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The explosive growth of online misinformation, such as false claims, has affected the social behavior of online users. In order to be persuasive and mislead the audience, false claims are made to trigger emotions in their audience. This paper contributes to understanding how misinformation in social media is shaped by investigating the emotional framing that authors of the claims try to create for their audience. We investigate how, firstly, the existence of emotional framing in the claims depends on the topic and credibility of the claims. Secondly, we explore how emotionally framed content triggers emotional response posts by social media users, and how emotions expressed in claims and corresponding users' response posts affect their sharing behavior on social media. Analysis of four data sets covering different topics (politics, health, Syrian war, and COVID-19) reveals that authors shape their claims depending on the topic area to pass targeted emotions to their audience. By analysing responses to claims, we show that the credibility of the claim influences the distribution of emotions that the claim incites in its audience. Moreover, our analysis shows that emotions expressed in the claims are repeated in the users' responses. Finally, the analysis of users' sharing behavior shows that negative emotional framing such as anger, fear, and sadness of false claims leads to more interaction among users than positive emotions. This analysis also reveals that in the claims that trigger happy responses, true claims result in more sharing compared to false claims.

Background: The emergence of COVID-19 was rapidly followed by infection and the deaths of millions of people across the globe. With much of the research and scientific advancement rightly focused on reducing the burden of severe and critical acute COVID-19 infection, the long-term effects endured by those who survived the acute infection has been previously overlooked. Now, an appreciation for the post-COVID-19 condition, including its neurological manifestations, is growing, although there remain many unknowns regarding the etiology and risk factors of the condition, as well as how to effectively diagnose and treat it.Methods: Here, drawing upon the experiences and expertise of the clinicians and academics of the European working group on COVID-19, we have reviewed the current literature to provide a comprehensive overview of the neurological sequalae of the post-COVID-19 condition.Results: In this review, we provide a summary of the neurological symptoms associated with the post-COVID-19 condition, before discussing the possible mechanisms which may underly and manifest these symptoms. Following this, we explore the risk factors for developing neurological symptoms as a result of COVID-19 and the post-COVID-19 condition, as well as how COVID-19 infection may itself be a risk factor for the development of neurological disease in the future. Lastly, we evaluate how the post-COVID condition could be accurately diagnosed and effectively treated, including examples of the current guidelines, clinical outcomes, and tools that have been developed to aid in this process, as well as addressing the protection provided by COVID-19 vaccines against the post-COVID-19 condition.Conclusions: Overall, this review provides a comprehensive overview of the neurological sequalae of the post-COVID-19 condition. Impact statementWith our understanding of the neurological complications of the post-COVID-19 condition currently lacking sufficient depth, this review aimed at highlighting th

Studien syftar till att undersöka hur influencer marketing påverkar konsumenternas attityd och trovärdighet gentemot marknadsförda Non-Fungible Token (NFT) projekt. Begreppet influencer marketing syftar till marknadsföringsstrategin som handlar om att utveckla relationer med influencers som sedan marknadsför en produkt eller varumärke för att påverka sina följare. Strategin används av företag inom olika marknadsområden för att kunna förmedla och rekommendera produkter på ett mer trovärdigt sätt. Många konsumenter upplever att marknadsföring av företag är för kommersiellt vilket leder till mindre trovärdighet. Genom att använda sig av influencers för att marknadsföra produkter, kan detta stärka trovärdigheten och information som förmedlas. Influencer marketing används även för att påverka konsumenter vid köp av NFT som blivit en populär trend att investera i eftersom det är en digital tillgång i form av konst och samlarobjekt. NFT köps online genom kryptovalutor och certifierar sedan en unik digital tillgång till sin ägare. Däremot finns det stora kunskapsluckor inom NFT vilket ställer högre krav på influencers expertis för att kunna få en högre trovärdighet av konsumenter, dessutom är NFT-marknaden volatil då priset korrelerar med Herding behavior och inlägg från sociala medier. Den instabila NFT-marknaden ihop med osäkerheten kring influencers trovärdighet skapar en försämrad effekt av förtroende i två olika led, dels influencer marketing och NFT. Studien baseras på kvalitativa intervjuer med totalt 8 respondenter. Frågorna som formats i intervjuguiden har utgått från det teoretiska ramverket med teorier om influencer marketing, AIDA, Source Credibility, Herding behavior och Electronic word-of-mouth. Teorierna är viktiga faktorer för att förstå och generera kunskap om hur konsumenter påverkas av influencers gällande NFT. Resultatet av studien visar att influencers har en tydlig och allmän stor påverkan på konsumenter. Dock är denna påverkan till en viss gräns och, The purpose of this study is to investigate how influencer marketing affects consumers´ attitudes and credibility towards marketed Non-fungible Token (NFT) projects. Influencer marketing refers to the marketing strategy which develops relationships with influencers who market a product or brand to influence their followers. The strategy is used by companies to recommend products in a more credible way. Many consumers feel that marketing by companies is too commercial, which leads to less credibility. By using influencers to market products, it can strengthen credibility and information can be conveyed. Influencer marketing is also used to influence consumers´purchases of NFT which has become a popular trend to invest in because it is a digital asset in the form of art and collectibles. NFT is purchased online through cryptocurrencies and certifies a digital unique access to its owner. On the other hand, there are knowledge gaps within NFT, which places higher demands on the influence of influencers in order to gain a higher credibility from consumers. In addition, the NFT market is volatile as the price correlates with herding behavior and posts from social media. The unstable NFT market together with the uncertainty surrounding influencer credibility creates a deteriorating effect of trust in two different stages, influencer marketing and NFT. The study is based on qualitative interviews with a total of 8 respondents. The questions formed in the interview guide have been based on the theoretical framework with theories on influencer marketing, AIDA, source credibility, herding behavior and Electronic word-of-mouth. The theories are important for understanding and generating knowledge about how consumers are affected by influencers regarding NFT. The results of the study show that influencers have a clearly large impact on consumers. However, this impact is to a certain extent and differs depending on consumers previous experiences. If consumers are new to the NFT s

IntroductionCoronavirus disease 2019 (COVID-19) has caused >3.5 million deaths worldwide and affected >160 million people. At least twice as many have been infected but remained asymptomatic or minimally symptomatic. COVID-19 includes central nervous system manifestations mediated by inflammation and cerebrovascular, anoxic, and/or viral neurotoxicity mechanisms. More than one third of patients with COVID-19 develop neurologic problems during the acute phase of the illness, including loss of sense of smell or taste, seizures, and stroke. Damage or functional changes to the brain may result in chronic sequelae. The risk of incident cognitive and neuropsychiatric complications appears independent from the severity of the original pulmonary illness. It behooves the scientific and medical community to attempt to understand the molecular and/or systemic factors linking COVID-19 to neurologic illness, both short and long term.MethodsThis article describes what is known so far in terms of links among COVID-19, the brain, neurological symptoms, and Alzheimer's disease (AD) and related dementias. We focus on risk factors and possible molecular, inflammatory, and viral mechanisms underlying neurological injury. We also provide a comprehensive description of the Alzheimer's Association Consortium on Chronic Neuropsychiatric Sequelae of SARS-CoV-2 infection (CNS SC2) harmonized methodology to address these questions using a worldwide network of researchers and institutions.ResultsSuccessful harmonization of designs and methods was achieved through a consensus process initially fragmented by specific interest groups (epidemiology, clinical assessments, cognitive evaluation, biomarkers, and neuroimaging). Conclusions from subcommittees were presented to the whole group and discussed extensively. Presently data collection is ongoing at 19 sites in 12 countries representing Asia, Africa, the Americas, and Europe.DiscussionThe Alzheimer's Association Global Consortium harmoniz

Introduction Coronavirus disease 2019 (COVID-19) has caused >3.5 million deaths worldwide and affected >160 million people. At least twice as many have been infected but remained asymptomatic or minimally symptomatic. COVID-19 includes central nervous system manifestations mediated by inflammation and cerebrovascular, anoxic, and/or viral neurotoxicity mechanisms. More than one third of patients with COVID-19 develop neurologic problems during the acute phase of the illness, including loss of sense of smell or taste, seizures, and stroke. Damage or functional changes to the brain may result in chronic sequelae. The risk of incident cognitive and neuropsychiatric complications appears independent from the severity of the original pulmonary illness. It behooves the scientific and medical community to attempt to understand the molecular and/or systemic factors linking COVID-19 to neurologic illness, both short and long term. Methods This article describes what is known so far in terms of links among COVID-19, the brain, neurological symptoms, and Alzheimer's disease (AD) and related dementias. We focus on risk factors and possible molecular, inflammatory, and viral mechanisms underlying neurological injury. We also provide a comprehensive description of the Alzheimer's Association Consortium on Chronic Neuropsychiatric Sequelae of SARS-CoV-2 infection (CNS SC2) harmonized methodology to address these questions using a worldwide network of researchers and institutions. Results Successful harmonization of designs and methods was achieved through a consensus process initially fragmented by specific interest groups (epidemiology, clinical assessments, cognitive evaluation, biomarkers, and neuroimaging). Conclusions from subcommittees were presented to the whole group and discussed extensively. Presently data collection is ongoing at 19 sites in 12 countries representing Asia, Africa, the Americas, and Europe. Discussion The Alzheimer's Association Global Consortium harmoni

Studien syftar till att undersöka hur influencer marketing påverkar konsumenternas attityd och trovärdighet gentemot marknadsförda Non-Fungible Token (NFT) projekt. Begreppet influencer marketing syftar till marknadsföringsstrategin som handlar om att utveckla relationer med influencers som sedan marknadsför en produkt eller varumärke för att påverka sina följare. Strategin används av företag inom olika marknadsområden för att kunna förmedla och rekommendera produkter på ett mer trovärdigt sätt. Många konsumenter upplever att marknadsföring av företag är för kommersiellt vilket leder till mindre trovärdighet. Genom att använda sig av influencers för att marknadsföra produkter, kan detta stärka trovärdigheten och information som förmedlas. Influencer marketing används även för att påverka konsumenter vid köp av NFT som blivit en populär trend att investera i eftersom det är en digital tillgång i form av konst och samlarobjekt. NFT köps online genom kryptovalutor och certifierar sedan en unik digital tillgång till sin ägare. Däremot finns det stora kunskapsluckor inom NFT vilket ställer högre krav på influencers expertis för att kunna få en högre trovärdighet av konsumenter, dessutom är NFT-marknaden volatil då priset korrelerar med Herding behavior och inlägg från sociala medier. Den instabila NFT-marknaden ihop med osäkerheten kring influencers trovärdighet skapar en försämrad effekt av förtroende i två olika led, dels influencer marketing och NFT. Studien baseras på kvalitativa intervjuer med totalt 8 respondenter. Frågorna som formats i intervjuguiden har utgått från det teoretiska ramverket med teorier om influencer marketing, AIDA, Source Credibility, Herding behavior och Electronic word-of-mouth. Teorierna är viktiga faktorer för att förstå och generera kunskap om hur konsumenter påverkas av influencers gällande NFT. Resultatet av studien visar att influencers har en tydlig och allmän stor påverkan på konsumenter. Dock är denna påverkan till en viss gräns och, The purpose of this study is to investigate how influencer marketing affects consumers´ attitudes and credibility towards marketed Non-fungible Token (NFT) projects. Influencer marketing refers to the marketing strategy which develops relationships with influencers who market a product or brand to influence their followers. The strategy is used by companies to recommend products in a more credible way. Many consumers feel that marketing by companies is too commercial, which leads to less credibility. By using influencers to market products, it can strengthen credibility and information can be conveyed. Influencer marketing is also used to influence consumers´purchases of NFT which has become a popular trend to invest in because it is a digital asset in the form of art and collectibles. NFT is purchased online through cryptocurrencies and certifies a digital unique access to its owner. On the other hand, there are knowledge gaps within NFT, which places higher demands on the influence of influencers in order to gain a higher credibility from consumers. In addition, the NFT market is volatile as the price correlates with herding behavior and posts from social media. The unstable NFT market together with the uncertainty surrounding influencer credibility creates a deteriorating effect of trust in two different stages, influencer marketing and NFT. The study is based on qualitative interviews with a total of 8 respondents. The questions formed in the interview guide have been based on the theoretical framework with theories on influencer marketing, AIDA, source credibility, herding behavior and Electronic word-of-mouth. The theories are important for understanding and generating knowledge about how consumers are affected by influencers regarding NFT. The results of the study show that influencers have a clearly large impact on consumers. However, this impact is to a certain extent and differs depending on consumers previous experiences. If consumers are new to the NFT s

Studien syftar till att undersöka hur utbildning av de anställda påverkar deras arbetssätt med Self-Service Business Intelligence (SSBI). SSBI kan sammanfattas som en arbetsmetod baserad på dataunderlag som ger beslutstöd för anställda inom verksamheten. Vid tidigare beslutstöd som Business intelligence (BI) fanns det specifika roller som använde sig av dataunderlag och skapade rapporter. Dessa roller befann sig i IT-avdelningen och fick förfrågningar av anställda som var i behov av rapporter för att ta beslut. Syftet med SSBI är att möjliggöra för anställda att vara oberoende av IT-avdelningen och självständigt kunna analysera och tolka data för att sedan skapa rapporter. Detta är något som effektiviserar arbetet hos företag och skapar mer värde genom att underlätta för IT-avdelningen. Även om SSBI tillåter anställda till att bli mer självständiga inom sitt arbete, finns det utmaningar vid införandet. Den väsentliga utmaningen som denna uppsats fokuserar på är hur utbildning påverkar BI-användarna i sitt arbete med SSBI. Studien baseras på kvalitativa intervjuer med totalt fyra företag och fem respondenter. Frågorna som ställts har utgått från det teoretiska ramverket med teorier och modeller om självständighet, kunskap, utbildning och värdeskapande. Detta har varit en substantiell aspekt för att kunna generera kunskap om huruvida utbildning påverkar anställdas arbetssätt med SSBI. Resultatet av uppsatsen presenterade att utbildning har en tydlig påverkan och en stor roll vid användningen av SSBI. Införandet av SSBI har lett till att anställda känner sig mer självständiga med en större frihet, däremot klarar de med formell utbildning mer avancerade arbetsuppgifter med SSBI. Arbetet inom organisationen har förenklats med SSBIeftersom navigering, definitioner och tolkning av data kan ske självständigt. Uppsatsen visar en tydlig indikation att deltagarna blivit påverkade av införandet av SSBI på olika nivåer framför allt beroende på utbildning men även tidigare kuns, The purpose of this study is to investigate how the education of employees affect their way of working with Self-Service Business intelligence (SSBI) as a working method. SSBI can be summarized as a working method based on data that provides decision support for employees within the business. In previous decision support such as Business intelligence (BI), there were specific roles that were used for data and creating of reports. These roles were in the IT department and received inquiries from employees who needed reports to make decisions. The purpose of SSBI is to enable employees to be independent of the IT department and to be able to independently analyze and interpret data so that reports can be created. With this method implemented in companies, it will create more value by creating more relief for the IT department. Although SSBI applies to employees to become more independent in their work, there are challenges with the implementation. The significant challenges that this study focuses on are how education affects BI users in their work with SSBI. The study has been conducted with qualitative interviews with a total of four companies and five respondents. The questions are based on the theories and models of independence, education, knowledge and value creation to generate knowledge whether training affects employees' working methods. The results of the study showed a clear impact on how education plays a major role in the use of SSBI. The implementation of SSBI has made employees feel more independent with greater freedom, but with a formal education they can handle more advanced tasks with SSBI. The work within the organization has been simplified with SSBI because navigation, definitions and interpretation of data independently. The study shows a clear indication that the participants have been affected by the introduction of SSBI at different levels, primarily due to training but also previous knowledge and how committed companies are to continuously

Studien syftar till att undersöka hur utbildning av de anställda påverkar deras arbetssätt med Self-Service Business Intelligence (SSBI). SSBI kan sammanfattas som en arbetsmetod baserad på dataunderlag som ger beslutstöd för anställda inom verksamheten. Vid tidigare beslutstöd som Business intelligence (BI) fanns det specifika roller som använde sig av dataunderlag och skapade rapporter. Dessa roller befann sig i IT-avdelningen och fick förfrågningar av anställda som var i behov av rapporter för att ta beslut. Syftet med SSBI är att möjliggöra för anställda att vara oberoende av IT-avdelningen och självständigt kunna analysera och tolka data för att sedan skapa rapporter. Detta är något som effektiviserar arbetet hos företag och skapar mer värde genom att underlätta för IT-avdelningen. Även om SSBI tillåter anställda till att bli mer självständiga inom sitt arbete, finns det utmaningar vid införandet. Den väsentliga utmaningen som denna uppsats fokuserar på är hur utbildning påverkar BI-användarna i sitt arbete med SSBI. Studien baseras på kvalitativa intervjuer med totalt fyra företag och fem respondenter. Frågorna som ställts har utgått från det teoretiska ramverket med teorier och modeller om självständighet, kunskap, utbildning och värdeskapande. Detta har varit en substantiell aspekt för att kunna generera kunskap om huruvida utbildning påverkar anställdas arbetssätt med SSBI. Resultatet av uppsatsen presenterade att utbildning har en tydlig påverkan och en stor roll vid användningen av SSBI. Införandet av SSBI har lett till att anställda känner sig mer självständiga med en större frihet, däremot klarar de med formell utbildning mer avancerade arbetsuppgifter med SSBI. Arbetet inom organisationen har förenklats med SSBIeftersom navigering, definitioner och tolkning av data kan ske självständigt. Uppsatsen visar en tydlig indikation att deltagarna blivit påverkade av införandet av SSBI på olika nivåer framför allt beroende på utbildning men även tidigare kuns, The purpose of this study is to investigate how the education of employees affect their way of working with Self-Service Business intelligence (SSBI) as a working method. SSBI can be summarized as a working method based on data that provides decision support for employees within the business. In previous decision support such as Business intelligence (BI), there were specific roles that were used for data and creating of reports. These roles were in the IT department and received inquiries from employees who needed reports to make decisions. The purpose of SSBI is to enable employees to be independent of the IT department and to be able to independently analyze and interpret data so that reports can be created. With this method implemented in companies, it will create more value by creating more relief for the IT department. Although SSBI applies to employees to become more independent in their work, there are challenges with the implementation. The significant challenges that this study focuses on are how education affects BI users in their work with SSBI. The study has been conducted with qualitative interviews with a total of four companies and five respondents. The questions are based on the theories and models of independence, education, knowledge and value creation to generate knowledge whether training affects employees' working methods. The results of the study showed a clear impact on how education plays a major role in the use of SSBI. The implementation of SSBI has made employees feel more independent with greater freedom, but with a formal education they can handle more advanced tasks with SSBI. The work within the organization has been simplified with SSBI because navigation, definitions and interpretation of data independently. The study shows a clear indication that the participants have been affected by the introduction of SSBI at different levels, primarily due to training but also previous knowledge and how committed companies are to continuously

Social media have created communication channels between citizens and policymakers but are also susceptible to rampant misinformation. This new context demands new social media policies that can aid policymakers in making evidence-based decisions for combating misinformation online. This paper reports on data collected from policymakers in Austria, Greece, and Sweden, using focus groups and in-depth interviews. Analyses provide insights into challenges and identify four important themes for supporting policy-making for combating misinformation: a) creating a trusted network of experts and collaborators, b) facilitating the validation of online information, c) providing access to visualisations of data at different levels of granularity, and d) increasing the transparency and explainability of flagged misinformative content. These recommendations have implications for rethinking how revised social media policies can contribute to evidence-based decision-making.

Collaborative consensus-finding is an integral element of many Web services and greatly determines the quality of information, content, and products that are available through the Web. That also means that the dynamics of democratic consensus-finding strengthen collective resilience against potential threats that attempt to degrade information, content, and products and affect Web data, users, behaviors, and even beyond as well as offline life. Even on Web platforms that are open to all, the influence of some first mover authors may shape future discussion and collaboration, which is comparable to academic citation networks for instance. In a social coding network such as GitHub, activities of a set of users can have influence on other users who can get interested in further actions, possibly contributing to a new project together with influential users. In this paper, we analyze the effect of contribution activities on gaining influence in this and comparable networks that provide users the functionality and aims for reaching collaborative goals on the Web.For this purpose, we present an empirical approach to identify the top influential users by using network features and contribution characteristics, which we find in existing and newly collected data set. We find that early adopter dynamics exist in the GitHub community, where early adopters have more followers in the end as expected. However, we also see counterexamples that arise due to the social networking behavior of late adopters, and due to the aging effect of older repositories and users. We publicly share the source code and the data sets for reproducing our paper., Comment: 11 pages. 5 figures

Unexplained infertility, one of the common gynecological disorders, affecting 10 to 15 % of women worldwide. Recurrent pregnancy loss affects approximately 1 to 3 % of pregnant women with an unknown etiology in 50 % of cases. Endocrine dysfunctions, including thyroid dysfunction, are one of the related factors to female reproductive disturbances. The aim of the thesis was to explore the importance of thyroid function and endometrial factors for implantation and pregnancy. Three groups of pregnant women, one group with high risk (n = 88) was compared to a low-risk (n = 511) and a general screening group (n = 699) to study the incidence of subclinical hypothyroidism and hypothyroidism, defined as TSH < 2.5 mIU/L. Women with recurrent pregnancy loss, (n = 165), and controls, (n = 289), were included in genetic analysis and gene expression array of endometrium, (n = 4 and n = 5 respectively). Infertile women (n = 19) and fertile women were included to study thyroid-related proteins in endometrium (n = 28) and Fallopian tube (n = 13). Human embryos, (n= 36), were used to study the effect of thyroid hormone on embryo development. Thyroid stimulating hormone (TSH), free thyroid hormone (fT4) and TPO antibodies (TPO-Ab) levels were analyzed by use of immunological methods. Genetic variations in the HABP2 gene was performed by use of TaqMan SNP Genotyping Assays. Gene expression array was used to study mRNA in endometrium of women with recurrent miscarriage at the time of implantation. Immunohistochemistry was used to analyze the presence and distribution of thyroid related proteins in endometrium. Additionally, influence of thyroid hormone (T4) on the early embryo development was analyzed. Approximately 10 % of all pregnant women, regardless of risk, had elevated TSH levels. Furthermore, hypothyroid women on levothyroxine supplementation had in almost 50 % of cases inadequate treatment. There were no significant differences in the presence of polymorphism in HABP2 genes in

Unexplained infertility, one of the common gynecological disorders, affecting 10 to 15 % of women worldwide. Recurrent pregnancy loss affects approximately 1 to 3 % of pregnant women with an unknown etiology in 50 % of cases. Endocrine dysfunctions, including thyroid dysfunction, are one of the related factors to female reproductive disturbances. The aim of the thesis was to explore the importance of thyroid function and endometrial factors for implantation and pregnancy. Three groups of pregnant women, one group with high risk (n = 88) was compared to a low-risk (n = 511) and a general screening group (n = 699) to study the incidence of subclinical hypothyroidism and hypothyroidism, defined as TSH < 2.5 mIU/L. Women with recurrent pregnancy loss, (n = 165), and controls, (n = 289), were included in genetic analysis and gene expression array of endometrium, (n = 4 and n = 5 respectively). Infertile women (n = 19) and fertile women were included to study thyroid-related proteins in endometrium (n = 28) and Fallopian tube (n = 13). Human embryos, (n= 36), were used to study the effect of thyroid hormone on embryo development. Thyroid stimulating hormone (TSH), free thyroid hormone (fT4) and TPO antibodies (TPO-Ab) levels were analyzed by use of immunological methods. Genetic variations in the HABP2 gene was performed by use of TaqMan SNP Genotyping Assays. Gene expression array was used to study mRNA in endometrium of women with recurrent miscarriage at the time of implantation. Immunohistochemistry was used to analyze the presence and distribution of thyroid related proteins in endometrium. Additionally, influence of thyroid hormone (T4) on the early embryo development was analyzed. Approximately 10 % of all pregnant women, regardless of risk, had elevated TSH levels. Furthermore, hypothyroid women on levothyroxine supplementation had in almost 50 % of cases inadequate treatment. There were no significant differences in the presence of polymorphism in HABP2 genes in

Unexplained infertility, one of the common gynecological disorders, affecting 10 to 15 % of women worldwide. Recurrent pregnancy loss affects approximately 1 to 3 % of pregnant women with an unknown etiology in 50 % of cases. Endocrine dysfunctions, including thyroid dysfunction, are one of the related factors to female reproductive disturbances. The aim of the thesis was to explore the importance of thyroid function and endometrial factors for implantation and pregnancy. Three groups of pregnant women, one group with high risk (n = 88) was compared to a low-risk (n = 511) and a general screening group (n = 699) to study the incidence of subclinical hypothyroidism and hypothyroidism, defined as TSH < 2.5 mIU/L. Women with recurrent pregnancy loss, (n = 165), and controls, (n = 289), were included in genetic analysis and gene expression array of endometrium, (n = 4 and n = 5 respectively). Infertile women (n = 19) and fertile women were included to study thyroid-related proteins in endometrium (n = 28) and Fallopian tube (n = 13). Human embryos, (n= 36), were used to study the effect of thyroid hormone on embryo development. Thyroid stimulating hormone (TSH), free thyroid hormone (fT4) and TPO antibodies (TPO-Ab) levels were analyzed by use of immunological methods. Genetic variations in the HABP2 gene was performed by use of TaqMan SNP Genotyping Assays. Gene expression array was used to study mRNA in endometrium of women with recurrent miscarriage at the time of implantation. Immunohistochemistry was used to analyze the presence and distribution of thyroid related proteins in endometrium. Additionally, influence of thyroid hormone (T4) on the early embryo development was analyzed. Approximately 10 % of all pregnant women, regardless of risk, had elevated TSH levels. Furthermore, hypothyroid women on levothyroxine supplementation had in almost 50 % of cases inadequate treatment. There were no significant differences in the presence of polymorphism in HABP2 genes in

Unexplained infertility, one of the common gynecological disorders, affecting 10 to 15 % of women worldwide. Recurrent pregnancy loss affects approximately 1 to 3 % of pregnant women with an unknown etiology in 50 % of cases. Endocrine dysfunctions, including thyroid dysfunction, are one of the related factors to female reproductive disturbances. The aim of the thesis was to explore the importance of thyroid function and endometrial factors for implantation and pregnancy. Three groups of pregnant women, one group with high risk (n = 88) was compared to a low-risk (n = 511) and a general screening group (n = 699) to study the incidence of subclinical hypothyroidism and hypothyroidism, defined as TSH < 2.5 mIU/L. Women with recurrent pregnancy loss, (n = 165), and controls, (n = 289), were included in genetic analysis and gene expression array of endometrium, (n = 4 and n = 5 respectively). Infertile women (n = 19) and fertile women were included to study thyroid-related proteins in endometrium (n = 28) and Fallopian tube (n = 13). Human embryos, (n= 36), were used to study the effect of thyroid hormone on embryo development. Thyroid stimulating hormone (TSH), free thyroid hormone (fT4) and TPO antibodies (TPO-Ab) levels were analyzed by use of immunological methods. Genetic variations in the HABP2 gene was performed by use of TaqMan SNP Genotyping Assays. Gene expression array was used to study mRNA in endometrium of women with recurrent miscarriage at the time of implantation. Immunohistochemistry was used to analyze the presence and distribution of thyroid related proteins in endometrium. Additionally, influence of thyroid hormone (T4) on the early embryo development was analyzed. Approximately 10 % of all pregnant women, regardless of risk, had elevated TSH levels. Furthermore, hypothyroid women on levothyroxine supplementation had in almost 50 % of cases inadequate treatment. There were no significant differences in the presence of polymorphism in HABP2 genes in

Unexplained infertility, one of the common gynecological disorders, affecting 10 to 15 % of women worldwide. Recurrent pregnancy loss affects approximately 1 to 3 % of pregnant women with an unknown etiology in 50 % of cases. Endocrine dysfunctions, including thyroid dysfunction, are one of the related factors to female reproductive disturbances. The aim of the thesis was to explore the importance of thyroid function and endometrial factors for implantation and pregnancy. Three groups of pregnant women, one group with high risk (n = 88) was compared to a low-risk (n = 511) and a general screening group (n = 699) to study the incidence of subclinical hypothyroidism and hypothyroidism, defined as TSH < 2.5 mIU/L. Women with recurrent pregnancy loss, (n = 165), and controls, (n = 289), were included in genetic analysis and gene expression array of endometrium, (n = 4 and n = 5 respectively). Infertile women (n = 19) and fertile women were included to study thyroid-related proteins in endometrium (n = 28) and Fallopian tube (n = 13). Human embryos, (n= 36), were used to study the effect of thyroid hormone on embryo development. Thyroid stimulating hormone (TSH), free thyroid hormone (fT4) and TPO antibodies (TPO-Ab) levels were analyzed by use of immunological methods. Genetic variations in the HABP2 gene was performed by use of TaqMan SNP Genotyping Assays. Gene expression array was used to study mRNA in endometrium of women with recurrent miscarriage at the time of implantation. Immunohistochemistry was used to analyze the presence and distribution of thyroid related proteins in endometrium. Additionally, influence of thyroid hormone (T4) on the early embryo development was analyzed. Approximately 10 % of all pregnant women, regardless of risk, had elevated TSH levels. Furthermore, hypothyroid women on levothyroxine supplementation had in almost 50 % of cases inadequate treatment. There were no significant differences in the presence of polymorphism in HABP2 genes in

Unexplained infertility, one of the common gynecological disorders, affecting 10 to 15 % of women worldwide. Recurrent pregnancy loss affects approximately 1 to 3 % of pregnant women with an unknown etiology in 50 % of cases. Endocrine dysfunctions, including thyroid dysfunction, are one of the related factors to female reproductive disturbances. The aim of the thesis was to explore the importance of thyroid function and endometrial factors for implantation and pregnancy. Three groups of pregnant women, one group with high risk (n = 88) was compared to a low-risk (n = 511) and a general screening group (n = 699) to study the incidence of subclinical hypothyroidism and hypothyroidism, defined as TSH < 2.5 mIU/L. Women with recurrent pregnancy loss, (n = 165), and controls, (n = 289), were included in genetic analysis and gene expression array of endometrium, (n = 4 and n = 5 respectively). Infertile women (n = 19) and fertile women were included to study thyroid-related proteins in endometrium (n = 28) and Fallopian tube (n = 13). Human embryos, (n= 36), were used to study the effect of thyroid hormone on embryo development. Thyroid stimulating hormone (TSH), free thyroid hormone (fT4) and TPO antibodies (TPO-Ab) levels were analyzed by use of immunological methods. Genetic variations in the HABP2 gene was performed by use of TaqMan SNP Genotyping Assays. Gene expression array was used to study mRNA in endometrium of women with recurrent miscarriage at the time of implantation. Immunohistochemistry was used to analyze the presence and distribution of thyroid related proteins in endometrium. Additionally, influence of thyroid hormone (T4) on the early embryo development was analyzed. Approximately 10 % of all pregnant women, regardless of risk, had elevated TSH levels. Furthermore, hypothyroid women on levothyroxine supplementation had in almost 50 % of cases inadequate treatment. There were no significant differences in the presence of polymorphism in HABP2 genes in

Unexplained infertility, one of the common gynecological disorders, affecting 10 to 15 % of women worldwide. Recurrent pregnancy loss affects approximately 1 to 3 % of pregnant women with an unknown etiology in 50 % of cases. Endocrine dysfunctions, including thyroid dysfunction, are one of the related factors to female reproductive disturbances. The aim of the thesis was to explore the importance of thyroid function and endometrial factors for implantation and pregnancy. Three groups of pregnant women, one group with high risk (n = 88) was compared to a low-risk (n = 511) and a general screening group (n = 699) to study the incidence of subclinical hypothyroidism and hypothyroidism, defined as TSH < 2.5 mIU/L. Women with recurrent pregnancy loss, (n = 165), and controls, (n = 289), were included in genetic analysis and gene expression array of endometrium, (n = 4 and n = 5 respectively). Infertile women (n = 19) and fertile women were included to study thyroid-related proteins in endometrium (n = 28) and Fallopian tube (n = 13). Human embryos, (n= 36), were used to study the effect of thyroid hormone on embryo development. Thyroid stimulating hormone (TSH), free thyroid hormone (fT4) and TPO antibodies (TPO-Ab) levels were analyzed by use of immunological methods. Genetic variations in the HABP2 gene was performed by use of TaqMan SNP Genotyping Assays. Gene expression array was used to study mRNA in endometrium of women with recurrent miscarriage at the time of implantation. Immunohistochemistry was used to analyze the presence and distribution of thyroid related proteins in endometrium. Additionally, influence of thyroid hormone (T4) on the early embryo development was analyzed. Approximately 10 % of all pregnant women, regardless of risk, had elevated TSH levels. Furthermore, hypothyroid women on levothyroxine supplementation had in almost 50 % of cases inadequate treatment. There were no significant differences in the presence of polymorphism in HABP2 genes in

Racism is a worldwide matter that is based on the physical characteristics of people's division into different categories on which some people become superior and some inferior. Racism and ethnicity are usually considered as the same concepts while in fact ethnicity is a sub-class of racism. In every nation, there are some ethnic groups with the same origin and similar customs that may or may not be judged equally by the power-handler ethnic groups. An example of such country is Afghanistan which is severely an ethnic country. This study explores the social, cultural, and scientific investigations done on the people's races and ethnical characteristics by using Afghan types as examples. Racism is not the result of scientific observation, but it is due to the human differences that happened between 16th and 19th century when people began differentiating among themselves. This aspect of racism is well expressed by the American sociologist "Feagin". In his view, the natural superiority of some people over others is rejected. The novel The Kite Runner depicts the two major Afghan ethnical populations, Pashtun and Hazara, and their social, cultural, and religious conflicts. Accordingly, this article will try to examine the root of ethnic prejudices and oppression among the Afghan people in the novel and the reasons for their ethnic conducts are explained and analyzed based on the Feagin's denial of human difference. Moreover, by providing some evidence it is proved that the biological difference is just some excuses for the powerful section to gain their egotistic goals.

Rapid expansion of knowledge and new technology have had an effect on national development. Development is influenced by factors such as culture, economy, and education. Libraries are important indicators of growth and development. They provide scientific services, fulfill social needs, and help individuals flourish. Librarians and library and information science (LIS) programs must recognize the need to change in order to strengthen development. This study discusses changing LIS curricula and the necessity of curricular changes in this field in Iran as a key factor in national development. The study provides some guidelines for these objectives.

Background and Purpose—Magnetic resonance imaging (MRI)–defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. Methods—One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. Results—Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64–16.34; P=0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1–16.8; P=0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without (P<0.002). MRIPH increased cumulative risk difference of future infarction by 47.1% at 3 years in those with intermediate carotid artery risk score (P=0.004). Conclusions—The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification.

Purpose: To investigate associations between neuroimaging markers of cerebrovascular disease, including lesion topography and extent and severity of strategic and global cerebral tissue injury, and cognition in carotid artery disease (CAD). Materials and Methods: All participants gave written informed consent to undergo brain magnetic resonance imaging and the Addenbrooke’s Cognitive Examination–Revised. One hundred eight patients with symptomatic CAD but no dementia were included, and a score less than 82 represented cognitive impairment. Group comparison and interrelations between global cognitive and fluency performance, lesion topography, and ultrastructural damage were assessed with voxel-based statistics. Associations between cognition, medial temporal lobe atrophy (MTA), lesion volumes, and global white matter ultrastructural damage indexed as increased mean diffusivity were tested with regression analysis by controlling for age. Diagnostic accuracy of imaging markers selected from a multivariate prediction model was tested with receiver operating characteristic analysis. Results: Cognitively impaired patients (n = 53 [49.1%], classified as having probable vascular cognitive disorder) were older than nonimpaired patients (P = .027) and had more frequent MTA (P<.001), more cortical infarctions (P = .016), and larger volumes of acute (P = .028) and chronic (P = .009) subcortical ischemic lesions. Lesion volumes did not correlate with global cognitive performance (lacunar infarctions, P = .060; acute lesions, P = .088; chronic subcortical ischemic lesions, P = .085). In contrast, cognitive performance correlated with presence of chronic ischemic lesions within the interhemispheric tracts and thalamic radiation (P< .05, false discovery rate corrected). Skeleton mean diffusivity showed the closest correlation with cognition (R2 = 0.311, P< .001) and promising diagnostic accuracy for vascular cognitive disorder (area under the curve, 0.82 [95% confidence interval

Background and Purpose—Magnetic resonance imaging (MRI)–defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. Methods—One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. Results—Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64–16.34; P=0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1–16.8; P=0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without (P<0.002). MRIPH increased cumulative risk difference of future infarction by 47.1% at 3 years in those with intermediate carotid artery risk score (P=0.004). Conclusions—The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification.

Purpose: To investigate associations between neuroimaging markers of cerebrovascular disease, including lesion topography and extent and severity of strategic and global cerebral tissue injury, and cognition in carotid artery disease (CAD). Materials and Methods: All participants gave written informed consent to undergo brain magnetic resonance imaging and the Addenbrooke’s Cognitive Examination–Revised. One hundred eight patients with symptomatic CAD but no dementia were included, and a score less than 82 represented cognitive impairment. Group comparison and interrelations between global cognitive and fluency performance, lesion topography, and ultrastructural damage were assessed with voxel-based statistics. Associations between cognition, medial temporal lobe atrophy (MTA), lesion volumes, and global white matter ultrastructural damage indexed as increased mean diffusivity were tested with regression analysis by controlling for age. Diagnostic accuracy of imaging markers selected from a multivariate prediction model was tested with receiver operating characteristic analysis. Results: Cognitively impaired patients (n = 53 [49.1%], classified as having probable vascular cognitive disorder) were older than nonimpaired patients (P = .027) and had more frequent MTA (P<.001), more cortical infarctions (P = .016), and larger volumes of acute (P = .028) and chronic (P = .009) subcortical ischemic lesions. Lesion volumes did not correlate with global cognitive performance (lacunar infarctions, P = .060; acute lesions, P = .088; chronic subcortical ischemic lesions, P = .085). In contrast, cognitive performance correlated with presence of chronic ischemic lesions within the interhemispheric tracts and thalamic radiation (P< .05, false discovery rate corrected). Skeleton mean diffusivity showed the closest correlation with cognition (R2 = 0.311, P< .001) and promising diagnostic accuracy for vascular cognitive disorder (area under the curve, 0.82 [95% confidence interval

Objective There is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis. Methods One hundred seventy-nine symptomatic patients with ≥50% stenosis were prospectively recruited, underwent carotid MRI, and were clinically followed up until CEA, death, or ischemic event. MRIPH was diagnosed if the plaque signal intensity was >150% that of the adjacent muscle. Event-free survival analysis was done using Kaplan–Meier plots and Cox regression models controlling for known vascular risk factors. We also undertook a meta-analysis of reported data on MRIPH and recurrent events. Results One hundred fourteen patients (63.7%) showed MRIPH, suffering 92% (57 of 62) of all recurrent ipsilateral events and all but 1 (25 of 26) future strokes. Patients without MRIPH had an estimated annual absolute stroke risk of only 0.6%. Cox multivariate regression analysis proved MRIPH as a strong predictor of recurrent ischemic events (hazard ratio [HR] = 12.0, 95% confidence interval [CI] = 4.8–30.1, p < 0.001) and stroke alone (HR = 35.0, 95% CI = 4.7–261.6, p = 0.001). Meta-analysis of published data confirmed this association between MRIPH and recurrent cerebral ischemic events in symptomatic carotid artery stenosis (odds ratio = 12.2, 95% CI = 5.5–27.1, p < 0.00001). Interpretation MRIPH independently and strongly predicts recurrent ipsilateral ischemic events, and stroke alone, in symptomatic ≥50% carotid artery stenosis. The very low stroke risk in patients without MRIPH puts into question current risk–benefit assessment for CEA in this subgroup.

Objective There is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis. Methods One hundred seventy-nine symptomatic patients with ≥50% stenosis were prospectively recruited, underwent carotid MRI, and were clinically followed up until CEA, death, or ischemic event. MRIPH was diagnosed if the plaque signal intensity was >150% that of the adjacent muscle. Event-free survival analysis was done using Kaplan–Meier plots and Cox regression models controlling for known vascular risk factors. We also undertook a meta-analysis of reported data on MRIPH and recurrent events. Results One hundred fourteen patients (63.7%) showed MRIPH, suffering 92% (57 of 62) of all recurrent ipsilateral events and all but 1 (25 of 26) future strokes. Patients without MRIPH had an estimated annual absolute stroke risk of only 0.6%. Cox multivariate regression analysis proved MRIPH as a strong predictor of recurrent ischemic events (hazard ratio [HR] = 12.0, 95% confidence interval [CI] = 4.8–30.1, p < 0.001) and stroke alone (HR = 35.0, 95% CI = 4.7–261.6, p = 0.001). Meta-analysis of published data confirmed this association between MRIPH and recurrent cerebral ischemic events in symptomatic carotid artery stenosis (odds ratio = 12.2, 95% CI = 5.5–27.1, p < 0.00001). Interpretation MRIPH independently and strongly predicts recurrent ipsilateral ischemic events, and stroke alone, in symptomatic ≥50% carotid artery stenosis. The very low stroke risk in patients without MRIPH puts into question current risk–benefit assessment for CEA in this subgroup.

Background and Purpose—Magnetic resonance imaging (MRI)–defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. Methods—One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. Results—Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64–16.34; P=0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1–16.8; P=0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without (P<0.002). MRIPH increased cumulative risk difference of future infarction by 47.1% at 3 years in those with intermediate carotid artery risk score (P=0.004). Conclusions—The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification.

Purpose: To investigate associations between neuroimaging markers of cerebrovascular disease, including lesion topography and extent and severity of strategic and global cerebral tissue injury, and cognition in carotid artery disease (CAD). Materials and Methods: All participants gave written informed consent to undergo brain magnetic resonance imaging and the Addenbrooke’s Cognitive Examination–Revised. One hundred eight patients with symptomatic CAD but no dementia were included, and a score less than 82 represented cognitive impairment. Group comparison and interrelations between global cognitive and fluency performance, lesion topography, and ultrastructural damage were assessed with voxel-based statistics. Associations between cognition, medial temporal lobe atrophy (MTA), lesion volumes, and global white matter ultrastructural damage indexed as increased mean diffusivity were tested with regression analysis by controlling for age. Diagnostic accuracy of imaging markers selected from a multivariate prediction model was tested with receiver operating characteristic analysis. Results: Cognitively impaired patients (n = 53 [49.1%], classified as having probable vascular cognitive disorder) were older than nonimpaired patients (P = .027) and had more frequent MTA (P<.001), more cortical infarctions (P = .016), and larger volumes of acute (P = .028) and chronic (P = .009) subcortical ischemic lesions. Lesion volumes did not correlate with global cognitive performance (lacunar infarctions, P = .060; acute lesions, P = .088; chronic subcortical ischemic lesions, P = .085). In contrast, cognitive performance correlated with presence of chronic ischemic lesions within the interhemispheric tracts and thalamic radiation (P< .05, false discovery rate corrected). Skeleton mean diffusivity showed the closest correlation with cognition (R2 = 0.311, P< .001) and promising diagnostic accuracy for vascular cognitive disorder (area under the curve, 0.82 [95% confidence interval

Objective There is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis. Methods One hundred seventy-nine symptomatic patients with ≥50% stenosis were prospectively recruited, underwent carotid MRI, and were clinically followed up until CEA, death, or ischemic event. MRIPH was diagnosed if the plaque signal intensity was >150% that of the adjacent muscle. Event-free survival analysis was done using Kaplan–Meier plots and Cox regression models controlling for known vascular risk factors. We also undertook a meta-analysis of reported data on MRIPH and recurrent events. Results One hundred fourteen patients (63.7%) showed MRIPH, suffering 92% (57 of 62) of all recurrent ipsilateral events and all but 1 (25 of 26) future strokes. Patients without MRIPH had an estimated annual absolute stroke risk of only 0.6%. Cox multivariate regression analysis proved MRIPH as a strong predictor of recurrent ischemic events (hazard ratio [HR] = 12.0, 95% confidence interval [CI] = 4.8–30.1, p < 0.001) and stroke alone (HR = 35.0, 95% CI = 4.7–261.6, p = 0.001). Meta-analysis of published data confirmed this association between MRIPH and recurrent cerebral ischemic events in symptomatic carotid artery stenosis (odds ratio = 12.2, 95% CI = 5.5–27.1, p < 0.00001). Interpretation MRIPH independently and strongly predicts recurrent ipsilateral ischemic events, and stroke alone, in symptomatic ≥50% carotid artery stenosis. The very low stroke risk in patients without MRIPH puts into question current risk–benefit assessment for CEA in this subgroup.

Background and Purpose—Magnetic resonance imaging (MRI)–defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. Methods—One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. Results—Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64–16.34; P=0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1–16.8; P=0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without (P<0.002). MRIPH increased cumulative risk difference of future infarction by 47.1% at 3 years in those with intermediate carotid artery risk score (P=0.004). Conclusions—The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification.

Purpose: To investigate associations between neuroimaging markers of cerebrovascular disease, including lesion topography and extent and severity of strategic and global cerebral tissue injury, and cognition in carotid artery disease (CAD). Materials and Methods: All participants gave written informed consent to undergo brain magnetic resonance imaging and the Addenbrooke’s Cognitive Examination–Revised. One hundred eight patients with symptomatic CAD but no dementia were included, and a score less than 82 represented cognitive impairment. Group comparison and interrelations between global cognitive and fluency performance, lesion topography, and ultrastructural damage were assessed with voxel-based statistics. Associations between cognition, medial temporal lobe atrophy (MTA), lesion volumes, and global white matter ultrastructural damage indexed as increased mean diffusivity were tested with regression analysis by controlling for age. Diagnostic accuracy of imaging markers selected from a multivariate prediction model was tested with receiver operating characteristic analysis. Results: Cognitively impaired patients (n = 53 [49.1%], classified as having probable vascular cognitive disorder) were older than nonimpaired patients (P = .027) and had more frequent MTA (P<.001), more cortical infarctions (P = .016), and larger volumes of acute (P = .028) and chronic (P = .009) subcortical ischemic lesions. Lesion volumes did not correlate with global cognitive performance (lacunar infarctions, P = .060; acute lesions, P = .088; chronic subcortical ischemic lesions, P = .085). In contrast, cognitive performance correlated with presence of chronic ischemic lesions within the interhemispheric tracts and thalamic radiation (P< .05, false discovery rate corrected). Skeleton mean diffusivity showed the closest correlation with cognition (R2 = 0.311, P< .001) and promising diagnostic accuracy for vascular cognitive disorder (area under the curve, 0.82 [95% confidence interval

Objective There is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis. Methods One hundred seventy-nine symptomatic patients with ≥50% stenosis were prospectively recruited, underwent carotid MRI, and were clinically followed up until CEA, death, or ischemic event. MRIPH was diagnosed if the plaque signal intensity was >150% that of the adjacent muscle. Event-free survival analysis was done using Kaplan–Meier plots and Cox regression models controlling for known vascular risk factors. We also undertook a meta-analysis of reported data on MRIPH and recurrent events. Results One hundred fourteen patients (63.7%) showed MRIPH, suffering 92% (57 of 62) of all recurrent ipsilateral events and all but 1 (25 of 26) future strokes. Patients without MRIPH had an estimated annual absolute stroke risk of only 0.6%. Cox multivariate regression analysis proved MRIPH as a strong predictor of recurrent ischemic events (hazard ratio [HR] = 12.0, 95% confidence interval [CI] = 4.8–30.1, p < 0.001) and stroke alone (HR = 35.0, 95% CI = 4.7–261.6, p = 0.001). Meta-analysis of published data confirmed this association between MRIPH and recurrent cerebral ischemic events in symptomatic carotid artery stenosis (odds ratio = 12.2, 95% CI = 5.5–27.1, p < 0.00001). Interpretation MRIPH independently and strongly predicts recurrent ipsilateral ischemic events, and stroke alone, in symptomatic ≥50% carotid artery stenosis. The very low stroke risk in patients without MRIPH puts into question current risk–benefit assessment for CEA in this subgroup.

Background and Purpose—Magnetic resonance imaging (MRI)–defined carotid plaque hemorrhage (MRIPH) can predict recurrent cerebrovascular ischemic events in severe symptomatic carotid stenosis. It is less clear whether MRIPH can improve risk stratification despite optimized medical secondary prevention in those with moderate risk. Methods—One-hundred fifty-one symptomatic patients with 30% to 99% carotid artery stenosis (median age: 77, 60.5% men) clinically deemed to not benefit from endarterectomy were prospectively recruited to undergo MRI and clinical follow-up (mean, 22 months). The clinical carotid artery risk score could be evaluated in 88 patients. MRIPH+ve was defined as plaque intensity >150% that of adjacent muscle. Survival analyses were performed with recurrent infarction (stroke or diffusion-positive cerebral ischemia) as the main end point. Results—Fifty-five participants showed MRIPH+ve; 47 had low, 36 intermediate, and 5 high carotid artery risk scores. Cox regression showed MRIPH as a strong predictor of future infarction (hazard ratio, 5.2; 95% confidence interval, 1.64–16.34; P=0.005, corrected for degree of stenosis), also in the subgroup with 50% to 69% stenosis (hazard ratio, 4.1; 95% confidence interval, 1–16.8; P=0.049). The absolute risk of future infarction was 31.7% at 3 years in MRIPH+ve versus 1.8% in patients without (P<0.002). MRIPH increased cumulative risk difference of future infarction by 47.1% at 3 years in those with intermediate carotid artery risk score (P=0.004). Conclusions—The study confirms MRIPH to be a powerful risk marker in symptomatic carotid stenosis with added value over current risk scores. For patients undergoing current secondary prevention medication with clinically uncertain benefit from recanalization, that is, those with moderate degree stenosis and intermediate carotid artery risk scores, MRIPH offers additional risk stratification.

Purpose: To investigate associations between neuroimaging markers of cerebrovascular disease, including lesion topography and extent and severity of strategic and global cerebral tissue injury, and cognition in carotid artery disease (CAD). Materials and Methods: All participants gave written informed consent to undergo brain magnetic resonance imaging and the Addenbrooke’s Cognitive Examination–Revised. One hundred eight patients with symptomatic CAD but no dementia were included, and a score less than 82 represented cognitive impairment. Group comparison and interrelations between global cognitive and fluency performance, lesion topography, and ultrastructural damage were assessed with voxel-based statistics. Associations between cognition, medial temporal lobe atrophy (MTA), lesion volumes, and global white matter ultrastructural damage indexed as increased mean diffusivity were tested with regression analysis by controlling for age. Diagnostic accuracy of imaging markers selected from a multivariate prediction model was tested with receiver operating characteristic analysis. Results: Cognitively impaired patients (n = 53 [49.1%], classified as having probable vascular cognitive disorder) were older than nonimpaired patients (P = .027) and had more frequent MTA (P<.001), more cortical infarctions (P = .016), and larger volumes of acute (P = .028) and chronic (P = .009) subcortical ischemic lesions. Lesion volumes did not correlate with global cognitive performance (lacunar infarctions, P = .060; acute lesions, P = .088; chronic subcortical ischemic lesions, P = .085). In contrast, cognitive performance correlated with presence of chronic ischemic lesions within the interhemispheric tracts and thalamic radiation (P< .05, false discovery rate corrected). Skeleton mean diffusivity showed the closest correlation with cognition (R2 = 0.311, P< .001) and promising diagnostic accuracy for vascular cognitive disorder (area under the curve, 0.82 [95% confidence interval

Objective There is a recognized need to improve selection of patients with carotid artery stenosis for carotid endarterectomy (CEA). We assessed the value of magnetic resonance imaging (MRI)-defined carotid plaque hemorrhage (MRIPH) to predict recurrent ipsilateral cerebral ischemic events, and stroke in symptomatic carotid stenosis. Methods One hundred seventy-nine symptomatic patients with ≥50% stenosis were prospectively recruited, underwent carotid MRI, and were clinically followed up until CEA, death, or ischemic event. MRIPH was diagnosed if the plaque signal intensity was >150% that of the adjacent muscle. Event-free survival analysis was done using Kaplan–Meier plots and Cox regression models controlling for known vascular risk factors. We also undertook a meta-analysis of reported data on MRIPH and recurrent events. Results One hundred fourteen patients (63.7%) showed MRIPH, suffering 92% (57 of 62) of all recurrent ipsilateral events and all but 1 (25 of 26) future strokes. Patients without MRIPH had an estimated annual absolute stroke risk of only 0.6%. Cox multivariate regression analysis proved MRIPH as a strong predictor of recurrent ischemic events (hazard ratio [HR] = 12.0, 95% confidence interval [CI] = 4.8–30.1, p < 0.001) and stroke alone (HR = 35.0, 95% CI = 4.7–261.6, p = 0.001). Meta-analysis of published data confirmed this association between MRIPH and recurrent cerebral ischemic events in symptomatic carotid artery stenosis (odds ratio = 12.2, 95% CI = 5.5–27.1, p < 0.00001). Interpretation MRIPH independently and strongly predicts recurrent ipsilateral ischemic events, and stroke alone, in symptomatic ≥50% carotid artery stenosis. The very low stroke risk in patients without MRIPH puts into question current risk–benefit assessment for CEA in this subgroup.