bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative Risk of Ischemic Stroke Among Users of Clopidogrel Together With Individual Proton Pump Inhibitors
Authors: Leonard Charles E. , Bilker Warren B. , Brensinger Colleen M. , Flockhart David A. , Freeman Cristin P. , Kasner Scott E. , Kimmel Stephen E. , Hennessy Sean 
Published: February 2015

Background and Purpose—
There is controversy and little information about whether individual proton pump inhibitors (PPIs) differentially alter the effectiveness of clopidogrel in reducing ischemic stroke risk. We, therefore, aimed to elucidate the risk of ischemic stroke among concomitant users of clopidogrel and individual PPIs.

Methods—

We conducted a propensity score-adjusted cohort study of adult new users of clopidogrel, using 1999 to 2009 Medicaid claims from 5 large states. Exposures were defined by prescriptions for esomeprazole, lansoprazole, omeprazole, rabeprazole, and pantoprazole—with pantoprazole serving as the referent. The end point was hospitalization for acute ischemic stroke, defined by
International Classification of Diseases Ninth Revision
Clinical Modification codes in the principal position on inpatient claims, within 180 days of concomitant therapy initiation.

Results—
Among 325 559 concomitant users of clopidogrel and a PPI, we identified 1667 ischemic strokes for an annual incidence of 2.4% (95% confidence interval, 2.3–2.5). Adjusted hazard ratios for ischemic stroke versus pantoprazole were 0.98 (0.82–1.17) for esomeprazole; 1.06 (0.92–1.21) for lansoprazole; 0.98 (0.85–1.15) for omeprazole; and 0.85 (0.63–1.13) for rabeprazole.

Conclusions—
PPIs of interest did not increase the rate of ischemic stroke among clopidogrel users when compared with pantoprazole, a PPI thought to be devoid of the potential to interact with clopidogrel.
Magnetic Resonance Imaging in Experimental Stroke and Comparison With Histology
Authors: Milidonis Xenios , Marshall Ian , Macleod Malcolm R. , Sena Emily S. 
Published: February 2015

Background and Purpose—
Because the new era of preclinical stroke research demands improvements in validity and generalizability of findings, moving from single site to multicenter studies could be pivotal. However, the conduct of magnetic resonance imaging (MRI) in stroke remains ill-defined. We sought to assess the variability in the use of MRI for evaluating lesions post stroke and to examine the possibility as an alternative to gold standard histology for measuring the infarct size.

Methods—
We identified animal studies of ischemic stroke reporting lesion sizes using MRI. We assessed the degree of heterogeneity and reporting of scanning protocols, postprocessing methods, study design characteristics, and study quality. Studies performing histological evaluation of infarct size were further selected to compare with corresponding MRI using meta-regression.

Results—

Fifty-four articles undertaking a total of 78 different MRI scanning protocols met the inclusion criteria. T
2
-weighted imaging was most frequently used (83% of the studies), followed by diffusion-weighted imaging (43%). Reporting of the imaging parameters was adequate, but heterogeneity between studies was high. Twelve studies assessed the infarct size using both MRI and histology at corresponding time points, with T
2
-weighted imaging–based treatment effect having a significant positive correlation with histology (

;
P
<0.001).

Conclusions—

Guidelines for standardized use and reporting of MRI in preclinical stroke are urgently needed. T
2
-weighted imaging could be used as an effective in vivo alternative to histology for estimating treatment effects based on the extent of infarction; however, additional studies are needed to explore the effect of individual parameters.
Time Course and Predictors of Neurological Deterioration After Intracerebral Hemorrhage
Authors: Lord Aaron S. , Gilmore Emily , Choi H. Alex , Mayer Stephan A. 
Published: February 2015

Background and Purpose—
Neurological deterioration (ND) is a devastating complication after intracerebral hemorrhage but little is known about time course and predictors.

Methods—
We performed a retrospective cohort study of placebo patients in intracerebral hemorrhage trials. We performed computed tomographic scans within 3 hours of symptoms and at 24 and 72 hours; and clinical evaluations at baseline, 1-hour, and days 1, 2, 3, and 15. Timing of ND was predefined as follows: hyperacute (within 1 hour), acute (1–24 hours), subacute (1–3 days), and delayed (3–15 days).

Results—

We enrolled 376 patients and 176 (47%) had ND within 15 days. In multivariate analyses of ND by category, hyperacute ND was associated with hematoma expansion (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.7–7.6) and baseline intracerebral hemorrhage volume (OR, 1.04 per mL; 95% CI 1.02–1.06); acute ND with hematoma expansion (OR, 7.59; 95% CI, 3.91–14.74), baseline intracerebral hemorrhage volume (OR, 1.02 per mL; 95% CI, 1.01–1.04), admission Glasgow Coma Scale (OR, 0.77 per point; 95% CI, 0.65–0.91), and interventricular hemorrhage (OR, 2.14; 95% CI, 1.05–4.35); subacute ND with 72-hour edema (OR, 1.03 per mL; 95% CI, 1.02–1.05) and fever (OR, 2.49; 95% CI, 1.01–6.14); and delayed ND with age (OR, 1.11 per year; 95% CI, 1.04–1.18), troponin (OR, 4.30 per point; 95% CI, 1.71–10.77), and infections (OR, 3.69; 95% CI, 1.11–12.23). Patients with ND had worse 90-day modified Rankin scores (5 versus 3;
P
<0.001).

Conclusions—
ND occurs frequently and predicts poor outcomes. Our results implicate hematoma expansion and interventricular hemorrhage in early ND, and cerebral edema, fever, and medical complications in later ND.
Impact of Language Barriers on Stroke Care and Outcomes
Authors: Shah Baiju R. , Khan Nadia A. , O’Donnell Martin J. , Kapral Moira K. 
Published: February 2015

Background and Purpose—
Language barriers may lead to poor quality of care, particularly for conditions like acute stroke for which diagnosis and treatment decision making rely on taking an accurate patient history. The purpose of this study was to determine the impact of patient language barriers on quality of stroke care and clinical outcomes.

Methods—
This retrospective cohort study used data from the Registry of the Canadian Stroke Network. All Ontario patients who were admitted with acute stroke or transient ischemic attack between July 2003 and March 2008 were selected. Mortality, stroke outcomes, in-hospital complications, quality of care, and disposition were compared between those without (n=12 787) and with (n=1506) language barriers, which was defined based on the patient’s preferred language. Hierarchical multivariable regression models determined the effect of language barriers, independent of baseline covariates.

Results—

Patients with language barriers had better 7-day mortality than those without (7.0% versus 9.2%; OR, 0.69; 95% CI, 0.57–0.82;
P
<0.001). However, they were more likely to be discharged with a moderate-to-severe neurological deficit (65.9% versus 51.5%; OR, 1.25; 95% CI, 1.15–1.35). In-hospital complication rates did not differ, and quality of care indicators generally favored patients with language barriers.

Conclusions—
Patients who had language barriers had reduced mortality and better performance on some quality of care measures. These differences existed despite adjustment for many potential confounders, including ethnicity, prognostic factors, and stroke characteristics.
Cold Pool and Precipitation Responses to Aerosol Loading: Modulation by Dry Layers
Authors: Grant Leah D. , van den Heever Susan C. 
Published: February 2015

Abstract
The relative sensitivity of midlatitude deep convective precipitation to aerosols and midlevel dry layers has been investigated in this study using high-resolution cloud-resolving model simulations. Nine simulations, including combinations of three moisture profiles and three aerosol number concentration profiles, were performed. Because of the veering wind profile of the initial sounding, the convection splits into a left-moving storm that is multicellular in nature and a right-moving storm, a supercell, which are analyzed separately.
The results demonstrate that while changes to the moisture profile always induce larger changes in precipitation than do variations in aerosol concentrations, multicells are sensitive to aerosol perturbations whereas supercells are less so. The multicellular precipitation sensitivity arises through aerosol impacts on the cold pool forcing. It is shown that the altitude of the dry layer influences whether cold pools are stronger or weaker and hence whether precipitation increases or decreases with increasing aerosol concentrations. When the dry-layer altitude is located near cloud base, cloud droplet evaporation rates and hence latent cooling rates are greater with higher aerosol loading, which results in stronger low-level downdrafts and cold pools. However, when the dry-layer altitude is located higher above cloud base, the low-level downdrafts and cold pools are weaker with higher aerosol loading because of reduced raindrop evaporation rates. The changes to the cold pool strength initiate positive feedbacks that further modify the cold pool strength and subsequent precipitation totals. Aerosol impacts on deep convection are therefore found to be modulated by the altitude of the dry layer and to vary inversely with the storm organization.
The thermal output evaluation of radiant heating panels by experiment
Authors: Shin Dae Uk , Shin Mi Su , Rhee Kyu Nam , Ryu Seong Ryong , Jeong Chang Ho , Yeo Myoung Souk , Kim Kwang Woo 
Published: February 2015

The purpose of this study is to make the target condition of experimental assessment based on the standard EN1264. To achieve this purpose, the characteristic errors, which are caused by characteristics of experimental setup and prevent the results from meeting the target condition, should be removed. This study proposes an experimental setup and suggests a control strategy based on standard EN1264. For the specifications of the experimental setup, the essential equipment and the configuration of the heat production system were deduced. For a proper control strategy, possible control strategies were derived by investigating the control-related factors such as reference points and control algorithms, and the most proper control strategy was validated by experimental assessment. Practical application: This study presents an experimental assessment to evaluate the thermal output of radiant floor heating systems based on the standard EN1264 referenced by ISO11855-2:2012. The proposed experimental assessment method will be able to supplement ISO11855-2:2012 and contribute to the development of thermally effective radiant heating panels. Therefore, it is expected that the results will be helpful to researchers for indoor environment, heating, ventilating, and air conditioning engineers, system manufacturers, and those who want to analyze the thermal output of radiant floor heating panels based on ISO 11855-2:2012.
MRSA Nasal Abscess after Elective Septorhinoplasty
Authors: Perry Katherine , Trujillo Oscar , Wright Richard J. , Ambro Bryan T. 
Published: February 2015

ObjectivePresent a case of an MRSA nasal abscess after elective septorhinoplasty. Discuss the role for MRSA screening and decolonization prior to elective septorhinoplasty.MethodThe case of a patient who underwent elective septorhinoplasty complicated by a nasal abscess is reviewed. Current literature regarding MRSA surgical site infections and role for preoperative decolonization are discussed.ResultsA 33‐year‐old man with nasal airway obstruction underwent functional septorhinoplasty. Mupirocin coated intranasal splints were placed, and he received 7 days of oral cephalexin. Six days postoperatively he presented with a nasoseptal abscess. He was taken to the OR for washout. Six months postoperatively he underwent revision septorhinoplasty. He was treated preoperatively with intranasal mupirocin and chlorhexidine body washes for 2 weeks. He experienced no further infectious complications. Despite MRSA being a well‐documented cause of surgical infections, there are few reports of such infections in septorhinoplasty. There are no guidelines regarding the role of MRSA screening and decolonization before septorhinoplasty.ConclusionDespite the well‐documented role of MRSA in surgical site infections in other specialties, such infections following septorhinoplasty are extremely rare with only one previously published case. We present a case of a nasoseptal abscess causing significant morbidity following elective functional septorhinoplasty. This case highlights the need for research and guidelines regarding the utility of MRSA screening and decolonization prior to elective septorhinoplasty.
Features of Patients with Eagle Syndrome
Authors: Herrera‐Hernandez Alvaro A. , Diaz‐Perez Julio A. , Aranda‐Valderrama Paola , Barajas‐Gamboa Juan S. , Reddy Abhinay 
Published: February 2015

ObjectiveEagle syndrome is a rare syndrome in which pain occurs cervico‐facially, due to the mineralization of the styloid process. We evaluated the features of Eagle syndrome in a Colombian (Latin American) population.MethodWe described the clinical and pathological features of 5 patients with Eagle syndrome, and conducted a discussion of this disorder during an observational study from 2005 to 2008, with targeted sampling of patients with Eagle syndrome in the Centers of Head and Neck Surgery in Bucaramanga, Colombia.ResultsThe patients collectively consulted for sore throat and referred otodinia. Two patients had pain at the opening of the oral cavity, and no patient had foreign body sensation or syncope. On physical examination the patients had great tenderness from bimanual palpations on the postero‐inferior face of the palatine tonsil. All patients underwent computed tomography and elongation of the styloid process was found. The patients underwent resection of the styloid process externally and endorally in 2 cases and in 3 cases respectively; none of them presented with disease recurrence after a mean follow‐up period of 11.4 months.ConclusionIn conclusion, this rare disease must be considered in the differential diagnosis of cervical‐facial pain, through imaging, plain radiography, or computed tomography. Treatment can be surgical or nonsurgical, although surgery is recommended.
Free Flap Reconstruction of Endoscopic Skull Base Defects
Authors: Kamal Sally M. , Cho Andrew , Jacobson Joel P. , Shahlaie Kiarash , Luu Quang C. 
Published: February 2015

Objective1) Propose a novel technique using free tissue transfer to reconstruct large endoscopic skull base surgery defects. 2) Demonstrate the anatomic feasibility of this technique.MethodTwo cadaver heads and forearms were obtained with permission from the university body donation program. Anterior skull base defects were created from planum sphenoidale to the frontal recess. Radial forearm free flaps were then harvested using standard techniques, taking care to preserve maximum length of the pedicle vessels.ResultsTo inset the flap, a maxillary antrostomy was performed. An incision was made in the gingivolabial sulcus of the upper lip and extended laterally and inferiorly. Subperiosteal dissection was performed, and an anterior maxillotomy created. Dissection was then performed through the incision over the mandible. A cervical incision was then made. A subcutaneous tunnel was created. The pedicle was tunnelled through the cervical incision, through the maxillotomy and maxillary antrostomy, and then inset by draping the skin paddle over the skull base defect. This provided ample coverage of the defect and the pedicle length comfortably spanned the course of dissection.ConclusionAs expanded endonasal approaches develop, so too must skull base reconstruction techniques. Vascularized tissue is ideal, especially in patients with extensive prior surgery and radiation. A vascularized free flap is a feasible option for reconstruction of large anterior skull base defects.
FV‐Guided Surgery Improves Outcome in HGD and Early Oral Cancer
Authors: Durham J. S. , Poh Catherine , Anderson Donald W. , Berean Ken , Williams Michelle , MacAulay Calum E. , Rosin Miriam P. 
Published: February 2015

Objective1) Become aware of the role of intraoperative fluorescence visualization in assessing subclinical changes at surgical margins in patients presenting with severe dysplasia and carcinoma in situ (HGD) or squamous cell carcinoma (SCC). 2) Understand the effectiveness of FV‐guided surgery in reducing locoregional recurrence and improving overall survival.MethodA retrospective review was conducted from September 1, 2004, to August 31, 2009, identifying 246 patients (SCC 132; HGD 114) presenting to the BCCA. Surgery was done under FV guidance in 149 patients while 97 were treated conventionally. Outcome measures included pathology‐proven local recurrence, regional failure, and death.ResultsThere was no significant difference between FV and control groups in age, smoking habit, lesion anatomic site, diagnosis, tumor size, and previous cancer history. There were more females in the FV group (51% vs 33%, P =. 006). Time to outcome curve was estimated by the Kaplan‐Meier method. With an average of 40 months follow‐up, the FV group shows significantly lower local recurrence (7% vs 38%), regional failure (6% vs 23%), and death (5% vs 20%), and significant longer time to recurrence (P <. 0001), regional failure (P =. 0007), and death of disease (P =. 004).ConclusionThe data strongly suggest that use of FV for surgical margin guidance can significantly improve outcomes in early stage oral cancer and HGD. An ongoing 5‐year multicenter phase III randomized surgical trial (COOLS), funded by Terry FoResearch Institute, has been established to validate the results of this study.
Head and Neck Cancer Surgery in the Elderly
Authors: Genther Dane J. , Gourin Christine G. 
Published: February 2015

ObjectiveWith increased life expectancy, there is a growing awareness of the effect of comorbidity on physiologic reserves in elderly surgical patients. We sought to determine the relationship between advanced comorbidity on in‐hospital mortality, postoperative complications, length of hospitalization, and costs in elderly patients undergoing head and neck cancer (HNCA) surgery.MethodDischarge data from the Nationwide Inpatient Sample for 36,948 patients aged 65 years and older who underwent ablative surgery for a malignant oral cavity, laryngeal, hypopharyngeal, or oropharyngeal neoplasm in 2003 to 2008 were analyzed using cross‐tabulations and multivariate regression. Frail elderly patients were defined as having comorbidity scores of 2 or higher.ResultsFrail elderly patients were more likely to be ≥80 years of age (OR 1.2, P =. 035) and more likely to require transfer to a short‐term hospital (OR = 3.7, P <. 001), transfer to another facility (OR = 2.5, P <. 001), or home health care (OR = 1.4, P <. 001). After controlling for all other variables, frail elderly patients were more likely to develop an acute medical complication (OR = 3.9, P <. 001) and had an increased risk of in‐hospital mortality (OR = 3.9, P <. 001). There was no significant association between frail elderly status and postoperative surgical complications; however, frail elderly status was associated with significantly increased length of hospitalization and hospital‐related costs.ConclusionAdvanced comorbidity in elderly HNCA surgical patients is associated with increased short‐term mortality and morbidity, length of hospitalization, hospital‐related costs, and advanced care following discharge, which may pose a significant challenge to health care reform as the elderly population increases in the future.
Hyperparathyroidism in a Colombian City
Authors: Herrera‐Hernandez Alvaro A. , Diaz‐Perez Julio A. , Barajas‐Gamboa Juan S. , Aranda‐Valderrama Paola , Reddy Abhinay 
Published: February 2015

ObjectiveHyperparathyroidism has a variable presentation. Clinical manifestations, histopathology, and treatment of patients with hyperparathyroidism in Bucaramanga City, Colombia, were analyzed.MethodA descriptive study was conducted.ResultsTwenty‐five patients (F:M ratio 1.5:1) with age ranging from 14 to 81 years (mean, 52.1 ± 18.15 years) were analyzed. Skeletal/osseous manifestations (100%), renal calculi (66%), muscle weakness (40%), and pruritus (24%) were the most common symptoms with mean duration of 24.2 months. Biochemical features included hypercalcemia (total corrected calcium 13.83 mg/dL), and high parathyroid hormone (mean, 1095.7). Twelve of 25 patients had primary hyperparathyroidism, 11 out of 25 secondary hyperparathyroidism, and 2 had tertiary hyperparathyroidism. A single patient had multinodular thyroid goiter. Parathyroidectomy was performed by Kocher’s incision in 21 out of 25 cases and minimally invasive open approach in 4 out of 25 cases. The following types of interventions have been performed: tumor resections (15/25), subtotal parathyroidectomies (6/25), and total parathyroidectomies (4/25). A total thyroidectomy was performed in the patient with associated thyroid disease (1/25). Histopathological examination revealed parathyroidian adenoma in 40% of patients, parathyroidian hyperplasia in 48%, and parathyroidian carcinoma in 4%. All symptoms and hypercalcemia resolved with the treatment. Such complication was observed in a case of hungry bone syndrome. No patients died within 15 months of follow‐up.ConclusionWe described the clinical and histopathological features of patients with hyperparathyroidism in Colombia. Although pathologic features of parathyroid carcinoma are diagnostically reliable, those of the more commonly encountered lesions of adenoma and hyperplasia may be overlapping and, therefore, indistinctive, more so if only a single gland is available for examination.
Hypopharyngeal and Esophageal Injury after ACDF
Authors: Wu Vivian F. , Andersen Peter E. , Ching Alexander , Wax Mark K. , Schindler Joshua S. 
Published: February 2015

ObjectiveTo evaluate presenting symptoms, workup, and management of hypopharyngeal and esophageal injury associated with ACDF.MethodWe performed a retrospective review of consecutive cases in an academic institution. Inclusion criteria included patients with esophageal injury and dysphagia after ACDF who presented to otolaryngology clinics from January 2006 to July 2011 (N = 10). Outcomes reviewed include time to presentation, presenting symptoms, repair method, and oral intake status.ResultsFour of 10 patients presented with dysphagia, hoarseness, neck pain, or abscess within a week after ACDF. Three of 10 presented >1 year after ACDF with abscess, aspiration pneumonia, or stridor. Three of 10 had delay in diagnosis (>1 year between presentation and final diagnosis). Fusion plate removal occurred in 9 out of 10 patients. Conservative treatment was successful in 3 out of 10 who had no esophageal injury or only small perforation on endoscopy. One of 10 underwent successful repair with SCM flap. Six of 10 underwent free tissue transfer (1 required salvage SCM flap, 2 had persistent fistula). On posttreatment MBS, 4 out of 10 had asymptomatic diverticulums. Seven of 10 patients were taking PO at 1 week‐9 months posttreatment.ConclusionIn patients with a history of ACDF and dysphagia, clinicians should maintain a high index of suspicion for morbid complications such as esophageal perforation. Greater than 3 months of mild‐moderate dysphagia should prompt evaluation with MBS whereas severe symptoms may indicate MBS/CT/endoscopy. Majority of patients will need fusion plate removed and will resume oral intake.