bluuebunny/crossref_metadata_2025_split huggingface dataset:
History of Stroke Is Independently Associated With In-Hospital Death in Patients With COVID-19
Authors: Kummer Benjamin R. , Klang Eyal , Stein Laura K. , Dhamoon Mandip S. , Jetté Nathalie 
Published: August 2020

Background and Purpose:
In December 2019, an outbreak of severe acute respiratory syndrome coronavirus causing coronavirus disease 2019 (COVID-19) occurred in China, and evolved into a worldwide pandemic. It remains unclear whether the history of cerebrovascular disease is associated with in-hospital death in patients with COVID-19.

Methods:
We conducted a retrospective, multicenter cohort study at Mount Sinai Health System in New York City. Using our institutional data warehouse, we identified all adult patients who were admitted to the hospital between March 1, 2020 and May 1, 2020 and had a positive nasopharyngeal swab polymerase chain reaction test for severe acute respiratory syndrome coronavirus in the emergency department. Using our institutional electronic health record, we extracted clinical characteristics of the cohort, including age, sex, and comorbidities. Using multivariable logistic regression to control for medical comorbidities, we modeled the relationship between history of stroke and all-cause, in-hospital death.

Results:

We identified 3248 patients, of whom 387 (11.9%) had a history of stroke. Compared with patients without history of stroke, patients with a history of stroke were significantly older, and were significantly more likely to have a history of all medical comorbidities except for obesity, which was more prevalent in patients without a history of stroke. Compared with patients without history of stroke, patients with a history of stroke had higher in-hospital death rates during the study period (48.6% versus 31.7%,
P
<0.001). In the multivariable analysis, history of stroke (adjusted odds ratio, 1.28 [95% CI, 1.01–1.63]) was significantly associated with in-hospital death.

Conclusions:
We found that history of stroke was associated with in-hospital death among hospitalized patients with COVID-19. Further studies should confirm these results.
The Role of Withholding in the Self-Enforcement of a Value-Added Tax: Evidence from Pakistan
Authors: Waseem Mazhar 
Published: August 2020

Abstract
I leverage the staggered rollout of VAT in Pakistan to document the role of withholding mechanism in the self-enforcement of a VAT. Focusing on firms already in the tax net, I see how their outcomes respond when the tax is extended upward to intermediates used by them. I find that the upward extension of VAT, which triggers the withholding mechanism, causes an immediate and large (more than 40 log points) surge in sales reported by firms. The evolution of bunching above the zero-liability point and of input costs reported by firms suggests that this large response is indeed driven by the withholding mechanism. I also explore the role of withholding in the extensive margin compliance choices of firms.
Peers with Special Needs: Effects and Policies
Authors: Balestra Simone , Eugster Beatrix , Liebert Helge 
Published: August 2020

Abstract
In light of the debate over inclusive education, this paper evaluates the impact of exposure to special needs (SN) peers. More classroom peers with SN lower performance, the probability of entering postcompulsory education, and income at ages 17 to 25. SN students and students at the lower end of the achievement distribution suffer most from higher inclusion. We analyze the effects of reallocation policies to alleviate negative externalities, and demonstrate that inclusion is preferable to segregation in terms of maximizing average test scores.
The Extreme El Niño Events Suppressing the Intraseasonal Variability in the Eastern Tropical Indian Ocean
Authors: Chen Gengxin , Wang Dongxiao , Han Weiqing , Feng Ming , Wang Fan , Li Yuanlong , Chen Ju , Gordon Arnold L. 
Published: August 2020

AbstractIn the eastern tropical Indian Ocean, intraseasonal variability (ISV) affects the regional oceanography and marine ecosystems. Mooring and satellite observations documented two periods of unusually weak ISV during the past two decades, associated with suppressed baroclinic instability of the South Equatorial Current. Regression analysis and model simulations suggest that the exceptionally weak ISVs were caused primarily by the extreme El Niño events and modulated to a lesser extent by the Indian Ocean dipole. Additional observations confirm that the circulation balance in the Indo-Pacific Ocean was disrupted during the extreme El Niño events, impacting the Indonesian Throughflow Indian Ocean dynamics. This research provides substantial evidence for large-scale modes modulating ISV and the abnormal Indo-Pacific dynamical connection during extreme climate modes.
Impact of the COVID-19 pandemic on core surgical training
Authors: Khan Khurram Shahzad , Keay Rona , McLellan Morag , Mahmud Sajid 
Published: August 2020

Background and aims COVID-19 pandemic has caused significant disruption in training which is even more pronounced in the surgical specialties. We aim to assess the impact of COVID-19 pandemic on core surgical training. Methods All core surgical and improving surgical trainees in West of Scotland region were invited to participate in an online voluntary anonymous survey via SurveyMonkey. Results 28 of 44 (63.6%) trainees responded, 15 (53.6%) were CT1/ST1. 14 (50.0%) working in teaching hospital and 15 (53.6%) working in general surgery. 20 (71.4%) felt that due to the pandemic they have less opportunity to operate as the primary surgeon. 21 (75.0%) have not attended any outpatient clinics. 8 (28.6%) did not have any form of access to the laparoscopic box-trainer. 20 (71.4%) felt their level of confidence in preforming surgical skills has been negatively impacted. 18 (64.3%) found it difficult to demonstrate progress in portfolio. 21 (75.0%) trainees have not attended any teaching. 10 (35.7%) trainees have been off-sick. 8 (28.6%) trainees have felt slightly or significantly more stressed. Conclusion COVID-19 pandemic has an unprecedented negative impact on all aspects of core surgical training. The long term impact on the current cohort of trainees is yet to be seen.
Risk Factors for the Recurrence of Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis
Authors: Li Shichang , Wang Zijing , Liu Yan , Cao Jie , Zheng Hongwei , Jing Yuanyuan , Han Lin , Ma Xin , Xia Ruiming , Yu Lisheng 
Published: August 2020

Objective: Benign paroxysmal positional vertigo (BPPV) has a high recurrence rate, but the risk factor–associated recurrence are elusive. Methods: Searches were performed in PubMed, Embase, Cochrane library, Web of science, Chinese National Knowledge Infrastructure, and Sino Med up to November 3, 2019. The effect size was analyzed by odds ratio and 95% CI. Data from eligible studies were meta-analyzed using Stata version 15.0. Results: Our search resulted in a total of 4076 hits. Twenty-four outcomes of sixty articles were included in the meta-analysis. Risk factors for the recurrence of BPPV included female gender, age (≥65years), hyperlipidemia, diabetes, hypertension, migraine, cervical spondylosis, osteopenia/osteoporosis, head trauma, otitis media, abnormal vestibular evoked myogenic potential, and long use of computers. No significant differences were found in side, type of the involved semicircular canals, smoking, alcohol consumption, stroke, ear surgery, duration of vertigo before treatment, the times of repositioning, Meniere disease, sleep disorders, hypercholesterolemia, and 25-hydroxy vitamin D. Conclusion: These findings strengthen clinical awareness of early warning to identify patients with potential relapse risk of BPPV and clinicians should counsel patients regarding the importance of follow-up after diagnosis of BPPV.
Macrophage ablation significantly reduces uptake of imaging probe into organs of the reticuloendothelial system
Authors: Sabel Bastian O , Brand Karsten , Rueckel Johannes , Hoppe Boj , Fink Nicola , Bartling Soenke 
Published: August 2020

Background Macrophages engulf particulate contrast media, which is pivotal for biomedical imaging. Purpose To introduce a macrophage ablation animal model by showing its power to manipulate the kinetics of imaging probes. Material and Methods The kinetics of a particulate computed tomography (CT) contrast media was compared in macrophage ablative mice and normal mice. Liposomes (size 220 µg), loaded with clodronate, were injected into the peritoneum of three C57BL/6 mice. On the third day, 200 µL of the particulate agent ExiTron nano 6000 were injected into three macrophage-ablative mice and three control mice. CT scans were acquired before and 3 min, 1 h, 6 h, and 24 h after the ExiTron application. The animals were sacrificed, and their spleens and livers removed. Relative CT values (CTV) were measured and analyzed. Results Liver and spleen enhancement of treated mice and controls were increasing over time. The median peak values were different with 225 CTV for treated mice and 582 CTV for controls in the liver ( P = 0.032) and 431 CTV for treated and 974 CTV in controls in the spleen ( P = 0.016). Conclusion Macrophage ablation leads to a decrease of enhancement in organs containing high numbers of macrophages, but only marginal changes in macrophage-poor organs. Macrophage ablation can influence the phagocytic activity and thus opens new potentials to investigate and manipulate the uptake of imaging probes.
Clinical value of matrix metalloproteinase-2 and -9 in ultrasound-guided radiofrequency ablation treatment for papillary thyroid carcinoma
Authors: Pan Qunyan , Yuan Tao , Ding Qian 
Published: August 2020

Objective This study aimed to investigate serum matrix metalloproteinase (MMP)-2 and MMP-9 levels in patients with papillary thyroid carcinoma (PTC). Methods Forty-one patients with PTC undergoing ultrasound-guided radiofrequency ablation (RFA) and 56 controls were included. Serum MMP-2 and MMP-9 levels were determined by enzyme-linked immunosorbent assay before and after surgery. Potential affecting factors were evaluated by logistic regression analysis. Results Serum MMP-2 and MMP-9 levels were significantly higher in PTC patients compared with controls, and decreased significantly after surgery. According to receiver operating characteristic curve analysis, diagnostic values for preoperative serum MMP-2 and MMP-9 levels were 82.4% and 86.6%. There was no contrast-agent perfusion in the ablation zone in 88.5% of lesions, and enhancement within or at the lesion edge in 11.4%. The volume reduction at 3 months’ follow-up was >40%. Age, microcalcification, irregular shape, and lesion diameter and number were influencing factors for PTC. Age, and lesion diameter and number were independent risk factors, while calcification and morphology were protective factors. Conclusion Serum MMP-2 and MMP-9 levels have important clinical values for the diagnosis and treatment of PTC by RFA. Preoperative serum MMP-2 and MMP-9 levels, combined with other affecting factors, contribute to disease prognosis.
Adductor canal block combined with local infiltration analgesia versus isolated adductor canal block in reducing pain and opioid consumption after total knee arthroplasty: a systematic review and meta-analysis
Authors: Lv Jianyong , Huang Cuiyuan , Wang Zuofeng , Ou Shan 
Published: August 2020

Objective To evaluate the efficacy and safety of the addition of local infiltration analgesia (LIA) to adductor canal block (ACB) for pain control after primary total knee arthroplasty (TKA). Methods Two reviewers independently searched for potentially relevant published studies using electronic databases, including PubMed® (1966 to June 2019), Embase® (1974 to June 2019) and Web of Science (1990 to June 2019). The results were pooled using the random-effects model to produce standard mean differences for continuous outcome data and odds ratio for categorical outcome data. Results A total of three randomized controlled trials (RCTs) and three non-RCTs were included for data extraction and meta-analysis. There were significant differences between the two groups regarding the postoperative pain score on postoperative day (POD) 0 and POD 1. The cumulative opioid consumption in the ACB plus LIA groups was significantly lower than that in the ACB groups on POD 0 and POD 1. No significant differences were found in terms of postoperative range of motion or length of hospitalization. Conclusion ACB plus LIA significantly reduced the postoperative pain score on POD 0 and POD 1 compared with isolated ACB. In addition, ACB plus LIA was associated with a significant reduction in opioid consumption during the early postoperative period.
Factors associated with nonadherence to antihypertensive medication among middle-aged adults with hypertension: findings from the Taiwan National Health Interview Survey
Authors: Chou Chia-Pei , Chen Chun-Yu , Huang Kun-Siang , Lin Shih-Chun , Huang Chih-Fang , Koo Malcolm 
Published: August 2020

Objective We aimed to investigate factors associated with nonadherence to antihypertensive medication among middle-aged Taiwanese adults with hypertension. Methods We used data from the 2009 Taiwan National Health Interview Survey (NHIS) to identify adults age 40 to 65 years with hypertension. We used logistic regression analyses to investigate factors associated with nonadherence to antihypertensive medication. Results A total 1,256 respondents with hypertension taking antihypertensive medication were included in this study. Multiple logistic regression analyses revealed that six factors were significantly and independently associated with nonadherence to medication: younger age (odds ratio, [OR] = 1.85), mean monthly personal income < TWD 20,000 (USD 660) (OR = 1.87), outpatient medical services use in the past month (OR = 0.57), hospitalization in the past year (OR = 1.70), diabetes or dyslipidemia (OR = 0.63), and alcohol use in the past month (OR = 2.38). Conclusions This secondary data analysis of the population-based NHIS identified six factors associated with nonadherence to antihypertensive medication. These factors should be considered when planning and implementing blood pressure control interventions among middle-aged adults with hypertension.
Combination of pegylated liposomal doxorubicin and docetaxel as neoadjuvant therapy for breast cancer with axillary lymph node metastasis
Authors: Wang Li , Hong Yang , Ma Jie , Han Meng , Zhang Shuo , Shan Baoen , Liu Yunjiang 
Published: August 2020

Objective To evaluate the efficacy and safety of the combination of pegylated liposomal doxorubicin and docetaxel as neoadjuvant therapy for breast cancer (BC) in patients with axillary lymph node metastasis. Methods In this single-arm study, 91 patients with clinical stage IIA–IIIc breast cancer received six cycles of pegylated liposomal doxorubicin plus docetaxel as neoadjuvant chemotherapy (NAC). Trastuzumab was allowed for patients with human epidermal growth factor receptor 2-positive tumors. The primary endpoint was pathologic complete response (pCR) in the breast after surgery. The overall response rate (ORR), Miller–Payne (MP) score of the primary tumors, and incidence of adverse events were also evaluated. Results In total, 88 patients completed all cycles of NAC. Fourteen patients (15.4%, 95% confidence interval [CI] = 7.8–22.9) achieved pCR. The ORR was 89% (95% CI = 82.5–95.6), and 72 lesions (79.1%) were rated as MP grade 3 or higher. The left ventricular ejection fraction (LVEF) was within the normal range, although four (4.4%) patients experienced an LVEF decline exceeding 10%. No symptomatic cardiac events were reported. Conclusion Preoperative NAC with pegylated liposomal doxorubicin and docetaxel appears effective and safe for treating BC with axillary lymph node metastasis.
Uncemented versus cemented total hip arthroplasty for displaced femoral neck fractures in elderly patients with osteoporosis: A retrospective analysis
Authors: Zhou Xiang , Chen Meiji , Yu Weiguang , Han Guowei , Ye Junxing , Zhuang Jintao 
Published: August 2020

Objective This study was performed assess the clinical outcomes of elderly patients with osteoporotic femoral neck fractures (FNFs) (AO/OTA: 31B/C) treated by initial uncemented total hip arthroplasty (UTA) or cemented total hip arthroplasty (CTA). Methods This study involved consecutive elderly patients with osteoporotic FNFs (AO/OTA: 31B/C) treated by initial UTA or CTA in our medical centre from 2010 to 2015. The primary outcomes were the Harris hip score (HHS) and the rates of revision, loosening, periprosthetic fracture, and dislocation. Results In total, 224 patients were included in the final analysis (UTA, n = 114; CTA, n = 110). The mean follow-up duration was 60 months (range, 32–68 months). The mean HHS was 75.34 ± 18.82 for UTA and 80.12 ± 17.83 for CTA. Significant dissimilarities were detected in the rates of revision, loosening, and periprosthetic fracture between UTA and CTA (14.0% vs. 5.5%, 20.2% vs. 10.0%, and 12.3% vs. 4.5%, respectively). A significant difference was also detected in the probability of revision between the two groups. Conclusion Elderly patients with osteoporotic FNFs (AO/OTA: 31B/C) treated with CTA show greater improvements in functional outcomes and key orthopaedic complications than those treated with UTA.
Dexmedetomidine versus magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia: a meta-analysis of randomized controlled trials
Authors: Wang Jinguo , Wang Zaitang , Song Xuesong , Wang Na 
Published: August 2020

Objective To compare the efficacy of dexmedetomidine and magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia. Methods A search of PubMed, Medline, Embase, the Cochrane Library, and Google Scholar was performed. Randomized controlled trials comparing the efficacy of dexmedetomidine and magnesium sulfate as a local anesthetic adjuvant in spinal anesthesia were identified. The primary outcome was sensory block duration. The mean difference (MD) or odds ratio along with the 95% confidence interval (CI) was used to analyze the outcomes. Results Six studies involving 360 patients were included. Intrathecal dexmedetomidine was associated with a significantly longer sensory block duration (MD = −73.62; 95% CI = −101.09 to −46.15), faster onsets of sensory blockade and motor blockade, and a longer motor block duration than intrathecal magnesium sulfate. There was no significant difference between the regarding the rates of hypotension, bradycardia, shivering, and postoperative nausea and vomiting between the groups. Conclusions Dexmedetomidine is superior to magnesium sulfate as an adjuvant to local anesthetics in spinal anesthesia because of its more rapid onset and longer duration of spinal block without significant adverse effects.
Early Onset of Postoperative Gastrointestinal Dysfunction Is Associated With Unfavorable Outcome in Cardiac Surgery: A Prospective Observational Study
Authors: Seilitz Jenny , Edström Måns , Sköldberg Martin , Westerling-Andersson Kristian , Kasim Alhamsa , Renberg Anja , Jansson Kjell , Friberg Örjan , Axelsson Birger , Nilsson Kristofer F. 
Published: August 2020

Objective: The distribution of postoperative gastrointestinal (GI) dysfunction and its association with outcome were investigated in cardiac surgery patients. Gastrointestinal function was evaluated using the Acute Gastrointestinal Injury (AGI) grade proposed by the European Society of Intensive Care Medicine. Design: Prospective observational study at a single center. Setting: University hospital. Patients: Consecutive patients presenting for elective cardiac surgery with extracorporeal circulation (ECC). Interventions: None. Results: Daily assessment using the AGI grade was performed on the first 3 postoperative days in addition to standard care. For analysis, 3 groups were formed based on the maximum AGI grade: AGI 0, AGI 1, and AGI ≥2. Five hundred and one patients completed the study; 32.7%, 65.1%, and 2.2% of the patients scored a maximum AGI 0, AGI 1, and AGI ≥2, respectively. Patients with AGI grade ≥2 had more frequently undergone thoracic aortic surgery and had longer surgery duration and time on ECC. Patients with AGI grade ≥2 had statistically significant higher frequency of GI complications within 30 days (63.6% vs 1.2% and 5.5% in patients with AGI 0 and AGI 1) and higher 30-day mortality (9.1% vs 0.0% and 1.8% in patients with AGI 0 and AGI 1). Conclusions: Early GI dysfunction following cardiac surgery was associated with an unfavorable outcome. Increased attention to GI dysfunction in cardiac surgery patients is warranted and the AGI grade could be a helpful adjunct to a structured approach.
Steering column support topology optimization including lattice structure for metal additive manufacturing
Authors: Mantovani S , Campo GA , Giacalone M 
Published: August 2020

Structural engineering in the automotive industry has moved towards weight reduction and passive safety whilst maintaining a good structural performance. The development of Additive Manufacturing (AM) technologies has boosted design freedom, leading to a wide range of geometries and integrating functionally-graded lattice structures. This paper presents three AM-oriented numerical optimization methods, aimed at optimizing components made of: i) bulk material, ii) a combination of bulk material and graded lattice structures; iii) an integration of solid, lattice and thin-walled structures. The optimization methods were validated by considering the steering column support of a mid-rear engine sports car, involving complex loading conditions and shape. The results of the three methods are compared, and the advantages and disadvantages of the solutions are discussed. The integration between solid, lattice thin-walled structures produced the best results, with a mass reduction of 49.7% with respect to the existing component.
Multimodality assessment of sleep outcomes in people living with HIV performed using validated sleep questionnaires
Authors: Milinkovic Ana , Singh Suveer , Simmons Bryony , Pozniak Anton , Boffito Marta , Nwokolo Nneka 
Published: August 2020

Studies conducted in people living with HIV (PLHIV) report high rates of sleep disturbance, without a clear explanation as to cause or effect. Therefore, we proposed use of multiple validated questionnaires that would allow a more comprehensive evaluation of sleep quality in PLHIV. We administered eight validated sleep and wellbeing questionnaires, recording different aspects of sleep in order to provide a comprehensive description of sleep quality, quantity, daytime functioning, wakefulness, and general wellbeing. Associations with demographics and clinical data were analyzed by univariable/multivariable analyses. Of 254 subjects 99% were male (98% men who have sex with men), 88% white, mean age 41 (SD ± 9.9) years, HIV duration eight years (SD ± 6.3), 94% were on antiretroviral therapy, mean CD4 cell count was 724 cells/mm3, 81% had HIV RNA<40 copies/ml, 72% were university educated, and 60% used ‘chemsex’ drugs. Almost half (45%) reported poor sleep quality, 22% insomnia, 21% daytime sleepiness, and 33% fatigue. As individual factors, HIV duration ≥10 years, anxiety, depression, and recreational drug use were associated with poor quality sleep, fatigue, and poorer functional outcomes (p ≤ 0.05). The prevalence of sleep disturbance was high in our cohort of PLHIV. Sleep disturbance was associated with longer duration of HIV infection, depression, anxiety, and recreational drug use.