bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes With Various Drug-Eluting or Bare Metal Stents in Patients With ST-Segment–Elevation Myocardial Infarction
Authors: Bangalore Sripal , Amoroso Nicholas , Fusaro Mario , Kumar Sunil , Feit Frederick 
Published: August 2013

Background—
The efficacy and safety of drug-eluting stents (DES) in patients with ST-segment–elevation myocardial infarction (STEMI) is controversial. Consequently, DES implantation has a class IIa indication in the American College of Cardiology/American Heart Association and the European Society of Cardiology STEMI guidelines.

Methods and Results—
PUBMED, EMBASE, and CENTRAL were searched for randomized clinical trials, until March 2013, comparing any of the 5 Food and Drug Administration–approved durable stent and polymer DES (sirolimus eluting stent, paclitaxel eluting stent, everolimus-eluting stent [EES], zotarolimus-eluting stent, and zotarolimus-eluting stent resolute), against each other or bare metal stents (BMS), and enrolling ≥50 patients with STEMI. Efficacy (target vessel revascularization) and safety (death, myocardial infarction, and stent thrombosis) outcomes at the longest reported follow-up times were evaluated. Twenty-eight randomized clinical trials with 34 068 patient-years of follow-up on subjects with STEMI fulfilled the inclusion criteria. When compared with BMS (reference rate ratio [RR] of 1), sirolimus eluting stent (RR, 0.46; 95% credibility interval [CrI], 0.36–0.56), paclitaxel eluting stent (RR, 0.69; 95% CrI, 0.53–0.87), and EES (RR, 0.42; 95% CrI, 0.26–0.62) were associated with a statistically significant reduction in rate of target vessel revascularization, with the point estimate for zotarolimus-eluting stent resolute trending in a similar direction. There was no increase in the risk of death, myocardial infarction, or stent thrombosis with any DES compared with BMS. Moreover, EES was associated with a statistically significant reduction in the rate of stent thrombosis when compared with sirolimus eluting stent (RR, 0.38; 95% CrI, 0.21–0.74), paclitaxel eluting stent (RR, 0.39; 95% CrI, 0.21–0.73), and even BMS (RR, 0.42; 95% CrI, 0.23–0.76). There was a 74% probability that EES had the lowest rate of any stent thrombosis when compared with all other stent types (no data on zotarolimus-eluting stent resolute). There was no increase in very late stent thrombosis with EES versus BMS (RR, 0.89; 95% CrI, 0.09–8.67).

Conclusions—
In patients with STEMI, DES versus BMS was associated with substantial decrease in the risk of target vessel revascularization without compromising safety. EES had the added advantage of substantial reduction in the risk of stent thrombosis when compared with first-generation DES and BMS with no increase in very late stent thrombosis.
Endovascular Repair of Type B Aortic Dissection
Authors: Nienaber Christoph A. , Kische Stephan , Rousseau Hervé , Eggebrecht Holger , Rehders Tim C. , Kundt Guenther , Glass Aenne , Scheinert Dierk , Czerny Martin , Kleinfeldt Tilo , Zipfel Burkhart , Labrousse Louis , Fattori Rossella , Ince Hüseyin 
Published: August 2013

Background—
Thoracic endovascular aortic repair (TEVAR) represents a therapeutic concept for type B aortic dissection. Long-term outcomes and morphology after TEVAR for uncomplicated dissection are unknown.

Methods and Results—

A total of 140 patients with stable type B aortic dissection previously randomized to optimal medical treatment and TEVAR (n=72) versus optimal medical treatment alone (n=68) were analyzed retrospectively for aorta-specific, all-cause outcomes, and disease progression using landmark statistical analysis of years 2 to 5 after index procedure. Cox regression was used to compare outcomes between groups; all analyses are based on intention to treat. The risk of all-cause mortality (11.1% versus 19.3%;
P
=0.13), aorta-specific mortality (6.9% versus 19.3%;
P
=0.04), and progression (27.0% versus 46.1%;
P
=0.04) after 5 years was lower with TEVAR than with optimal medical treatment alone. Landmark analysis suggested a benefit of TEVAR for all end points between 2 and 5 years; for example, for all-cause mortality (0% versus 16.9%;
P
=0.0003), aorta-specific mortality (0% versus 16.9%;
P
=0.0005), and for progression (4.1% versus 28.1%;
P
=0.004); Landmarking at 1 year and 1 month revealed consistent findings. Both improved survival and less progression of disease at 5 years after elective TEVAR were associated with stent graft induced false lumen thrombosis in 90.6% of cases (
P
<0.0001).

Conclusions—
In this study of survivors of type B aortic dissection, TEVAR in addition to optimal medical treatment is associated with improved 5-year aorta-specific survival and delayed disease progression. In stable type B dissection with suitable anatomy, preemptive TEVAR should be considered to improve late outcome.

Clinical Trial Registration—

URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01415804.
Higher Persistence in Newly Diagnosed Nonvalvular Atrial Fibrillation Patients Treated With Dabigatran Versus Warfarin
Authors: Zalesak Martin , Siu Kimberly , Francis Kevin , Yu Chen , Alvrtsyan Hasmik , Rao Yajing , Walker David , Sander Stephen , Miyasato Gavin , Matchar David , Sanchez Herman 
Published: August 2013

Background—
Oral anticoagulation therapy is the primary tool in reducing stroke risk in patients with nonvalvular atrial fibrillation but is underused. Patients nonpersistent with therapy contribute to this underuse. The objective of this study was to compare persistence rates in newly diagnosed nonvalvular atrial fibrillation patients treated with warfarin versus dabigatran as their oral anticoagulation.

Methods and Results—

US Department of Defense administrative claims were used to identify patients receiving warfarin or dabigatran between October 28, 2010, and June 30, 2012. Patient records were examined for a minimum of 12 months before index date to restrict the analyses to those newly diagnosed with nonvalvular atrial fibrillation and naive-to-treatment, identifying 1775 on warfarin and 3370 on dabigatran. Propensity score matching was used to identify 1745 matched pairs. Persistence was defined as time on therapy to discontinuation. Kaplan–Meier curves were used to depict persistence over time. Cox proportional hazards model was used to determine the factors significantly associated with persistence. Using a 60-day permissible medication gap, the persistence rates were higher for dabigatran than for warfarin at both 6 months (72% versus 53%) and 1 year (63% versus 39%). Patients on dabigatran with a low-to-moderate risk of stroke (CHADS
2
<2) or with a higher bleed risk (HEMORR
2
HAGES>3) had a higher likelihood of nonpersistence (hazard ratios, 1.37; 95% confidence interval, 1.17–1.60;
P
<0.001; and hazard ratios, 1.24; 95% confidence interval, 1.04–1.47;
P
=0.016).

Conclusions—
Patients who initiated dabigatran treatment were more persistent than patients who began warfarin treatment. Within each cohort, patients with lower stroke risk were more likely to discontinue therapy.
Human Enterovirus in the Gastrocnemius of Patients With Peripheral Arterial Disease
Authors: Kim Julian K. S. , Zhu Zhen , Casale George , Koutakis Panagiotis , McComb Rodney D. , Swanson Stanley , Thompson Jonathan , Miserlis Dimitrios , Johanning Jason M. , Haynatzki Gleb , Pipinos Iraklis I. 
Published: August 2013

Background

Peripheral arterial disease (
PAD
) is characterized by myofiber degeneration and loss of function in muscles of the lower limbs. Human enterovirus (
HEV
) infection has been implicated in the pathogenesis of a number of muscle diseases. However, its association with
PAD
has not been studied. In this study, we tested the hypothesis that infectious
HEV
is present in skeletal muscle of patients with
PAD
and is associated with severity of disease.

Methods and Results

Gastrocnemius biopsies from 37 patients with
PAD
and 14 controls were examined for the presence of
HEV RNA
, viral capsid protein, viral
RNA
copy number, and viral infectivity.
HEV RNA
was detected in 54% of the biopsies from patients with
PAD
but was not detected in muscle biopsies from control patients. This difference in prevalence among
PAD
and control patients was significant at
P
<0.001. Viral
RNA
copy numbers were increased significantly at the later stages of disease; Fontaine Stage IV (10
5.50
copies/mg muscle wet weight, at
P
<0.005) and Stage III (10
4.87
copies/mg, at
P
<0.010) compared to Stage II (10
2.50
copies/mg). Viral replication was confirmed by the presence of the negative‐strand of viral
RNA
in all specimens positive for
HEV RNA
. Cultures of HeLa and human skeletal muscle cells treated with muscle homogenates showed
HEV
replication and the presence of
HEV
capsid protein.

Conclusion

Our data identified infectious
HEV
in the gastrocnemius of
PAD
patients but not in controls. Viral copy number and prevalence of infection were higher in the later stages of disease. Our data point to the need for further studies to determine the contribution of
HEV
infection to the pathophysiology of
PAD
.
Brain Imaging and Cognitive Predictors of Stroke and Alzheimer Disease in the Framingham Heart Study
Authors: Weinstein Galit , Beiser Alexa S. , DeCarli Charles , Au Rhoda , Wolf Philip A. , Seshadri Sudha 
Published: August 2013

Background and Purpose—
Exposure to vascular risk factors has a gradual deleterious effect on brain MRI and cognitive measures. We explored whether a pattern of these measures exists that predicts stroke and Alzheimer disease (AD) risk.

Methods—
A cognitive battery was administered to 1679 dementia and stroke-free Framingham offspring (age, >55 years; mean, 65.7±7.0) between 1999 and 2004; participants were also free of other neurological conditions that could affect cognition and >90% also had brain MRI examination. We related cognitive and MRI measures to risks of incident stroke and AD ≤10 years of follow-up. As a secondary analysis, we explored these associations in The Framingham Heart Study original cohort (mean age, 67.5±7.3 and 84.8±3.3 years at the cognitive assessment and MRI examination, respectively).

Results—
A total of 55 Offspring participants sustained strokes and 31 developed AD. Offspring who scored <1.5 SD below predicted mean scores, for age and education, on an executive function test, had a higher risk of future stroke (hazard ratio [HR], 2.27; 95% confidence interval [CI], 1.06–4.85) and AD (HR, 3.60; 95% CI, 1.52–8.52); additional cognitive tests also predicted AD. Participants with low (<20 percentile) total brain volume and high (>20 percentile) white matter hyperintensity volume had a higher risk of stroke (HR, 1.97; 95% CI, 1.03–3.77 and HR, 2.74; 95% CI, 1.51–5.00, respectively) but not AD. Hippocampal volume at the bottom quintile predicted AD in the offspring and original cohorts (HR, 4.41; 95% CI, 2.00–9.72 and HR, 2.37; 95% CI, 1.12–5.00, respectively). A stepwise increase in stroke risk was apparent with increasing numbers of these cognitive and imaging markers.

Conclusions—
Specific patterns of cognitive and brain structural measures observed even in early aging predict stroke risk and may serve as biomarkers for risk prediction.
Imaging of Contrast Medium Extravasation in Anticoagulation-Associated Intracerebral Hemorrhage With Dual-Energy Computed Tomography
Authors: Won Sae-Yeon , Schlunk Frieder , Dinkel Julien , Karatas Hulya , Leung Wendy , Hayakawa Kazuhide , Lauer Arne , Steinmetz Helmuth , Lo Eng H. , Foerch Christian , Gupta Rajiv 
Published: August 2013

Background and Purpose—
Contrast medium extravasation (CE) in intracerebral hemorrhage (ICH) is a marker of ongoing bleeding and a predictor of hematoma expansion. The aims of the study were to establish an ICH model in which CE can be quantified, characterized in ICH during warfarin and dabigatran anticoagulation, and to evaluate effects of prothrombin complex concentrates on CE in warfarin-associated ICH.

Methods—
CD1-mice were pretreated orally with warfarin, dabigatran, or vehicle. Prothrombin complex concentrates were administered in a subgroup of warfarin-treated mice. ICH was induced by stereotactic injection of collagenase VIIs into the right striatum. Contrast agent (350 μL Isovue 370 mg/mL) was injected intravenously after ICH induction (2–3.5 hours). Thirty minutes later, mice were euthanized, and CE was measured by quantifying the iodine content in the hematoma using dual-energy computed tomography.

Results—

The optimal time point for contrast injection was found to be 3 hours after ICH induction, allowing detection of both an increase and a decrease of CE using dual-energy computed tomography. CE was higher in the warfarin group compared with the controls (
P
=0.002). There was no significant difference in CE between dabigatran-treated mice and controls. CE was higher in the sham-treated warfarin group than in the prothrombin complex concentrates–treated warfarin group (
P
<0.001).

Conclusions—
Dual-energy computed tomography allows quantifying CE, as a marker of ongoing bleeding, in a model of anticoagulation-associated ICH. Dabigatran induces less CE in ICH than warfarin and consequently reduces risks of hematoma expansion. This constitutes a potential safety advantage of dabigatran over warfarin. Nevertheless, in case of warfarin anticoagulation, prothrombin complex concentrates reduce this side effect.
Population-Based Study of Disability and Institutionalization After Transient Ischemic Attack and Stroke
Authors: Luengo-Fernandez Ramon , Paul Nicola L.M. , Gray Alastair M. , Pendlebury Sarah T. , Bull Linda M. , Welch Sarah J.V. , Cuthbertson Fiona C. , Rothwell Peter M. 
Published: August 2013

Background and Purpose—
Long-term outcome information after transient ischemic attack (TIA) and stroke is required to help plan and allocate care services. We evaluated the impact of TIA and stroke on disability and institutionalization over 5 years using data from a population-based study.

Methods—
Patients from a UK population-based cohort study (Oxford Vascular Study) were recruited from 2002 to 2007 and followed up to 2012. Patients were followed up at 1, 6, 12, 24, and 60 months postevent and assessed using the modified Rankin scale. A multivariate regression analysis was performed to assess the predictors of disability postevent.

Results—

A total of 748 index stroke and 440 TIA cases were studied. For patients with TIA, disability levels increased from 14% (63 of 440) premorbidly to 23% (60 of 256) at 5 years (
P
=0.002), with occurrence of subsequent stroke being a major predictor of disability. For stroke survivors, the proportion disabled (modified Rankin scale >2) increased from 21% (154 of 748) premorbidly to 43% (273 of 634) at 1 month (
P
<0.001), with 39% (132 of 339) of survivors disabled 5 years after stroke. Five years postevent, 70% (483 of 690) of patients with stroke and 48% (179 of 375) of patients with TIA were either dead or disabled. The 5-year risk of care home institutionalization was 11% after TIA and 19% after stroke. The average 5-year cost per institutionalized patient was $99 831 (SD, 67 020) for TIA and $125 359 (SD, 91 121) for stroke.

Conclusions—
Our results show that 70% of patients with stroke are either dead or disabled 5 years after the event. Thus, there remains considerable scope for improvements in acute treatment and secondary prevention to reduce postevent disability and institutionalization.
External Validation of the Secondary Intracerebral Hemorrhage Score in The Netherlands
Authors: van Asch Charlotte J.J. , Velthuis Birgitta K. , Greving Jacoba P. , van Laar Peter Jan , Rinkel Gabriël J.E. , Algra Ale , Klijn Catharina J.M. 
Published: August 2013

Background and Purpose—
We aimed to validate externally in a setting outside the United States the secondary intracerebral hemorrhage (ICH) score that was developed to predict the probability of macrovascular causes in patients with nontraumatic ICH.

Methods—
Patients with nontraumatic ICH admitted to the University Medical Center Utrecht, the Netherlands, between 2003 and 2011 were included if an angiographic examination, neurosurgical inspection, or pathological examination had been performed. Secondary ICH score performance was assessed by calibration (agreement between predicted and observed outcomes) and discrimination (separation of those with and without macrovascular cause).

Results—

Forty-eight of 204 patients (23.5%) had a macrovascular cause. The secondary ICH score showed modest calibration (
P
=0.06) and modest discriminative ability (
c
-statistic 0.73; 95% confidence interval, 0.65–0.80). Discrimination improved slightly using only noncontrast computed tomography categorization (
c
-statistic 0.79; 95% confidence interval, 0.72–0.86).

Conclusions—
The discriminative ability and calibration of the secondary ICH score are moderate in a university hospital setting outside the United States. Clues on noncontrast computed tomography are the strongest predictor of a macrovascular cause in patients with ICH.
Custody Regulations in the United Arab Emirates: Legal Reforms and Social Realities
Authors: Möller Lena-Maria 
Published: August 2013

Abstract
One major area of discussion during the 2005 process of initially codifying Muslim personal status law in the United Arab Emirates (UAE) were regulations regarding the divorced mother’s right to custody of her minor children. The new rules regarding the allocation and duration of female custodianship are the outcome of fiery debates amongst various actors involved in the codification process. The new codified custody rules differ from traditional Islamic law and concede large discretionary powers to the judiciary. The courts’ discretion in allocating custody is verbalized in the term “maṣ laḥat al-maḥḍūn” (the welfare of the child under custody). At the same time, courts in the UAE have thus far refrained from defining in clear terms what actually constitutes the child’s welfare. While one of the major aims of the codification of Muslim personal status law in the UAE was to guarantee legal certainty, the reformed custody regulations do not serve this purpose. They rather point towards the legislator’s will to put in force more flexible rules on custody which allow for the accommodation of changing societal needs and values.
Offended Christians, Anti-Mission Churches and Colonial Politics: One Man’s Story of the Messy Birth of the African Orthodox Church in Kenya
Authors: Black Joseph William 
Published: August 2013

Abstract
Thomas Nganda Wangai’s personal account of the beginnings of the Orthodox Church in Kenya gives a first-hand narrative of the Kikuyu resistance to mission Christianity and mission-imposed education that led to the break with the mission churches and colonial-approved mission schools. The subsequent creation of the Kikuyu Independent Schools Association and the Kikuyu Karing’a Education Association as well as independent churches attempted to create a new identity outside the mission church establishment in colonial Kenya. This desire to remain Christian while throwing off the yoke of Western versions of Christianity led Nganda and other early leaders to seek out a nonmission form of Christianity that reflected the ancient purity of the early church. Nganda tells the story of how a schismatic archbishop of the African Orthodox Church provided the initial leadership for the nascent Orthodox movement. Nganda charts the interrelatedness of the search for an ecclesiastical identity and the decision to align with the Alexandrian Patriarchate and the growing political conflict with the Kenyan colonial authorities. The paper concludes with Nganda’s description of the Orthodox Church’s response to the declaration of Emergency in 1953, along with the hardship and suffering that the subsequent ten years of proscription imposed.
Theory and Observations of Controls on Lightning Flash Size Spectra
Authors: Bruning Eric C. , MacGorman Donald R. 
Published: August 2013

Abstract
Previous analyses of very high frequency (VHF) Lightning Mapping Array (LMA) observations relative to the location of deep convective updrafts have noted a systematic pattern in flash characteristics. In and near strong updrafts, flashes tend to be smaller and more frequent, while flashes far from strong vertical drafts exhibit the opposite tendency. This study quantitatively tests these past anecdotal observations using LMA data for two supercell storms that occurred in Oklahoma in 2004. The data support a prediction from electrostatics that frequent breakdown and large flash extents are opposed. An energetic scaling that combines flash rate and flash area exhibits a power-law scaling regime on scales of a few kilometers and a maximum in flash energy at about 10 km. The spectral shape is surprisingly consistent across a range of moderate to large flash rates. The shape of this lightning flash energy spectrum is similar to that expected of turbulent kinetic energy spectra in thunderstorms. In line with the hypothesized role of convective motions as the generator of thunderstorm electrical energy, the correspondence between kinematic and electrical energy spectra suggests that advection of charge-bearing precipitation by the storm’s flow, including in turbulent eddies, couples the electrical and kinematic properties of a thunderstorm.
A Diagnostic Evaluation of Precipitation in CORDEX Models over Southern Africa
Authors: Kalognomou Evangelia-Anna , Lennard Christopher , Shongwe Mxolisi , Pinto Izidine , Favre Alice , Kent Michael , Hewitson Bruce , Dosio Alessandro , Nikulin Grigory , Panitz Hans-Jürgen , Büchner Matthias 
Published: August 2013

The authors evaluate the ability of 10 regional climate models (RCMs) to simulate precipitation over Southern Africa within the Coordinated Regional Climate Downscaling Experiment (CORDEX) framework. An ensemble of 10 regional climate simulations and the ensemble average is analyzed to evaluate the models' ability to reproduce seasonal and interannual regional climatic features over regions of the subcontinent. All the RCMs use a similar domain, have a spatial resolution of ~50 km, and are driven by the Interim ECMWF Re-Analysis (ERA-Interim; 1989–2008). Results are compared against a number of observational datasets.In general, the spatial and temporal nature of rainfall over the region is captured by all RCMs, although individual models exhibit wet or dry biases over particular regions of the domain. Models generally produce lower seasonal variability of precipitation compared to observations and the magnitude of the variability varies in space and time. Model biases are related to model setup, simulated circulation anomalies, and moisture transport. The multimodel ensemble mean generally outperforms individual models, with bias magnitudes similar to differences across the observational datasets. In the northern parts of the domain, some of the RCMs and the ensemble average improve the precipitation climate compared to that of ERA-Interim. The models are generally able to capture the dry (wet) precipitation anomaly associated with El Niño (La Niña) events across the region. Based on this analysis, the authors suggest that the present set of RCMs can be used to provide useful information on climate projections of rainfall over Southern Africa.