty-first century in these two countries, a dynamism impelled by its reputation abroad which has been spurring Indian practitioners to migrate and popularize it.
Two notes on Proto-Ersuic
Authors: HILL Nathan W. 
Published: March 2022

Abstract
This paper looks at the history of Tosu using 'forward reconstruction'. It concludes that Proto-Ersuic changed *-im to *-am already before its breakup as a unity, but the ‘brightening’ of *-a- to -i- took place independently in Tosu and Lizu-Ersu. In Tosu this brightening did not target labial (or velar) initial words lacking an inherited medial *-j-. A number of changes in the history of Tosu probably preceded brightening, namely *-um, *-ak > -o and *-u, *-it, *-at, *-ra > -e. In contrast, the change *-e- > -i- in Tosu, of unclear conditioning, appears to be quite late. A dissimilation *CeCe > CeCa is potentially also a recent change.
Morphologie affixale et radicale du verbe simple kulung
Authors: LAMONTRE Jean-Baptiste 
Published: March 2022

Résumé
Cet article esquisse la description morphologique du verbe simple en kulung (kiranti, tibéto-birman), à l’ exclusion des formations réfléchies et composées. Comme l’ ensemble des langues kiranties, le kulung se signale par une morphologie verbale non triviale associant polysynthèse, indexation biactantielle et allormorphie radicale. La description de la morphologie affixale clarifie et complète celle qu’ en donne Tolsma (2006). La description de l’ allomorphie radicale fait appel à la notion d’ espace thématique telle qu’ explicitée dans les travaux de Boyé & Bonami (2003) et Bonami (2014). L’ ensemble des modifications apportées à la description de Tolsma (2006) repose à la fois sur une analyse des contradictions internes de l’ ouvrage, et sur l’ analyse d’ un corpus opportuniste de 150 000 mots.
Aspek Fawāṣil Dalam Manuskrip Al-Quran Terengganu IAMM 2012.13.6 Dan Implikasi Terhadap Penafsiran Ayat Dalam Surah Al-Baqarah
Authors: bin Azmi Riswadi , bin Abdullah Mustaffa , bin Embong Abdul Hanis 
Published: March 2022

Abstract
Terengganu Quran manuscript is one of the best manuscripts ever produced in the 19th century AD. Copying this manuscript requires precision in various aspects, especially in the aspect of writing because it is a scripture that needs to be preserved. Since at that time there was no evidence to say that there was a body that checked the accuracy of the writing method, then a study on the aspect of the fawāṣil is very necessary to do. This study focuses on the Terengganu Quran manuscript IAMM 2012.13.6 which is a collection at the Islamic Art Museum Malaysia. The objective of this study is to look at the aspect of fawāṣil which is one of the important aspects in the writing of the Quran. In addition, the meaning aspect of the sentence is also examined to see if it has implications that can change the meaning of the sentence. Qualitative research methods are used to examine the text of the Quran from surah al-Baqarah and the data are analyzed using inductive and deductive methods. The same method is also used to examine aspects of sentence meaning. The results of the study found that there is a difference of fawāṣil in the Terengganu Quran manuscript if seen in the view of the scholars fawāṣil. Differences in this aspect have led to the effect of sentence interpretation. However, this difference does not change the law because the place of the difference does not occur in the sentence of law. The results of the study also prove, most likely that the writer of this manuscript has its own method based on the knowledge available at that time.
Dilated cardiomyopathy: An unusual and severe condition in juvenile systemic lupus erythematosus
Authors: Bouayed Kenza , Faid Tiaaza , Sakhi Asmaa , Boutaleb Amine Mamoun , Drighil Abdenasser 
Published: March 2022

Background Systemic juvenile lupus erythematosus can affect any organ including the heart. While pericarditis and endocarditis are the most common cardiac complications, dilated cardiomyopathy remains rare. We report the full recovery of dilated cardiomyopathy in a girl with juvenile lupus. Case presentation A 7-year-old girl presented with persistent fever, weight loss, alopecia, positive anti-lupus antibodies, and decreased complement. Examination found dyspnea, tachycardia, and hypotension. Chest X-ray revealed an enlarged cardiac silhouette, and echocardiography showed a left ventricular ejection fraction of 35%. After excluding other causes, systemic lupus erythematosus related dilated cardiomyopathy was selected. Heart failure treatment, Prednisone, and hydroxychloroquine were prescribed. On day three, she developed macrophage activation syndrome which responded to methylprednisolone boluses. Clinical and biological improvement was observed after 4 weeks, normalization of echocardiography after 4 months. Conclusion A review of the literature confirmed the rare and severe nature of dilated cardiomyopathy in juvenile lupus emphasizing the importance of performing echocardiography at the slightest cardiac sign.