bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clopidogrel Versus Aspirin as Chronic Maintenance Antiplatelet Monotherapy in Patients After Percutaneous Coronary Intervention With Chronic Kidney Disease: A Post Hoc Analysis of the HOST‐EXAM Trial
Authors: Kang Jeehoon , Park Sang‐Hyeon , Park Kyung Woo , Koo Bon‐Kwon , Lee Huijin , Han Minju , Hwang Doyeon , Yang Han‐Mo , Chae In‐Ho , Shin Won‐Yong , Oh Ju Hyeon , Kim Yong Hoon , Park Tae‐Ho , Kim Bum Soo , Han Jung‐Kyu , Shin Eun‐Seok , Kim Hyo‐Soo 
Published: September 2024

Background
Clopidogrel monotherapy improved clinical outcomes compared with aspirin monotherapy during a chronic maintenance period in patients who underwent coronary stenting in the HOST‐EXAM (Harmonizing Optimal Strategy for Treatment of Coronary Artery Stenosis–Extended Antiplatelet Monotherapy) trial. However, it is uncertain whether the beneficial effect of clopidogrel over aspirin is different according to the renal function.

Methods and Results

We conducted a post hoc analysis of the HOST‐EXAM trial. Chronic kidney disease (CKD) was defined as baseline estimated glomerular filtration rate <60 mL/min per 1.73 m
2
. The primary end point was a composite of all‐cause death, nonfatal myocardial infarction, stroke, readmission due to acute coronary syndrome, and Bleeding Academic Research Consortium bleeding type ≥3, during the 2‐year follow up. Among the 5438 patients enrolled in the HOST‐EXAM trial, 4844 patients (mean age, 63.3±10.6 years; 74.9% men) with a baseline creatinine value were analyzed in this study. A total of 508 (10.5%) patients had CKD, who were at higher risk of the primary end point compared with those without CKD (hazard ratio [HR], 2.01 [95% CI, 1.51–2.67]). Clopidogrel monotherapy was associated with a lower rate of the primary end point in both patients with CKD (HR, 0.74 [95% CI, 0.44–1.25]) and patients without CKD (HR, 0.71 [95% CI, 0.56–0.91]). No significant interaction was observed between the treatment effect and CKD status (
P
for interaction=0.889).

Conclusions
During the chronic maintenance period after coronary stenting, the risk of thrombotic and bleeding events was significantly higher in patients with CKD compared with those without CKD. There was no statistical difference in the treatment effect of clopidogrel monotherapy in those with versus without CKD.
Association Between Oral Anticoagulant Adherence and Serious Clinical Outcomes in Patients With Atrial Fibrillation: A Long‐Term Retrospective Cohort Study
Authors: Safari Abdollah , Helisaz Hamed , Salmasi Shahrzad , Adelakun Adenike , De Vera Mary A. , Andrade Jason G. , Deyell Marc W. , Loewen Peter 
Published: September 2024

Background
Patients with atrial fibrillation are frequently nonadherent to oral anticoagulants (OACs) prescribed for stroke and systemic embolism (SSE) prevention. We quantified the relationship between OAC adherence and atrial fibrillation clinical outcomes using methods not previously applied to this problem.

Methods and Results
Retrospective observational cohort study of incident cases of atrial fibrillation from population‐based administrative data over 23 years. The exposure of interest was proportion of days covered during 90 days before an event or end of follow‐up. Cox proportional hazard models were used to evaluate time to first SSE and the composite of SSE, transient ischemic attack, or death and several secondary outcomes. A total of 44 172 patients were included with median follow‐up of 6.7 years. For direct OACs (DOACs), each 10% decrease in adherence was associated with a 14% increased hazard of SSE and 5% increased hazard of SSE, transient ischemic attack, or death. For vitamin K antagonist (VKA) the corresponding increase in SSE hazard was 3%. Receiving DOAC or VKA was associated with primary outcome hazard reduction across most the proportion of days covered spectrum. Differences between VKA and DOAC were statistically significant for all efficacy outcomes and at most adherence levels.

Conclusions
Even small reductions in OAC adherence in patients with atrial fibrillation were associated with significant increases in risk of stroke, with greater magnitudes for DOAC than VKA. DOAC recipients may be more vulnerable than VKA recipients to increased risk of stroke and death even with small reductions in adherence. The worsening efficacy outcomes associated with decreasing adherence occurred without the benefit of major bleeding reduction.
Pharmacist Use of a Population Management Dashboard for Safe Anticoagulant Prescribing: Evaluation of a Nationwide Implementation Effort
Authors: Barnes Geoffrey D. , Chen Charity , Holleman Rob , Errickson Joshua , Seagull F. Jacob , Dorsch Michael P. , Allen Arthur L. , Spoutz Patrick , Sussman Jeremy B. 
Published: September 2024

Background
Direct oral anticoagulants (DOACs) have complex dosing regimens and are often incorrectly prescribed. We evaluated a nationwide DOAC population management dashboard rollout whose purpose includes pharmacist review and correction of off‐label dosing prescriptions.

Methods and Results
Using data from Veterans Health Affairs, we identified all patients prescribed DOACs for atrial fibrillation or venous thromboembolism between August 2015 and December 2019. Sites were grouped on the basis of the timing of moderate‐high usage of the DOAC population management tool dashboard. Effectiveness was defined as the monthly rate of off‐label DOAC prescribing and the rate of clinical adverse events (bleeding, composite of stroke or venous thromboembolism). Implementation was evaluated as the percentage of off‐label DOAC prescriptions changed within 7 days. Among the 128 652 patients receiving DOAC therapy at 123 centers, between 6.9% and 8.6% had off‐label DOAC prescriptions. Adoption of the DOAC population management tool dashboard before July 2018 was associated with a decline in off‐label dosing prescriptions (8.7%–7.6%). Only 1 group demonstrated a significant reduction in monthly rates of bleeding following implementation. All sites experienced a reduction in the composite of venous thromboembolism or stroke following dashboard adoption. There was no difference in the implementation outcome of DOAC prescription change within 7 days in any of the adoption groups.

Conclusions
Early adoption of the DOAC population management tool dashboard was associated with decreased rates of off‐label DOAC dosing prescription and reduced bleeding. Following adoption of the DOAC population management tool dashboard, all sites experienced reductions in venous thromboembolism and stroke events.
Dual Antiplatelet Therapy and Outcomes in Acute Mild to Moderate Stroke With Versus Without Large‐Artery Atherosclerosis Post Hoc Analysis of ATAMIS
Authors: Cui Yu , Liu Quan‐Ying , Chen Hui‐Sheng 
Published: September 2024

Background
We conducted a post hoc analysis of the ATAMIS (Antiplatelet Therapy in Acute Mild to Moderate Ischemic Stroke) trial to investigate whether the priority of clopidogrel plus aspirin to aspirin alone was consistent between patients with and without stroke pathogenesis of large‐artery atherosclerosis (LAA).

Methods and Results

Patients with stroke classification randomized to a clopidogrel‐plus‐aspirin group and aspirin‐alone group in a modified intention‐to‐treat analysis set of ATAMIS were classified into LAA and non‐LAA subtypes. The primary outcome was early neurologic deterioration at 7 days, defined as a >2‐point increase in National Institutes of Health Stroke Scale score compared with baseline, and safety outcomes were bleeding events and intracranial hemorrhage. We compared treatment effects in each stroke subtype and investigated the interaction. Among 2910 patients, 225 were assigned into the LAA subtype (119 in the clopidogrel‐plus‐aspirin group and 106 in the aspirin‐alone group) and 2685 into the non‐LAA subtype (1380 in the clopidogrel‐plus‐aspirin group and 1305 in the aspirin‐alone group). Median age was 66 years, and 35% were women. A lower proportion of early neurologic deterioration was found to be associated with dual antiplatelet therapy in the LAA subtype (adjusted risk difference, −10.4% [95% CI, −16.2% to −4.7%];
P
=0.001) but not in the non‐LAA subtype (adjusted risk difference, −1.4% [95% CI, −2.6% to 0.1%];
P
=0.06). No significant interaction was found (
P
=0.11).

Conclusions
Compared with the non‐LAA subtype, patients with stroke of the LAA subtype may get more benefit from dual antiplatelet therapy with clopidogrel plus aspirin with respect to early neurologic deterioration at 7 days.

Registration

URL:
clinicaltrials.gov
; UnIque identifier: NCT02869009.
L’actualité du style à la lumière des Soulsborne
Authors: Dernoncourt Pierre 
Published: September 2024

Résumé
La notion de style permet d’aborder certains questionnements relatifs à l’analyse du jeu vidéo sous un jour nouveau, en tenant ensemble les pôles de la création et de la réception vidéoludiques dans un horizon esthétique. De surcroît, les interrogations liées à la notion d’auteur, employée dans le champ vidéoludique depuis une quinzaine d’années, engagent une réflexion approfondie sur la notion de style auctorial et sa pertinence dans un medium caractérisé par une production standardisée, sous-tendue par des contraintes techniques et des conventions laissant peu de place à l’individualité créatrice. C’est essentiellement sur le mode de l’écart que ce vocable révèle toute sa richesse pour analyser la série de jeux vidéo ayant le plus marqué la décennie passée : les Soulsborne. Ces œuvres sont indissociables de leur auteur, Hidetaka Miyazaki, et sont caractérisées par une direction artistique et un game design originaux et exemplaires pour l’ensemble du medium vidéoludique.
Phylogeny and taxonomic revision of Hygrophorus robustus (Hygrophoraceae, Agaricales) from southwestern China
Authors: HUANG HONG-YAN , WANG RAN , ZHANG WEN-HAO , YU FU-QIANG , TANG LI-PING 
Published: September 2024

Hygrophorus robustus was originally described from Yunnan province, China. This taxon is characterized by its robust basidiomata, salmon buff lamellae, tapered toward the base of the stipe, the odor of Tricholoma matsutake, the absence of cystidia and clamp connections, and a symbiotic association with Castanopsis delavayi. In this study, the phylogenetic position of this taxon is inferred by molecular phylogenetic analysis based on DNA sequences of internal transcribed spacer (ITS). The ITS result showed that it is nested within the genus Tricholoma and is affiliated with the North American T. grave. The morphological anatomy of this species also shows that its characteristics fit the concept of the genus Tricholoma, such as regular lamellar trama. Thus, H. robustus should be taxonomically transferred to Tricholoma, and the name of the new combination should be T. robustum. However, this name was used in the genus as Tricholoma robustum (Alb. & Schwein.) Ricken. Thus, we propose a new name T. aurantiophyllum for H. robustus.
Association between interleukin-6 levels and stroke: a systematic review and meta-analysis
Authors: Huang Xinyi , Zhang Manman , Wang Jiaojiao , Hu Fuyong 
Published: September 2024

Objectives We aimed to evaluate the association of interleukin-6 (IL-6) expression levels with stroke. Methods According to the set search strategy, we systematically screened relevant studies using PubMed and extracted study results regarding IL-6 from the literature for comprehensive quantitative analysis to explore the relationship between IL-6 level and stroke risk. Results This study included 15 publications with a total of 1696 participants, with 975 cases in the case group and 721 cases in the control group. Meta-analysis showed that IL-6 levels were significantly higher in the stroke population than those in the control group (standardized mean difference = 1.22, 95% confidence interval = 0.79–1.64). Subgroup analysis showed that there was no significant difference in heterogeneity for IL-6 detection methods between the two groups ( I2 = 0, P = 0.47). The difference in heterogeneity test results regarding geographic region was statistically significant ( I2 = 89.7%, P < 0.01). The results of heterogeneity testing for mean participant age were also statistically significant ( I2 = 84.3%, P = 0.01). Conclusion The present study results showed that IL-6 may be significantly associated with stroke development.
Mechanical property, oxidation resistance, and ceramization mechanism of MoSi2-SiB6 reinforced phenolic resin matrix composites
Authors: Shen Qiang , Yang Suohui , Zhang Shiquan , Hu Sheng , Li Junguo , Zhang Jian 
Published: September 2024

Ceramizable phenolic resin matrix composites have a significant potential for widespread applications in the field of aerospace ablation. However, due to the sharp decrease of mechanical properties at elevated temperatures, the composite fails to meet the requirements of thermal protection as well as load-bearing of aircraft in a wide temperature range. In this study, boron phenolic composites modified by MoSi2 and SiB6 with high strength in a wide temperature range are prepared. The flexural strength of composites after ablation within the temperature range of 800 °C to 1600 °C ranges from 48.07 to 82.49 MPa. In particular, a significant increase of 224.9% is obtained at 1400 °C with 6 wt% SiB6. The mass ablation rate and line ablation rate of the composites are increased to 0.054 g/s and 0.013 mm/s, respectively. The cooperation effect of oxygen consumption, carbon fixation, oxygen barrier, and liquid phase bonding produced by ceramization reactions involving SiB6, MoSi2, O2, and pyrolytic carbon at different temperatures, resulting in an improvement of the mechanical property and the oxidation resistance of the composite. These composites have a potential in long term thermal protection and load-bearing of new ablation materials.
IC-ECG guided PICC tip location in a dextrocardia: A case report
Authors: Qiao Weiru , Qiao Liping , Li Dongdong , Wang Yuanyong , Ren Yaru , Liu Qiao , Wang Ying , Li Yufang , Wang Dongdong , Lv Feifei , Wu Rong , Shi Yuan , Hou Lihua , Yan Xiaolong 
Published: September 2024

Introduction: Mirror people have difficulty with PICC placement due to inversion of organs. Intracavitary electrocardiography (IC-ECG) guided peripherally inserted central catheter (PICC) tip location technique has been widely applied in clinical practice. Case description: Herein, we admitted a 59-year-old man diagnosed with esophageal cancer (EC). Chest X-ray and computed tomography (CT) revealed that the patient was with a mirror-image dextrocardia and situs inversus totalis: the heart and stomach located in the right side of the body, whereas the liver located in the left side. Echocardiography suggested that the apex of the heart pointed toward the right, while the left and right chambers were inverted. The relationship of the heart chambers, structure, and function were normal: left ventricular ejection fraction was 0.67, left atrial diameter was 31 mm, and heart output was 4.7 L/min. Surface ECG showed typical features of a dextrocardia: P-wave inverted on lead I. Amplitude of the R-wave and S-wave decreased gradually on lead chest from V1 to V5. Compared with the normal ECG image, the waves completely exchanged on lead II and III, so as on aVR and aVL. Methods: Column of saline technique can assist operator estimate the tip position in real-time according to P-wave changes. When the height of P-wave reaches to its highest, it means that the tip of catheter has advanced to the target position of cavo-atrial junction (CAJ). Outcomes: Patient was inserted catheter and no adverse events were reported. Conclusions: Measuring the predicted length of catheter is still an indispensible procedure to help precisely adjusting the tip position in IC-ECG guided PICC. Our work provides both supplement for clinical data to facilitate further research and better understanding of special types of PICC to clinicians.
Optimizing Oil Distributor Port for Low-Pulsation Cam-Lobe Hydraulic Motors
Authors: Duan Yiman , Tan Hao , Fang Yu , Zheng Zhijian , Zhang Junhui , Xu Bing , Su Qi , Zhang Chao 
Published: September 2024

AbstractHigh-end equipment always operate in low-speed and heavy-load working environments, highlighting the need for cam-lobe hydraulic motors with excellent speed stability (< 1 r/min) and ultrahigh-power rotary output (> 1 MW). The successful operation of cam-lobe hydraulic motors relies on the circulation supply of high- and low-pressure oil. However, the switching between high-/low-pressure oil controlled by the oil distributor inevitably causes an obvious pressure impact and speed pulsation, which directly reduces the speed stability of hydraulic motors. Therefore, an optimization design approach for the oil distributor port is proposed to minimize the speed pulsation of cam-lobe hydraulic motors. In the proposed approach, a simulation model that links the oil distributor port structural parameters with the hydraulic motor speed pulsation was developed to clarify the effect of the oil distributor structural parameters on speed pulsation. Then, an orthogonal analysis method was used to identify the optimized oil distributor port structural parameters while minimizing the hydraulic motor’s speed pulsation as much as possible. Finally, several experiments were conducted to validate the effectiveness and accuracy of the proposed optimization design approach. The experimental results indicate that the pulsation rate of the hydraulic motor equipped with the optimized oil distributor was 62.5% lower than that of the original motor at a working pressure of 25 MPa, which is consistent with the simulation results using the proposed optimization design approach. The findings of this study offer a feasible and effective approach to guide the design optimization of the oil distributor port for low-pulsation hydraulic motors.
Evaluation of the physical properties of bromelain-modified biodentine for direct pulp capping
Authors: Agrawal Paridhi , Chandak Manoj , Patel Aditya , Bhopatkar Jay 
Published: September 2024

Abstract
Background
This study aims to evaluate the compressive strength, solubility, radiopacity, and flow of Bromelain (BR)-modified Biodentine (BD) for direct pulp capping (DPC). This is suggested to determine the impact of BR on the physical properties of BD.

Methods
Eighty samples were prepared according to the ISO and ADA specifications and evaluated for compressive strength, solubility, radiopacity, and flow. The compressive strength was evaluated at 24 h and 21 days via a universal testing machine. The solubility was determined by weight loss after 24-hours immersion in deionized water. Radiopacity was assessed via X-ray with aluminum step-wedges, and flow was measured by the diameter of the discs under a standard weight. Independent sample t-tests were used to statistically assess the data. A significance level of 5% was considered.

Results
The compressive strength was 41.08 ± 1.84 MPa for BD and 40.92 ± 1.80 MPa for BR + BD after 24 h, and 88.93 ± 3.39 MPa for BD and 87.92 ± 3.76 MPa for BR + BD after 21 days, with no significant differences. Solubility was slightly greater in the BR + BD (2.75 ± 0.10%) compared to BD (2.62 ± 0.25%), but not significantly different. The radiopacity was similar between BD (2.82 ± 0.11 mm) and BR + BD (2.73 ± 0.10 mm). BR + BD resulted in significantly greater flow (9.99 ± 0.18 mm) than did BD (9.65 ± 0.27 mm) (p ≤ 0.05).

Conclusion
BR-modified BD maintains BD’s physical properties, with improved flow, making it a promising DPC agent that warrants further study.
The association between cumulative exposure to PM2.5 and DNA methylation measured using methyl-capture sequencing among COPD patients
Authors: Ji Hyun Woo , Kang Jieun , Kim Hwan-Cheol , Jung Junghee , Lee Seon-Jin , Jung Ji Ye , Lee Sei Won 
Published: September 2024

Abstract
Background
Particulate matter with a diameter of < 2.5 μm (PM2.5) influences gene regulation via DNA methylation; however, its precise mechanism of action remains unclear. Thus, this study aimed to examine the connection between personal PM2.5 exposure and DNA methylation in CpG islands as well as explore the associated gene pathways.

Methods
A total of 95 male patients with chronic obstructive pulmonary disease (COPD) were enrolled in this study. PM2.5 concentrations were measured for 12 months, with individual exposure recorded for 24 h every 3 months. Mean indoor and estimated individual PM2.5 exposure levels were calculated for short-term (7 days), mid-term (35 days), and long-term (90 days). DNA methylation analysis was performed on the blood samples, which, after PCR amplification and hybridization, were finally sequenced using an Illumina NovaSeq 6000 system. Correlation between PM2.5 exposure and CpG methylation sites was confirmed via a mixed-effects model. Functional enrichment analysis was performed on unique CpG methylation sites associated with PM2.5 exposure to identify the relevant biological functions or pathways.

Results
The number of CpG sites showing differential methylation was 36, 381, and 182 for the short-, mid-, and long-term indoor models, respectively, and 3, 98, and 28 for the short-, mid-, and long-term estimated exposure models, respectively. The representative genes were TMTC2 (p = 1.63 × 10-3, R2 = 0.656), GLRX3 (p = 1.46 × 10-3, R2 = 0.623), DCAF15 (p = 2.43 × 10-4, R2 = 0.623), CNOT6L (p = 1.46 × 10-4, R2 = 0.609), BSN (p = 2.21 × 10-5, R2 = 0.606), and SENP6 (p = 1.59 × 10-4, R2 = 0.604). Functional enrichment analysis demonstrated that the related genes were mostly associated with pathways related to synaptic transmission in neurodegenerative diseases and cancer.

Conclusion
A significant association was observed between PM2.5 exposure and DNA methylation upon short-term exposure, and the extent of DNA methylation was the highest upon mid-term exposure. Additionally, various pathways related to neurodegenerative diseases and cancer were associated with patients with COPD.

ClinicalTrials.gov identifier
NCT04878367.
Association of parental adverse childhood experiences with offspring sleep problems: the role of psychological distress and harsh discipline
Authors: Zhu Yantong , Zhang Gengli , Zhan Shuwei 
Published: September 2024

Abstract
Background
Sleep problems are common in early childhood and may be affected by parental adverse childhood experiences (ACEs). However, few studies have examined the longitudinal effect of parental ACEs on offspring sleep problems and the underlying mechanism. This study examined parents’ psychological distress and harsh discipline (psychological aggression and corporal punishment) as mediators in the longitudinal pathway from parental ACEs to offspring sleep problems.

Methods
The participants included 617 3-year-old children (mean age of 43.13 months, SD = 3.82) and their parents (mean age of 33.24 years, SD = 4.01) from Wuhu, China. The participants completed an online questionnaire on ACEs, psychological distress, and demographic characteristics in September 2022 (Time 1). Parents completed another online questionnaire in September 2023 (Time 2) on harsh discipline and offspring sleep problems. A path model was used to examine the associations.

Results
Parental ACEs did not directly predict offspring sleep problems. Psychological distress (β = 0.041, 95% CI [0.005, 0.111]) and harsh discipline in the form of psychological aggression (β = 0.019, 95% CI [0.006, 0.056]) separately mediated the relationship between parental ACEs and offspring sleep problems. Psychological distress and psychological aggression also played a serial mediating role in the association of parental ACEs with offspring sleep problems (β = 0.014, 95% CI [0.007, 0.038]).

Conclusions
Our findings showed the importance of psychological distress and psychological aggression in the intergenerational effect of trauma on offspring sleep problems. Specific interventions aimed at improving mental health and parenting practices should be provided for parents who were exposed to ACEs.