bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of Events Across Bleeding Scales in the ENGAGE AF-TIMI 48 Trial
Authors: Bergmark Brian A. , Kamphuisen Pieter W. , Wiviott Stephen D. , Ruff Christian T. , Antman Elliott M. , Nordio Francesco , Kuder Julia F. , Mercuri Michele F. , Lanz Hans J. , Braunwald Eugene , Giugliano Robert P. 
Published: October 2019

Background:
Numerous scales exist for the classification of major bleeding events. Limited data compare the most commonly used bleeding scales within a single at-risk cohort of patients with atrial fibrillation. Here, we analyze bleeding outcomes according to the ISTH (International Society on Thrombosis and Hemostasis), TIMI (Thrombolysis in Myocardial Infarction), GUSTO (Global Usage of Strategies to Open Occluded Arteries), and BARC (Bleeding Academic Research Consortium) bleeding scales in the ENGAGE AF (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation)–TIMI 48 trial (NCT00781391) of edoxaban versus warfarin.

Methods:

A total of 21 105 patients with atrial fibrillation at risk for stroke (CHADS
2
score ≥2) were enrolled in the ENGAGE AF-TIMI 48 trial comparing warfarin with a higher- (60/30 mg daily) or lower- (30/15 mg daily) dose edoxaban regimen. Median follow-up was 2.8 years. Bleeding events occurring among on-treatment patients were examined. Annualized event rates were calculated by the ISTH, TIMI, GUSTO, and BARC scales and compared across treatment arms. Cox proportional hazards for a first bleeding event of each type were calculated for higher-dose edoxaban regimen vs warfarin and lower-dose edoxaban regimen versus warfarin.

Results:
A total of 10 311 bleeding events were reported. In a comparison of the most severe events in each scale, ISTH major bleeding was the most common (n=1289), followed by TIMI major (n=548), GUSTO severe/life-threatening (n=347), and BARC 3c+5 (n=276) bleeding. Lower bleeding risk with edoxaban compared with warfarin was seen regardless of bleeding scale (higher-dose edoxaban regimen range: hazard ratio [HR], 0.47 [95% CI, 0.35–0.62] for BARC 3c+5 versus HR, 0.80 [95% CI, 0.71–0.91] for ISTH major; lower-dose edoxaban regimen range: HR, 0.32 [95% CI, 0.23–0.45] for BARC 3c+5 versus HR, 0.47 [95% CI, 0.41–0.55] for ISTH major). Furthermore, a gradient of more pronounced risk reduction with edoxaban was observed with greater severity of first bleeding event (higher-dose edoxaban regimen: HR, 0.47 [95% CI, 0.35–0.62] for BARC 3c+5 bleeds versus HR, 0.86 [95% CI, 0.81–0.91] for any BARC bleed; lower-dose edoxaban regimen: HR, 0.32 [95% CI, 0.23–0.45] for BARC 3c+5 bleeds versus HR, 0.68 [95% CI, 0.63–0.72] for any BARC bleed). The direction of this trend was consistent for both gastrointestinal bleeding and nongastrointestinal bleeding.

Conclusions:
Among patients with atrial fibrillation at risk for stroke, there was a >4-fold difference in the frequency of the most severe bleeding events across commonly used bleeding scales. Furthermore, the relative safety of edoxaban compared with warfarin tended to increase with greater severity of bleeding.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT00781391.
Associations Between Left Ventricular Structure, Function, and Cerebral Amyloid
Authors: Johansen Michelle C. , Mosley Thomas H. , Knopman David S. , Wong Dean F. , Wagenknecht Lynne E. , Shah Amil M. , Solomon Scott D. , Gottesman Rebecca F. 
Published: October 2019

Background and Purpose—
Cardiovascular disease is a known risk factor for cognitive decline, although the mechanisms remain unclear. We hypothesize that Aβ (β-amyloid), a core pathology of Alzheimer's disease, will be associated with subclinical cardiac structure and function echocardiogram indices.

Methods—
Three hundred six nondemented participants from the ARIC study (Atherosclerosis Risk in Communities Study) underwent florbetapir positron emission tomography and 2D echocardiography (echo). Cross-sectional associations between echo markers of left ventricular structure and function and global cortical Aβ (≥1.2 standardized uptake value ratio were evaluated using multivariable logistic regression with interaction terms when appropriate.

Results—
Participants ranged in age from 67 to 88 years, were 57% female and 42% black. Per 1 cm increase in end-diastolic left ventricular diameter, the odds of elevated florbetapir standardized uptake value ratio doubled (odds ratio, 2.04 [95% CI, 1.10–3.77]), with similar findings when excluding mild cognitive impairment (odds ratio, 2.61 [95% CI, 1.22–5.59]).

Conclusions—
We have demonstrated a significant association between a marker of left ventricular structure and elevated florbetapir standardized uptake value ratio, identified using positron emission tomography. Ongoing prospective work will help determine if changes in cardiac structure and function either precede, or occur simultaneously with deposition of amyloid.
Perceptions of Hurricane-Track Forecasts in the United States
Authors: Senkbeil Jason , Reed Jacob , Collins Jennifer , Brothers Kimberly , Saunders Michelle , Skeeter Walker , Cerrito Emily , Chakraborty Saurav , Polen Amy 
Published: October 2019

AbstractHurricanes Isaac (2012), Harvey (2017), and Irma (2017) were storms with different geophysical characteristics and track forecast consistencies. Despite the differences, common themes emerged from the perception of track forecasts from evacuees for each storm. Surveys with a mixture of closed and open-ended responses were conducted during the evacuations of each storm while the storm characteristics and decision-making were fresh in the minds of evacuees. Track perception accuracy for each evacuee was quantified by taking the difference between three metrics: perceived track and official track (PT − OT), perceived track and forecast track (PT − FT), and home location and perceived track (HL − PT). Evacuees from Hurricanes Isaac and Harvey displayed a tendency to perceive hurricane tracks as being closer to their home locations than what was forecast to occur and what actually occurred. The large sample collected for Hurricane Irma provided a chance to statistically verify some of the hypotheses generated from Isaac and Harvey. Results from Hurricane Irma confirmed that evacuees expected a storm to be closer to their home locations after controlling for regional influences. Furthermore, participants with greater previous hurricane experience perceived a track as being closer to their home locations, and participants residing in zip codes corresponding with nonmandatory evacuation zones also perceived tracks as being closer to their home locations. These findings suggest that most evacuees from hurricanes in the United States appear to perceive storms as being closer to their home locations than they are and overestimate wind speeds at their homes, thus overestimating the true danger from landfalling hurricanes in many storms.
Acute Noncalculous Cholecystitis in a Three-Year-Old Child: Report of a Case Diagnosed at Operation
Authors: Hopkins James W. , Lynn Hugh B. , Dower John C. 
Published: October 2019

Several generalizations emerge from these studies and are illustrated by our three-year-old patient. Cholecystitis in childhood is “very uncommon, probably rare,” and, “Certainly choledocholithiasis is rare” (Ulin14). An acute systemic disease is often a forerunner of acute cholecystitis in children and may be causally related in some cases; it may obscure the diagnosis. Systemic symptoms accompanying localized abdominal findings should strengthen the suspicion of acute cholecystitis. Abdominal pain and guarding and evidence of a mass are the keys to the diagnosis. The pain patterns of radiating colic and gastro-intestinal upset of the adult are not often seen in childhood. The etiology of acute noncalculous type of cholecystitis is not known. Acute symptoms of short duration and bacterial and polymorphonuclear infiltration of the wall of the gallbladder tend to distinguish childhood cholecystitis from its adult counterpart clinically and pathologically. Stones, when present, are often of hemolytic origin and occur more frequently in older children. An important difference in the surgical management of affected children as compared with adults is that jaundice alone, or stones in the gallbladder, usually do not demand exploration of the common duct. Cholecystectomy, when not contraindicated by severe associated illness, appears to be the treatment of choice.
Cognitive Training: Transfer Beyond the Laboratory?
Authors: Lintern Gavan , Boot Walter R. 
Published: October 2019

Objective To assess the evidence of general transfer from training on abstract computer-based exercises and video games to driving and flight control. Background Many believe that training on abstract computer-based exercises and video games enhances cognitive capacities to the benefit of performance in operational contexts. The basic research in this area is controversial. Method We summarize reviews of the basic research data on transfer from training on abstract computer-based exercises and video games and undertake a detailed methodological review of flight and driving transfer studies. Results Reviews of basic transfer research fail to reveal evidence of general transfer, although a few applied studies are said to show general transfer to driving or flight control. Our review of these applied studies identifies issues with research methods and data interpretation that compromise the credibility of their results to an extent that they do not provide robust evidence of general transfer from abstract computer-based exercises or video games. Conclusion The state of cognitive training and video game training in relation to transfer has failed to meet early expectations. Much of the research in this area suffers from inadequate experimental control and flawed interpretation of results. We call for adherence to robust experimental design, critical evaluation of data patterns, and replication of keystone results. We also call for a theoretically grounded research effort, and we outline relevant theoretical conceptions of transfer. Application A robust theory of transfer and better understanding of transfer effects can guide development of principles for design and use of training simulators.
Black and White Differences in Life Expectancy in 4 US States, 1969-2013
Authors: Kaufman Jay S. , Riddell Corinne A. , Harper Sam 
Published: October 2019

Objectives: Racial differences in mortality in the United States have narrowed and vary by time and place. The objectives of our study were to (1) examine the gap in life expectancy between white and black persons (hereinafter, racial gap in life expectancy) in 4 states (California, Georgia, Illinois, and New York) and (2) estimate trends in the contribution of major causes of death (CODs) to the racial gap in life expectancy by age group. Methods: We extracted data on the number of deaths and population sizes for 1969-2013 by state, sex, race, age group, and 6 major CODs. We used a Bayesian time-series model to smooth and impute mortality rates and decomposition methods to estimate trends in sex- and age-specific contributions of CODs to the racial gap in life expectancy. Results: The racial gap in life expectancy at birth decreased in all 4 states, especially among men in New York (from 8.8 to 1.1 years) and women in Georgia (from 8.0 to 1.7 years). Although few deaths occurred among persons aged 1-39, racial differences in mortality at these ages (mostly from injuries and infant mortality) contributed to the racial gap in life expectancy, especially among men in California (1.0 year of the 4.3-year difference in 2013) and Illinois (1.9 years of the 6.7-year difference in 2013). Cardiovascular deaths contributed most to the racial gap in life expectancy for adults aged 40-64, but contributions decreased among women aged 40-64, especially in Georgia (from 2.8 to 0.5 years). The contribution of cancer deaths to inequality increased in California and Illinois, whereas New York had the greatest reductions in inequality attributable to cancer deaths (from 0.6 to 0.2 years among men and from 0.2 to 0 years among women). Conclusions: Future research should identify policy innovations and economic changes at the state level to better understand New York’s success, which may help other states emulate its performance.
Randomized Comparative Study of Microwave Ablation and Electrocautery for Control of Recurrent Epistaxis
Authors: Lou Zheng-Cai , Jin Kan-Feng 
Published: October 2019

Objective: To compare the outcomes of adult patients with recurrent epistaxis treated intraoperatively with either bipolar electrocautery or microwave ablation (MWA). Study Design: Prospective randomized control study. Materials and Methods: One hundred ten patients with idiopathic recurrent epistaxis who met the inclusion criteria were randomly assigned into MWA group and bipolar electrocautery group. Primary outcomes were the proportion of patients in each group whose bleeding had stopped within 24 hours after treatment and time to achieve successful hemostasis. Secondary outcomes were the rebleeding rate after 3 days, 1 and 12 weeks, and 6 months and complications. Results: Successful immediate arrest of epistaxis was achieved in all patients. The times to achieve successful hemostasis were 2.13 ± 1.04 minutes in the MWA group and 6.60 ± 2.68 minutes in the bipolar electrocautery group ( P = .000). The rates of recurrent bleeding were similar in patients treated with the different approaches ( P = .231). However, secondary crusting was observed endoscopically in 59 patients in the bipolar electrocautery group, while pseudomembrane of the ablation zone was seen in 19 (36.5%) patients in the MWA group. Nevertheless, there were no severe postoperative complications, including septal perforation and orbit and brain complications, in either group at the 6-month follow-up. Conclusion: Bipolar electrocautery and MWA had similar outcomes for the treatment of adult patients with recurrent epistaxis. However, MWA resulted in rapid hemostasis with less local nasal pain and less crust. Thus, MWA could be a favorable treatment option for patients with idiopathic recurrent epistaxis.
Comparison of the Effects of 2 Surgical Techniques Used in the Treatment of Concha Bullosa on Olfactory Functions
Authors: Akkoca Özlem , Tüzüner Arzu , Ünlü Ceren Ersöz , Şimşek Gökçe , Kaytez Selda Kargın , Uğurlu Gülay Aktar 
Published: October 2019

Introduction: Concha bullosa (CB), which is pneumatization of the concha, is one of the most commonly seen anatomic variations of the lateral nasal wall. Objective: To investigate the effects on olfactory function of lateral turbinectomy and crushing methods used in the surgical treatment of CB. Methods: The study included a total of 47 patients operated on for a diagnosis of CB and nasal septum deviation. The patients comprised 22 females and 25 males, with bilateral CB in 18 cases and unilateral in 29 cases. Intervention was made to a total of 65 CB. The cases were separated as those applied with septoplasty and lateral turbinectomy in group 1 (n = 34) and those applied with the septoplasty and crushing method in group 2 (n = 31). The olfactory function of the patients was evaluated preoperatively and at 3 months postoperatively with the Brief Smell Identification Test. Results: A statistically significant increase was determined in the postoperative smell test results compared with the preoperative values in both group 1 ( P = .021) and group 2 ( P = .001). When the change in the smell test results from preoperative to postoperative was compared between the groups, the increase in group 2 was determined to be statistically significantly greater ( P = .002). Conclusion: The results of this study showed that the crushing method in surgical treatment of CB increased olfactory functions more than the lateral resection method, and as the improvement in olfactory functions was greater, this demonstrated that only increasing the nasal cavity is not sufficient and the nasal mucosa should be protected as far as possible.
Interim use of a maxillary lip bumper during interdisciplinary management of ectopically erupted incisor teeth
Authors: Singh Harpreet , Sharma Poonam , Maurya Raj Kumar , Kapoor Pranav , Mittal Tanmay , Yadav Priya , Mittal Meenu 
Published: October 2019

Introduction: Ectopic eruption, manifesting as an aberration in the normal path of eruption of a tooth, can adversely impact facial aesthetics, phonetics and psychosocial development. Description: This case series describes the orthodontic management of two adolescent patients with different clinical presentations of ectopically erupted maxillary central incisors secondary to trauma during the primary dentition period. The therapy primarily included periodontal soft-tissue surgery accompanied by orthodontic traction to align the ectopic incisors. Frenectomy was performed in one patient and surgical excision of a hypertrophied pseudo-pouch in the second patient. A modified maxillary lip bumper was used concomitantly for management of associated soft-tissue trauma, thus facilitating healing and aiding orthodontic traction. Results: Appropriately planned interdisciplinary management involving the interim use of a modified lip bumper allowed proper alignment of the ectopically positioned incisors with a stable outcome at three-year follow-up. Conclusion: Fixed orthodontic therapy with concurrent use of modified maxillary lip bumper is an effective approach to treat incisors erupted ectopically in relation to the upper lip and frenum.
Orthodontic plate for management of obstructive sleep apnoea in infants with Pierre Robin sequence: experience and protocol in Hong Kong
Authors: Ho Angus CH , Wong Ricky WK , Cheung Tania , Ng Daniel K , Siu KK , Fung SC 
Published: October 2019

Objective: To present the application of the pre-epiglottic baton plate (PEBP) in infants with Pierre Robin sequence (PRS) in the Southern Chinese population (Hong Kong) and to present the diagnosis and management protocol of these infants in our centre. Design: Retrospective case series of three patients with PRS. Setting: Neonatal Intensive Care Unit in Kwong Wah Hospital and Craniofacial Orthodontic Centre in United Christian Hospital, Hong Kong. Participants: Three new-born infants (two girls, one boy) with PRS and upper airway obstruction due to glossoptosis. Methods: A protocol for the diagnosis and management of these infants in the Southern Chinese population (Hong Kong) was presented. The three patients received nasal high-flow oxygen and/or continuous positive airway pressure (CPAP) as first-line respiratory support, followed by PEBP for 3–5 months. A two-stage approach was undertaken to ensure accurate positioning of the PEBP. Results: All three infants had improvement in clinical signs, symptoms and polysomnography upon discharge. PEBP and other respiratory aids were weaned off at 3–6 months. Conclusions: The PEBP, combined with other respiratory support, is a useful modality in the treatment of obstructive sleep apnoea in infants with PRS.
Accurate diagnosis and treatment of isolated mesenteric artery dissections
Authors: Gang Chen , Xiujuan Gao , Yingjiang Xu , Xun Cui , Dan Shang , Jianyong Liu , Bi Jin 
Published: October 2019

Objectives Diagnosis and treatment of isolated mesenteric artery dissections (IMAD) are overlooked. The purpose of this study was to assess the clinical feature, possible diagnostic errors and treatment methods. Methods From January 2010 to December 2017, 99 consecutive patients who were diagnosed with IMAD on computed tomography angiography were enrolled retrospectively. Thirty-nine misdiagnosed patients, false negative, and 60 accurate diagnosis patients with revealed IMAD were compared. In addition, therapeutic schemes were evaluated. Results Ninety-nine patients participated in this study; 39 patients (34 men, 5 women; median age, 51.41 years, range 38–64 years) were included in group A who were misdiagnosed initial visit; the remaining 60 patients (52 men, 8 women; median age, 52.07 years, range 38–68 years) with IMAD who were diagnosed accurately initial visit were included in group B. Significant differences were observed between the two groups with respect to dissection length (55.26 ± 3.88 mm vs. 43.37 ± 2.75 mm; p = 0.01), and branch involvement (14 and 9, respectively; p = 0.04). Ultimately, 33 patients (group A 14 patients and group B 19 patients) underwent invasive interventional therapy, and 66 patients with conservative treatment with antithrombotic agents (group A 25 patients and group B 41 patients). A total of 86 (86.87%) had follow-up computed tomography angiography with a median duration of 24.51 months (range 2–71 months). Three patients died during follow-up. The remaining patients recovered smoothly. Conclusion Physicians should raise the awareness of IMAD and use the optimal treatment time frame. Diagnosis of IMAD depends on imaging examinations, especially computed tomography angiography. Additionally, conservative management is the most common initial treatment. For patients in whom conservative treatment fails, endovascular and/or surgery may be necessary.
Exploring a physiotherapy well‐being review to deliver community‐based rehabilitation in patients with pulmonary hypertension
Authors: Keen Carol , Hashmi‐Greenwood Molly , York Janelle , Armstrong Iain J , Sage Karen , Kiely David 
Published: October 2019

BackgroundHighly structured, supervised exercise training has been shown to be beneficial in patients with pulmonary hypertension. Despite evidence of the effectiveness of community‐based rehabilitation in other cardiopulmonary diseases, there are limited data in patients with pulmonary hypertension.MethodsThis prospective study evaluated the intervention of a physiotherapist well‐being review in patients with pulmonary hypertension who had been established on targeted drug therapy for between 3 and 12 months. The intervention included a detailed consultation assessing functional, social and motivational status to identify individual patient rehabilitation goals and facilitate tailored referrals to community‐based services.ResultsOne hundred and thirty‐eight patients (79% pulmonary arterial hypertension, 17% chronic thromboembolic disease), age 67 ± 14 years, diagnosed over a one year period were evaluated between July 2017 and January 2018. Fifty‐two per cent of patients were referred to community‐based pulmonary rehabilitation programmes, 19% received other forms of community rehabilitation, 17% were given exercise advice, 5% had an assessment of social support and 7% declined any intervention. At the end of the study, 32% of patients were undertaking independent exercise.ConclusionThis study has identified that the majority of patients with pulmonary hypertension who are optimised on targeted drug therapy have rehabilitation needs. The use of a physiotherapy well‐being review can identify this need and facilitate access to community‐based rehabilitation. Further research is required to evaluate the efficacy of such interventions in pulmonary hypertension.