bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of the Effects of Ticagrelor and Clopidogrel on Microvascular Dysfunction in Patients With Acute Coronary Syndrome Using Invasive Physiologic Indices
Authors: Park Kyungil , Cho Young-Rak , Park Jong-Sung , Park Tae-Ho , Kim Moo-Hyun , Kim Young-Dae 
Published: September 2019

Background:
Ticagrelor reduced the rate of myocardial infarction and death compared with clopidogrel in patients with acute coronary syndrome. However, little is understood about chronic treatment of ticagrelor on microvascular dysfunction. The objective of this study was to assess the impact of ticagrelor maintenance treatment on microvascular system and coronary flow in comparison with clopidogrel.

Methods:
This study was a nonblinded, open-label, parallel-group, prospective, randomized controlled trial that enrolled 120 patients with acute coronary syndrome requiring stent implantation. Patients were randomized into the ticagrelor (180 mg loading dose, 90 mg twice daily thereafter) or clopidogrel (300 to 600 mg loading dose, 75 mg daily thereafter) group. The primary end point was coronary microvascular dysfunction as measured by an index of microcirculatory resistance (IMR) at 6 months after treatment.

Results:

The baseline clinical characteristics and physiological parameters, such as fractional flow reserve, coronary flow reserve, and IMR, did not differ between the ticagrelor and clopidogrel groups. Six-month follow-up physiological data showed that the IMR value was significantly lower in the ticagrelor group than the clopidogrel group (15.57±5.65 versus 21.15±8.39,
P
<0.01), and coronary flow reserve was higher in the ticagrelor group than in the clopidogrel group (3.85±0.72 versus 3.37±0.76,
P
<0.01). However, there was no difference in fractional flow reserve (0.87±0.08 versus 0.87±0.09,
P
=0.94) between the 2 groups. The improvement in IMR after 6 months of treatment was higher in the ticagrelor group (
P
<0.01). Analyses of 223 nonculprit vessels of registered patients based on physiological results showed no differences in baseline fractional flow reserve (0.93±0.13 versus 0.92±0.09,
P
=0.58), coronary flow reserve (3.62±1.27 versus 3.51±1.24,
P
=0.16), or IMR (21.37±12.37 versus 24.19±21.08,
P
=0.22) or in follow-up fractional flow reserve (0.91±0.09 versus 0.91±0.08,
P
=0.67), coronary flow reserve (3.91±1.22 versus 3.75±1.16,
P
=0.36), or IMR (19.43±10.32 versus 21.52±18.90,
P
=0.34) between the 2 groups.

Conclusions:
Compared with clopidogrel, 6 months of ticagrelor therapy significantly improved microvascular dysfunction in acute coronary syndrome patients with stent implantation.

Clinical Trial Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02618733.
Return to Employment After Stroke in Young Adults
Authors: Jarvis Hannah L. , Brown Steven J. , Price Michelle , Butterworth Claire , Groenevelt Renee , Jackson Karl , Walker Louisa , Rees Nia , Clayton Abigail , Reeves Neil D. 
Published: September 2019

Background and Purpose—
A quarter of individuals who experience a stroke are under the age of 65 years (defined as young adults), and up to 44% will be unable to return to work poststroke, predominantly because of walking difficulties. No research study has comprehensively analyzed walking performance in young adult’s poststroke. The primary aim of this study is to investigate how a stroke in young adults affects walking performance (eg, walking speed and metabolic cost) compared with healthy age-matched controls. The secondary aim is to determine the predictive ability of walking performance parameters for return to employment poststroke.

Methods—
Forty-six individuals (18–40 years: n=6, 41–54 years: n=21, 55–65 years: n=19) who have had a stroke and 15 healthy age-matched able-bodied controls were recruited from 6 hospital sites in Wales, United Kingdom. Type, location, cause of stroke, and demographic factors (eg, employment status) were recorded. Temporal and spatial walking parameters were measured using 3-dimensional gait analysis. Metabolic energy expenditure and metabolic cost of walking were captured during 3 minutes of walking at self-selected speed from measurements of oxygen consumption.

Results—

Stroke participants walked slower (
P
<0.004) and less efficiently (
P
<0.002) than the controls. Only 23% of stroke participants returned to employment poststroke. Walking speed was the strongest predictor (sensitivity, 0.90; specificity, 0.82) for return to work (
P
=0.004) with a threshold of 0.93 m/s identified: individuals able to walk faster than 0.93 m/s were significantly more likely to return to work poststroke than those who walked slower than this threshold.

Conclusions—
This study is the first to capture walking performance parameters of young adults who have had a stroke and identifies slower and less efficient walking. Walking speed emerged as the strongest predictor for return to employment. It is recommended that walking speed be used as a simple but sensitive clinical indicator of functional performance to guide rehabilitation and inform readiness for return to work poststroke.
Admission Diffusion-Weighted Imaging Lesion Volume in Patients With Large Vessel Occlusion Stroke and Alberta Stroke Program Early CT Score of ≥6 Points
Authors: Yu Inwu , Bang Oh Young , Chung Jong-Won , Kim Yoon-Chul , Choi Eun-Hyeok , Seo Woo-Keun , Kim Gyeong-Moon , Menon Bijoy K. , Demchuk Andrew M. , Goyal Mayank , Hill Michael D. ,   Calgary-Samsung Stroke Collaborators
Published: September 2019

Background and Purpose—
We hypothesized that the pial collateral status at the time of presentation could predict the infarct size on magnetic resonance imaging in patients with similar degrees of early ischemic changes on computed tomography. We tested the association between serial changes in collateral status and infarct volume defined on diffusion-weighted imaging (DWI) in patients with large vessel occlusion and small core.

Methods—
Consecutive patients who were candidates for endovascular treatment (Alberta Stroke Program Early CT Score [ASPECTS] of ≥6 points) and who underwent both pretreatment multiphasic computed tomography angiography (mCTA) and multimodal magnetic resonance imaging were enrolled. The baseline early ischemic changes and collateral status were determined using both mCTA and magnetic resonance imaging–based collateral maps. Multivariable linear regression was used to evaluate adjusted estimates of the effect of collateral status on predicting MR DWI lesion volume before endovascular treatment.

Results—

Of 65 patients (39 men; median age, 76 years; median ASPECTS, 8 points [range, 6–10]), 10 (15.4%), 8 (12.3%), and 47 (72.3%) presented poor, intermediate, and good collaterals on mCTA, respectively. After adjusting for the initial stroke severity, ASPECTS, time to DWI, and mismatch volume, the mCTA collateral grade was the only factor independently associated with the DWI lesion volume (β=−35.657, SE mean=3.539;
P
<0.0001). An excellent correlation between the mCTA- and magnetic resonance imaging-based collateral grades was observed (matching grade seen in 92.3%), suggesting a collateral status persistence during the hyperacute stroke phase.

Conclusions—
The mCTA assessed collateral adequacy is the sole predictor of eventual DWI lesion volume before endovascular treatment. The added value of collateral assessment in early ischemic changes and large vessel occlusion for decision-making regarding more aggressive revascularizations requires further evaluation.

Clinical Trial Registration—

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT03234634 and NCT02668627.
Connie Palmen’s and Jan Fabre’s Grief Staged as Landscape of Memory
Authors: Solakidi Sylvia 
Published: September 2019

AbstractTwo works focusing on the corporeality of grief, The Logbook of a Merciless Year by Connie Palmen and the theatre text Requiem for a Metamorphosis by Jan Fabre, are explored alongside Merleau-Ponty’s ontology for their way to transform personal grief, characterized by identity crisis and spatiotemporal disorientation, into an act of remembering. The two works are approached as fictions of the body in pain, enacting grief like body art pieces in order to make pre-reflective sense of it. Pain becomes an agent, allowing the authors to open up by transforming their introvert portraits of grief into corporeal landscapes, characterized by a temporality of stillness/movement. Based on Merleau-Ponty’s notions of simultaneity and institution, this essay demonstrates how movement allows a spatiotemporal opening so that memory may be enacted from the point of view of the present upon all temporal moments. Therefore, grievers reinvent themselves in their works, as those who enact memory.
Impact of age on outcomes of patients assisted by veno-arterial or veno-venous extra-corporeal membrane oxygenation: 403 patients between 2005 and 2015
Authors: Marie Basile , Anselmi Amedeo , Flecher Erwan , Nesseler Nicolas , Launey Yoann , Tadie Jean-Marc , Verhoye Jean-Philippe 
Published: September 2019

Introduction: To assess the impact of age on early outcomes and mortality in veno-arterial extra-corporeal membrane oxygenation and veno-venous extra-corporeal membrane oxygenation recipients, and to investigate predictors of mortality. Methods: Single-center retrospective study on prospectively collected data including all patients treated by veno-venous extra-corporeal membrane oxygenation and veno-arterial extra-corporeal membrane oxygenation (January 2005-July 2015). Outcomes were compared among two subgroups: aged less than 65 years (Group 1) versus more than 65 years (Group 2) and by type of support (veno-arterial extra-corporeal membrane oxygenation or veno-venous extra-corporeal membrane oxygenation). Results: Among 403 patients, 20.3% were treated by veno-venous extra-corporeal membrane oxygenation and 79.7% by veno-arterial extra-corporeal membrane oxygenation. Veno-arterial extra-corporeal membrane oxygenation group: 76.6% were included in Group 1 and were more severe (pH 7.30 ± 0.19 vs. 7.35 ± 0.13 in Group 2, p = 0.003; lactates 7.5 ± 5.6 mmol/L vs. 5.8 ± 4.5 mmol/L in Group 2, p = 0.003). Weaning rate was higher in Group 1 (63.8% vs. 45.3%, p = 0.0043). The 30-day survival was higher in Group 1 (52.0% vs. 25.3%, p < 0.001). Univariate analysis identified higher Simplified Acute Physiology Score II (p = 0.02) and noradrenaline (p = 0.04) to be associated with mortality. Veno-venous extra-corporeal membrane oxygenation group: 80.5% were in Group 1. Mean PaO2 was 73.5 ± 42.9 mm Hg versus 100.8 ± 80.3 mm Hg (p = 0.24); FiO2 90.1% ± 18% versus 89.4% ± 16.4% (p = 0.89); and 30-day survival 56.1% versus 25.0% (p = 0.048). Conclusion: Patients older than 65 years have higher mortality after veno-arterial extra-corporeal membrane oxygenation or veno-venous extra-corporeal membrane oxygenation. This therapeutic strategy is feasible in the elderly, but comorbidities and clinical presentation have a major impact on prognosis and need to be seriously considered to avoid futile treatment.
Predictive value of the serum anti-Müllerian level for spontaneous pregnancy in women after endometriosis surgery
Authors: Zhou Yong , Chen Chaolu , Hu Changchang , Wang Yuan , Zhang Xian , Wu Ruijin 
Published: September 2019

Objective This study was performed to assess the predictive value of the anti-Müllerian hormone (AMH) serum level for spontaneous pregnancy in women after endometriosis surgery. Methods In total, 124 patients with suspected ovarian endometrioma planning to undergo laparoscopic ovarian cystectomy were divided into a high AMH group (AMH > 2 ng/mL) and low AMH group (AMH ≤ 2 ng/mL) according to their preoperative AMH levels. The postoperative AMH levels were also measured, and pregnancy outcomes were followed up. Results Twenty-one patients were excluded, and 52 pregnancies were registered in the remaining 103 patients diagnosed with endometriosis. The pregnancy rate was significantly greater in the high than low AMH group. Receiver operator characteristics analysis of preoperative AMH, postoperative AMH, and the AMH decline rate showed that preoperative AMH was associated with the greatest area under the curve. Kaplan–Meier curves showed that women in the high AMH group had a significantly higher cumulative pregnancy rate than those in the low AMH group. Conclusion The preoperative AMH level might be a useful marker to predict the occurrence of natural pregnancy and could be offered as part of the fertility strategy to women who desire pregnancy after endometriosis surgery.
Decompression for recurrent carpal tunnel syndrome provides significant functional improvement and patient satisfaction
Authors: Stirling Paul H. C. , Yeoman Thomas F. M. , Duckworth Andrew D. , Clement Nicholas D. , Jenkins Paul J. , McEachan Jane E. 
Published: September 2019

This prospective single-centre study describes the functional outcomes, satisfaction and health-related quality of life after open revision carpal tunnel decompression for recurrent carpal tunnel syndrome. The QuickDASH, patient satisfaction and EuroQol-5 dimensions questionnaires were collected preoperatively and postoperatively over a 5-year period (2013–2018). The median time to revision was 13.3 years (range 3.9–35.4 years; interquartile range 7.2–15.9 years). Outcomes were available for 14 hands in 13 patients at a mean of 20 months after revision surgery. The mean preoperative and postoperative QuickDASH scores were 55 and 29, respectively, and the mean improvement in QuickDASH was 26. The mean improvement in EuroQol-5 dimensions score was 0.1, and 13 of the 14 patients were satisfied. The net promoter score was 85. This study confirms that patients undergoing revision open carpal tunnel decompression for recurrent carpal tunnel syndrome experience a significant improvement in function and health-related quality of life. Level of evidence: IV
Lifestyle intervention for gastroesophageal reflux disease: a national multicenter survey of lifestyle factor effects on gastroesophageal reflux disease in China
Authors: Yuan Ling-Zhi , Yi Ping , Wang Gang-Shi , Tan Shi-Yun , Huang Guang-Ming , Qi Ling-Zhi , Jia Yan , Wang Fen 
Published: September 2019

Background: Poor habits can worsen gastroesophageal reflux disease (GERD) and reduce treatment efficacy. Few large-scale studies have examined lifestyle influences, particularly eating habits, on GERD in China, and research related to eating quickly, hyperphagia, and eating hot foods is quite limited. The aim of this study was to evaluate the relationship between GERD pathogenesis and lifestyle factors to produce useful information for the development of a clinical reference guide through a national multicenter survey in China. Methods: Symptom and lifestyle/habit questionnaires included 19 items were designed. The questionnaire results were subjected to correlation analysis relative to GERD symptom onset. A standard proton pump inhibitor (PPI) was advised to correct patients with unhealthful lifestyle habits. Results: A total of 1518 subjects (832 GERD, 686 non-GERD) enrolled from six Chinese hospitals completed symptom and lifestyle/habit questionnaires. The top lifestyle factors related to GERD were fast eating, eating beyond fullness, and preference for spicy food. Univariate analysis showed that 21 factors, including male gender, a supra-normal body mass index (BMI), smoking, drinking alcohol, fast eating, eating beyond fullness, eating very hot foods, and drinking soup, among others, were associated with GERD ( p < 0.05). Logistic multivariate regression analysis revealed the following risk factors for GERD [with odds ratios (ORs)]: fast eating (4.058), eating beyond fullness (2.849), wearing girdles or corsets (2.187), eating very hot foods (1.811), high BMI (1.805), lying down soon after eating (1.544), and smoking (1.521). Adjuvant lifestyle interventions improved outcomes over medication alone ( z = –8.578, p < 0.001 Mann–Whitney rank sum test). Conclusions: Lifestyle interventions can improve medication efficacy in GERD patients. Numerous habits, including fast eating, eating beyond fullness, and eating very hot foods, were associated with GERD pathogenesis. The present results may be useful as a reference for preventive education and treatment.
Over‐the‐scope clips are cost‐effective in recurrent peptic ulcer bleeding
Authors: Kuellmer Armin , Behn Juliane , Meier Benjamin , Wannhoff Andreas , Bettinger Dominik , Thimme Robert , Caca Karel , Schmidt Arthur 
Published: September 2019

BackgroundA recent prospective randomised controlled trial (‘STING’) showed superiority of over‐the‐scope clips compared to standard treatment in recurrent peptic ulcer bleeding. Cost‐effectiveness studies on haemostasis with over‐the‐scope clips have not been reported so far.ObjectiveThe aim of this study was to investigate whether the higher efficacy of the over‐the‐scope clips treatment outweighs the higher costs of the device compared to standard clips.MethodsFor the analysis, the study population of the STING trial was used. Costs for the hospital stay in total as well as treatment‐related costs were obtained. The average cost‐effectiveness ratio, representing the mean costs per designated outcome, and the incremental cost‐effectiveness ratio, expressing the additional costs of a new treatment strategy per difference in outcome were calculated. The designated outcome was defined as successful haemostasis without rebleeding within seven days, which was the primary endpoint of the STING trial. Average cost‐effectiveness ratio and incremental cost‐effectiveness ratio were calculated for total costs of the hospital stay as well as the haemostasis treatment alone. The cost‐effectiveness analysis is taken from the perspective of the care provider.Results: Total costs and treatment‐related costs per patient were 13,007.07 € in the standard group vs 12,808.56 € in the over‐the‐scope clip group (p = 0.812) and 2084.98 € vs 1984.71 € respectively (p = 0.663). The difference was not statistically significant. Total costs per successful haemostasis (average cost‐effectiveness ratio) were 30,677.05 € vs 15,104.43 € and 4917.41 € vs 2340.46 € for the haemostasis treatment. The additional costs per successful haemostasis with over‐the‐scope clip treatment (incremental cost‐effectiveness ratio) is –468.18 € for the whole treatment and –236.49€ for the haemostasis treatment.ConclusionsOver‐the‐scope clip treatment is cost‐effective in recurrent peptic ulcer bleeding.
Treatment of lumbosacral tuberculosis by anterior internal fixation combined with computed tomography angiography
Authors: Wu Wenjie , Yang Sen , Wang Cheng , Lyu Jingtong , Liu Xun , Zhang Zehua , Xu Jianzhong , Luo Fei 
Published: September 2019

Objective: This study aims to examine the iliac vascular space in patients with lumbosacral tuberculosis and to evaluate the feasibility of anterior internal fixation for lumbosacral tuberculosis. Methods: A retrospective analysis was performed in 36 patients with lumbosacral tuberculosis. The preoperative three-dimensional computed tomography angiography images were analyzed for anatomical parameters. Results: There were large variations among the anterior lumbosacral iliac vessels. Predominantly, the left iliac vein and the right iliac artery formed the two borders of the triangular iliac vascular space in the coronal plane. The mean distance between the iliac vessels straddle point and the inferior endplate of L5 was 15.01 ± 15.08 mm. In the sagittal plane, presacral abscess increased the distance between the posterior iliac vessel and the anterior vertebra. The distances on the left and right sides were 9.94 ± 6.03 and 10.15 ± 5.46 mm, respectively, at the inferior endplate of L5 and were 11.90 ± 6.97 and 11.68 ± 5.52 mm, respectively, at the superior endplate of S1. Conclusions: The space on sagittal plane occupied by presacral abscess may push forward the vessels and therefore provide opportunities for anterior internal fixation.
Effect of the screw tightening sequence on the stress distribution of a dynamic compression plate: A pilot finite element study
Authors: Feng Xiaoreng , Qi Weichen , Wang Chengyong , Leung Frankie , Chen Bin 
Published: September 2019

Objective: Although the optimal screw tightening sequence is a common question orthopaedists encounter during fractures fixation with a dynamic compression plate (DCP), the effect of the screw tightening sequence on the stability of the plate has never been explored. This study explores the effect of the screw tightening sequence on the stress distribution of a DCP using a finite element method. Methods: Idealized finite element analysis models of the femoral diaphysis with six-hole or eight-hole DCPs were constructed. The screw tightening preload was simulated using ‘bolt load’ in ABAQUS. Two screw tightening sequences were studied for the six-hole plate and six sequences were studied for the eight-hole plate. U magnitude and Von Mises stress were used to evaluate the deformation and stress distribution of the plate, respectively. Deformation and stress distribution plots from different sequences were compared. Results: The different screw tightening sequences showed different deformation processes, while all had the same final deformation after all the screws were tightened. Each screw tightening step of different tightening sequences showed different stress distributions in the plate, while all had the same stress distribution after all the screws were tightened. Conclusion: Using different screw tightening sequences to fix the same DCP can produce the same stability, which means in terms of fixation stability, after the two screws nearest to the fracture line are tightened, surgeons do not need to hesitate about the order in which the rest screws should be inserted during the surgery.
Insufficiency and deficiency of vitamin D in elderly patients with fragility fractures of the hip in the Japanese population
Authors: Niikura Takahiro , Oe Keisuke , Sakai Yoshitada , Iwakura Takashi , Fukui Tomoaki , Nishimoto Hanako , Hayashi Shinya , Matsumoto Tomoyuki , Matsushita Takehiko , Maruo Akihiro , Yagata Yukihisa , Kishimoto Kenta , Sakurai Atsushi , Kuroda Ryosuke 
Published: September 2019

Background: Data of vitamin D sufficiency in Asian patients with osteoporotic fragility hip fractures are limited. This study aimed to obtain data from the Japanese population. Methods: Patients aged 60 years or older with hip fractures were prospectively enrolled. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured. Levels were compared between patients receiving and not receiving treatment for osteoporosis, those with and without previous contralateral hip fractures, and those with femoral neck versus trochanteric fractures. Sex-based differences were also assessed. The serum levels in patients younger than 60 years with extremity fractures were assessed, and differences between elderly and younger patients were evaluated. The individual correlation between 25(OH)D levels and the ultraviolet (UV) index and age was analyzed in elderly patients with hip fractures. Results: The data of 360 patients (aged 84.7 ± 8.2 years), comprising 80 men and 280 women, were analyzed. The mean 25(OH)D level was 16.5 ± 7.2 ng/mL. The prevalence of vitamin D insufficiency (25(OH)D <30 ng/mL) and deficiency (25(OH)D <20 ng/mL) was 93.9% and 71.7%, respectively. A significant difference was noted in the prevalence of vitamin D deficiency between patients with and without previous contralateral hip fractures. Age and 25(OH)D levels were found to be correlated, with no correlation between the UV index and the 25(OH)D levels. The 25(OH)D level in the younger population ( n = 123) was 20.7 ± 8.6 ng/mL, which was significantly higher than that of the elderly. Conclusion: Perennial vitamin D insufficiency is prevalent in elderly Japanese patients with hip fractures.