bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tailoring Antiplatelet Therapy Intensity to Ischemic and Bleeding Risk
Authors: Baber Usman , Leisman Daniel E. , Cohen David J. , Gibson C. Michael , Henry Timothy D. , Dangas George , Moliterno David , Kini Annapoorna , Krucoff Mitchell , Colombo Antonio , Chieffo Alaide , Sartori Samantha , Witzenbichler Bernhard , Steg Philippe Gabriel , Pocock Stuart J. , Mehran Roxana 
Published: January 2019

Background:
Balancing ischemic and bleeding risk is an evolving framework.

Methods and Results:
Our objectives were to simulate changes in risks for adverse events and event-driven costs with use of ticagrelor or prasugrel versus clopidogrel according to varying levels of ischemic and bleeding risk. Using the validated PARIS risk functions, we estimated 1-year ischemic (myocardial infarction or stent thrombosis) and bleeding (Bleeding Academic Research Consortium types 3 or 5) event rates among PARIS study participants who underwent percutaneous coronary intervention with drug-eluting stent implantation for an acute coronary syndrome and were discharged with aspirin and clopidogrel (n=1497). Simulated changes in adverse events with ticagrelor or prasugrel were calculated by applying treatment effects from randomized trials for a 1-year time horizon. Event costs were estimated using National Inpatient Sample data. Net costs were calculated between antiplatelet therapy groups according to level of ischemic and bleeding risk. After weighting events for quality-of-life impact, we calculated event rates and costs for risk-tailored treatment versus clopidogrel under multiple drug pricing assumptions. One-year rates (per 1000 person-years) for ischemic events were 12.6, 24.1, and 66.1, respectively, among those at low (n=630), intermediate (n=536), and high (n=331) ischemic risk. Analogous bleeding rates were 11.0, 23.9, and 66.2, respectively, among low (n=728), intermediate (n=634), and high (n=135) bleeding risk patients. Mean per event costs were $22 174 (ischemic) and $12 203 (bleeding). When risks for ischemia matched or exceeded bleeding, simulated utility-weighted event rates favored ticagrelor/prasugrel, whereas clopidogrel reduced utility-weighted events when bleeding exceeded ischemic risk. One-year costs were sensitive to drug pricing assumptions, and risk-tailored treatment with either agent progressed from cost incurring to cost saving with increasing generic market share.

Conclusions:
Tailoring antiplatelet therapy intensity to patient risk may improve health utility and could produce cost savings in the first year after percutaneous coronary intervention.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00998127.
In-Hospital Management and Outcomes After ST-Segment–Elevation Myocardial Infarction in Medicaid Beneficiaries Compared With Privately Insured Individuals
Authors: Patel Nirav , Gupta Ankur , Doshi Rajkumar , Kalra Rajat , Bajaj Navkaranbir S. , Arora Garima , Arora Pankaj 
Published: January 2019

Background:
Medicaid expansion among previously uninsured individuals has led to improved healthcare access. However, considerably lower reimbursement rates of Medicaid have raised concerns on the unintended consequence of lower utilization of life-saving therapies and inferior outcomes compared with private insurance. We examined the rates of revascularization and in-hospital mortality among Medicaid beneficiaries versus privately insured individuals hospitalized with ST-segment–elevation myocardial infarction (STEMI).

Methods and Results:

We queried the National Inpatient Sample from 2012 to 2015 for STEMI hospitalizations with Medicaid or private insurance as primary payer. Hospitalizations with the following criteria were excluded: (1) age <18 or ≥65 years, (2) transfer to another acute care facility, and (3) left against medical advice. Outcomes were compared in propensity score–matched cohort based on demographics, socioeconomic status (income based), clinical comorbidities, including drug and alcohol use, STEMI acuity (cardiac arrest and cardiogenic shock), and hospital characteristics. A total of 42 645 and 171 545 STEMI hospitalizations were identified as having Medicaid and private insurance, respectively. In unadjusted analyses, Medicaid beneficiaries with STEMI had lower rates of coronary revascularization (88.9% versus 92.3%; odds ratio, 0.67; 95% CI, 0.65–0.70) and higher rates of in-hospital mortality (4.9% versus 2.8%; odds ratio, 1.81; 95% CI, 1.72–1.91) compared with privately insured individuals (
P
<0.001 for both). In propensity-matched cohort of 40 870 hospitalizations per group, similar results for lower rates of revascularization (89.1% versus 91.1%; odds ratio, 0.80; 95% CI, 0.76–0.84) and higher in-hospital mortality (4.9% versus 3.7%; odds ratio, 1.35; 95% CI, 1.26–1.45) were observed in Medicaid compared with private insurance, despite extensive matching (
P
<0.001 for both).

Conclusions:
Medicaid beneficiaries with STEMI had lower rates of revascularization, although small absolute difference, and higher in-hospital mortality compared with privately insured individuals. Further studies are needed to identify and understand the variation in STEMI outcomes by insurance status.
"Gramatika kaszëbsczégò jãzëka" – rozpoznanie i opracowanie struktury współczesnego literackiego języka kaszubskiego. Odpowiedź na głosy krytyki
Authors: Makurat Hanna 
Published: January 2019

The Grammar of the Kashubian Language – recognition and description of the structure of the contemporary Kashubian. Response to criticismThe article is a response to criticism of Hanna Makurat’s book titled The Grammar of the Kashubian Language; the book, published in 2016, is the first normative description of contemporary Kashubian. The Kashubian newspaper Skra has published a review which questioned the substantive content of the entire book. The author of the review showed incompatibilities between the book and Friedrich Lorentz’s Pomeranian Grammar, which was published in 1927–1937. However, the reviewer did not take into account the fact that Lorentz described the system of 76 Kashubian dialects, while Hanna Makurat described the system of contemporary Kashubian literary language, which evolved and developed standard forms. What is more, this review, written by an amateur, became the basis for the publication by the Kashubian Language Council of the statement – not supported by any arguments – that Hanna Makurat’s book was not a normative grammar. Due to lack of arguments, the Kashubian Language Council, after a month and a half, removed this statement from its website. Gramatika kaszëbsczégò jãzëka – rozpoznanie i opracowanie struktury współczesnego literackiego języka kaszubskiego. Odpowiedź na głosy krytykiArtykuł stanowi odpowiedź na krytykę, z jaką spotkała się książka Hanny Makurat Gramatika kaszëbsczégò jãzëka, wydany w 2016 roku pierwszy normatywny opis współczesnego języka kaszubskiego. Kaszubska gazeta „Skra” opublikowała recenzję, która podaje w wątpliwość istotną część zawartych w książce ustaleń. Autor recenzji wskazał niezgodności między książką Makurat a Gramatyką pomorską Friedricha Lorentza, którą opublikowano w latach 1927–1937. Recenzent nie wziął jednak pod uwagę, że Lorentz opisywał system 76 gwar kaszubskich, Makurat zaś opisała system współczesnego kaszubskiego języka literackiego, który dopracował się form standardowych. Omawiana recenzja, której autor jest amatorem, stała się na dodatek powodem opublikowania przez Radę Języka Kaszubskiego niepopartego żadnymi argumentami oświadczenia, że gramatyka Hanny Makurat nie ma charakteru normatywnego. Wobec braku argumentów po upływie półtora miesiąca Rada Języka Kaszubskiego usunęła oświadczenie ze swojej strony internetowej.
A Long-Term Study of Sea-Breeze Characteristics: A Case Study of the Coastal City of Adelaide
Authors: Masouleh Zahra Pazandeh , Walker David John , McCauley Crowther John 
Published: January 2019

AbstractThe sea-breeze characteristics of the Adelaide, Australia, coastline have been studied by applying a sea-breeze detection algorithm to 3- and 6-hourly meteorological records of near-surface and upper-air data at Adelaide Airport from 1955 to 2007. The sea breeze is typically a westerly gulf breeze combined with a later-occurring southerly ocean breeze. Regression analysis showed a significant increasing trend in the intensity of sea breezes but not in their frequency. Over the 52-yr period, there was an average increase of 1 m s−1 in zonal and 0.7 m s−1 in meridional sea-breeze wind speed components. The annually and seasonally averaged maximum wind speeds on sea-breeze days increased significantly over the 52-yr period of the study by 0.65 m s−1 for the whole year, 0.48 m s−1 in spring, 1.02 m s−1 in summer, and 1.10 m s−1 in autumn. A comparison of hourly data for 1985–95 with those for 1996–2007 showed frequencies of sea-breeze onset times less than 4 h from sunrise increasing from 29% to 36%, durations greater than 8 h increasing from 51% to 59%, and times of maximum sea breeze between 2 and 6 h after sunrise increasing from 44% to 50%. The monthly frequency of sea breezes was found to increase by 2.8 percentage points for each degree Celsius rise in monthly average maximum air temperature at Adelaide Airport. The meridional ocean-breeze wind speed, unlike the gulf-breeze wind speed, is also correlated with maximum air temperature at Adelaide Airport.
The Zonal Oscillation and the Driving Mechanisms of the Extreme Western North Pacific Subtropical High and Its Impacts on East Asian Summer Precipitation
Authors: Cheng Tat Fan , Lu Mengqian , Dai Lun 
Published: January 2019

AbstractThis paper scrutinizes the zonal oscillation of the western North Pacific subtropical high (WNPSH) via diagnosing its two extreme phases, which are defined by the top 10% strongest (positive phase) and the weakest (negative phase) WNPSH index (WNPSHI) days during summers in 1979–2016. Key findings include the following: a tripole pattern consisting of intensified (weakened) precipitation over the Maritime Continent and the East Asian summer monsoon regions, and suppressed (strengthened) precipitation over the western North Pacific summer monsoon region during positive (negative) WNPSH phases; a westward movement of WNPSH-induced precipitation anomalies that subsequently affects eastern China, Japan, and the Korean Peninsula at different time lags; an OLR–vorticity pattern explained by atmospheric responses to thermal sources is suggested to drive the oscillation; and the competitive interaction of local air–sea feedbacks, especially during the positive phase. In addition, moderate-to-strong positive correlations between the WNPSHI and the Niño-3.4 index are found on 1–2-, 2–3-, and 3–6-yr time scales; both exhibit decadal shifts to a higher-frequency mode, suggesting the intensification of both the zonal WNPSH oscillation and the ENSO under the changing climate and their close interdecadal association. A nonlinear quasi-biennial WNPSH–ENSO relationship is identified: the positive (negative) WNPSH phase sometimes occurs during 1) a decaying El Niño (La Niña) in the preceding summer/autumn, and/or 2) a developing La Niña (El Niño) in the current summer/autumn. A full ENSO transition from moderate-to-strong El Niño to La Niña is often seen during the positive phase, offering potential in predicting ENSO events and extreme WNPSH phases and thereby the summer monsoon rainfall in East Asia.
Ray Curvature on a Flat Earth for Computing Virtual WSR-88D Signatures of Simulated Supercell Storms
Authors: Davies-Jones Robert , Wood Vincent T. , Askelson Mark A. 
Published: January 2019

Abstract
Two accepted postulates for applications of ground-based weather radars are that Earth’s surface is a perfect sphere and that all the rays launched at low-elevation angles have the same constant small curvature. To accommodate a straight vertically launched ray, we amend the second postulate by making the ray curvature dependent on the cosine of the launch angle. A standard atmospheric stratification determines the ray-curvature value at zero launch angle. Granted this amended postulate, we develop exact formulas for ray height, ground range, and ray slope angle as functions of slant range and launch angle on the real Earth. Standard practice assumes a hypothetical equivalent magnified earth, for which the rays become straight while ray height above radar level remains virtually the same function of the radar coordinates. The real-Earth and equivalent-earth formulas for height agree to within 1 m. Our ultimate goal is to place a virtual Doppler radar within a numerical or analytical model of a supercell and compute virtual signatures of simulated storms for development and testing of new warning algorithms. Since supercell models have a flat lower boundary, we must first compute the ray curvature that preserves the height function as the earth curvature tends to zero. Using an approximate height formula, we find that keeping planetary curvature minus the ray curvature at zero launch angle constant preserves ray height to within 5 m. For standard refraction the resulting ray curvature is negative, indicating that rays bend concavely upward relative to a flat earth.
A Simple Ex Vivo Semiquantitative Fluorescent Imaging Utilizing Planar Laser Scanner: Detection of Reactive Oxygen Species Generation in Mouse Brain and Kidney
Authors: Hosoi Rie , Sato Sota , Shukuri Miho , Fujii Yuka , Todoroki Kenichiro , Arano Yasushi , Sakai Toshihiro , Inoue Osamu 
Published: January 2019

Objective: Oxidative stress plays an important role in the onset of many neuronal and peripheral disorders. We examined the feasibility of obtaining semiquantitative fluorescent images of reactive oxygen species (ROS) generation in mouse brain and kidney utilizing a planar laser scanner and dihydroethidium (DHE). Methods: To investigate ROS generation in brain, sodium nitroprusside was injected into the striatum. Dihydroethidium was injected into the tail vein. After DHE injection, tissue slices were analyzed utilizing a planar laser scanner. For kidney study, cis-diamminedichloroplatinum [II] (cisplatin) was intraperitoneally administrated into mice. Results: Clear and semiquantitative fluorescent images of ROS generation in the mouse brain and kidney were obtained. Furthermore, the fluorescence intensity was stable and not affected by fading. Sodium nitroprusside induced approximately 6 times the fluorescence accumulation in the brain. Cisplatin caused renal injury in all mice, and in comparison with control mice, more than 10 times fluorescence accumulation was observed in the renal medulla with tubular necrosis and vacuolization. Conclusions: We successfully obtained ex vivo semiquantitative fluorescent images of ROS generation utilizing a planar laser scanner and DHE. This simple method is useful for ROS detection in several ROS-related animal models and would be applicable to a variety of biochemical processes.
Total Hip Arthroplasty for Hip Fractures: Time to Surgery With Respect to Surgical Revision, Failure, and Mortality
Authors: Müller Franz , Galler Michael , Zellner Michael , Bäuml Christian , Grechenig Stephan , Kottmann Tanja , Füchtmeier Bernd 
Published: January 2019

Introduction: There are increasing demands to perform surgery of hip fractures without delay. However, few studies have assessed the time to surgery in relation to outcome measurements. Methods: A total of 643 consecutive patients with a minimum age of 60 years underwent total hip arthroplasty (THA) for an intracapsular hip fracture. For this retrospective case series, demographic data and the outcome measurements—(1) any surgical revision, (2) implant failure, and (3) mortality—were documented from a prospective clinical database. The time from admission to surgery was also documented prospectively and then data were divided into 4 groups according to the time of surgery: (1) within 12 hours, (2) >12 to 24 hours, (3) >24 to 48 hours, and (4) later than >48 hours. The study end point was 2 years after surgery. Final evaluation was conducted for any missing data through a telephone interview. Results: The patients comprised 456 women (70.9%) and 187 men (29.1%) with a mean age of 80.2 years (range 60-104 years; standard deviation ±7.4). Descriptive data were without effect in all 4 groups. Time to surgery did not significantly influence revision for any reason ( P = .323), implant failure ( P = .521), and mortality ( P = .643). Cox regression analysis identified male sex ( P < .001; 95% confidence interval (CI), 1.27-2.44), American Society of Anesthesiologists score ≥3 ( P < .001; 95% CI, 2.12-21.59), C-reactive protein level >21 mg/L ( P < .018; 95% CI, 1.09-2.60), hemoglobin level <12.0 g/dL ( P = .033; 95% CI, 1.04-2.68), and dementia ( P < .000; 95% CI, 1.50-2.86) as independent significant risk factors for mortality. Conclusion: Time to surgery had no effect on revision for any reason, implant failure, and mortality in patients undergoing THA for an intracapsular hip fracture.
Kaposi sarcoma–associated herpesvirus/human herpesvirus 8–associated lymphoproliferative disorders
Authors: Oksenhendler Eric , Boutboul David , Galicier Lionel 
Published: January 2019

Abstract
Kaposi sarcoma–associated herpesvirus/human herpesvirus 8 is associated with multicentric Castleman disease (MCD) and primary effusion lymphoma (PEL). In MCD, infected B cells, although polyclonal, express a monotypic immunoglobulin Mλ phenotype, probably through editing toward λ light chain in mature B cells. They are considered to originate from pre–germinal center (GC) naive B cells. Both viral and human interleukin-6 contribute to the plasmacytic differentiation of these cells, and viral replication can be observed in some infected cells. PEL cells are clonal B cells considered as GC/post-GC B cells. One can also hypothesize that they originate from the same infected naive B cells and that additional factors could be responsible for their peculiar phenotype.
Normal interpupillary, inner canthal distance and outer canthal distance in a normal population of Pakistan
Authors: Hayat Nausheen , Alkhairy Saba , Cheema Alyscia , Ehsan Muneeb , Khan Muhammad Athar 
Published: January 2019

Objective: This study was conducted to quantify the normal indices of anthropometric measures related to ophthalmology including Interpupillary distance (IPD), Inner canthal distance (ICD), Outer canthal distance (OCD) in a normal, healthy Pakistani population.
Methods: This is a cross sectional study. Total 500 patients were chosen randomly but 499 were included in this study. Patients were selected randomly in an outpatient department of Jinnah Post Graduate Medical Centre Karachi, over the period of five months. IPD, ICD & OCD all measurements were taken with the help of plastic rule by only one researcher to minimize chances of error as much as possible. IPD was reconfirmed from auto refractometer while ICD and OCD readings were taken twice by occluding one eye of researcher to reduce error. Participants were divided into four categories on basis of: Age, Gender, ethnicity and geographical location. Patients were further categorized on basis of Ethnicity to Urdu Speaking, Sindhi, Punjabi, Pathan, and others. Moreover, four age groups were drawn ranging from 15-24 years, 25-44 years, 45-64 years and 65 years and greater.
Results: Our study comprised a total of 499 patents of which 272(54.5%) were males, and 227(45.5%) were females. The mean age of the participants was 39.3 ± 14.5 years. The mean values for the IPD, ICD and OCD in mm were 61.8 ± 6.2, 30.9 ± 2.9 and 85.2 ± 6.6 respectively. A statistically significant difference was observed between IPD, ICD and OCD Indices among male and female study participants (p<0.001, p=0.043, p<0.001). While comparing the IPD, ICD and OCD indices amongst the different ethnic groups, we found no statistically significant difference (p=0.09. p=0.28, p=0.06). Overall, there was no correlation between the age and other variables i.e. IPD, ICD, OCD, (r = 0.07, p = 0.085), (r = 0.005, p = 0.906), (r = -0.08, p = 0.058).
Conclusion: This work has recommended normative values of IPD, ICD and OCD in Pakistani population on the basis different variables including gender, age, and ethnicity.
How to cite this:Hayat N, Alkhairy S, Cheema A, Ehsan M, Khan MA. Normal interpupillary, inner canthal distance and outer canthal distance in a normal population of Pakistan. Pak J Med Sci. 2019;35(1):50-54. doi: https://doi.org/10.12669/pjms.35.1.288
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ambiguous genitalia: An overview of 7 years experience at the Children’s Hospital & Institute of Child Health, Lahore, Pakistan
Authors: Manzoor Jaida , Aftab Sommayya , Yaqoob Muhammad 
Published: January 2019

Objective: To determine the classification and etiological diagnosis of children presented with ambiguous genitalia/atypical genitalia according to the newer classification system of Disorder of Sex Development (DSD).
Methods: This observational, cross-sectional study was conducted at the Department of Pediatric Endocrinology and Diabetes at The Children’s Hospital &Institute of Child Health, Lahore from January, 2007 to December; 2014. Files of all the children with ambiguous genitalia were retrospectively analyzed and relevant data was retrieved. All the information was recorded on predesigned proforma and analyzed accordingly.
Results: A total of 300 cases of ambiguous genitalia classified according to the new DSD classification. 46, XX DSD were 54.3% (n=163), 46, XY DSD were 43.7% (n=131), sex chromosome DSD were 2% (n=6). Among 46, XX DSD cases, the most common cause was congenital adrenal hyperplasia (97%, n=158). However, in 46, XY DSD partial androgen insensitivity/5α-reductase deficiency (62%. n=81) constituted the most commonest disorder. Other causes of 46XY DSD include testosterone synthesis defect(23%), congenital adrenal hyperplasia (CAH,12%), testis regression syndrome (1.5%) and persistent mullerian duct syndrome (PMDS,1.5%). Sex chromosome disorder constituted one case of iso-chromosome X turner syndrome, mixed gonadal dysgenesis (n=3), ovotesticular DSD/chimerism (n=2).
Conclusion: Ambiguous genitalia have varied etiologies, 46; XXDSD found being the commonest of all, showing predominance of CAH especially salt loosing type. The early detection and prompt treatment of cases of ambiguous genitalia plays a pivotal role in the management of acute life threatening condition and gender assignment.
How to cite this:Manzoor J, Aftab S, Yaqoob M. Ambiguous genitalia: An overview of 7 years experience at the Children’s Hospital & Institute of Child Health, Lahore, Pakistan. Pak J Med Sci. 2019;35(1):151-155. doi: https://doi.org/10.12669/pjms.35.1.289
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.