bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dual Versus Mono Antiplatelet Therapy in Large Atherosclerotic Stroke
Authors: Kim Dohoung , Park Jong-Moo , Kang Kyusik , Cho Yong-Jin , Hong Keun-Sik , Lee Kyung Bok , Park Tai Hwan , Lee Soo Joo , Kim Jae Guk , Han Moon-Ku , Kim Beom Joon , Lee Jun , Cha Jae-Kwan , Kim Dae-Hyun , Nah Hyun-Wook , Kim Dong-Eog , Ryu Wi-Sun , Kim Joon-Tae , Choi Kang-Ho , Choi Jay Chol , Lee Byung-Chul , Yu Kyung-Ho , Oh Mi Sun , Kim Wook-Joo , Kwon Jee-Hyun , Shin Dong-Ick , Sohn Sung-Il , Hong Jeong-Ho , Lee Ji Sung , Lee Juneyoung , Gorelick Philip B. , Bae Hee-Joon ,   on behalf of Clinical Research Collaboration for Stroke in Korea (CRCS-K) Investigators
Published: April 2019

Background and Purpose—
Two large-scale randomized controlled trials of recurrent stroke prevention suggest that dual antiplatelet therapy with clopidogrel plus aspirin is beneficial for prevention of subsequent ischemic events. There is a paucity of data, however, on the efficacy or effectiveness of such an approach in the treatment of stroke patients with symptomatic large artery atherosclerotic occlusive disease.

Methods—
We used a multicenter stroke registry database (Clinical Research Collaboration for Stroke in Korea) to analyze acute ischemic stroke patients due to large artery atherosclerotic occlusive disease who were treated with aspirin alone or combination of clopidogrel and aspirin from May 2008 to May 2015. The results were analyzed by intention-to-treat, per-protocol, and as-treated methodologies. The primary end point was the 1-year composite outcome of stroke recurrence, myocardial infarction, and all-cause death. To balance the differences between groups, a frailty model using propensity scores and inverse probability of treatment weighting was used.

Results—

A total of 5934 patients with symptomatic large artery atherosclerotic occlusive disease were treated either with clopidogrel plus aspirin (n=2903, 49%) or aspirin (n=3031, 51%). The frequency of the primary outcome was 12% (n=353) in the clopidogrel-aspirin group and 14% (n=410) in the aspirin group. The hazards of the primary outcome with combination over aspirin only were significantly reduced in the per-protocol and as-treated analyses (hazard ratio, 0.71; 95% CI, 0.57–0.88;
P
=0.002 and hazard ratio, 0.81; 95% CI, 0.69–0.96;
P
=0.02, respectively), but there was borderline significance in the intention-to-treat analysis (hazard ratio, 0.86; 95% CI, 0.74–1.01;
P
=0.06). Combination therapy was beneficial for all-cause death in all analyses but did not reduce recurrent stroke.

Conclusions—
Compared with patients receiving aspirin monotherapy, the primary outcome seemed to occur less frequently in patients receiving dual antiplatelet therapy, which is explained mainly by the decrease of all-cause death. Since this is a nonrandomized, retrospective, observational study, our study should be cautiously interpreted.
Beyond psychiatry: motivations for considering an Australian wellbeing program within Malaysian health services
Authors: Silim Umi Adzlin , Suhaimi Aida Farhana , Moore Gaye , Ryan Brigid , Castle David J 
Published: April 2019

Objectives: To explore the relevance and adaptability of the Optimal Health Program for mental and primary healthcare providers in Malaysia. Methods: Evaluate stakeholder engagement and training programme for psychiatrists, family medicine specialists, public health specialists, physicians, clinical psychologists, counsellors, and representatives from a patient support group. Evaluate the programme for applicability, as well as participant’s knowledge and confidence in using key components. Results: The training was very well received in terms of content, training materials and facilitation style. Development of culturally specific materials will be needed. Improvement in the self-rating measurement for knowledge and confidence in using key Optimal Health Program components was reported at the completion of the 2-day training. Conclusions: The Optimal Health Program has potential as a comprehensive socio-culturally responsive self-management programme that is relevant within mental health services and adaptable for task-sharing of mental health care in Malaysia.
Comparison of Dorsal Dermal Fascial Fenestrations With Fasciotomy in an Acute Compartment Syndrome Model in the Foot
Authors: Lufrano Reuben , Nies Matt , Ebben Beau , Hetzel Scott , O’Toole Robert V. , Doro Christopher J. 
Published: April 2019

Background: Treatment of compartment syndrome of the foot with fasciotomy remains controversial because of the theoretical risk of infection and soft tissue coverage issues. The purpose of this study was to evaluate the efficacy of compartment decompression with dorsal dermal fascial fenestration compared with fasciotomy in a cadaveric foot compartment syndrome model. We hypothesized that fasciotomies and dorsal dermal fenestrations would provide equivalent compartment decompression. Methods: Intracompartmental pressure was monitored in the first dorsal interosseous (FDIO), abductor (ABD), and superficial plantar (SP) compartments of 10 fresh frozen cadaveric limbs. A compartment syndrome model was created. Pressure measurements were obtained after dorsal dermal fascial fenestrations and after formal fasciotomies. Primary outcome variables were intracompartmental pressure in the FDIO, ABD, and SP compartments for 4 specific conditions: (1) baseline pressure, (2) pressure after compartment syndrome, (3) pressure after dermal fascial fenestrations, and (4) pressure after fasciotomies. Results: Fasciotomies decreased compartment pressures to within 10 mm Hg of baseline in all compartments ( P < .001). Compared with fasciotomies, dorsal dermal fascial fenestrations decreased the average pressure only in the FDIO compartment. Pressure decreases after fasciotomies compared with dorsal dermal fascial fenestrations were significantly greater ( P < .005). Conclusion: Fasciotomies were more effective than dorsal dermal fascial fenestrations at decreasing intracompartmental pressure. It seems that dermal fascial fenestrations were unable to provide effective decompression of the ABD and SP compartments of the foot and could provide only partial decompression of the dorsal compartments. Clinical Relevance: The findings of this study indicate the need for caution in using fenestrations alone to treat acute compartment syndrome of the foot.
Effectiveness of alternative routes of intra-arterial chemotherapy administration for retinoblastoma: Potential for response and complications
Authors: Quinn Coridon , Tummala Ramachandra , Anderson Jill , Dahlheimer Tambra , Nascene David , Jagadeesan Bharathi 
Published: April 2019

Objective Intra-arterial chemotherapy (IAC) is now the first line treatment for selected patients with retinoblastoma (Rb). Typically, IAC is infused following the selective catheterization of the ophthalmic artery (OA) on the affected side. However, in some patients, the OA alone may not provide vascular supply to the tumor, whereas in other instances the efficacy of IAC could be compromised due to the presence of prominent collateral vessels from the external carotid artery (ECA). We report our experience with catheterizing vessels other than the OA for IAC treatment for Rb. Methods After institutional review board approval, a retrospective analysis was conducted of electronic medical records and imaging of our Rb population. Results We identified 13 patients who received IAC for Rb treatment. Of these, five patients required alternative methods of chemotherapy delivery other than through the OA, totaling 17 treatments. Two patients needed balloon-assisted occlusion of the ECA, two patients required selective catheterization of the middle meningeal artery, and one patient had no internal carotid artery supply to the choroidal blush, thus the superficial temporal artery provided access for IAC. Total globe salvage rate was 76% and 80% with the alternative route subset. Conclusions Alternatives to the OA may be necessary to deliver IAC for selected cases of Rb. These routes can be safe and effective. However, thorough understanding of the orbital blood supply is essential. Whether these alternative IAC methods result in similar outcomes to OA infusions has not been established.
Early Sports Specialization in Elite Wrestlers
Authors: McDonald Colin , Deitch John , Bush Chelsea 
Published: April 2019

Background: Sports specialization is becoming an increasingly common training strategy in young athletes. Very little research currently exists examining the occurrence of serious injury (>3 months off sport or loss of season) in elite-level wrestlers who specialize early (before age 12 years). Hypothesis: Wrestlers who specialize early will sustain more serious injuries than wrestlers who specialize at age 12 years or older. Study Design: Descriptive epidemiological study. Methods: We sent an anonymous online survey to a total of 312 elite-level wrestlers (National Collegiate Athletic Association Division I athletes and World/Olympic team members) containing questions documenting age of specialization and number of serious injuries sustained. The number of serious injuries both before and after starting college were compared between wrestlers specializing at <12 years old and ≥12 years old using an independent-samples t test. Respondents’ opinions on the necessity of early specialization and their primary source of encouragement to specialize were also reported. Results: A total of 143 wrestlers completed the survey, for a total response rate of 46%. Thirty-six (25%) wrestlers specialized at <12 years old. The early specialization group sustained significantly more serious injuries than the late specialization group (1.14 vs 0.60; P = 0.035). Sixty-two (43%) believed early specialization was necessary to achieve elite-level status. The decision to specialize was encouraged primarily by the athlete (78/143; 55%), parents (37/143; 26%), and coaches (22/143; 15%). Conclusion: Elite wrestlers who specialize prior to age 12 years sustain a greater number of serious injuries before starting college than those who specialize at or after the age of 12 years. Clinical Relevance: Athletes, coaches, and parents should consider the risk of injury before adopting a wrestling-specialized training strategy at a young age.
Cost of peripheral neuropathy in patients receiving treatment for multiple myeloma: a US administrative claims analysis
Authors: Song Xue , Wilson Kathleen L. , Kagan Jerry , Panjabi Sumeet 
Published: April 2019

Background: Peripheral neuropathy (PN) is a common consequence of multiple myeloma (MM) among those commonly treated with older-generation proteasome inhibitors (PIs). In this study, we evaluated the economic burden attributable to PN among MM patients in real-world practice settings in the US. Methods: Adults diagnosed with MM and first treated (index event) between 1 July 2006 and 28 February 2017 were identified from MarketScan® Commercial and Medicare claim databases. Continuous enrollment for at least 12 months without treatment and PN diagnoses were required pre-index. Patients were followed for at least 3 months until inpatient death or end of data. The International Classification of Diseases, ninth revision, Clinical Modification (ICD-9-CM) and ICD-10-CM diagnosis codes were used to identify PN. Propensity-score matching was applied to match every patient with PN to two MM patients without a PN diagnosis (controls). Healthcare utilization and expenditures per patient per month (PPPM) in the postindex period were estimated. Results: Of 11,851 patients meeting the study criteria, 15.5% had PN. After matching 1387 patients with PN and 2594 controls were identified. Baseline characteristics were well balanced between cohorts; mean follow up was 23–26 months. PPPM total costs were significantly higher by $1509 for patients with PN than controls, driven by higher hospitalization (PN 77.4%, controls 67.2%; p < 0.001) and emergency department rates (PN 67.8%, controls 58.4%; p < 0.001) and more outpatient hospital-based visits PPPM (PN 13.5 ± 14.7, controls 11.5 ± 18.0; p < 0.001). Conclusions: PN is a prevalent MM treatment complication associated with a significant economic burden adding to the complexity and cost of MM treatment. Highly effective novel treatments such as carfilzomib may reduce the overall disease burden.
Gender variation in symptomatic peripheral arterial occlusive disease among type-2 diabetic patients
Authors: Al-Zoubi Nabil A , Shatnawi Nawaf J 
Published: April 2019

Purpose: Little is known about the existence of potential gender disparities in peripheral arterial occlusive disease. To our knowledge, this is the first study to analyze differences attributed to gender in type-2 diabetic patients with symptomatic peripheral arterial occlusive disease, with regard to clinical presentations, risk factors and anatomical distributions of atherosclerosis. Patients and methods: This study was conducted at King Abdullah University Hospital, Jordan. Medical records of all diabetic (type-2) patients who presented with symptomatic peripheral arterial occlusive disease in the period from January 2012 and November 2017 were reviewed, data were collected retrospectively. In all, 364 patients (282 males and 82 females) were involved. Criteria for diagnosis include the following Ankle-Brachial Index ⩽ 0.9 and intermittent claudication or critical limb ischemia. Risk factors for atherosclerosis (age, smoking and hypertension) and computed tomography-angiogram findings were analyzed using Statistical Package for the Social Sciences. p < 0.05 was considered statistically significant. Results: The mean age was higher in females than males (67.61 vs 62.61 years; p = 0.001). Females had greater prevalence of uncontrolled diabetes compared to males (HbA1c 9.07 in females vs 8.51 in males; p = 0.03). High density lipoprotein was higher in females than males (1.02 vs 0.935; p = 0.009). Females presented more with critical limb ischemia than intermittent claudication in comparison with males (p = 0.017). Involvement of superficial femoral artery, deep femoral artery and peroneal artery in hemodynamic relevant atherosclerotic lesion was significantly higher in females than males (p < 0.05). However, involvement of common iliac artery with hemodynamic relevant atherosclerotic lesion was significantly higher in males than females (p = 0.003). Conclusions: Clinical presentation, risk factors and anatomical distributions of atherosclerosis among type-2 diabetic patients with symptomatic peripheral arterial occlusive disease are different between males and females. When compared to males, female patients presented more with critical limb ischemia than intermittent claudication. Females showed higher age at presentation, poor control of diabetes mellitus and higher level of high density lipoprotein. Involvement of superficial femoral artery, deep femoral artery and peroneal artery in hemodynamic relevant atherosclerotic lesion were significantly higher in females than males. In contrast, common iliac artery involvement with hemodynamic relevant atherosclerotic lesion was significantly higher in males than females.
Surgical or Radiation Therapy for the Treatment of Cervical Spine Metastases: Results From the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) Cohort
Authors: Bond Michael R. , Versteeg Anne L. , Sahgal Arjun , Rhines Laurence D. , Sciubba Daniel M. , Schuster James M. , Weber Michael H. , Fehlings Michael G. , Lazary Aron , Clarke Michelle J. , Boriani Stefano , Bettegowda Chetan , Arnold Paul M. , Gokaslan Ziya L. , Fisher Charles G. 
Published: April 2019

Study Design: Ambispective cohort study design. Objectives: Cervical spine metastases have distinct clinical considerations. The aim of this study was to determine the impact of surgical intervention (± radiotherapy) or radiotherapy alone on health-related quality of life (HRQOL) outcomes in patients treated for cervical metastatic spine tumours. Methods: Patients treated with surgery and/or radiotherapy for cervical spine metastases were identified from the Epidemiology, Process, and Outcomes of Spine Oncology (EPOSO) international multicentre prospective observational study. Demographic, diagnostic, treatment, and HRQOL (numerical rating scale [NRS] pain, EQ-5D (3L), SF-36v2, and SOSGOQ) measures were prospectively collected at baseline, 6 weeks, 3 months, and 6 months postintervention. Results: Fifty-five patients treated for cervical metastases were identified: 38 underwent surgery ± radiation and 17 received radiation alone. Surgically treated patients had higher mean spinal instability neoplastic scores compared with the radiation-alone group (13.0 vs 8.0, P < .001) and higher NRS pain scores and lower HRQOL scores compared to the radiation alone group ( P < .05). From baseline to 6 months posttreatment, surgically treated patients demonstrated statistically significant improvements in NRS pain, EQ-5D (5L), and SOSGOQ2.0 scores compared with nonsignificant improvements in the radiotherapy alone group. Conclusions: Surgically treated cervical metastases patients presented with higher levels of instability, worse baseline pain and HRQOL scores compared with patients who underwent radiotherapy alone. Significant improvements in pain and HRQOL were noted for those patients who received surgical intervention. Limited or no improvements were found in those treated with radiotherapy alone.
Implementing robotic assisted myomectomy in surgical practice – a retrospective cohort study
Authors: Aendekerk Silvie , Verguts Jasper , Housmans Susanne , Timmerman Dirk 
Published: April 2019

Abstract
Background
To compare surgical outcomes of patients with leiomyomas after robotic-assisted laparoscopic myomectomy (RALM), laparoscopic myomectomy (LsM), or laparotomic myomectomy (LtM) and to construct a useful algorithm for the best modus operandi for uterine leiomyomas.

Methods
Design: A retrospective chart review. Data included patient (age and BMI) and fibroid characteristics (number, measurements of the primary fibroid, type, and location), operating time, blood loss, hospitalization length, complications during and after surgery, and complications during posttreatment pregnancies. Comparisons were based on chi-square and two-sample t tests. Setting: University teaching hospital. Patients: Between 1 January 2009 and 31 December 2016, 51 RALMs, 84 LsMs, and 52 LtMs were performed at our institution. Interventions: Three different approaches of myomectomy were performed: robotic-assisted laparoscopy (RALM), laparoscopy (LsM), and laparotomy (LtM).

Results
There was no significant difference in the distribution of the location and the type of myoma between the three groups. The mean size of the largest myoma removed by LsM, RALM, and LtM was 60.9, 70.8, and 92.6 mm (p < 0.05), respectively. Surgical outcomes between the three modalities were comparable except for increased mean blood loss and postoperative bleeding and longer hospital stay for patients with LtM and for longer operation time when performing RALM.

Conclusion
RALM should replace open surgery if feasible and should not replace traditional laparoscopy unless other benefits are proven.
On construction of a cloud storage system with heterogeneous software-defined storage technologies
Authors: Yang Chao-Tung , Chen Shuo-Tsung , Chan Yu-Wei , Shen Yu-Chuan 
Published: April 2019

AbstractWith the rapid development of networks and Information technologies, cloud computing is not only becoming popular, the types of cloud services available are also increasing. Through cloud services, users can upload their requirements via the Internet to the cloud environment and receive responses following post-processing, for example, with cloud storage services. Software-Defined Storage (SDS) is a virtualization technology for cloud storage services. SDS uses software to integrate storage resources and to improve the accessibility and usability of storage services. Currently, there are many different open source projects available for SDS development. This work aims to utilize these open source projects to improve the efficiency of integration for hardware and software resources. In other words, in this work, we propose a cloud storage system that integrates various open source SDS software to make cloud storage services more compatible and user friendly. The cloud service systems can also be managed in a more convenient and flexible manner. The experimental results demonstrate the benefits of the proposed system.
Occupation-specific suicide risk in England: 2011–2015
Authors: Windsor-Shellard Ben , Gunnell David 
Published: April 2019

BackgroundPrevious research has documented marked occupational differences in suicide risk, but these estimates are 10 years old and based on potentially biased risk assessments.AimsTo investigate occupation-specific suicide mortality in England, 2011–2015.MethodEstimation of indirectly standardised mortality rates for occupations/occupational groups based on national data.ResultsAmong males the highest risks were seen in low-skilled occupations, particularly construction workers (standardised mortality ratio [SMR] 369, 95% CI 333–409); low-skilled workers comprised 17% (1784/10 688) of all male suicides (SMR 144, 95% CI 137–151). High risks were also seen among skilled trade occupations (SMR 135 95% CI 130–139; 29% of male suicides). There was no evidence of increased risk among some occupations previously causing concern: male healthcare professionals and farmers. Among females the highest risks were seen in artists (SMR 399, 95% CI 244–616) and bar staff (SMR 182, 95% CI 123–260); nurses also had an increased risk (SMR 123, 95% CI 104–145). People in creative occupations and the entertainment industry – artists (both genders), musicians (males) and actors (males) – were at increased risk, although the absolute numbers of deaths in these occupations were low. In males (SMR 192, 95% CI 165–221) and females (SMR 170, 95% CI 149–194), care workers were at increased risk and had a considerable number of suicide deaths.ConclusionsSpecific contributors to suicide in high-risk occupations should be identified and measures – such as workplace-based interventions – put in place to mitigate this risk. The construction industry seems to be an important target for preventive interventions.Declaration of interestNone.
Treatment of Multiple Myeloma: ASCO and CCO Joint Clinical Practice Guideline
Authors: Mikhael Joseph , Ismaila Nofisat , Cheung Matthew C. , Costello Caitlin , Dhodapkar Madhav V. , Kumar Shaji , Lacy Martha , Lipe Brea , Little Richard F. , Nikonova Anna , Omel James , Peswani Namrata , Prica Anca , Raje Noopur , Seth Rahul , Vesole David H. , Walker Irwin , Whitley Alexander , Wildes Tanya M. , Wong Sandy W. , Martin Tom 
Published: April 2019

PURPOSE To provide evidence-based recommendations on the treatment of multiple myeloma to practicing physicians and others. METHODS ASCO and Cancer Care Ontario convened an Expert Panel of medical oncology, surgery, radiation oncology, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and some phase II studies published from 2005 through 2018. Outcomes of interest included survival, progression-free survival, response rate, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. RESULTS The literature search identified 124 relevant studies to inform the evidence base for this guideline. RECOMMENDATIONS Evidence-based recommendations were developed for patients with multiple myeloma who are transplantation eligible and those who are ineligible and for patients with relapsed or refractory disease.