bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Effectiveness of Dual Antiplatelet Therapy With Aspirin and Clopidogrel Versus Aspirin Monotherapy in Mild-to-Moderate Acute Ischemic Stroke According to the Risk of Recurrent Stroke
Authors: Lee Hak-Loh , Kim Joon-Tae , Lee Ji Sung , Park Man-Seok , Choi Kang-Ho , Cho Ki-Hyun , Kim Beom Joon , Park Jong-Moo , Kang Kyusik , Lee Soo Joo , Kim Jae Guk , Cha Jae-Kwan , Kim Dae-Hyun , Park Tai Hwan , Park Sang-Soon , Lee Kyung Bok , Lee Jun , Hong Keun-Sik , Cho Yong-Jin , Park Hong-Kyun , Lee Byung-Chul , Yu Kyung-Ho , Sun Oh Mi , Kim Dong-Eog , Ryu Wi-Sun , Choi Jay Chol , Kwon Jee-Hyun , Kim Wook-Joo , Shin Dong-Ick , Sohn Sung Il , Hong Jeong-Ho , Lee Juneyoung , Bae Hee-Joon 
Published: November 2020

Background:
This study compared the effectiveness of dual antiplatelet therapy (DAPT) with clopidogrel-aspirin with that of aspirin monotherapy (AM) in mild-to-moderate acute ischemic stroke considering the risk of recurrent stroke using the Stroke Prognosis Instrument II (SPI-II) score.

Methods:
This study is a retrospective analysis of data from a prospective, nationwide, multicenter stroke registry database between January 2011 and July 2018. We included patients with mild-to-moderate (National Institutes of Health Stroke Scale score ≤10), acute (within 24 hours of onset), noncardioembolic ischemic stroke. The primary outcome was a 3-month composite of stroke (either hemorrhagic or ischemic), myocardial infarction, and all-cause mortality. Propensity scores using the inverse probability of treatment weighting method were used to mitigate baseline imbalances between the DAPT and AM groups and within each subgroup considering SPI-II scores.

Results:

Among the 15 430 patients (age, 66±13 years; men, 62.0%), 45.1% (n=6960) received DAPT and 54.9% (n=8470) received AM. Primary outcome events were significantly more frequent in the AM group (16.7%) than in the DAPT group (15.5%;
P
=0.03). Weighted Cox proportional hazards models showed a reduced risk of 3-month primary vascular events in the DAPT group versus the AM group (hazard ratio, 0.84 [0.78–0.92];
P
<0.001), with no interaction between acute treatment type and SPI-II risk subgroups (
P
interaction
=0.44). However, among the high-risk patients with SPI-II scores >7, a substantially larger absolute benefit was observed for 3-month composite vascular events in the DAPT group (weighted absolute risk differences, 5.4%), whereas smaller absolute benefits were observed among patients in the low- or medium-risk SPI-II subgroups (1.7% and 2.4%, respectively).

Conclusions:
Treatment with clopidogrel-aspirin was associated with a reduction in 3-month vascular events compared with AM in mild-to-moderate acute noncardioembolic ischemic stroke patients. Larger magnitudes of the effects of DAPT with clopidogrel-aspirin were observed in the high-risk subgroup by SPI-II risk scores.
Finerenone and Cardiovascular Outcomes in Patients With Chronic Kidney Disease and Type 2 Diabetes
Authors: Filippatos Gerasimos , Anker Stefan D. , Agarwal Rajiv , Pitt Bertram , Ruilope Luis M. , Rossing Peter , Kolkhof Peter , Schloemer Patrick , Tornus Ingo , Joseph Amer , Bakris George L. ,   For the FIDELIO-DKD Investigators
Published: November 2020

Background:
The FIDELIO-DKD trial (Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease) evaluated the effect of the nonsteroidal, selective mineralocorticoid receptor antagonist finerenone on kidney and cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes with optimized renin–angiotensin system blockade. Compared with placebo, finerenone reduced the composite kidney and cardiovascular outcomes. We report the effect of finerenone on individual cardiovascular outcomes and in patients with and without history of atherosclerotic cardiovascular disease (CVD).

Methods:

This randomized, double-blind, placebo-controlled trial included patients with type 2 diabetes and urine albumin-to-creatinine ratio 30 to 5000 mg/g and an estimated glomerular filtration rate ≥25 to <75 mL per min per 1.73 m
2
, treated with optimized renin–angiotensin system blockade. Patients with a history of heart failure with reduced ejection fraction were excluded. Patients were randomized 1:1 to receive finerenone or placebo. The composite cardiovascular outcome included time to cardiovascular death, myocardial infarction, stroke, or hospitalization for heart failure. Prespecified cardiovascular analyses included analyses of the components of this composite and outcomes according to CVD history at baseline.

Results:

Between September 2015 and June 2018, 13 911 patients were screened and 5674 were randomized; 45.9% of patients had CVD at baseline. Over a median follow-up of 2.6 years (interquartile range, 2.0–3.4 years), finerenone reduced the risk of the composite cardiovascular outcome compared with placebo (hazard ratio, 0.86 [95% CI, 0.75–0.99];
P
=0.034), with no significant interaction between patients with and without CVD (hazard ratio, 0.85 [95% CI, 0.71–1.01] in patients with a history of CVD; hazard ratio, 0.86 [95% CI, 0.68–1.08] in patients without a history of CVD;
P
value for interaction, 0.85). The incidence of treatment-emergent adverse events was similar between treatment arms, with a low incidence of hyperkalemia-related permanent treatment discontinuation (2.3% with finerenone versus 0.8% with placebo in patients with CVD and 2.2% with finerenone versus 1.0% with placebo in patients without CVD).

Conclusions:
Among patients with chronic kidney disease and type 2 diabetes, finerenone reduced incidence of the composite cardiovascular outcome, with no evidence of differences in treatment effect based on preexisting CVD status.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02540993.
Ultrafast Hypothermia Selectively Mitigates the Early Humoral Response After Cardiac Arrest
Authors: Boissady Emilie , Kohlhauer Matthias , Lidouren Fanny , Hocini Hakim , Lefebvre Cécile , Chateau‐Jouber Sophie , Mongardon Nicolas , Deye Nicolas , Cariou Alain , Micheau Philippe , Ghaleh Bijan , Tissier Renaud 
Published: November 2020

Background
Total liquid ventilation (TLV) has been shown to prevent neurological damage though ultrafast cooling in animal models of cardiac arrest. We investigated whether its neuroprotective effect could be explained by mitigation of early inflammatory events.

Methods and Results
Rabbits were submitted to 10 minutes of ventricular fibrillation. After resuscitation, they underwent normothermic follow‐up (control) or ultrafast cooling by TLV and hypothermia maintenance for 3 hours (TLV). Immune response, survival, and neurological dysfunction were assessed for 3 days. TLV improved neurological recovery and reduced cerebral lesions and leukocyte infiltration as compared with control (eg, neurological dysfunction score=34±6 versus 66±6% at day 1, respectively). TLV also significantly reduced interleukin‐6 blood levels during the hypothermic episode (298±303 versus 991±471 pg/mL in TLV versus control at 3 hours after resuscitation, respectively), but not after rewarming (752±563 versus 741±219 pg/mL in TLV versus control at 6 hours after resuscitation, respectively). In vitro assays confirmed the high temperature sensitivity of interleukin‐6 secretion. Conversely, TLV did not modify circulating high‐mobility group box 1 levels or immune cell recruitment into the peripheral circulation. The link between interleukin‐6 early transcripts (<8 hours) and neurological outcome in a subpopulation of the previously described Epo‐ACR‐02 (High Dose of Erythropoietin Analogue After Cardiac Arrest) trial confirmed the importance of this cytokine at the early stages as compared with delayed stages (>8 hours).

Conclusions
The neuroprotective effect of hypothermic TLV was associated with a mitigation of humoral interleukin‐6 response. A temperature‐dependent attenuation of immune cell reactivity during the early phase of the post–cardiac arrest syndrome could explain the potent effect of rapid hypothermia.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT00999583.
Daoists, the Imperial Cult of Sage-Kings, and Mongol Rule
Authors: Jinping Wang 
Published: November 2020

Abstract
This article demonstrates the central position that Daoists occupied in the representations of state power in north China under Mongol rule. In the mid-thirteenth century, Daoist Master Jiang Shanxin and his disciples, under Khubilai Khan’s patronage, actively rebuilt several temples of Confucian sage-kings in southern Shanxi province. Jiang Shanxin’s lineage was a product of dynamic interactions between the Mongol conquerors and local Chinese Daoists in which the two found common ground in sage-kings worship that had served to strengthen imperial legitimacy in previous dynasties. The strong Mongol-Daoist alliance in reordering the empire’s ritual space resulted in not just the revival of but also the creation of new ritual precedents for the Chinese imperial cult of sage-kings.
Establishing a Literati Spirit-Writing Altar in Early Qing Suzhou: The Optimus Prophecy of Peng Dingqiu (1645-1719)
Authors: Burton-Rose Daniel 
Published: November 2020

Abstract
In recent years the Suzhou literatus Peng Dingqiu (1645-1719) has attracted scholarly attention as a figure embodying the rich diversity of elite religiosity in the early Qing dynasty Yangzi delta. The present article employs Peng Dingqiu’s previously neglected manuscript autobiography Shijiang gong nianpu to hone in on a prophecy he claimed to have received in 1674 of his two-fold optimus success in 1676. It provides detail on the social conventions of verification of spirit-altar communications and probes the challenges Peng Dingqiu’s solitary method of communicating posed to communal verification. Concurrently, the article establishes a baseline of historically plausible events and identifies the narrative elements most likely modified by Peng Dingqiu and his admirers after the achievement of the prophecy.
Catholic Youth Ministry between 1896 and Today
Authors: Höring Patrik C. 
Published: November 2020

Abstract
The involvement (participation) of young people is the central characteristic of youth work in Germany. Where does this approach come from? And what role does it play in practice today? The following article gives a short introduction into youth work in Germany and traces how the idea of participation has developed in Catholic youth associations and what demands and challenges it poses in practice today.
The Image of Africa in Ghana's Press
Authors: Serwornoo Michael 
Published: November 2020

The Image of Africa in Ghana’s Press is a comprehensive and highly analytical study of the impact of foreign news organisations on the creation of an image of Africa in its own press. Identifying a problematic focus on the Western media in previous studies of the African media image, Serwornoo uses the Ghanaian press as a case study to explore the effects of centuries of Afro-pessimistic discourse in the foreign press on the continent’s self-description.
This study brings together a number of theoretical approaches, including newsworthiness, intermedia agenda setting, postcolonial theory and the hierarchy of influences, to question the processes underpinning the creation of media content. It is particularly innovative in its application of the methodological frameworks of ethnographic content analysis and ethnographic interview techniques to unveil the perspectives of journalists and editors.
The Image of Africa in Ghana’s Press presents a vital contribution of the highest academic standard to the growing literature surrounding Afro-pessimism and postcolonial studies. It will be of great value to scientists in the field of journalism studies, as well as researchers interested in the merging of journalism research, postcolonial studies, and ethnography.
Fluctuations in Inner-Core Structure during the Rapid Intensification of Super Typhoon Nepartak (2016)
Authors: Hardy Sam , Schwendike Juliane , Smith Roger K. , Short Chris J. , Reeder Michael J. , Birch Cathryn E. 
Published: November 2020

AbstractThe key physical processes responsible for inner-core structural changes and associated fluctuations in the intensification rate for a recent, high-impact western North Pacific tropical cyclone that underwent rapid intensification [Nepartak (2016)] are investigated using a set of convection-permitting ensemble simulations. Fluctuations in the inner-core structure between ringlike and monopole states develop in 60% of simulations. A tangential momentum budget analysis of a single fluctuation reveals that during the ringlike phase, the tangential wind generally intensifies, whereas during the monopole phase, the tangential wind remains mostly constant. In both phases, the mean advection terms spin up the tangential wind in the boundary layer, whereas the eddy advection terms deepen the storm’s cyclonic circulation by spinning up the tangential wind between 1.5 and 4 km. Calculations of the azimuthally averaged, radially integrated vertical mass flux suggest that periods of near-constant tangential wind tendency are accompanied by a weaker eyewall updraft, which is unable to evacuate all the mass converging in the boundary layer. Composite analyses calculated from 18 simulations produce qualitatively similar results to those from the single case, a finding that is also in agreement with some previous observational and modeling studies. Above the boundary layer, the integrated contribution of the eddy term to the tangential wind tendency is over 80% of the contribution from the mean term, irrespective of inner-core structure. Our results strongly indicate that to fully understand the storm’s three-dimensional evolution, the contribution of the eddies must be quantified.
Implementing a systems approach to suicide prevention in a mental health service using the Zero Suicide Framework
Authors: Turner Kathryn , Sveticic Jerneja , Almeida-Crasto Alice , Gaee-Atefi Taralina , Green Vicki , Grice Diana , Kelly Petra , Krishnaiah Ravikumar , Lindsay Luke , Mayahle Brian , Patist Carla , Van Engelen Heidy , Walker Sarah , Welch Matthew , Woerwag-Mehta Sabine , Stapelberg Nicolas JC 
Published: November 2020

Objective: The Zero Suicide Framework, a systems approach to suicide prevention within a health service, is being implemented across a number of states in Australia, and internationally, although there is limited published evidence for its effectiveness. This paper aims to provide a description of the implementation process within a large health service in Australia and describes some of the outcomes to date and learnings from this process. Method: Gold Coast Mental Health and Specialist Services has undertaken an implementation of the Zero Suicide Framework commencing in late 2015, aiming for high fidelity to the seven key elements. This paper describes the practical steps undertaken by the service, the new practices embedded, emphasis on supporting staff following the principles of restorative just culture and the development of an evaluation framework to support a continuous quality improvement approach. Results: Improvements have been demonstrated in terms of processes implementation, enhanced staff skills and confidence, positive cultural change and innovations in areas such as the use of machine learning for identification of suicide presentations. A change to ‘business as usual’ has benefited thousands of consumers since the implementation of a Suicide Prevention Pathway in late 2016 and achieved reductions in rates of repeated suicide attempts and deaths by suicide in Gold Coast Mental Health and Specialist Services consumers. Conclusion: An all-of-service, systems approach to suicide prevention with a strong focus on cultural shifts and aspirational goals can be successfully implemented within a mental health service with only modest additional resources when supported by engaged leadership across the organisation. A continuous quality improvement approach is vital in the relentless pursuit of zero suicides in healthcare.
Revisiting the Radiation Therapy Oncology Group 1221 Hypothesis: Treatment for Stage III/IV HPV‐Negative Oropharyngeal Cancer
Authors: Jacobs Daniel , Torabi Sina J. , Park Henry S. , Rahmati Rahmatullah , Young Melissa R. , Mehra Saral , Judson Benjamin L. 
Published: November 2020

ObjectiveIn 2014, the Radiation Therapy Oncology Group 1221 trial was initiated to analyze whether surgery with risk‐based radiation therapy or chemoradiation therapy was superior to chemoradiation therapy alone in patients with clinically staged T1‐2N1‐2bM0 HPV‐negative oropharyngeal squamous cell carcinoma. However, the study was prematurely terminated. Given the lack of a randomized controlled trial, we retrospectively approached the same question using large national cancer databases.Study DesignRetrospective cohort study.SettingThe National Cancer Database and Surveillance, Epidemiology, and End Results (SEER) program from 2010 to 2016.MethodsWe identified 3004 patients in the National Cancer Database and 670 patients in the SEER database. Statistical techniques included Kaplan‐Meier survival analysis, binary and multinomial logistic regressions, Cox proportional hazard regressions, and inverse propensity score weighting.ResultsOn weighted multivariable Cox regression, patients recommended to receive frontline surgery had improved overall survival as compared with those recommended to receive chemoradiation therapy alone (hazard ratio [HR], 0.77; 95% CI, 0.68‐0.86). On post hoc multivariable analysis based on therapy actually received, frontline surgery with adjuvant chemoradiation therapy was associated with improved overall survival (HR, 0.59; 95% CI, 0.50‐0.71) as compared with chemoradiation therapy without surgery. Analysis of the SEER cohort revealed improved overall survival (HR, 0.69; 95% CI, 0.54‐0.87) and head and neck cancer–specific survival (HR, 0.59; 95% CI, 0.41‐0.84) in patients recommended to receive frontline surgery over chemoradiation therapy alone.ConclusionOur findings support the use of surgery with risk‐based addition of adjuvant therapy in patients with cT1‐2N1‐2bM0 HPV‐negative oropharyngeal cancer.
Therapeutic drug monitoring of valproic acid in extracorporeal membrane oxygenation
Authors: Hunt Megan F , Clark Katharine T , Grant Michael C , Choi Chun Woo , Whitman Glenn , Cho Sung-Min , Farrokh Salia 
Published: November 2020

Introduction: Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for those in cardiopulmonary failure, including post-cardiac arrest. Despite a high volume of ECMO patients using anti-seizure medication, there is a paucity of data concerning the dosing, levels, and clinical scenarios for their use. Case Report: We present three cases of ECMO patients post-PEA arrest who were on valproic acid (VPA) for treatment of seizure and/or myoclonus. The total and free levels of VPA are reported. Discussion: The trough levels are consistent throughout therapy, suggesting VPA is not significantly removed by the ECMO circuitry. Although the total serum levels remained below the toxic range, the free level was elevated in two patients. These patients did not develop signs of toxicity. Conclusion: VPA may be an effective anti-seizure medication in ECMO patients. Free VPA levels should be more readily available to better quantify efficacy or toxicity, especially in ECMO patients.
Combined onabotulinumtoxinA/atogepant treatment blocks activation/sensitization of high-threshold and wide-dynamic range neurons
Authors: Melo-Carrillo Agustin , Strassman Andrew M , Schain Aaron J , Adams Aubrey Manack , Brin Mitchell F , Burstein Rami 
Published: November 2020

Background OnabotulinumtoxinA and agents that block calcitonin gene‒receptor peptide action have both been found to have anti-migraine effects, but they inhibit different populations of meningeal nociceptors. We therefore tested the effects of combined treatment with onabotulinumtoxinA and the calcitonin gene‒receptor peptide antagonist atogepant on activation/sensitization of trigeminovascular neurons by cortical spreading depression. Material and methods Single-unit recordings were obtained of high-threshold and wide-dynamic-range neurons in the spinal trigeminal nucleus, and cortical spreading depression was then induced in anesthetized rats that had received scalp injections of onabotulinumtoxinA 7 days earlier and intravenous atogepant infusion 1 h earlier. The control group received scalp saline injections and intravenous vehicle infusion. Results OnabotulinumtoxinA/atogepant pretreatment prevented cortical spreading depression-induced activation and sensitization in both populations (control: Activation in 80% of high-threshold and 70% of wide-dynamic-range neurons, sensitization in 80% of high-threshold and 60% of wide-dynamic-range neurons; treatment: activation in 10% of high-threshold and 0% of wide-dynamic-range neurons, sensitization in 0% of high-threshold and 5% of wide-dynamic-range neurons). Discussion We propose that the robust inhibition of high-threshold and wide-dynamic-range neurons by the combination treatment was achieved through dual blockade of the Aδ and C classes of meningeal nociceptors. Combination therapy that inhibits meningeal C-fibers and prevents calcitonin gene‒receptor peptide from activating its receptors on Aδ-meningeal nociceptors may be more effective than a monotherapy in reducing migraine days per month in patients with chronic migraine.
Atrial fibrillation and migraine with aura in young adults with ischemic stroke
Authors: Gollion Cédric , Gazagnes Julie , Fabry Vincent , Barbieux-Guillot Marianne , Lerebours Fleur , Larrue Vincent 
Published: November 2020

Background Migraine is associated with an increased risk of ischemic stroke. The associations are stronger in migraine with aura than in migraine without aura, in women than in men, and in younger subjects. However, the mechanisms by which migraine might increase the risk of ischemic stroke are debated. Methods We analysed the associations between migraine without aura and migraine with aura and the causes of ischemic stroke in patients aged 18–54 years treated consecutively in a university hospital stroke center. Results A total of 339 patients (mean/SD age 43.8/8.8 years, 62.83% male) were included. Migraine with aura was diagnosed in 58 patients, and migraine without aura in 54 patients. Patients with migraine with aura were younger and had fewer traditional cardiovascular risk factors than patients with no migraine. Migraine with aura was strongly associated with atrial fibrillation (odds ratio, 5.08; 95% confidence interval, 1.24–21.92; p = 0.011) and negatively associated with atherosclerosis (odds ratio, 0.29; 95% confidence interval, 0.05–0.97; p = 0.033) and small vessel disease (odds ratio, 0.13; 95% confidence interval, 0.00–0.87; p = 0.022). No other cause of stroke was significantly associated with migraine. The most common cause of stroke was atherosclerosis in no-migraine patients, dissection in migraine without aura patients and patent foramen ovale in migraine with aura patients. Atrial fibrillation was, together with dissection, the second leading cause of stroke in migraine with aura patients, accounting for 10.34% of cases in this subgroup. Conclusion We showed that atrial fibrillation was a common cause of ischemic stroke in young adults with migraine with aura.