bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Versus Benefit of Combined Aspirin and Warfarin Therapy in Patients With Atrial Fibrillation
Authors: Nagaraj Tara A , Snider Melissa J. , Davidson Erica , Weiss Raul , Li Junan , Afzal Muhammad 
Published: April 2020

Purpose: Guidelines have differing recommendations for aspirin use in patients with an indication for anticoagulation. The purpose of this study was to evaluate the incidence of major bleeding and thromboembolic events (TEs) in patients with atrial fibrillation (AF) receiving warfarin alone (monotherapy group) versus warfarin plus aspirin (combination therapy group). Methods: This was a retrospective, cohort study including patients from a pharmacist-run anticoagulation clinic. Inclusion criteria were patients with AF receiving anticoagulation between January 2013 and January 2014 observed over 5 years. Results: One hundred forty-two patients were included in the combination group versus 89 in monotherapy group. In the combination group, 60 (42.3%) patients were on aspirin for no apparent indication, 19 (13.4%) had stable coronary artery disease and diabetes, and 26 (18.3%) had diabetes alone. Major bleeding occurred in 21 (14.9%) patients in the combination group versus 7 (7.9%) patients in the monotherapy group (odds ratio [OR] = 2.02, 95% confidence interval [CI]: 0.78-5.91; P = .17). TE occurred in 10 (7%) patients in the combination group versus 4 (4.5%) in the monotherapy group (OR = 1.61, 95% CI: 0.44-7.24; P = .57). There was no significant difference in bleeding ( P = .85) or TE ( P = .37) rates between aspirin indications in the combination group. Conclusion: Combination therapy versus monotherapy may increase bleeding risk with little benefit in decreasing AF-related stroke or cardiovascular events.
Impact of diabetes as a risk factor in patients undergoing subcutaneous implantable cardioverter defibrillator implantation: A single-centre study
Authors: Kaya Elif , Siebermair Johannes , Vonderlin Nadine , Hadjamu Nino , Azizy Obayda , Rassaf Tienush , Wakili Reza 
Published: April 2020

Introduction: Patients with diabetes mellitus are known to carry an increased risk for surgical site infections and perioperative complications. The subcutaneous implantable cardioverter defibrillator is an established treatment option in patients at risk for sudden cardiac death especially with an increased risk for infection over time. Methods and Results: Forty-eight patients (mean age = 55.0 ± 21.3 years, 31.3% patients with diabetes mellitus, 75% male) who underwent consecutive subcutaneous implantable cardioverter defibrillator surgery between February 2016 and May 2019 were retrospectively analysed. Overall adverse events including relevant bleeding complications, any surgical wound problems and infections requiring reoperation or device malfunction were evaluated as primary combined safety endpoint. Patients with diabetes mellitus tended to be older with a higher body mass index compared to non-diabetes mellitus. Procedure duration and postsurgery hospital days were not different in diabetes mellitus versus non-diabetes mellitus patients. Analysis of the primary combined endpoint showed no significant difference but a trend towards higher event rates in the diabetes mellitus group (diabetes mellitus vs non-diabetes mellitus: 20% vs 12.1%, p = 0.119). Conclusion: Diabetes mellitus is a frequent and relevant variable in patients undergoing subcutaneous implantable cardioverter defibrillator implantation represented by 31.3% in this consecutive cohort. Our results suggest that diabetes mellitus is not associated with a prolonged hospital stay or increased rate of periprocedural adverse events.
Pregnancy complications in women of Russian, Somali, and Kurdish origin and women in the general population in Finland
Authors: Bastola Kalpana , Koponen Päivikki , Härkänen Tommi , Luoto Riitta , Gissler Mika , Kinnunen Tarja I 
Published: April 2020

Objective: We compared the prevalence of gestational diabetes and hypertensive disorders in the most recent pregnancy among women of Russian, Somali, and Kurdish origin and women in the general population in Finland. Methods: The study groups were selected from population-based samples of 18- to 64-year-old women. The women were of Russian (n = 318), Somali (n = 583), and Kurdish (n = 373) origin or from the general population (n = 243), and had given birth in Finland between 2004 and 2014. The data were obtained from the National Medical Birth Register and the Hospital Discharge Register. Data on gestational diabetes and hypertensive disorders were extracted based on relevant International Classification of Diseases, Tenth Revision codes. The main statistical methods were logistic regression analyses adjusted for age, parity, body mass index, socioeconomic status, and smoking. Results: The prevalence of gestational diabetes was 19.1% in Kurdish, 14.4% in Somali, 9.3% in Russian, and 11.8% in the general population. The prevalence of hypertensive disorders was 5.4% in the general population, 3.8% in Somali, 3.1% in Kurdish, and 1.7% in Russian. When adjusted for confounders, Kurdish women had two-fold odds for gestational diabetes (odds ratio = 1.98; 95% confidence interval = 1.20–3.32) compared with the general population, but the odds for hypertensive disorders did not differ between groups. Conclusion: Women of Kurdish origin were more likely to develop gestational diabetes. Studies with larger samples are required to confirm these findings to develop prevention strategies for later development of type 2 diabetes. Future research including other migrant groups is recommended to identify differences in pregnancy complications among the women in migrant and general population.
Handheld ultrasound in training – The future is getting smaller!
Authors: Wilkinson Jonathan N , Saxhaug Lars Mølgaard 
Published: April 2020

Traditional ultrasound teaching is normally delivered using large, costly and often quite advanced cart-based systems. These carts are often large systems on wheels, usually limited to the departments that own them i.e. clinics, wards or radiology. Portability has been further improved by the development of laptop style systems, which are easier to wheel in-between patients/departments. In our experience and anecdotally, many of these systems can be intimidating to the novice and can lead to early attrition or poor uptake of ultrasound into clinical practice. Carts can also restrict the amount of training deliverable to practitioners, as they are limited in number due to cost and can take quite some time to boot up, reducing convenience. This dogma is being progressively changed with the advent of smaller handheld devices, some clearly within the financial grasps of most practitioners, and even to the point of medical schools offering students their own personal device.1,2 This relative inexpensiveness can lead to the purchase of these devices for novelty and convenience, over need. Obvious caution is needed in these circumstances, but with increased ease of purchase, better availability and inbuilt simplicity, ultrasound learning can be seamlessly integrated into day-to-day practice. This review discusses how one of the most disruptive innovations in modern medicine is changing ultrasound from a classic imaging modality to become integrated as the fifth pillar of clinical examination, and how these new devices can serve as springboards to more advanced ultrasound training. In fact, within what has become a bigger area of clinical examination, things are getting smaller.
Usefulness of the advanced monoenergetic image reconstruction in dual-energy computed tomography for detecting the perforator vein of lower extremity varix
Authors: Matsumae Hidekazu , Nakagawa Motoo , Ozawa Yoshiyuki , Asano Miki , Shimohira Masashi , Shibamoto Yuta 
Published: April 2020

Background Identification of the perforator vein is important for treating lower extremity varix. Purpose We evaluated the ability of 40-keV advanced monoenergetic images to depict the perforator vein in patients with lower extremity varix. Material and Methods Thirty-three patients aged 52–86 years were examined with contrast-enhanced dual-energy computed tomography (CT) and advanced virtual monoenergetic images (40 keV) were reconstructed. For evaluating enhancement of a lower extremity vein and the difference in CT number between the vein and muscle, we set the region of interest on the popliteal vein (PV). We also evaluated the ability of 100-kVp and 40-keV volume-rendering (VR) images to depict the perforator veins. Results The mean CT numbers of the PV at 100 kVp and 40 keV were 113 ± 16 and 321 ± 63 HU, respectively ( P < 0.01). In 40-keV transverse images of 33 patients, 84 of the perforator veins were detected. In those 84 veins, 70 (83%) were depicted and 14 (17%) were not depicted on VR images that were reconstructed from 40-keV transverse images. At 100 kVp, 10 (12%) of the perforator veins could be depicted in VR images because the muscles buried them or the PVs were blurred due to insufficient enhancement. Conclusion The advanced monoenergetic reconstruction technique is useful for evaluating the perforator vein in patients with lower extremity varix.
A National Survey: Current Clinical Practice in Pediatric Anesthesia for Congenital Heart Surgery
Authors: Baehner Torsten , Kiefer Nicholas , Ghamari Shahab , Graeff Ingo , Huett Christopher , Pflugradt Stefan , Sendzik Bjoern , Heinze Ingo , Mueller Matthias , Schindler Ehrenfried , Duerr Georg Daniel , Ellerkmann Richard , Velten Markus 
Published: April 2020

Background: Providing anesthesia for pediatric patients undergoing congenital cardiac surgery is complex and requires profound knowledge and clinical experience. Prospective studies on best anesthetic management are missing, partially due to different standards. The aim of the present study was to survey the current standard practice in anesthetic management in pediatric cardiac surgical centers in Germany. Methods: All 78 cardiac surgical centers in Germany were reviewed for a congenital cardiac surgery program. Centers with an active program for congenital cardiac surgery were interviewed to participate in the present online questionnaire to assess their current anesthetic practice. Results: Twenty-seven German centers running an active program for congenital heart surgery were identified, covering more than 3,000 pediatric cardiac surgeries annually. Of these centers, 96.3% (26/27) participated in our survey. Standard induction agents were etomidate in 26.9% (7/26), propofol in 19.2% (5/26), a combination of benzodiazepines and ketamine in 19.2% (5/26), and barbiturates in 11.5% (3/26). General anesthesia was preferentially maintained using volatile agents, 61.5% (16/26), with sevoflurane being the most common volatile agent within this group, 81.2% (13/16). Intraoperative first-choice/first-line inotropic drug was epinephrine, 53.8% (14/26), followed by milrinone, 23.1% (6/26), and dobutamine 15.4% (4/26). Fast-track programs performing on-table extubation depending on the type of surgical procedure were established at 61.5% (16/26) of the centers. Conclusion: This study highlights the diversity of clinical standards in pediatric cardiac anesthesia for congenital cardiac surgery in Germany.
Utility of CT Angiography for the Prediction of Coronary Artery Compression in Patients Undergoing Transcatheter Pulmonary Valve Replacement
Authors: Rinaldi Elizabeth , Sadeghi Soraya , Rajpal Saurabh , Boe Brian A. , Daniels Curt , Cheatham John , Sinha Sanjay , Levi Daniel S. , Aboulhosn Jamil 
Published: April 2020

Objectives: We aimed to evaluate the utility of computed tomography angiography (CTA) for coronary compression (CC) prediction in patients with congenital heart disease undergoing balloon-expandable transcatheter pulmonary valve replacement (TPVR). Background: Coronary compression is a serious complication of TPVR, but the value of preprocedural CTAs to assess CC risk is largely unexplored. Methods: In all, 586 patients underwent TPVR between January 2009 and July 2018. Adults with a pre-TPVR CTA and children with a CTA performed less than one year prior to TPVR were included. Patients with poor CTA image quality or with aborted cases due to reasons other than CC were excluded. Sixty-six patients were finally included. Cardiac anatomy was assessed via multiplanar reconstruction of CTAs. Results: Coronary compression occurred in 9 (14%) of the 66 patients who underwent TPVR. Most CC cases (seven of nine) occurred in patients with conduits. Proximity of the right ventricular outflow tract (RVOT) landing zone to the coronary arteries and to the chest wall was a significant risk factor for compression ( P < .001 and P = .019, respectively). Compression risk increased significantly if patients had an RVOT to coronary artery distance of ≤3 mm ( P < .001) and an RVOT to chest wall distance of ≤8 mm ( P = .026). Anomalous course of coronary arteries was another significant univariate risk factor ( P = .003). Conclusions: Right ventricular outflow tract landing zone distance of ≤3 mm to a coronary artery, landing zone distance of ≤8 mm to the chest wall, and anomalous coronary arteries are associated with increased CC risk. Electrocardiogram gating may not be necessary if coronary arteries are opacified on CTAs. Larger studies are needed to explore and confirm these coronary artery compression risk factors.
Does Previous Cardiac Surgery Predict Impaired Quality of Life in Adults With Congenital Heart Disease?
Authors: Wang Qi Feng , Rouse Sarah , Hay Margaret , Menahem Samuel 
Published: April 2020

Background: Improved survival of children with congenital heart disease (CHD) into adult life has led to further study of their quality of life (QoL) and its determinants. The QoL including the symptoms of anxiety and depression of adults with CHD was analyzed to determine the relationship, if any, between prior cardiac surgery and QoL. Methods: Adults with CHD who were recruited from a single community-based cardiology practice completed self-reported questionnaires on their QoL, which included symptoms of anxiety and depression. Standard linear regression analysis was used to determine whether prior cardiac surgery predicted lower QoL scores. Results: One hundred forty-nine adult patients with CHD were sent QoL questionnaires. Completed questionnaires were received from 135 patients: 71 (53%) males and 64 (47%) females, with a mean age of 26.3 years (standard deviation: 7.8, min: 17, max: 49). Respondents were assigned to two groups: those who had (n = 89, 66%) or had not (n = 46, 34%) previously undergone one or more cardiac surgical interventions. Results from standard linear regression analyses revealed no predictive relationship between history of previous cardiac surgery, whether one or more operations, and QoL. Conclusions: Among adult patients with CHD who completed QoL questionnaires, we observed no association between a patient’s history of prior cardiac surgery and self-reported QoL measures. This welcome and important finding may be a reflection of the good functional capacity of both groups (postsurgical and nonsurgical) irrespective of the original CHD diagnosis and need for surgical intervention.
Predictors of Acute Kidney Injury After Hip Fracture in Older Adults
Authors: Braüner Christensen Julie , Aasbrenn Martin , Sandoval Castillo Luana , Ekmann Anette , Giver Jensen Thomas , Pressel Eckart , Haxholdt Lunn Troels , Suetta Charlotte , Palm Henrik 
Published: April 2020

Introduction: This study aimed to investigate the prevalence of acute kidney injury (AKI) following hip fracture surgery in geriatric patients and to identify predictors for development of AKI with a focus on possible preventable risk factors. Methods: In this retrospective cohort study, we reviewed electronic medical records of all patients above 65 years of age who underwent hip fracture surgery at Copenhagen University Hospital, Bispebjerg, Denmark, in 2018. Acute kidney injury was assessed according to the Kidney Disease Improving Global Outcomes guidelines. Multivariate logistic regression analyses were used to identify independent risk factors for AKI. Results: Postoperative AKI developed in 28.4% of the included patients (85/299). Acute kidney injury was associated with increased length of admission (11.3 vs 8.7 days, P < .001) and 30-day mortality (18/85 vs 16/214, P = .001). In multivariable analysis, higher age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.08, P = .004), heart disease (OR: 1.78, 95% CI: 1.01-3.11, P = .045), and postoperative blood transfusion (OR: 1.84, 95% CI: 1.01-3.36, P = .048) were associated with AKI. Moreover, a higher postoperative C-reactive protein (199.0 ± 99.9 in patients with AKI, 161.3 ± 75.2 in patients without AKI) and lower postoperative diastolic blood pressure were observed in patients developing AKI. Discussion and Conclusion: Acute kidney injury was common following hip fracture surgery and associated with longer admissions and increased mortality. Patients developing AKI were older and showed several postoperative similarities, including higher C-reactive protein, lower postoperative diastolic pressure, and the need for blood transfusion.
Variations in the Delivery of Primary Diabetes Care in Malaysia: Lessons to Be Learnt and Potential for Improvement
Authors: Mustapha Feisul Idzwan , Aagaard-Hansen Jens , Lim Shiang Cheng , Nasir Nazrila Hairizan , Aris Tahir , Bjerre-Christensen Ulla 
Published: April 2020

Background: The article describes variations in the organization of clinical services for diabetes patients in 10 public primary health clinics in Malaysia with the view to learn from current innovations and improve diabetes service provision. Methods: This study combined the use of secondary data and a qualitative multicase study approach applying observations in 10 randomly selected Ministry of Health (MOH) health clinics in Kuala Lumpur and Selangor and semistructured interviews of the family medicine specialists from the same clinics. Results: Although there are specific MOH guidelines for diabetes care, some clinics had introduced innovations for diabetes care such as the novel ‘personalized care’, ‘one-stop-centre’ and utilization of patients’ waiting time for health education. Analysis showed that there was room for improvement in terms of task shifting to free precious time of staff with specialized functions, streamlining appointments for various examinations, increasing continuity of consultations with same doctors, and monitoring of performance. Conclusion: We contend that there is a potential for increased effectiveness and efficiency of primary diabetes care in Malaysia without increasing the resources – a potential that may be tapped into by systematic learning from ongoing innovation.
High occurrence of impaired emotion recognition after ischemic stroke
Authors: Aben Hugo P , Visser-Meily Johanna MA , Biessels Geert Jan , de Kort Paul LM , Spikman Jacoba M ,   on behalf of the PROCRAS study group
Published: April 2020

Introduction Deficits of emotion recognition after ischemic stroke are often overlooked by clinicians, and are mostly not spontaneously reported by patients. However, impaired emotion recognition after stroke negatively affects the ability to return to work and the quality of life. It is still unknown how often impairments of emotion recognition occur shortly after ischemic stroke. We aimed to estimate the occurrence of impaired emotion recognition after ischemic stroke and to characterise these patients with impaired emotion recognition. Patients and methods Two hundred thirty patients were included, derived from a prospective study of cognitive recovery. Five weeks after ischemic stroke a neuropsychological assessment was performed, including an emotion recognition task (i.e. Ekman 60-faces test). Emotion recognition was regarded as impaired if the total score was below the fifth percentile for a large independent reference sample. Results Emotion recognition was impaired in 33.5% of patients. Patients with impaired emotion recognition were more likely to have an abnormal Montreal Cognitive Assessment during hospitalisation, and 5 weeks after their stroke, a higher proportion of them had a vascular cognitive disorder (VCD). Even 20% of patients without VCD had impaired emotion recognition. Discussion: Emotion recognition was often impaired after ischemic stroke. This is clinically relevant, since impaired emotion recognition negatively impacts social functioning. Conclusion: Even when there was no cognitive disorder in traditional cognitive domains, emotion recognition was impaired in 1 out of 5 patients. Clinicians should systematically ask patients and their caregivers about deficits in emotion recognition, and, if needed, test for these deficits.
EPCR deficiency or function-blocking antibody protects against joint bleeding–induced pathology in hemophilia mice
Authors: Magisetty Jhansi , Pendurthi Usha R. , Esmon Charles T. , Rao L. Vijaya Mohan 
Published: April 2020

Abstract
We recently showed that clotting factor VIIa (FVIIa) binding to endothelial cell protein C receptor (EPCR) induces anti-inflammatory signaling and protects vascular barrier integrity. Inflammation and vascular permeability are thought to be major contributors to the development of hemophilic arthropathy following hemarthrosis. The present study was designed to investigate the potential influence of FVIIa interaction with EPCR in the pathogenesis of hemophilic arthropathy and its treatment with recombinant FVIIa (rFVIIa). For this, we first generated hemophilia A (FVIII−/−) mice lacking EPCR (EPCR−/−FVIII−/−) or overexpressing EPCR (EPCR++ FVIII−/−). Joint bleeding was induced in FVIII−/−, EPCR−/−FVIII−/−, and EPCR++FVIII−/− mice by needle puncture injury. Hemophilic synovitis was evaluated by monitoring joint bleeding, change in joint diameter, and histopathological analysis of joint tissue sections. EPCR deficiency in FVIII−/− mice significantly reduced the severity of hemophilic synovitis. EPCR deficiency attenuated the elaboration of interleukin-6, infiltration of macrophages, and neoangiogenesis in the synovium following hemarthrosis. A single dose of rFVIIa was sufficient to fully prevent the development of milder hemophilic synovitis in EPCR−/−FVIII−/− mice. The development of hemophilic arthropathy in EPCR-overexpressing FVIII−/− mice did not significantly differ from that of FVIII−/− mice, and 3 doses of rFVIIa partly protected against hemophilic synovitis in these mice. Consistent with the data that EPCR deficiency protects against developing hemophilic arthropathy, administration of a single dose of EPCR-blocking monoclonal antibodies markedly reduced hemophilic synovitis in FVIII−/− mice subjected to joint bleeding. The present data indicate that EPCR could be an attractive new target to prevent joint damage in hemophilia patients.