bluuebunny/crossref_metadata_2025_split huggingface dataset:
Limitations of Specific Coagulation Tests for Direct Oral Anticoagulants: A Critical Analysis
Authors: Ebner Matthias , Birschmann Ingvild , Peter Andreas , Härtig Florian , Spencer Charlotte , Kuhn Joachim , Rupp André , Blumenstock Gunnar , Zuern Christine S. , Ziemann Ulf , Poli Sven 
Published: September 2018

Background

During treatment with direct oral anticoagulants (
DOAC
), coagulation assessment is required before thrombolysis, surgery, and if anticoagulation reversal is evaluated. Limited data support the accuracy of
DOAC
‐specific coagulation assays around the current safe‐for‐treatment threshold of 30 ng/
mL
.

Methods and Results

In 481 samples obtained from 96 patients enrolled at a single center,
DOAC
concentrations were measured using Hemoclot direct thrombin inhibitor assay, Biophen direct thrombin inhibitor assay or ecarin clotting time for dabigatran, chromogenic anti‐Xa assay (
AXA
) for factor Xa inhibitors (rivaroxaban, apixaban) and ultraperformance liquid chromatography–tandem mass spectrometry as reference. All dabigatran‐specific assays had high sensitivity to concentrations >30 ng/
mL
, but specificity was lower for Hemoclot direct thrombin inhibitor assay (78.2%) than for Biophen direct thrombin inhibitor assay (98.9%) and ecarin clotting time (94.6%).
AXA
provided high sensitivity and specificity for rivaroxaban, but low sensitivity for apixaban (73.8%; concentrations up to 82 ng/
mL
were misclassified as <30 ng/
mL
). If no
DOAC
‐specific calibration for
AXA
is available, results 2‐fold above the upper limit of normal indicate relevant rivaroxaban concentrations. For apixaban, all elevated results should raise suspicion of relevant anticoagulation.

Conclusions

DOAC
‐specific tests differ considerably in diagnostic performance for concentrations close to the currently accepted safe‐for‐treatment threshold. Compared with Biophen direct thrombin inhibitor assay and ecarin clotting time, limited specificity of Hemoclot direct thrombin inhibitor assay poses a high risk of unnecessary anticoagulation reversal or treatment delays in patients on dabigatran. While
AXA
accurately detected rivaroxaban, the impact of low apixaban levels on the assay was weak. Hence,
AXA
results need to be interpreted with extreme caution when used to assess hemostatic function in patients on apixaban.

Clinical Trial Registration

URL
:
https://www.clinicaltrials.gov
. Unique identifiers:
NCT
02371044,
NCT
02371070.
Fifteen‐Year Trends in Management and Outcomes of Non–ST‐Segment–Elevation Myocardial Infarction Among Black and White Patients: The ARIC Community Surveillance Study, 2000–2014
Authors: Arora Sameer , Stouffer George A. , Kucharska‐Newton Anna , Vaduganathan Muthiah , Qamar Arman , Matsushita Kunihiro , Kolte Dhaval , Reynolds Harmony R. , Bangalore Sripal , Rosamond Wayne D. , Bhatt Deepak L. , Caughey Melissa C. 
Published: September 2018

Background

Standardization of evidence‐based medical therapies has improved outcomes for patients with non–
ST
‐segment–elevation myocardial infarction (
NSTEMI
). Although racial differences in
NSTEMI
management have previously been reported, it is uncertain whether these differences have been ameliorated over time.

Methods and Results

The ARIC (Atherosclerosis Risk in Communities) Community Surveillance study conducts hospital surveillance of acute myocardial infarction in 4
US
communities.
NSTEMI
was classified by physician review, using a validated algorithm. From 2000 to 2014, 17 755 weighted hospitalizations for
NSTEMI
(patient race: 36% black, 64% white) were sampled by
ARIC
. Black patients were younger (aged 60 versus 66 years), more often female (45% versus 38%), and less likely to have medical insurance (88% versus 93%) but had more comorbidities. Black patients were less often administered aspirin (85% versus 92%), other antiplatelet therapy (45% versus 60%), β‐blockers (85% versus 88%), and lipid‐lowering medications (68% versus 76%). After adjustments, black patients had a 24% lower probability of receiving nonaspirin antiplatelets (relative risk: 0.76; 95% confidence interval, 0.71–0.81), a 29% lower probability of angiography (relative risk: 0.71; 95% confidence interval, 0.67–0.76), and a 45% lower probability of revascularization (relative risk: 0.55; 95% confidence interval, 0.50–0.60). No suggestion of a changing trend over time was observed for any
NSTEMI
therapy (
P
values for interaction, all >0.20).

Conclusions

This longitudinal community surveillance of hospitalized
NSTEMI
patients suggests black patients have more comorbidities and less likelihood of receiving guideline‐based
NSTEMI
therapies, and these findings persisted across the 15‐year period. Focused efforts to reduce comorbidity burden and to more consistently implement guideline‐directed treatments in this high‐risk population are warranted.
Conspecifics of the Striped Lava Lizard are able to distinguish sex and male colour morphs in apparently homogeneous dull dorsal colouration
Authors: Bruinjé Andre C. , Moura Mauricio O. , Maggi Bruno S. , São-Pedro Vinicius A. , Pessoa Daniel M.A. , Costa Gabriel C. 
Published: September 2018

Abstract
Animal colouration plays a key role in inter and intraspecific interactions, pre-eminently in mate signalling. When multiple types of colouration occur within sexes it is possible that they show alternative reproductive strategies. In lizards, most colouration studies do not incorporate how colour is perceived by conspecifics. Here, we used unbiased colour analysis methods (spectrophotometry and visual modelling) to test for sexual dimorphism and within male dichromatism in the Striped Lava Lizard. We found that males express two distinct colourations that are different from females in several dorsal and ventral body regions. Our results showed UV reflection at the throat, an important body region for signalling. Ventral patches, the coloured badge seen in adult males of Tropidurus spp., have two distinct colour classes within males (Y and B males). Morphs are best discriminated by blue and yellow chroma, and brightness. Body size had little influence on colouration, suggesting that colour may be linked to inheritance rather than growth. Our study clearly shows sexual dichromatism and the existence of colour morphs in this species. Moreover, morph differences in colouration are perceptible by conspecifics. These differences are not only between ventral patches, but also in other body parts such as the dorsum, previously considered as cryptic by human observers. We suggest that colouration at the ventral patches and throat might play a role in intraspecific interactions. Patches increase colour intensity during breeding season and are likely to be costly by pigment-based expression, whereas throat’s UV reflection might have a cost infringed by conspicuousness.
Examining WRF’s Sensitivity to Contemporary Land-Use Datasets across the Contiguous United States Using Dynamical Downscaling
Authors: Mallard Megan S. , Spero Tanya L. , Taylor Stephany M. 
Published: September 2018

AbstractLand-use (LU) representation plays a critical role in simulating air–surface interactions that affect meteorological conditions and regional climate. In the Noah LSM within the WRF Model, LU categories are used to set the radiative properties of the surface and to influence exchanges of heat, moisture, and momentum between the air and land surface. Previous literature examined the sensitivity of WRF simulations to LU using short-term meteorological modeling approaches. Here, the sensitivity to LU representation is studied using continental-scale dynamical downscaling, which typically uses longer temporal and larger spatial scales. Two LU datasets, the U.S. Geological Survey (USGS) dataset and the 2006 National Land Cover Dataset (NLCD), are utilized in 3-yr dynamically downscaled WRF simulations over a historical period. Precipitation and 2-m air temperature are evaluated against observation-based datasets for simulations covering the contiguous United States. The WRF-NLCD simulation tends to produce lower precipitation than the WRF-USGS run, with slightly warmer mean monthly temperatures. However, WRF-NLCD results in more notable increases in the frequency of hot days [i.e., days with temperature >90°F (32.2°C)]. These changes are attributable to reductions in forest and agricultural area in the NLCD relative to USGS. There is also subtle but important sensitivity to the method of interpolating LU data to the WRF grid in the model preprocessing. In all cases, the sensitivity resulting from changes in the LU is smaller than model error. Although this sensitivity is small, it persists across spatial and temporal scales.
Does advance care planning in addition to usual care reduce hospitalisation for patients with advanced heart failure: A systematic review and narrative synthesis
Authors: Kernick Lucy A , Hogg Karen J , Millerick Yvonne , Murtagh Fliss E M , Djahit Ayse , Johnson Miriam 
Published: September 2018

Background: People with advanced heart failure have repeated hospital admissions. Advance care planning can support patient preferences, but studies in people with heart failure have not been assessed. Aim: To evaluate the literature regarding advance care planning in heart failure. Design: Systematic review and narrative analysis (PROSPERO CRD42017059190). Data sources: Electronic databases were searched (1990 to 23 March 2017): MEDLINE(R), Cochrane Library, CINAHL and Scopus. Four journals were hand searched. Two independent researchers screened against eligibility criteria. One reviewer extracted all data and a sample by a second. Quality was assessed by Cochrane Risk of Bias or the Critical Appraisal Skills Programme Tool for Cohort Studies. Results: Out of the 1713 articles, 8 were included representing 14,357 participants from in/outpatient settings from five countries. Two randomised controlled trials and one observational study assessed planning as part of a specialist palliative care intervention; one randomised controlled trial assessed planning in addition to usual cardiology care; one randomised controlled trial and one observational study assessed planning in an integrated cardiology–palliative care model; one observational study assessed evidence of planning (advance directive) as part of usual care and one observational study was a secondary analysis of trial participants coded Do Not Attempt Cardiopulmonary Resuscitation. Advance care planning: (1) reduced hospitalisation (5/7 studies); (2) increased referral/use of palliative services (4/4 studies); and (3) supported deaths in the patient-preferred place (2/2 studies). Conclusion: Advance care planning as part of specialist palliative care reduces hospitalisation. Preliminary studies of planning integrated into generic care, accessing specialist palliative care support if needed, are promising.
Percutaneous Cannulation for Extracorporeal Life Support in Severely and Morbidly Obese Patients
Authors: Keyser Andreas , Philipp Alois , Zeman Florian , Lubnow Matthias , Lunz Dirk , Zimmermann Markus , Schmid Christof 
Published: September 2018

Background: Extracorporeal life support systems are well-established devices for treating patients with acute cardiopulmonary failure. Severe or morbid obesity may result in complications such as limb ischemia, bleeding, unsuccessful cannulation, or infection at the cannulation sites. This article reports on our experience with cannulation and associated complications in severely and morbidly obese patients. Methods: Between January 2006 and September 2016, 153 severely or morbidly obese patients with a body mass index >35 kg/m2 were cannulated percutaneously for extracorporeal life support at our center. Among those, 115 patients were treated with venovenous extracorporeal membrane oxygenation (VV ECMO) for acute lung failure and 38 patients with venoarterial extracorporeal membrane oxygenation (VA ECMO) for cardiogenic shock. Complications related to percutaneous access and long-term follow-up were analyzed retrospectively. Primary focus was on the success of cannulation, outcome, thrombosis, bleeding, limb ischemia, and infection at the cannulation site. Normal-weight patients receiving extracorporeal life support served as control. Results: Percutaneous cannulation was successfully performed in all patients. Eighty-five (74%) patients were weaned from VV ECMO and 20 (52%) patients were weaned from VA ECMO. Limb ischemia requiring surgical intervention occurred in 5 (3%) patients, bleeding in 7 (5%) patients, and wound infection in 3 (2%) patients. In all other patients, decannulation was uneventful. These data as well as the long-term survival rates were comparable to those of normal-weight patients ( P > .05). Conclusion: Percutaneous vessel cannulation for extracorporeal life support systems is generally feasible. Therefore, percutaneous cannulation may well be performed in severely and morbidly obese patients. Patient outcome rather depends on appropriate support than on anatomy.
Cost‐utility analysis of colonoscopy or faecal immunochemical test for population‐based organised colorectal cancer screening
Authors: Areia Miguel , Fuccio Lorenzo , Hassan Cesare , Dekker Evelien , Dias-Pereira António , Dinis-Ribeiro Mário 
Published: September 2018

BackgroundOrganised programmes for colorectal cancer screening demand a high burden of medical and economic resources. The preferred methods are the faecal immunochemical test and primary colonoscopy.ObjectiveThe purpose of this study was to perform an economic analysis and comparison between these tests in Europe.MethodsWe used a Markov cost‐utility analysis from a societal perspective comparing biennial faecal immunochemical test or colonoscopy every 10 years screening versus non‐screening in Portugal. The population was screened, aged from 50–74 years, and efficacy was evaluated in quality‐adjusted life years. For the base‐case scenario, the faecal immunochemical test cost was €3 with 50% acceptance and colonoscopy cost was €397 with 38% acceptance. The threshold was set at €39,760/quality‐adjusted life years and the primary outcome was the incremental cost‐effectiveness ratio.ResultsScreening by biennial faecal immunochemical test and primary colonoscopy every 10 years resulted in incremental utilities of 0.00151 quality‐adjusted life years and 0.00185 quality‐adjusted life years at additional costs of €4 and €191, respectively. The faecal immunochemical test was the most cost‐effective option providing an incremental cost‐effectiveness ratio of €2694/quality‐adjusted life years versus €103,633/quality‐adjusted life years for colonoscopy. Colonoscopy capacity would have to increase 1.3% for a faecal immunochemical test programme or 31% for colonoscopy.ConclusionBiennial faecal immunochemical test screening is better than colonoscopy as it is cost‐effective, allows more individuals to get screened, and provides a more rational use of the endoscopic capacity available.
Does Open versus Arthroscopic Surgical Technique Affect the Union Rate of Tibiotalar Arthrodesis?
Authors: Neumann Julie , Weinberg Maxwell , Saltzman Charles , Barg Alexej 
Published: September 2018

Category: Arthroscopy Introduction/Purpose: To date, there are only a handful of studies directly comparing outcomes of open versus arthroscopic ankle arthrodesis. Major limitations of these studies are small patient cohorts, lack of long-term follow-up, lack of assessment pre-operative patient demographics and imaging, and post-operatively evaluation of clinical outcomes but not union rates. The purpose of this clinical study is to compare the rate of union in ankle fusions in patients that underwent open arthrodesis to those that underwent arthroscopic arthrodesis. The hypothesis of this study was that there would be no difference in union rate in patients that underwent open versus arthroscopic arthrodesis. Methods: This is a retrospective review of 521 consecutive patients from October 2002 to April 2016. One hundred twenty-five ankles from 121 patients met inclusion criteria. These patients underwent primary tibiotalar arthrodesis without the use of autograft. Fifty-nine patients underwent open tibiotalar arthrodesis and 66 patients underwent arthroscopic tibiotalar arthrodesis. Age, gender, body mass index, smoking, and preoperative radiographic deformity were controlled. The primary outcome measure was union rate of tibiotalar arthrodesis. Secondary outcome measures were time to union, rate of wound complications, rate of return to operating room, and rate of development of post-operative deep vein thrombosis (DVT). Results: One hundred twenty-one patients (125 ankles) were available for final follow-up. Average age of the patients was 55.3 +/- 17.2 years. Mean follow-up time was 35.4 months. Unions were assessed on routine post-operative radiographs. If there was a concern for nonunion, computerized tomography scan was utilized for further assessment. Nonunion rate of patients who had open surgery was 10/59 (17%) and nonunion rate of those who had arthroscopic surgery was 13/66 (20%) (p=0.69) [Table 1]. There was a statistically significant difference between those who had open versus arthroscopic surgery in wound complication rate (39% vs 6%, p=<0.001) and DVT rate (7% vs 0%, p=0.047). There was no statistically significant difference in rate of return to the operating room. No major complications occurred in this study. Conclusion: This study is the largest study to directly compare union rate and complications in patients who had open versus arthroscopic ankle arthrodesis. In this study, no significant association was found between surgical technique and union rate in patients undergoing ankle arthrodesis. Additionally, use of the arthroscopic technique has significantly lower rates of wound complication and post-operative DVTs.
Matrix-associated Stem Cell Transplantation (MAST) in Chondral Lesions at the Ankle as Part of a Complex Surgical Approach
Authors: Richter Martinus , Zech Stefan 
Published: September 2018

Category: Ankle Introduction/Purpose: The aim of the study was to assess the 5-year-follow-up after matrix-associated stem cell transplantation (MAST) in chondral lesions at the ankle as part of a complex surgical approach. Methods: In a prospective consecutive non-controlled clinical follow-up study, all patients with chondral defect that were treated with MAST from April1 2009 to September 30, 2011 were analyzed. Size and location of the chondral defects and the Visual-Analogue-Scale Foot and Ankle (VAS FA) before treatment and at follow-up were analysed. Stem cell-rich blood was harvested during the procedure from the ipsilateral pelvic bone marrow with a Jamshidi needle (10 x 3 mm, Cardinal, Dublin, OH, USA) and a special syringe (Arthrex-ACP, Arthrex, Naples, FL, USA) through a stab incision. The syringe was centrifuged (10 minutes, 1,500 rotations per minute). The supernatant was used to impregnate a collagen I/III matrix (Chondro-Gide, Geistlich, Wollhusen, Switzerland) that was cut to the size of the cartilage defect roughly before and definitely after. The matrix with stem cells was fixed into the chondral defect with fibrin glue (Tissucoll, Deerfield, IL, USA). Results: Sixty-six patients with 69 chondral defects were included in the study. The age of the patients was 35 years on average (range, 12-64 years). VAS FA before surgery was 48.9 on average (range, 16.5-75.9). The defects were located as follows, medial talar shoulder, n=28; lateral talar shoulder, n=28 (medial and lateral talar shoulder, n=3), tibia, n=3. The defect size was 1.4 cm2 on average (range, .6 - 6 cm2). 60 patients (91%) completed 5-year-follow-up. No patient was converted to fusion or total ankle replacement. The VAS FA improved to an average of 78.2 (range, 60.8-100; p=.01). Conclusion: MAST as part of a complex surgical approach led to improved and high validated outcome scores in the mid-term-follow-up. No method related complications were registered. Even though a control group is missing, we conclude that MAST as part of a complex surgical approach is an effective method for the treatment of chondral lesions of the ankle for at least five years.
Objectifying the Assessment of Pain
Authors: Strauss Michael , Strauss Wendy 
Published: September 2018

Category: Other Introduction/Purpose: Pain is a pervasive problem that accounts for a high percentage of referrals to health care providers including foot and ankle surgeons and is an important factor in narcotic addictions and their related deaths. Unfortunately, the analogue pain scores are determined by subjective (SUB) responses of the patient and fail to utilize objective criteria for making the assessments. In an attempt to resolve the subjectivity/objectivity concerns, we developed a scoring system that uses objective (OBJ) criteria based on three 0-to-10 scales. The measurements include the patients’ requirements for analgesics, how the pain affects their levels of activity and how it affects their thought processes. Methods: Over an 18 month period and as part of a physician pain management group’s initial assessment of their patients, the study group was asked to rate their pain using the three SUB scales (Numerical Rating Scale, Visual Analogue Scale and Verbal Rating Scale) as well as our three OBJ scales. Each of our three OBJ (analgesics, activities and thought processes) scales used precise terms to quantify the numerical value for the scale. For example, the analgesics requirement ranged from no drug (0-points) to requirement for hospitalization for pain management (10-points). The activity scale ranged from no limitations (0-points) to pain noticed only with activity (4-points) to total limitation of activities (10-points). Analogous objective criteria were used for the third scale, how pain affects thought processes. Data analysis included patients’ responses to the objective pain measurements as well as correlations between OBJ and SUB evaluation scoring systems. Results: Data was collected prospectively on 109 patients. The mean scores (summation of the3 SUB pain scales divided by 3 and doing likewise for the OBJ pain scales was significantly higher for the SUB scores (6.4 vs. 4.2, p < 0.001). The lowest correlations between the SUB scores and each OBJ scale was with analgesic use (r = .36 vs. r’s = .53 for the other 2 OBJ scales). In general patients who scored highest on the SUB scores, preferred them to the OBJ measurements. Differences between the scores on the OBJ activity scale versus the OBJ thought processes scale helped distinguish pain of central versus peripheral origins. Ninety percent of patients completed the SUB plus OBJ scoring in less than 3 minutes. Conclusion: Our OBJ Pain Score helped differentiate those patients who magnified their pain symptom from those who did not. Patients with higher scores on the thought processes scale would appear to be best managed by central nervous system acting drugs. Conversely those with higher OBJ activity scores would likely respond to peripheral acting agents such as non-steroidal analgesics, local injections or analgesic patches. In summary, our scoring system moves the evaluation of pain from subjective to objective. This has important ramifications for pain management, analgesic selection and avoidance of narcotic dependency.