bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concomitant Use of Single Antiplatelet Therapy With Edoxaban or Warfarin in Patients With Atrial Fibrillation: Analysis From the ENGAGE AF‐TIMI48 Trial
Authors: Xu Haiyan , Ruff Christian T. , Giugliano Robert P. , Murphy Sabina A. , Nordio Francesco , Patel Indravadan , Shi Minggao , Mercuri Michele , Antman Elliott M. , Braunwald Eugene 
Published: February 2016

Background

We studied the concomitant use of single antiplatelet therapy (
SAPT
) on the efficacy and safety of the anti‐Xa agent edoxaban in patients with atrial fibrillation (
AF
).

Methods and Results

ENGAGE AF
‐
TIMI
48 was a randomized trial that compared 2 dose regimens of edoxaban with warfarin. We studied both the approved higher‐dose edoxaban regimen (
HDER
; 60 mg daily reduced by one half in patients with anticipated increased drug exposure), as well as a lower‐dose edoxaban regimen (
LDER
; 30 mg daily, also reduced by one half in patients with anticipated increased drug regimen).
SAPT
(aspirin in 92.5%) was administered at the discretion of the treating physician. Cox proportional hazard regressions stratified by
SAPT
at 3 months with treatment as a covariate were performed. The 4912 patients who received
SAPT
were more frequently male, with histories of coronary artery disease and diabetes, and had higher
CHADS
2
Vasc and
HAS BLED
scores than did the 14 997 patients not receiving
SAPT
. When compared to patients not receiving
SAPT
, those receiving
SAPT
had a higher incidence of major bleeding; (adjusted hazard ratio [
HR
adj
]=1.46; 95%
CI
, 1.27–1.67,
P
<0.001).
SAPT
did not alter the relative efficacy of edoxaban compared to warfarin in preventing stroke or systemic embolic events (
SEEs
): edoxaban versus warfarin without
SAPT
, hazard ratio (
HR
adj
for
HDER
)=0.94; (95%
CI
: 0.77–1.15) with
SAPT
,
HR
adj
=0.70 (95%
CI
: 0.50–0.98),
P
interaction (
P
int
)=0.14. (
HR
adj
for
LDER
versus warfarin without
SAPT
=1.19 (95%
CI
0.99–1.43) With
SAPT
, 1.03 (95%
CI
, 0.76–1.39)
P
int
=0.42. Major bleeding was lower with edoxaban than warfarin both without
SAPT
,
HR
adj
for
HDER
=0.80 (95%
CI
, 0.68–0.95), and with
SAPT
,
HR
adj
=0.82 (95%
CI
, 0.65–1.03;
P
int
=0.91). For
LDER
without
SAPT
(
HR
adj
=0.56 [95%
CI
0.46–0.67]) and with
SAPT
(
HR
adj
=0.51 [95%
CI
0.39–0.66]),
P
int
=0.59.

Conclusions

Patients with
AF
who were selected by their physicians to receive
SAPT
in addition to an anticoagulant had a similar risk of stroke/
SEE
and higher rates of bleeding than those not receiving
SAPT
. Edoxaban exhibited similar relative efficacy and reduced bleeding compared to warfarin, with or without concomitant
SAPT
.

Clinical Trial Registration

URL
:
http://www.clinicaltrials.gov/
. Unique identifier:
NCT
00781391.
Temporal Evolution of Myocardial Hemorrhage and Edema in Patients After Acute ST‐Segment Elevation Myocardial Infarction: Pathophysiological Insights and Clinical Implications
Authors: Carrick David , Haig Caroline , Ahmed Nadeem , Rauhalammi Samuli , Clerfond Guillaume , Carberry Jaclyn , Mordi Ify , McEntegart Margaret , Petrie Mark C. , Eteiba Hany , Hood Stuart , Watkins Stuart , Lindsay M. Mitchell , Mahrous Ahmed , Welsh Paul , Sattar Naveed , Ford Ian , Oldroyd Keith G. , Radjenovic Aleksandra , Berry Colin 
Published: February 2016

Background

The time course and relationships of myocardial hemorrhage and edema in patients after acute
ST
‐segment elevation myocardial infarction (
STEMI
) are uncertain.

Methods and Results

Patients with
ST
‐segment elevation myocardial infarction treated by primary percutaneous coronary intervention underwent cardiac magnetic resonance imaging on 4 occasions: at 4 to 12 hours, 3 days, 10 days, and 7 months after reperfusion. Myocardial edema (native T2) and hemorrhage (T2*) were measured in regions of interest in remote and injured myocardium. Myocardial hemorrhage was taken to represent a hypointense infarct core with a T2* value <20 ms. Thirty patients with
ST
‐segment elevation myocardial infarction (mean age 54 years; 25 [83%] male) gave informed consent. Myocardial hemorrhage occurred in 7 (23%), 13 (43%), 11 (33%), and 4 (13%) patients at 4 to 12 hours, 3 days, 10 days, and 7 months, respectively, consistent with a unimodal pattern. The corresponding median amounts of myocardial hemorrhage (percentage of left ventricular mass) during the first 10 days after myocardial infarction were 2.7% (interquartile range [
IQR
] 0.0–5.6%), 7.0% (
IQR
4.9–7.5%), and 4.1% (
IQR
2.6–5.5%;
P
<0.001). Similar unimodal temporal patterns were observed for myocardial edema (percentage of left ventricular mass) in all patients (
P
=0.001) and for infarct zone edema (T2, in ms: 62.1 [
SD
2.9], 64.4 [
SD
4.9], 65.9 [
SD
5.3];
P
<0.001) in patients without myocardial hemorrhage. Alternatively, in patients with myocardial hemorrhage, infarct zone edema was reduced at day 3 (T2, in ms: 51.8 [
SD
4.6];
P
<0.001), depicting a bimodal pattern. Left ventricular end‐diastolic volume increased from baseline to 7 months in patients with myocardial hemorrhage (
P
=0.001) but not in patients without hemorrhage (
P
=0.377).

Conclusions
The temporal evolutions of myocardial hemorrhage and edema are unimodal, whereas infarct zone edema (T2 value) has a bimodal pattern. Myocardial hemorrhage is prognostically important and represents a target for therapeutic interventions that are designed to preserve vascular integrity following coronary reperfusion.

Clinical Trial Registration

URL
:
https://clinicaltrials.gov/
. Unique identifier:
NCT
02072850.
Prediction of Atrial Fibrillation in a Racially Diverse Cohort: The Multi‐Ethnic Study of Atherosclerosis (MESA)
Authors: Alonso Alvaro , Roetker Nicholas S. , Soliman Elsayed Z. , Chen Lin Y. , Greenland Philip , Heckbert Susan R. 
Published: February 2016

Background

Existing equations for prediction of atrial fibrillation (
AF
) have been developed and validated in white and African‐American populations. Whether these models adequately predict
AF
in more racially and ethnically diverse populations is unknown.

Methods and Results

We studied 6663 men and women 45 to 84 years of age without
AF
at baseline (2000–2002) enrolled in the Multi‐Ethnic Study of Atherosclerosis (
MESA
). Of these, 38% were non‐Hispanic whites, 28% non‐Hispanic African Americans, 22% Hispanics, and 12% Chinese Americans.
AF
during follow‐up was ascertained from hospitalization discharge codes through 2012. Information collected at baseline was used to calculate predicted 5‐year risk of
AF
using the previously published simple
CHARGE
‐
AF
model, which only includes clinical variables, and a biomarker‐enriched
CHARGE
‐
AF
model, which also considers levels of circulating N‐terminal of the prohormone B‐type natriuretic peptide and C‐reactive protein. For comparison purposes, we also assessed performance of the 10‐year Framingham
AF
model. During a mean follow‐up of 10.2 years, 351 cases of
AF
were identified. The C‐statistic of the
CHARGE
‐
AF
models were 0.779 (95%
CI
, 0.744–0.814) for the simple model and 0.825 (95%
CI
, 0.791–0.860) for the biomarker‐enriched model. Calibration was adequate in the biomarker‐enriched model (χ
2
=7.9;
P
=0.55), but suboptimal in the simple model (χ
2
=25.6;
P
=0.002). In contrast, the 10‐year Framingham score had a C‐statistic (95%
CI
) of 0.746 (0.720–0.771) and showed poor calibration (χ
2
=57.4;
P
<0.0001).

Conclusion

The
CHARGE
‐
AF
risk models adequately predicted 5‐year
AF
risk in a large multiethnic cohort. These models could be useful to select high‐risk individuals for
AF
screening programs or for primary prevention trials in diverse populations.
Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke
Authors: Broeg-Morvay Anne , Mordasini Pasquale , Bernasconi Corrado , Bühlmann Monika , Pult Frauke , Arnold Marcel , Schroth Gerhard , Jung Simon , Mattle Heinrich P. , Gralla Jan , Fischer Urs 
Published: February 2016

Background and Purpose—
Five randomized controlled trials have consistently shown that mechanical thrombectomy (MT) in addition to best medical treatment (±intravenous tissue-type plasminogen activator) improves outcome after acute ischemic stroke in patients with large artery anterior circulation stroke. Whether direct MT is equally effective as combined intravenous thrombolysis with MT (ie, bridging thrombolysis) remains unclear.

Methods—
We retrospectively compared clinical and radiological outcomes in 167 bridging patients with 255 patients receiving direct MT because of large artery anterior circulation stroke. We matched all patients from the direct MT group who would have qualified for intravenous tissue-type plasminogen activator with controls from the bridging group, using multivariate and propensity score analyses. Functional independence was defined as modified Rankin Scale score of 0 to 2.

Results—

From February 2009 to August 2014, 40 patients from the direct MT group would have qualified for bridging thrombolysis but were treated with MT only. Clinical and radiological characteristics did not differ from the bridging cohort, except for higher rates of hypercholesterolemia (
P
=0.019), coronary heart disease (
P
=0.039), and shorter intervals from symptom onset to endovascular intervention (
P
=0.01) in the direct MT group. Functional independence, mortality, and intracerebral hemorrhage rates did not differ (
P
>0.1). After multivariate matching analysis outcome in both groups did not differ, except for lower rates of asymptomatic intracerebral hemorrhage (
P
=0.023) and lower mortality (
P
=0.007) in the direct MT group.

Conclusions—
In patients with large anterior circulation stroke, direct mechanical intervention seems to be equally effective as bridging thrombolysis. A randomized trial comparing direct MT with bridging therapy is warranted.
Assessing the Impact of Typhoons on Rice Production in the Philippines
Authors: Blanc Elodie , Strobl Eric 
Published: February 2016

AbstractThis study quantifies the impact of typhoons on rice production in the Philippines. To this end, satellite-derived reflectance data are used to detect the location of rice fields at 500-m resolution. Utilizing typhoon-track data within a wind field model and satellite-derived precipitation measures, fragility curves are then employed to proxy the damage of storms on rice production within each rice field. The results from a panel spatial regression model show that typhoons substantially reduced local provincial production in the quarter of the strike, having caused losses of up to 12.5 million tons since 2001. Using extreme value theory to predict future losses, the results suggest that a typhoon like the recent Haiyan, which is estimated to have caused losses of around 260 000 tons, has a return period of 13 years. This methodology can provide a relatively timely tool for rice damage assessments after tropical cyclones in the region.
Three-Dimensional Chaotic Advection by Mixed Layer Baroclinic Instabilities
Authors: Mukiibi Daniel , Badin Gualtiero , Serra Nuno 
Published: February 2016

AbstractThree-dimensional (3D) finite-time Lyapunov exponents (FTLEs) are computed from numerical simulations of a freely evolving mixed layer (ML) front in a zonal channel undergoing baroclinic instability. The 3D FTLEs show a complex structure, with features that are less defined than the two-dimensional (2D) FTLEs, suggesting that stirring is not confined to the edges of vortices and along filaments and posing significant consequences on mixing. The magnitude of the FTLEs is observed to be strongly determined by the vertical shear. A scaling law relating the local FTLEs and the nonlocal density contrast used to initialize the ML front is derived assuming thermal wind balance. The scaling law only converges to the values found from the simulations within the pycnocline, while it displays differences within the ML, where the instabilities show a large ageostrophic component. The probability distribution functions of 2D and 3D FTLEs are found to be non-Gaussian at all depths. In the ML, the FTLEs wavenumber spectra display −1 slopes, while in the pycnocline, the FTLEs wavenumber spectra display −2 slopes, corresponding to frontal dynamics. Close to the surface, the geodesic Lagrangian coherent structures (LCSs) reveal a complex stirring structure, with elliptic structures detaching from the frontal region. In the pycnocline, LCSs are able to detect filamentary structures that are not captured by the Eulerian fields.
The Effect of Monitoring
Authors: Gathani Sachin , Gomez Maria Paula , Sabates Ricardo , Stoelinga Dimitri 
Published: February 2016

Background: The impact of surveying on individuals’ behavior and decision making has been widely studied in academic literature on market research but not so much the impact of monitoring on economic development interventions. Objectives: To estimate whether different monitoring strategies lead to improvement in participation levels and adoption of best practices for coffee production for farmer who participated in TechnoServe Agronomy Training Program in Rwanda. Research Design: Farmers were identified randomly for monitoring purposes to belong to two different groups and then selected depending on the additional criterion of having productive coffee trees. We estimate treatment-on-the-treated and intention-to-treat effects on training attendance rates and farmers best-practice adoptions using difference-in-differences estimation techniques. Subjects: Farmers were randomly identified to a high or low monitoring with different type and frequency of data collection and selected if they had productive coffee trees as part of the monitoring strategy. Measures: Attendance to training sessions by all farmers in the program and best-practice adoption data for improving coffee yield. Results: We find that monitoring led to surprisingly large increases in farmer participation levels in the project and also improved best-practice adoption rates. We also find that higher frequency of data collection has long-lasting effects and are more pronounced for low-attendance farmers. Conclusions: Monitoring not only provides more data and a better understanding of project dynamics, which in turn can help improve design, but can also improve processes and outcomes, in particular for the least engaged.
Association between Lateral Skull Base Thickness and Surgical Outcomes in Spontaneous CSF Otorrhea
Authors: Stevens Shawn M. , Rizk Habib G. , McIlwain Wesley R. , Lambert Paul R. , Meyer Ted A. 
Published: February 2016

Objectives(1) Correlate skull base thickness with perioperative outcomes for spontaneous cerebrospinal fluid (CSF) otorrhea. (2) Augment perioperative counseling of patients with abnormally thin skull bases.Study DesignCase series with chart review.SettingTertiary center. Patients with spontaneous CSF otorrhea have thin skull bases. This is associated with obesity and/or idiopathic intracranial hypertension. The influence of skull base thinning on perioperative outcomes is unknown.Subjects and MethodsA retrospective review was conducted from 2004 to 2014. Forty‐eight cases of spontaneous CSF otorrhea met the inclusion criteria of primary surgery by the senior authors: preoperative dedicated temporal bone computed tomography, absence of other leak etiologies, and follow‐up >6 months. Patients were stratified into thin (<0.9 mm) and thick (>0.9 mm) groups based on computed tomography measures of their tegmen. Primary outcomes measures were as follows: postoperative meningitis, recurrent leak, second site leak (contralateral ear/anterior fossa), and permanent shunt placement. Hearing outcomes were not assessed in this study.ResultsThirty and 15 patients composed the thin and thick groups, respectively. Both the incidence (P <. 0001) and the rate (P =. 005) of adverse outcomes were significantly higher in the thin group. Only 2 patients in the thick group experienced an adverse outcome. Eleven patients underwent multiple procedures for spontaneous leaks. The recurrence rate was 14.5%. All but 1 recurrence occurred in the thin group.ConclusionsAn abnormally thin tegmen was significantly associated with adverse perioperative outcomes in cases of spontaneous CSF otorrhea. A thick skull base and the presence of an encephalocele may be protective against recurrence. The effect of untreated intracranial hypertension on the results is unknown.
Anatomic Derkay Score Is Associated with Voice Handicap in Laryngeal Papillomatosis in Adults
Authors: Kupfer Robbi A. , Çadalli Tatar Emel , Barry Jonnae O. , Allen Clint T. , Merati Albert L. 
Published: February 2016

ObjectiveThe Derkay staging system quantifies recurrent respiratory papillomatosis (RRP) severity based on involvement of laryngeal structures. Despite its broad use in the laryngology literature, the association between Derkay score and voice‐related quality of life has not previously been studied. It is hypothesized that Derkay score positively correlates with the Voice Handicap Index–10 (VHI‐10).Study DesignCase series with chart review.SettingTertiary medical center.Subjects and MethodsForty‐six adult RRP patients treated from 2007 to 2013 at a tertiary medical center were included. Anatomic Derkay scores at the time of each RRP procedure were calculated. VHI‐10 scores obtained within 30 days preceding the procedures were used to assess for correlation between Derkay staging system and VHI‐10.ResultsNinety‐three procedures performed on 46 patients met inclusion criteria. Mean Derkay score was 11.9 (range, 2‐28), and mean VHI‐10 was 18.0 (range, 0‐40). There was a significant positive correlation between Derkay score and VHI‐10 (Spearman coefficientr= 0.42,P<. 0001).ConclusionThe anatomic burden of RRP as assessed by Derkay staging system is positively correlated with voice‐related quality of life as quantified by the VHI‐10.
Utility of Esophagram versus High‐Resolution Manometry in the Detection of Esophageal Dysmotility
Authors: O’Rourke Ashli K. , Lazar Andreea , Murphy Benjamin , Castell Donald O. , Martin‐Harris Bonnie 
Published: February 2016

ObjectiveThis study compared barium esophagram with high‐resolution esophageal manometry (HRM) results to determine whether esophagram is an adequate screening examination for esophageal motility disorders, a common cause of dysphagia.Study DesignCase series with chart review.SettingTertiary academic medical center.Subjects and MethodsA retrospective review was completed of 281 patients who underwent both HRM and esophagram from March 2012 to June 2014. Inclusion criteria included a specific assessment of the presence or absence of dysmotility on both examinations.ResultsEighty‐four males and 197 females were included in the study. Average age was 57 years (range, 16‐84). Average time between studies was 19 days (range, 0‐90). Motility was judged to be normal in 40.2% (113 of 281) of esophagrams and 46.6% (131 of 281) of HRM studies. However, disagreement between the study findings was significant (P =. 04). The sensitivity of esophagram for detecting esophageal dysmotility was 0.69, and specificity was 0.50. The positive and negative predictive values of esophagram for dysmotility were 0.61 and 0.58, respectively.ConclusionsEsophagram is useful in the assessment of anatomic abnormalities but is a poor screening examination for the detection of esophageal dysmotility. Patients with suspected esophageal dysphagia should be referred for HRM to evaluate motility disorders and identify potential treatment targets, regardless of esophagram results.
Paravertebral Nerve Block for Donor Site Pain in Stage I Microtia Reconstruction
Authors: Shaffer Amber D. , Jabbour Noel , Visoiu Mihaela , Yang Charles I. , Yellon Robert F. 
Published: February 2016

Acute Interventional Perioperative Pain Service consultants have routinely placed paravertebral nerve block (PVB) catheters for the continuous release of ropivacaine following stage I microtia reconstruction with costal cartilage graft at our institution since 2010. A retrospective chart review from July 2006 was performed to compare the length of hospital stay, median pain score (0‐10 scale), and opioid use of patients receiving PVB with those of historical controls. Statistical analysis included t, Mann‐Whitney U, and Fisher’s exact tests. A total of 15 stage I microtia surgeries were included, 10 with PVB and 5 without. Patients with and without PVB had high peak pain scores (8.4 vs 7.8), remained in the hospital for 3.5 and 3.8 days, and consumed 0.69 and 0.36 mg/kg morphine equivalents, respectively. These findings highlight the feasibility of PVB, but larger studies are needed to optimize pain relief in this population.
Diagnosis of Metastasis to the Thyroid Gland
Authors: Choi Sang Hyun , Baek Jung Hwan , Ha Eun Ju , Choi Young Jun , Song Dong Eun , Kim Jae Kyun , Chung Ki‐Wook , Kim Tae Yong , Lee Jeong Hyun 
Published: February 2016

ObjectivesEarly detection and diagnosis of metastasis to the thyroid gland is important. This study aims to evaluate the clinical value of core‐needle biopsy (CNB) by comparing the results of CNB and fine‐needle aspiration (FNA) in patients with clinically suspected metastasis to the thyroid gland.Study DesignCase series with chart review.SettingTertiary referral practice.SubjectsFifty‐two thyroid nodules from 52 patients with clinically suspected metastasis to the thyroid gland (mean age, 62.8 years).MethodsOf these 52 patients, FNA was initially used in 41 patients and CNB in 20 patients (11 patients as the initial approach and 9 patients after inconclusive FNA results). Ultrasound features of metastasis to the thyroid gland were evaluated. The diagnostic performance, repeated diagnostic examination rate, and diagnostic surgery rate were evaluated for FNA and CNB.ResultsAmong these 52 patients, 46 were diagnosed with thyroid metastases and 6 were diagnosed with primary thyroid cancer. Common ultrasound features were an ovoid to round shape (58.7%), ill‐defined margin (56.5%), hypoechogenicity (65.2%), and no calcifications (87.0%). Core‐needle biopsy achieved a significantly higher sensitivity than FNA (100.0% vs 58.6%, P =. 008) without any false‐negative results. Both the repeated diagnostic examination rate and the diagnostic surgery rate were significantly lower in CNB than in FNA (5.0% vs 46.3%, P =. 001, and 5.0% vs 34.1%, P =. 013, respectively).ConclusionsIn cases of known rare primary malignancy, nontypical ultrasound features of primary thyroid malignancy, and need for an additional immunohistochemical analysis, CNB may be primarily considered.