bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dual Antiplatelet Therapy Continuation Beyond 1 Year After Drug-Eluting Stents
Authors: Ferrante Giuseppe , Condorelli Gianluigi , Pagnotta Paolo , Reimers Bernhard 
Published: May 2017

Background—
The benefits and harms of dual antiplatelet therapy (DAPT) continuation beyond 1 year after drug-eluting stent implantation as compared with 1-year DAPT remain controversial.

Methods and Results—

We searched for randomized trials that compared longer than 1-year DAPT versus 1-year DAPT after drug-eluting stenting. A meta-analysis was performed by using standard frequentist and random-effects Bayesian approaches. Four trials comprising 17 650 participants were included. Compared with 1-year DAPT, extended DAPT did not affect all-cause mortality (odds ratio [OR], 1.11; 95% confidence interval [CI], 0.79–1.5;
P
=0.53) or cardiovascular mortality (OR, 1.03; 95% CI, 0.72–1.46;
P
=0.88). Extended DAPT was associated with a reduction in the risk of myocardial infarction (OR, 0.56; 95% CI, 0.43–0.73;
P
<0.001), nonsignificant reductions of stent thrombosis (OR, 0.46; 95% CI, 0.16–1.27;
P
=0.13), similar risk of stroke (OR, 0.91; 95% CI, 0.65–1.26;
P
=0.56), and an increased risk of major bleeding (OR, 1.49; 95% CI, 1.06–2.11;
P
=0.02). By using Bayesian meta-analysis, we found moderate evidence of a reduction of myocardial infarction (OR, 0.62; 95% credible intervals, 0.39–1.05) and weak evidence of an increase in major bleeding (OR, 1.66; 95% credible intervals, 0.89–3.09) associated with extended DAPT.

Conclusions—
In this meta-analysis, extended DAPT beyond 1 year prevented myocardial infarctions and increased major bleedings, but the strength of evidence for these effects was not strong. DAPT continuation beyond 1 year showed no effects on mortality.
High- Versus Low-Gradient Severe Aortic Stenosis
Authors: Taniguchi Tomohiko , Morimoto Takeshi , Shiomi Hiroki , Ando Kenji , Kanamori Norio , Murata Koichiro , Kitai Takeshi , Kawase Yuichi , Izumi Chisato , Miyake Makoto , Mitsuoka Hirokazu , Kato Masashi , Hirano Yutaka , Matsuda Shintaro , Inada Tsukasa , Nagao Kazuya , Murakami Tomoyuki , Takeuchi Yasuyo , Yamane Keiichiro , Toyofuku Mamoru , Ishii Mitsuru , Minamino-Muta Eri , Kato Takao , Inoko Moriaki , Ikeda Tomoyuki , Komasa Akihiro , Ishii Katsuhisa , Hotta Kozo , Higashitani Nobuya , Kato Yoshihiro , Inuzuka Yasutaka , Maeda Chiyo , Jinnai Toshikazu , Morikami Yuko , Saito Naritatsu , Minatoya Kenji , Kimura Takeshi 
Published: May 2017

Background—

There is considerable debate on the management of patients with low-gradient severe aortic stenosis (LG-AS), defined as aortic valve area <1 cm
2
with peak aortic jet velocity ≤4.0 m/s, and mean aortic pressure gradient ≤40 mm Hg.

Methods and Results—

In the CURRENT AS registry (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis), there were 2097 patients (initial aortic valve replacement [AVR] strategy: n=977, and conservative strategy: n=1120) with high-gradient severe aortic stenosis (HG-AS) and 1712 patients (initial AVR strategy: n=219, and conservative strategy: n=1493) with LG-AS. AVR was more frequently performed in HG-AS patients than in LG-AS patients (60% versus 28%) during the entire follow-up. In the comparison between the initial AVR and conservative groups, the propensity score–matched cohorts were developed in both HG-AS (n=887 for each group) and LG-AS (n=218 for each group) strata. The initial AVR strategy when compared with the conservative strategy was associated with markedly lower risk for a composite of aortic valve–related death or heart failure hospitalization in both HG-AS and LG-AS strata (hazard ratio, 0.30; 95% confidence interval, 0.25–0.37;
P
<0.001 and hazard ratio, 0.46; 95% confidence interval, 0.32–0.67;
P
<0.001, respectively). Among 1358 patients with LG-AS with preserved left ventricular ejection fraction, the initial AVR strategy was associated with a better outcome than the conservative strategy (adjusted hazard ratio, 0.37; 95% confidence interval, 0.23–0.59;
P
<0.001).

Conclusions—
The initial AVR strategy was associated with better outcomes than the conservative strategy in both HG-AS and LG-AS patients, although AVR was less frequently performed in LG-AS patients than in HG-AS patients. The favorable effect of initial AVR strategy was also seen in patients with LG-AS with preserved left ventricular ejection fraction.

Clinical Trial Registration—

URL:
http://www.umin.ac.jp/ctr/index.htm
. Unique identifier: UMIN000012140.
Thirty-Year Mortality After Coronary Artery Bypass Graft Surgery
Authors: Adelborg Kasper , Horváth-Puhó Erzsébet , Schmidt Morten , Munch Troels , Pedersen Lars , Nielsen Per Hostrup , Bøtker Hans Erik , Toft Sørensen Henrik 
Published: May 2017

Background—
Data are sparse on long-term mortality after coronary artery bypass graft (CABG) surgery. We examined short-term and long-term mortality of patients undergoing CABG surgery and a general population comparison cohort.

Methods and Results—
Linking data from Danish registries, we conducted a nationwide, population-based cohort study on 51 307 CABG patients and 513 070 individuals from the general population matched on age, sex, and calendar year (1980–2009). The mortality risk was higher in patients having isolated CABG surgery than in the general population, particularly during 0 to 30 days (3.2% versus 0.2%), 11 to 20 years (51.1% versus 35.6%), and 21 to 30 years (62.4% versus 44.8%), but not substantially higher during 31 to 364 days (2.9% versus 2.4%) or 1 to 10 years (30.7% versus 25.8%). The 30-day adjusted mortality rate ratio for isolated CABG surgery was 13.51 (95% confidence interval [CI], 12.59–14.49). Between 31 to 364 days and 1 to 10 years, the isolated CABG surgery cohort had a slightly higher mortality rate than the general population comparison cohort, adjusted mortality rate ratios of 1.15 (95% CI, 1.09–1.21) and 1.09 (95% CI, 1.08–1.11), respectively. Between 11 to 20 years and 21 to 30 years, the adjusted mortality rate ratios were 1.62 (95% CI, 1.58–1.66) and 1.76 (95% CI, 1.62–1.91). Within 30 days, CABG patients had a 25-fold, a 26-fold, and a 18-fold higher risk of dying from myocardial infarction, heart failure, or stroke, respectively, than members of the general population comparison cohort. We found substantial heterogeneity in absolute mortality rates according to baseline risk groups.

Conclusions—
The isolated CABG cohort had a higher mortality rate than the general population comparison cohort, especially within 30 days of and 10 years after surgery.
Causal Associations of Adiposity and Body Fat Distribution With Coronary Heart Disease, Stroke Subtypes, and Type 2 Diabetes Mellitus
Authors: Dale Caroline E. , Fatemifar Ghazaleh , Palmer Tom M. , White Jon , Prieto-Merino David , Zabaneh Delilah , Engmann Jorgen E.L. , Shah Tina , Wong Andrew , Warren Helen R. , McLachlan Stela , Trompet Stella , Moldovan Max , Morris Richard W. , Sofat Reecha , Kumari Meena , Hyppönen Elina , Jefferis Barbara J. , Gaunt Tom R. , Ben-Shlomo Yoav , Zhou Ang , Gentry-Maharaj Aleksandra , Ryan Andy , Mutsert Renée de , Noordam Raymond , Caulfield Mark J. , Jukema J. Wouter , Worrall Bradford B. , Munroe Patricia B. , Menon Usha , Power Chris , Kuh Diana , Lawlor Debbie A. , Humphries Steve E. , Mook-Kanamori Dennis O. , Sattar Naveed , Kivimaki Mika , Price Jacqueline F. , Davey Smith George , Dudbridge Frank , Hingorani Aroon D. , Holmes Michael V. , Casas Juan P. 
Published: May 2017

Background:
The implications of different adiposity measures on cardiovascular disease etiology remain unclear. In this article, we quantify and contrast causal associations of central adiposity (waist-to-hip ratio adjusted for body mass index [WHRadjBMI]) and general adiposity (body mass index [BMI]) with cardiometabolic disease.

Methods:
Ninety-seven independent single-nucleotide polymorphisms for BMI and 49 single-nucleotide polymorphisms for WHRadjBMI were used to conduct Mendelian randomization analyses in 14 prospective studies supplemented with coronary heart disease (CHD) data from CARDIoGRAMplusC4D (Coronary Artery Disease Genome-wide Replication and Meta-analysis [CARDIoGRAM] plus The Coronary Artery Disease [C4D] Genetics; combined total 66 842 cases), stroke from METASTROKE (12 389 ischemic stroke cases), type 2 diabetes mellitus from DIAGRAM (Diabetes Genetics Replication and Meta-analysis; 34 840 cases), and lipids from GLGC (Global Lipids Genetic Consortium; 213 500 participants) consortia. Primary outcomes were CHD, type 2 diabetes mellitus, and major stroke subtypes; secondary analyses included 18 cardiometabolic traits.

Results:

Each one standard deviation (SD) higher WHRadjBMI (1 SD≈0.08 U) associated with a 48% excess risk of CHD (odds ratio [OR] for CHD, 1.48; 95% confidence interval [CI], 1.28–1.71), similar to findings for BMI (1 SD≈4.6 kg/m
2
; OR for CHD, 1.36; 95% CI, 1.22–1.52). Only WHRadjBMI increased risk of ischemic stroke (OR, 1.32; 95% CI, 1.03–1.70). For type 2 diabetes mellitus, both measures had large effects: OR, 1.82 (95% CI, 1.38–2.42) and OR, 1.98 (95% CI, 1.41–2.78) per 1 SD higher WHRadjBMI and BMI, respectively. Both WHRadjBMI and BMI were associated with higher left ventricular hypertrophy, glycemic traits, interleukin 6, and circulating lipids. WHRadjBMI was also associated with higher carotid intima-media thickness (39%; 95% CI, 9%–77% per 1 SD).

Conclusions:
Both general and central adiposity have causal effects on CHD and type 2 diabetes mellitus. Central adiposity may have a stronger effect on stroke risk. Future estimates of the burden of adiposity on health should include measures of central and general adiposity.
Self-extubation Laryngeal Injuries at an Academic Tertiary Care Center: A Retrospective Pilot Study
Authors: Cohn Jason E. , Touati Andrew , Lentner Mark , Weitzel Mark , Fisher Casey , Sataloff Robert T. 
Published: May 2017

Objectives: The purpose of this study is to identify laryngeal symptoms and injuries in self-extubated patients. Methods: A retrospective chart review was conducted to identify symptoms and clinical findings associated with self-extubation. A novel scoring system was developed and used to quantify these findings. Symptom score included all symptoms that patients reported after self-extubation. Clinical score consisted of laryngeal findings visualized on nasopharyngeal laryngoscopy. Finally, a total self-extubation score was calculated as the sum of the symptom and clinical scores. Additionally, duration of intubation and endotracheal tube size were correlated with these scores. Results: Sixty (n = 60) patients who self-extubated in our institution’s intensive care unit were identified. Average calculated symptom, clinical, and total self-extubation scores were 0.92, 1.43, and 2.35, respectively. The most common symptom observed was hoarseness (62%), while the most common clinical finding was posterior laryngeal edema (58%). A significant positive correlation was found between duration of intubation and both symptom score and total self-extubation score (r = 0.314, P = .008 and r = 0.223, P = .05, respectively). Symptom score predicted clinical score with a significant positive correlation present (r = 0.278, P = .02). Conclusions: This study demonstrates that the majority of self-extubated patients have laryngeal symptoms and clinical findings. A comprehensive, multidisciplinary evaluation is warranted for self-extubations.
Sensitivity of postnatal fasting plasma glucose in identifying impaired glucose tolerance in women with gestational diabetes – 25 Years’ data
Authors: Kapaya Habiba , May Lucy , Jacques Richard , Madhuvrata Priya 
Published: May 2017

Objective To assess the uptake of postnatal oral glucose tolerance test and to determine the sensitivity of fasting postnatal blood sugar in predicting 2-h impaired glucose tolerance. Methods Retrospective study of 1961 women diagnosed with gestational diabetes mellitus. All women were offered oral glucose tolerance test six weeks post-delivery. Results Of 1961 women, 1090 (56%) returned for postpartum oral glucose tolerance test. A fasting plasma glucose of ≥6.1 mmol/l identified only 76 of 167 women with impaired glucose tolerance detected by a 2-h oral glucose tolerance test (sensitivity of 45.5%; 95%CI: 38.1–53.1). We observed a normal fasting glucose but an impaired 2-h glucose tolerance in 91 out of 968 (9.4%) women. Asian ethnicity, admission on special care baby unit and antenatal insulin therapy strongly predicted 2-h impaired postnatal blood glucose levels (P < 0.05). Conclusion Although fasting plasma glucose is a convenient method, it lacks sensitivity in identifying women with impaired glucose tolerance postnatally.
The impact of magnetic viscosity on time-domain electromagnetic data from iron oxide minerals embedded in rocks at Opemiska, Québec, Canada
Authors: Gaucher Frédéric E. S. , Smith Richard S. 
Published: May 2017

The magnetic viscosity (MV) effects observed at time scales between 0.01 and 10 ms at Opemiska are associated with magnetic grains of variable size in rocks. Recent observations made during a ground time-domain electromagnetic (TDEM) survey at Opemiska are consistent with four aspects of the spatial and amplitude characteristics of a MV response: (1) the [Formula: see text] decay rate is roughly proportional to [Formula: see text], where [Formula: see text], (2) the anomalies are mainly visible on the [Formula: see text]-component, when the EM receiver sensor is located inside or just outside the transmitter loop, (3) there is no obvious [Formula: see text]- or [Formula: see text]-component response, and (4) the sites where MV effects are seen in the TDEM data are coincident with an airborne magnetic anomaly. Previous studies have demonstrated that MV could be caused by (1) fine-grained particles of maghemite or magnetite in the overburden, regolith, or soil that were formed through lateritic weathering processes, (2) volcanic glass shards from tuff containing approximately 1% by weight magnetite, which occur as grains approximately [Formula: see text] in size precipitated in a spatially uniform way, or (3) from the Gallionella bacterium that precipitates ferrihydrite that oxidizes to nanocrystalline maghemite aggregates. The sites investigated at Opemiska are outcropping and well-exposed with relatively little or no overburden, and they are unfavorable for the formation of maghemite; hence, it is assumed that the source of MV seen at Opemiska cannot be the maghemite, or the other aforementioned causes. Hand samples were collected from Opemiska to identify the minerals present. Polished thin sections observed under an optical reflecting microscope identified the accessory minerals magnetite, ilmenite, and pyrrhotite, all known for their relatively high magnetic susceptibility. The use of the scanning electron microscope confirmed fine-grained magnetite grains as small as [Formula: see text]. An electromagnetic induction spectrometer confirmed the viscous nature of the susceptibility of the Opemiska samples. This suggests that MV could originate not only from fine-grained magnetite and maghemite particles located in the weathered regolith but also from other iron oxides and magnetic minerals embedded in the rock itself.
Trends in Perioperative Practice and Resource Utilization in Patients With Obstructive Sleep Apnea Undergoing Joint Arthroplasty
Authors: Cozowicz Crispiana , Poeran Jashvant , Olson Ashley , Mazumdar Madhu , Mörwald Eva E. , Memtsoudis Stavros G. 
Published: May 2017

BACKGROUND:
Emerging evidence associating obstructive sleep apnea (OSA) with adverse perioperative outcomes has recently heightened the level of awareness among perioperative physicians. In particular, estimates projecting the high prevalence of this condition in the surgical population highlight the necessity of the development and adherence to “best clinical practices.” In this context, a number of expert panels have generated recommendations in an effort to provide guidance for perioperative decision-making. However, given the paucity of insights into the status of the implementation of recommended practices on a national level, we sought to investigate current utilization, trends, and the penetration of OSA care-related interventions in the perioperative management of patients undergoing lower joint arthroplasties.

METHODS:
In this population-based analysis, we identified 1,107,438 (Premier Perspective database; 2006–2013) cases of total hip and knee arthroplasties and investigated utilization and temporal trends in the perioperative use of regional anesthetic techniques, blood oxygen saturation monitoring (oximetry), supplemental oxygen administration, positive airway pressure therapy, advanced monitoring environments, and opioid prescription among patients with and without OSA.

RESULTS:
The utilization of regional anesthetic techniques did not differ by OSA status and overall <25% and 15% received neuraxial anesthesia and peripheral nerve blocks, respectively. Trend analysis showed a significant increase in peripheral nerve block use by >50% and a concurrent decrease in opioid prescription. Interestingly, while the absolute number of patients with OSA receiving perioperative oximetry, supplemental oxygen, and positive airway pressure therapy significantly increased over time, the proportional use significantly decreased by approximately 28%, 36%, and 14%, respectively. A shift from utilization of intensive care to telemetry and stepdown units was seen.

CONCLUSIONS:
On a population-based level, the implementation of OSA-targeted interventions seems to be limited with some of the current trends virtually in contrast to practice guidelines. Reasons for these findings need to be further elucidated, but observations of a dramatic increase in absolute utilization with a proportional decrease may suggest possible resource constraints as a contributor.
Preoperative Low-Dose Aspirin Exposure and Outcomes After Emergency Neurosurgery for Traumatic Intracranial Hemorrhage in Elderly Patients
Authors: Lee Alex T. , Gagnidze Arni , Pan Sharon R. , Sookplung Pimwan , Nair Bala , Newman Shu-Fang , Ben-Ari Alon , Zaky Ahmed , Cain Kevin , Vavilala Monica S. , Rozet Irene 
Published: May 2017

BACKGROUND:
Antiplatelet medications are usually discontinued before elective neurosurgery, but this is not an option for emergent neurosurgery. We performed a retrospective cohort study to examine whether preoperative aspirin use was associated with worse outcomes after emergency neurosurgery in elderly patients.

METHODS:
We analyzed all cases of emergency neurosurgical procedures for traumatic intracranial hemorrhage from 2008 to 2012 at a level 1 trauma center. Demographics, comorbidities, and outcomes were compared for patients ≥65 years by preoperative aspirin exposure. Exclusion criteria were: (1) polytrauma, (2) concomitant use of other preoperative anticoagulants or antiplatelet agents, (3) surgical indication other than subdural, extradural, or intraparenchymal hemorrhage, and (4) repeat neurosurgical procedures within a single admission. Estimated intraoperative blood loss, postprocedural intracranial bleeding requiring reoperation, death in hospital, intensive care unit, and hospital lengths of stay and perioperative blood product transfusion from 48 hours before 48 hours after surgery were the study outcomes. We also examined whether platelet transfusion had an impact on outcomes for patients on aspirin.

RESULTS:
The cohort included 171 patients. Patients receiving preoperative aspirin (n = 87, 95% taking 81 mg/day) were the same age as patients not receiving aspirin (n = 84; 78.3 ± 7.8 vs 75.9 ± 7.9 years, P > .05), had slightly higher admission Glasgow Coma Scale scores (12.8 ± 3.4 vs 11.4 ± 4, P = .02) and tended to have more coronary artery disease (P< .05). Adjusted for Glasgow Coma Scale and coronary artery disease, patients receiving preoperative aspirin had a higher odds of perioperative platelet transfusion (adjusted odds ratio 9.89, 95% confidence interval, 4.24–26.25). There were no other differences in outcomes between the 2 groups. Preoperative or intraoperative platelet transfusion was not associated with better outcomes among aspirin patients.

CONCLUSIONS:
In patients age ≥65 years undergoing emergency neurosurgery for traumatic intracranial hemorrhage, preoperative low-dose aspirin treatment was not associated with increased perioperative bleeding, hospital lengths of stay, or in-hospital mortality.
The Labor Analgesia Requirements in Nulliparous Women Randomized to Epidural Catheter Placement in a High or Low Intervertebral Space
Authors: Moore Albert , Villeneuve Valerie , Bravim Bruno , el-Bahrawy Aly , el-Mouallem Eva , Kaufman Ian , Hatzakorzian Roupen , Li Pi Shan William 
Published: May 2017

BACKGROUND:
We hypothesized that an epidural catheter placed in a lower vertebral interspace will require less medication for labor analgesia.

METHODS:
Nulliparous women requesting neuraxial labor analgesia were randomized to epidural catheter placement at the ultrasound-confirmed L1-2 or L4-5 interspace. Patient-controlled epidural analgesia and breakthrough manual epidural boluses of 10 mL of 0.125% bupivacaine with 50 µg of fentanyl or 8 mL of 2% lidocaine were utilized. Abdominal and perineal pain scores were assessed at 30 and 60 minutes after standardized initiation of epidural analgesia. Pain scores during pushing were assessed after delivery. The primary outcome was the proportion of patients requiring manual boluses and was compared using a χ2 test. Secondarily, we analyzed the number of boluses given in early (up to 4 hours before delivery) versus late labor using χ2 tests and the pain scores using Mann-Whitney U tests, with adjustment of P values for multiple testing.

RESULTS:
We analyzed 148 patients. Overall, the percentage of patients in the low versus high groups who required manual boluses was 46% vs 51% (P = 1.0). For the 56 patients in each group who delivered vaginally, 22 (52%) vs 20 (48%) manual boluses were given to the low epidural group in early versus late labor, compared to 9 (20%) vs 36 (80%) in the high epidural group (P = .014). There was no statistical difference in patient-controlled epidural analgesia requirements or patient satisfaction. Comparing the low versus high groups, the median (interquartile range) pain scores were: 3 (1, 6) vs 0 (0, 2) (P = .013) at 30 minutes and 1 (1, 3) vs 0 (0, 1) (P = .013) at 60 minutes for abdominal pain; 0 (0, 2) vs 1 (1, 3) (P = .36) and 0 (0, 1) vs 1 (1, 3) (P = .014) at these same time points for perineal pain; and 1 (0, 5) vs 0 (0, 3) (P = .9) for abdominal and 2 (0, 5) vs 4 (1, 8) (P = .025) for perineal pain during pushing. The percentage of patients who underwent instrumental delivery was 15% vs 5% (P = .06) for the low versus high group.

CONCLUSIONS:
An L4-5 epidural catheter initially provides less relief of abdominal pain but more relief of perineal labor pain. Patients with an L4-5 catheter require more manual boluses during early labor but less during late labor. The possible association of low epidural catheters with instrumental delivery merits further investigation.