bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ischemic Stroke and Intracranial Hemorrhage With Aspirin, Dabigatran, and Warfarin
Authors: Ho Chi-Wai , Ho Mei-Han , Chan Pak-Hei , Hai Jo-Jo , Cheung Emmanuel , Yeung Chun-Yip , Lau Kui-Kai , Chan Koon-Ho , Lau Chu-Pak , Lip Gregory Y.H. , Leung Gilberto Ka-Kit , Tse Hung-Fat , Siu Chung-Wah 
Published: November 2014

Background and Purpose—
Little is known about the impact of quality of anticoagulation control, as reflected by time in therapeutic range (TTR), on the effectiveness and safety of warfarin therapy in Chinese patients with atrial fibrillation. We investigated the risks of ischemic stroke and intracranial hemorrhage (ICH) in relation to warfarin at various TTRs in a real-world cohort of Chinese patients with atrial fibrillation receiving warfarin and compared with those on dabigatran, aspirin, and no therapy.

Methods—
This is an observational study.

Results—

Of 8754 Chinese patients with atrial fibrillation and CHA
2
DS
2
-VASc ≥1 (79.5±9.2 years; CHA
2
DS
2
-VASc, 4.1±1.5; and Hypertension, Abnormal Renal/Liver Function, Stroke, Bleeding History or Predisposition, Labile International Normalized Ratio, Elderly (>65 years), Drugs/Alcohol Concomitantly [HAS-BLED], 2.2±0.9), 16.3% received warfarin, 41.1% aspirin, 4.5% dabigatran, and 38.1% received no therapy. The incidence of ischemic stroke was highest in patients with no therapy (10.38%/y), followed by patients on aspirin (7.95%/y). The incidence of stroke decreased progressively with increasing TTR quartiles (<17.9%, 17.9%–38.8%, 38.8%–56.2%, and >56.2%) from 7.34%/y (first quartile) to 3.10%/y (fourth quartile). Patients on dabigatran had the lowest incidence of stroke among all groups (2.24%/y). The incidence of ICH was lowest in patients on dabigatran (0.32%/y) compared with those on warfarin (0.90%/y), aspirin (0.80%/y), and no therapy (0.53%/y). ICH incidence decreased with increasing TTR from 1.37%/y (first quartile) to 0.74%/y (fourth quartile).

Conclusions—
In Chinese patients with atrial fibrillation, the benefits of warfarin therapy for stroke prevention and ICH risk are closely dependent on the quality of anticoagulation, as reflected by TTR. Even at the top TTR quartile, warfarin was associated with a higher stroke and ICH risk than dabigatran.
Holden Caulfield: Sort of a Christian
Authors: Taylor Bryce A. 
Published: November 2014

Many critics have remarked on the deeply religious character of J. D. Salinger’s The Catcher in the Rye; the novel has been discussed, for example, in terms of Zen Buddhism and Gnosticism. Catcher’s treatment of Christianity, however, has received little attention. This omission is regrettable given the characteristic acuity with which its narrator, Holden Caulfield, addresses Christian sources and themes. The aim of this article, therefore, is to consider in detail Holden’s conflicted attitude toward Christianity. It contends that despite Holden’s biting complaints against Christians (e.g., that many are hypocritical, cliquish, or ostentatious), he manifests an affinity for Christ and an attraction to Christian forms of religious life. This approach to the novel makes much of Holden’s allusion to the story, found in the Synoptic Gospels, of Legion, the Gerasene demoniac. Holden, like Legion, seems ostracized, masochistic, and obsessed by death, but in the novel’s climactic scene at the carousel, he finds healing. Furthermore, in the carousel scene especially, one can detect parallels between Catcher and the Divine Comedy. Just as Dante is guided from hell, through purgatory, to the beatific vision, so Holden is led (principally by his deceased brother Allie and his sister Phoebe) from misery, through purgation, to a moment of ineffable joy. The novel therefore may be read, this article contends, as a religious quest in which Holden comes to perceive the fundamental goodness of the world and its Creator.
Factors affecting recompression of augmented vertebrae after successful percutaneous balloon kyphoplasty: a retrospective analysis
Authors: Niu Junjie , Zhou Haifei , Meng Qian , Shi Jinhui , Meng Bin , Yang Huilin 
Published: November 2014

Background The instantaneously recovered stability and strength following vertebral augmentation prevent continuous micro-motion and further collapse of fractured vertebrae. Despite this, during follow-up of our patients, we observed recompression of augmented vertebrae with significant vertebral height loss and aggravation of local kyphotic deformity. Purpose To identify the risk factors related to recompression and to evaluate the clinical significance of recompression. Material and Methods One hundred and twenty-one patients who underwent single-level kyphoplasty for osteoporotic vertebral fractures were retrospectively analyzed and classified into the following two groups: group 1 with recompression and group 2 without recompression. Characteristics of patients and fractured vertebrae were compared between the two groups. Univariate and multivariate regression analyses were performed to identify risk factors for recompression. We evaluated the visual analogue scale (VAS) and the Oswestry disability index (ODI) scores in both groups to elucidate the clinical impact. Results During an average of 20.75 ± 4.43 months of follow-up, 17 augmented vertebrae developed recompression. In the recompression group, vertebral height loss was accompanied by significantly aggravated local kyphotic deformity. The local kyphotic angle differed significantly between the two groups at final follow-up ( P = 0.011). However, the VAS and ODI scores were maintained at final follow-up in both groups although the values were slightly higher in group 1. Solid lump distribution pattern (OR = 8.718; P = 0.003) and the degree of vertebral height restoration (OR = 1.260; P < 0.001) were identified as the most important risk factors for recompression. Conclusion Fractured vertebrae containing solid lump cement and those with more vertebral height restoration are at higher risk of recompression. More attention should be given to these patients considering the aggravated local kyphotic deformity.
CT triage for lung malignancy: coronal multiplanar reformation versus images in three orthogonal planes
Authors: Kusk Martin Weber , Karstoft Jens , Mussmann Bo Redder 
Published: November 2014

Background Generation of multiplanar reformation (MPR) images has become automatic on most modern computed tomography (CT) scanners, potentially increasing the workload of the reporting radiologists. It is not always clear if this increases diagnostic performance in all clinical tasks. Purpose To assess detection performance using only coronal multiplanar reformations (MPR) when triaging patients for lung malignancies with CT compared to images in three orthogonal planes, and to evaluate performance comparison of novice and experienced readers. Material and Methods Retrospective study of 63 patients with suspicion of lung cancer, scanned on 64-slice multidetector computed tomography (MDCT) with images reconstructed in three planes. Coronal images were presented to four readers, two novice and two experienced. Readers decided whether the patients were suspicious for malignant disease, and indicated their confidence on a five-point scale. Sensitivity and specificity on per-patient basis was calculated with regards to a reference standard of histological diagnosis, and compared with the original report using McNemar’s test. Receiver operating characteristic (ROC) curves were plotted to compare the performance of the four readers, using the area under the curve (AUC) as figure of merit. Results No statistically significant difference of sensitivity and specificity was found for any of the readers when compared to the original reports. ROC analysis yielded AUCs in the range of 0.92–0.93 for all readers with no significant difference. Inter-rater agreement was substantial (kappa = 0.72). Conclusion Sensitivity and specificity were comparable to diagnosis using images in three planes. No significant difference was found between experienced and novice readers.
Preoperative 18F-FDG PET/CT predicts disease-free survival in patients with primary invasive ductal breast cancer
Authors: Jo Ji Eun , Kim Jin You , Lee Suck Hong , Kim Suk , Kang Taewoo 
Published: November 2014

Background Previous studies have correlated the maximum standardized uptake value (SUVmax) of breast cancer lesions with histological and biological characteristics such as tumor size, histologic grade, or hormonal receptor expression status. However, controversy remains concerning the prognostic value of SUVmax in breast cancer. Purpose To determine if the SUVmax of a tumor on 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) is associated with disease-free survival in patients with primary invasive ductal breast cancer. Material and Methods The institutional review board of our hospital approved this retrospective study. From 2009 to 2011, 508 women (mean age, 53.6 years; age range, 26–85 years) with newly diagnosed invasive ductal breast cancer who had undergone preoperative 18F-FDG PET/CT followed by surgery were identified. Clinicopathological variables and FDG uptake quantified by SUVmax were analyzed. The Cox proportional hazards model was used to evaluate the association between SUVmax and disease-free survival after controlling for clinicopathological parameters. Results There were 21 recurrences at a median follow-up of 46 months. The mean SUVmax of the primary tumor was significantly higher in patients with a recurrence than those who remained disease-free (9.5 ± 3.5 vs. 6.6 ± 4.2, P < 0.001). A receiver operating characteristic curve indicated that a SUVmax of 5.95 was the optimal cut-off value to predict disease-free survival. Multivariate analysis identified a high SUVmax (≥5.95) and high T stage as independent significant variables associated with worse disease-free survival. Conclusion A high primary tumor SUVmax on 18F-FDG PET/CT was an independent factor associated with worse disease-free survival in patients with primary invasive ductal breast cancer.
Intramuscular Compartment Pressure Measurement in Chronic Exertional Compartment Syndrome
Authors: Roscoe David , Roberts Andrew J. , Hulse David 
Published: November 2014

Background: Patients with chronic exertional compartment syndrome (CECS) have pain during exercise that subsides with rest. Diagnosis is usually confirmed by intramuscular compartment pressure (IMCP) measurement. Controversy exists regarding the accuracy of existing diagnostic criteria. Purpose: (1) To compare dynamic IMCP measurement and anthropometric factors between patients with CECS and asymptomatic controls and (2) to establish the diagnostic utility of dynamic IMCP measurement. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 40 men aged 21 to 40 years were included in the study: 20 with symptoms of CECS of the anterior compartment and 20 asymptomatic controls. Diagnoses other than CECS were excluded with rigorous inclusion criteria and magnetic resonance imaging. The IMCP was measured continuously before, during, and after participants exercised on a treadmill, wearing identical footwear and carrying a 15-kg load. Results: Pain experienced by study subjects increased incrementally as the study progressed ( P < .001). Pain levels experienced by the case group during each phase of the exercise were significantly different ( P = .021). Subjects had higher IMCP immediately upon standing at rest compared with controls (23.8 mm Hg [controls] vs 35.5 mm Hg [subjects]; P = .006). This relationship persisted throughout the exercise protocol, with the greatest difference corresponding to the period of maximal tolerable pain (68.7 mm Hg [controls] vs 114 mm Hg [subjects]; P < .001). Sensitivity and specificity were consistently higher than the existing criteria with improved diagnostic value (sensitivity = 63%, specificity = 95%; likelihood ratio = 12.5 [95% CI, 3.2-49]). Conclusion: Anterior compartment IMCP is elevated immediately upon standing at rest in subjects with CECS. In patients with symptoms consistent with CECS, diagnostic utility of IMCP measurement is improved when measured continuously during exercise. A cutoff of 105 mm Hg in phase 2 provides better diagnostic accuracy than do the Pedowitz criteria of 30 mm Hg and 20 mm Hg at 1 and 5 minutes after exercise, respectively.
Increased prevalence of JC polyomavirus viruria was associated with arthritis/arthralgia in patients with systemic lupus erythematosus
Authors: Lu M-C , Yin W-Y , Liu S-Q , Koo M , Tung C-H , Huang K-Y , Lai N-S 
Published: November 2014

Objective The objective of this paper is to investigate the prevalence of reactivation of the human polyomavirus John Cunningham virus (JCV) in patients with systemic lupus erythematosus (SLE) and its associated clinical manifestations. Methods Sixty-one patients with SLE and 22 controls were enrolled. Urine JCV viral load was quantified by real-time polymerase chain reaction (PCR). Length variants of the VP1 gene were analyzed using capillary electrophoresis. Results The prevalence of JCV viruria (63.9% vs. 18.2%, p < 0.001) and urine JCV viral load (2.92 ± 2.76 vs. 0.81 ± 1.85 copies/ml by log10 scale, p < 0.001) were significantly higher in patients with SLE compared with controls. JCV viruria (+) SLE patients had a higher occurrence of arthritis/arthralgia compared with JCV viruria (−) SLE patients (64.1% vs. 22.7%, p = 0.003). In SLE patients, the urine JCV viral load was significantly associated with the occurrence of arthritis/arthralgia. SLE patients with urine JCV viral load >10,000 copies/ml exhibited a 12.75-fold (95% confidence interval 2.88–56.40) risk in clinical arthritis/arthralgia, 18.90-fold (95% confidence interval 2.10–170.39) risk in persistent arthritis, and significantly greater number of length variants in the VP1 gene of JCV compared with JCV viruria (−) SLE patients. Conclusion Reactivation of JCV in the urinary tract of SLE patients was very common. Both JCV viruria and urine JCV viral load were associated with the occurrence of arthritis/arthralgia in patients with SLE. High urine JCV viral load also was associated with the genetic variant in the VP1 gene.
Methadone in combination with medetomidine as premedication prior to ovariohysterectomy and castration in the cat
Authors: Slingsby Louisa S , Bortolami Elisa , Murrell Joanna C 
Published: November 2014

Objectives The aim of the study was to evaluate the tolerability, sedative and analgesic effects of methadone in combination with medetomidine for premedication prior to neutering in healthy cats. Methods This was an assessor-blinded, randomised, clinical research study. Forty-five cats were recruited and divided into three treatment groups of 15. Following premedication with medetomidine (20 µg/kg) and one of the three test drugs – methadone 0.5 mg/kg, buprenorphine 20 µg/kg or butorphanol 0.4 mg/kg intramuscularly – anaesthesia was induced with propofol and maintained with isoflurane, and neutering was carried out. Sedation and physiological parameters were assessed before premedication, after premedication before induction of anaesthesia, and at 90 mins and 2, 3, 4, 6, 7, 8 and 24 h after premedication. Pain and mechanical nociceptive threshold were assessed at similar time points. Results There were no differences between groups with respect to age, sex, duration of anaesthesia or surgery. Most cats had low pain scores in the postoperative period, with small differences in pain scores between groups at individual time points only. Five, two and no cats required additional rescue analgesia in the postoperative period in the butorphanol, methadone and buprenorphine groups, respectively, representing no significant difference between groups. Conclusions and relevance Medetomidine combined with methadone for premedication prior to neutering in healthy cats provided adequate analgesia for the first 6 h after administration with no adverse effects; effects overall were comparable with medetomidine combined with buprenorphine or butorphanol. Administration of further analgesia with methadone at 6 h and a non-steroidal anti-inflammatory drug at 8 h provided adequate analgesia for the first 24 h after surgery.
Evaluation of Men’s and Women’s Gymnastics Injuries
Authors: Westermann Robert W. , Giblin Molly , Vaske Ashley , Grosso Kylie , Wolf Brian R. 
Published: November 2014

Background: Injuries are common in collegiate gymnasts. Most descriptive studies of injury patterns in collegiate gymnasts are limited in duration or are only inclusive of women. Hypothesis: Injury patterns in men and women differ significantly; women sustain a higher rate of injuries than men. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: Musculoskeletal and head injuries reported in the Sports Injury Monitoring System at a single National Collegiate Athletic Association institution for Division 1 men’s and women’s gymnastics teams between 2001 and 2011 were identified. The variables assessed included sex, injured body part, year of eligibility, injury severity, surgical procedures, missed time, and team activity at the onset of injury. Results: From 2001 to 2011, 64 male gymnasts sustained 240 injuries, while 55 female gymnasts sustained 201 injuries. The injury incidence was 8.78 per 1000 athlete-exposures for men and 9.37 per 1000 athlete-exposures for women. Female gymnasts more commonly suffered major injuries compared with men, and more commonly underwent surgery after injury (24.4% of female injuries required surgery vs 9.2% in males). The anatomic region most often injured in men was the hand and wrist (24%). The anatomic region most often injured in women was the foot and ankle (39%). Overall, injury rates were highest in freshman-eligible athletes. Conclusion: Injury rates, overall, were similar in men and women gymnasts. Female gymnasts more commonly underwent surgical procedures after injury. Injury rates were higher in freshman-eligible athletes and decreased with increasing year of experience. Clinical Relevance: Specific attention should be given to gymnasts transitioning into collegiate-level gymnastics; injury prevention strategies should focus on the ankle and foot, as well as the elbow, wrist, and hand.
Magnetic resonance imaging findings in probable Creutzfeld-Jacob disease: comparison with electroencephalography and cerebrospinal fluid characteristics
Authors: Bozluolcay Melda , Elmali Ayse D , Menku Sukriye F , Zeydan Burcu , Benbir Gulcin , Delil Sakir , Yeni Naz 
Published: November 2014

Background Creutzfeld-Jacob disease (CJD) is a rare, progressive disease that has a vast clinical manifestation range. Cranial magnetic resonance imaging (MRI), electroencephalography (EEG), and measurement of 14-3-3 in cerebrospinal fluid (CSF) may offer a pragmatic approach in the diagnosis of CJD as an alternative to histopathological confirmation. Purpose To present the symptoms and signs of the CJD patients in regard to radiological and neurophysiological findings. Material and Methods We collected all cases with the diagnosis of probable CJD admitted to our neurology department between June 2010 and June 2014. The medical records and laboratory data, clinical features, results of MRI (including diffusion weighted images), EEG and CSF evaluations, and other laboratory data to exclude other possible diagnoses were recorded. None of the patients underwent biopsy or autopsy for histological diagnosis. Results Of 20 patients, 11 (55%) were men and nine (45%) were women. The mean age at disease onset was 60.0 ± 9.5 years (age range, 47–80 years). All patients without exception had characteristic abnormalities in DWI and/or FLAIR on admission, about 4 months after the initial symptom. Periodic complexes on EEGs characteristic for CJD were detected only in 10 patients (50%) on admission and in 13 patients (65%) during disease course. Out of 14 patients who underwent CSF examination, 11 (78.5%) were positive for 14-3-3 protein. Conclusion Although the definite diagnosis of CJD is made histopathologically, we aimed to discuss the value of magnetic resonance imaging in the diagnosis of CJD in respect to EEG findings and protein 14-3-3 levels in CSF.
The role of the Internet for people with chronic pain: examples from the DIPEx International Project
Authors: Ziebland Sue , Lavie-Ajayi Maya , Lucius-Hoene Gabriele 
Published: November 2014

In this article we consider how people with chronic illness are using the internet, drawing on examples from published qualitative interview studies of experiences of chronic pain in the UK, Germany and Israel. Extracts from the interviews can be seen on the websites from the www.dipexinternational.org collaboration which publishes analyses and many thousands of video and audio interview clips on country specific web platforms. The UK branch of the collaboration has been operating for over a decade and currently includes broad based samples of qualitative interviews with patients about their experiences of over 80 health problems. The research has demonstrated that people living with chronic pain are increasingly using the web to find information, support and practical advice for self-management and also for reassurance, encouragement, to compare experiences of treatment and to offer advice and support to others. The internet is changing the way that people are experiencing illness, although access to relevant and reliable online material is not equally distributed. Those who do not speak one of the handful of dominant languages are less likely to find online experiences that resonate with their own.
Influence of ethnicity on the perception and treatment of early post-operative pain
Authors: Al-Hashimi Mhamad , Scott Simon , Griffin-Teall Nicola , Thompson Jonathan 
Published: November 2014

Background: Previous studies indicated that patients from Black, Asian and minority ethnic (BAME) groups tend to receive less analgesics compared to Caucasian (White) patients after similar surgical procedures. Most such data originated from North America and suggested that health-care professionals may perceive the expression of excessive pain by BAME patient groups as an exaggerated response to pain, rather than sub-optimal treatment. There are limited data comparing acute pain management between South Asian and White British patients. Objective: We aimed to investigate correlation between patients’ ethnicity and disparities of early post-operative pain perception/management, in an ethnically diverse population. Methods: We conducted a retrospective case note review of acute post-operative pain after total abdominal hysterectomy (TAH) in 60 South Asian and 60 age-matched White British females. Data for 140 variables (pre-, intra- and post-operative) for each patient were recorded. We used propensity score matching to produce 30 closely matched patients in each group minimizing effects of recorded co-variates. Data were analysed with and without propensity score matching. Results: There were no significant differences in acute post-operative pain scores, morphine requirements, pain management, adverse effects or duration of post-operative care unit stay between South Asian and White British patients. The median duration of hospital stay of South Asian patients was longer (4.5 days versus 3.0 days, p < 0.001). Conclusion: We conclude that in an institution where both patients and health-care professionals are from an ethnically diverse population, neither post-operative pain nor pain management are influenced significantly by South Asian ethnicity.
Telomere attrition and candidate gene mutations preceding monosomy 7 in aplastic anemia
Authors: Dumitriu Bogdan , Feng Xingmin , Townsley Danielle M. , Ueda Yasutaka , Yoshizato Tetsuichi , Calado Rodrigo T. , Yang Yanqin , Wakabayashi Yoshiyuki , Kajigaya Sachiko , Ogawa Seishi , Zhu Jun , Young Neal S. 
Published: November 2014

Key Points
Accelerated telomere attrition precedes chromosomal loss and malignant transformation to MDS/AML arising from aplastic anemia.