bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nationwide Patterns of Pathologic Fractures Among Patients Hospitalized With Bone Metastases
Authors: Jairam Vikram , Lee Victor , Yu James B. , Park Henry S. 
Published: July 2020

Objectives:
Pathologic fractures from bone metastases can significantly affect quality-of-life, although it is unclear which patients may be at high risk of this outcome. We aim to determine risk factors for pathologic fracture among patients admitted with bone metastases and to evaluate the association of pathologic fracture with clinical and economic outcomes.

Methods:
The Healthcare Cost and Utilization Project National Inpatient Sample was queried for all patients hospitalized with bone metastases in 2016. Baseline differences between patients with and without pathologic fractures were assessed by χ2 and analysis of variance testing. Multivariable logistic regression was used to identify factors associated with fractures.

Results:
In 2016, 272,275 hospital admissions were associated with a diagnosis of bone metastases, of which 11,960 (4.4%) had a primary diagnosis of pathologic fracture. Patients with pathologic fractures had a longer length-of-hospital-stay (mean 7.5 vs. 6.4 d; P<0.001) and higher cost-of-hospital-stay (mean $23,611 vs. $15,942; P<0.001) compared to patients without pathologic fractures. Primary cancers associated with increased likelihood of pathologic fracture included liver and intrahepatic bile duct (odds ratio [OR] 2.34; 95% confidence interval [CI], 1.65-3.32), multiple myeloma (OR 1.94; 95% CI, 1.31-2.86), and kidney and renal pelvis cancer (OR 1.89; 95% CI, 1.50-2.37).

Conclusions:
Nearly 5% of hospitalizations with bone metastases presented with a concomitant pathologic fracture, which was associated with longer inpatient stay and higher cost. Patients with hepatobiliary, renal cell carcinoma, or multiple myeloma, had a higher likelihood of pathologic fracture. These groups may benefit from increased outpatient monitoring, prophylactic stabilization, or early irradiation.
The association of depressive symptoms to sleep-related symptoms during menopausal transition: racial/ethnic differences
Authors: Im Eun-Ok , Yang You Lee , Liu Jianghong , Chee Wonshik 
Published: July 2020

Abstract

Objectives:
Despite an increasing number of studies reporting significant associations of depression to sleep problems in general, few studies have been conducted on racial/ethnic variations in the associations among midlife women in their menopausal transition. The purpose of this study was to determine the associations between depressive symptoms and sleep-related symptoms in a multiethnic group of midlife women while considering the women's race/ethnicity and menopausal status.

Methods:
This was a secondary analysis of the data from 1,054 midlife women in two larger studies. The depression index for midlife women and the sleep index for midlife women were used to measure sleep-related symptoms and depressive symptoms. Descriptive and inferential statistics including hierarchical multiple regression analyses were used for data analyses.

Results:
In the regression models by race/ethnicity, the total numbers (0.294 in non-Hispanic [NH] African Americans ≤ β ≤ 0.410 in NH Asians), and total severity scores (0.141 in Hispanic ≤ β ≤ 0.365 in NH Whites) of depressive symptoms were positively associated with the total severity of sleep-related symptoms (all P < 0.01). In the regression models by menopausal status, the total numbers (β = 0.106 in premenopausal and 0.443 in postmenopausal) and total severity scores (0.272 ≤ β ≤ 0.561) of depressive symptoms were positively associated with the total severity scores of sleep-related symptoms (all P < 0.05).

Conclusions:
Further studies with diverse groups of midlife women using objective measurements and biomarkers are warranted to confirm the findings.
Cognitive complaints are associated with smaller right medial temporal gray-matter volume in younger postmenopausal women
Authors: Conley Alexander C. , Albert Kimberly M. , Boyd Brian D. , Kim Shin-Gyeom , Shokouhi Sepideh , McDonald Brenna C. , Saykin Andrew J. , Dumas Julie A. , Newhouse Paul A. 
Published: July 2020

Abstract

Objective:
Menopause is associated with increasing cognitive complaints and older women are at increased risk of developing Alzheimer disease compared to men. However, there is difficulty in early markers of risk using objective performance measures. We investigated the impact of subjective cognitive complaints on the cortical structure in a sample of younger postmenopausal women.

Methods:
Data for this cross-sectional study were drawn from the baseline visit of a longer double-blind study examining estrogen-cholinergic interactions in normal postmenopausal women. Structural Magnetic Resonance Imaging was acquired on 44 women, aged 50-60 years and gray-matter volume was defined by voxel-based morphometry. Subjective measures of cognitive complaints and postmenopausal symptoms were obtained as well as tests of verbal episodic and working memory performance.

Results:
Increased levels of cognitive complaints were associated with lower gray-matter volume in the right medial temporal lobe (r = −0.445, P < 0.002, R

2
= 0.2). Increased depressive symptoms and somatic complaints were also related to increased cognitive complaints and smaller medial temporal volumes but did not mediate the effect of cognitive complaints. In contrast, there was no association between performance on the memory tasks and subjective cognitive ratings, or medial temporal lobe volume.

Conclusions:
The findings of the present study indicate that the level of reported cognitive complaints in postmenopausal women may be associated with reduced gray-matter volume which may be associated with cortical changes that may increase risk of future cognitive decline.

Video Summary:
http://links.lww.com/MENO/A626.
Masked morning hypertension correlated with target organ damage in non-dialysis patients with chronic kidney disease
Authors: Li Xue , Lian Rongli , Zhu Ye , Ke Jianting , Li Man , Wang Cheng , Lou Tanqi 
Published: July 2020

Objective:To determine the prevalence of masked morning hypertension and investigate its role in target organ damage in nondialysis patients with chronic kidney disease.Methods:A total of 1841 patients with chronic kidney disease admitted to our hospital were recruited. According to measurements of clinic blood pressure and ambulatory blood pressure, they were divided into four groups: normotension, white-coat hypertension, masked morning hypertension, and sustained hypertension. Multivariate logistic regression analyses were used to evaluate the association between masked morning hypertension and cardiovascular and renal parameters.Results:Overall, 288 (15.6%) patients were diagnosed with masked morning hypertension. Patients with masked morning hypertension had a higher prevalence of left ventricular hypertrophy, abnormal carotid intima–media thickness, and impaired renal function when compared with normotensive patients, although lower than those with sustained hypertension. After adjustment for demographics and clinical characteristics, masked morning hypertension was related to cardiovascular damage and renal dysfunction compared with normotension. The odds ratio for left ventricular hypertrophy, abnormal carotid intima–media thickness and impaired renal function was 1.955 [95% confidence interval (CI), 1.247–3.065], 1.469 (95% CI: 1.011–2.133), and 1.819 (95% CI: 1.112–2.976), respectively. Masked morning hypertension correlated with target organ damage even when patients with a history of cardiovascular disease were excluded.Conclusion:The prevalence of masked morning hypertension in nondialysis chronic kidney disease patients was high, and masked morning hypertension was associated with target organ damage in chronic kidney disease patients.
Central SBP and executive function in children and adolescents with primary and secondary hypertension
Authors: Stabouli Stella , Chrysaidou Katerina , Kotsis Vasilios , Chainoglou Nancy , Chatzipapa Nikoleta , Gidaris Dimos , Zafeiriou Dimitrios 
Published: July 2020

Objectives:
The aims of the study were to assess executive function performance in children and adolescents with primary and secondary hypertension, and to investigate for associations with central SBP and ambulatory blood pressure.

Methods:
Forty-six pediatric patients with secondary hypertension because of kidney diseases and 46 patients with primary hypertension underwent ambulatory blood pressure monitoring, pulse wave analysis, and assessment of executive function using Behavior Rating Inventory of Executive Function. Results for comparisons are presented as mean (SD). Analysis of covariance was performed to examine the effect of blood pressure parameters and hypertension cause.

Results:
Patients with secondary hypertension had higher T scores in parent and self-reported Metacognition Indices compared with those with primary hypertension (51.2 ± 8.9 vs. 47.6 ± 7.5, P = 0.05 and 49.6 ± 9.1 vs. 42.1 ± 7.9, P = 0.001, respectively), but did not differ in Behavior Regulation Index T scores, as well as in mean arterial pressure z-score. Patients with secondary hypertension had higher central SBP z-scores (P = 0.05). Adjustment for central SBP attenuated differences in parent Metacognition Index between groups. Central SBP z-score associated with parent Metacognition (B = 0.95, 95% CI 0.02–1.87), Behavior Regulation (B = 1.14, 95% CI 0.07–2.21), and self-reported Metacognition Indices T scores (B = 1.48, 95% CI 0.39–2.56), independent of mean arterial pressure z-score, age, sex, socioeconomic status, hypertension cause, and antihypertensive treatment.

Conclusion:
Central SBP associates with executive function performance in youth with hypertension and could have complementary role to ambulatory blood pressure for identifying children at risk for adverse cognitive outcomes.
Predictive value of admission blood pressure for 3-month mortality in patients undergoing revascularization for critical limb ischemia
Authors: Yannoutsos Alexandra , Lin Franck , Billuart Olivier , Gaisset Roxane , Sacco Emmanuelle , Beaussier Hélène , Buronfosse Anne , Mourad Jean-Jacques , Emmerich Joseph , Lazareth Isabelle , Priollet Pascal 
Published: July 2020

Objective:In patients with critical limb ischemia (CLI), blood pressure (BP) impact on mortality is unknown. We analyzed the predictive value of SBP, DBP and pulse pressure (PP) at hospital admission on 3-month mortality in patients with CLI undergoing revascularization procedure.Methods:From November 2013 to December 2018, 297 consecutive patients were retrospectively included. Admission BP was recorded using automated brachial sphygmomanometer, before revascularization procedure. A median of seven (IQR3–13) separate readings were recorded for each patient and the average represented patient's mean BP (mBP). Clinical and biological parameters were recorded at baseline.Results:The cohort included 163 men (55%) and 134 women (45%) with a mean age of 77.7 ± 11.9 years. Treated hypertension and diabetes were present in, respectively, 62 and 48% of patients. Mean SBP, DBP and PP were 132 ± 18, 70 ± 8 and 62 ± 16 mmHg. Thirty-four patients (11.4%) died during 3-month follow-up, mostly from cardiovascular causes. In univariate analysis, age, female sex, brain natriuretic peptide and C-reactive protein were positively correlated with mortality. BMI, mSBP, mDBP, mPP, hemoglobin, serum albumin and statin treatment were negatively correlated with mortality. In single-pressure multivariate analyses, mSBP (P = 0.024) and mPP (P = 0.030) were negatively correlated with mortality. Association between mSBP and mortality had an asymptotic curve pattern and SBP level 135 mmHg or less was significantly correlated with mortality.Conclusion:In patients undergoing revascularization for CLI, admission SBP is an independent predictor for short-term mortality with a negative relationship. SBP level 135 mmHg or less represents a warning sign to explore and correct associated comorbidities.
Home device-monitored sleep blood pressure reflects large artery stiffness: the Nagahama study
Authors: Tabara Yasuharu , Matsumoto Takeshi , Murase Kimihiko , Setoh Kazuya , Kawaguchi Takahisa , Kosugi Shinji , Nakayama Takeo , Hirai Toyohiro , Wakamura Tomoko , Chin Kazuo , Matsuda Fumihiko 
Published: July 2020

Background:
High sleep blood pressure (BP) has been suggested to be an independent risk factor for cardiovascular outcomes. To assess the applicability of sleep BP measured using a timer-equipped home device, we investigated the association between home device-measured sleep BP and large artery stiffness.

Methods:
We performed a cross-sectional analysis of a dataset from the Nagahama study (N = 5916), a general population-based cohort study. Home morning BP and sleep BP were measured using a timer-equipped cuff-oscillometric device (HEM-7080IC). Office BP, carotid intima--media thickness (IMT), and brachial--ankle pulse wave velocity (baPWV) were measured at the follow-up investigation of the Nagahama study.

Results:
Sleep hypertension (SBP ≥120 mmHg and/or DBP ≥70 mmHg) was associated with the arterial parameters (IMT: β = 0.051, baPWV: β = 0.141, both P < 0.001) independently of morning hypertension (IMT: β = 0.093, baPWV: β = 0.216, both P < 0.001) irrespective of antihypertensive medication status. Individuals exhibiting isolated sleep hypertension (N = 801) had thicker IMT (0.69 ± 0.14 vs. 0.64 ± 0.13 mm, P = 0.017) and faster baPWV (1,299 ± 197 vs. 1,183 ± 178 cm/s, P < 0.001) than normotensives. A sleep SBP at least 110 mmHg and a sleep DBP at least 65 mmHg were identified as the lower threshold BP values for the association with arterial parameters.

Conclusion:
Sleep BP measurement using a home device may be a simple way to assess cardiovascular risks overlooked by office and home morning BP measurements.
The anti-inflammatory effect of resistance training in hypertensive women: the role of purinergic signaling
Authors: Lammers Mônica D. , Anéli Nyasmin M. , de Oliveira Gabriela G. , de Oliveira Maciel Sarah F.V. , Zanini Daniela , Mânica Aline , de Resende e Silva Débora T. , Bagatini Margarete D. , Sévigny Jean , De Sá Clodoaldo A. , Manfredi Leandro H. , Cardoso Andréia M. 
Published: July 2020

Background and methods:
Essential arterial hypertension triggers a chronic inflammatory process that seems to be linked to purinergic signaling. Physical exercise exhibit anti-inflammatory properties and is able to modulates purinergic system. The aim of this study was to evaluate the effect of 6 months of resistance training on inflammatory markers, purinergic system components, hemodynamic and anthropometric parameters in hypertensive woman.

Methods:
A total of 31 hypertensive group and 28 normotensive (control group) middle-aged sedentary women were submitted to 6 months of resistance training. All measurements and blood collection were carried out before (pretest), after 3 months and after 6 months (posttest) of training. Purinergic enzymes [nucleoside triphosphate diphosphohydrolase (NTPDase) and adenosine deaminase] were assessed in lymphocytes; IL-6, IL-10, ATP and C-reactive protein levels were measured in serum.

Results:
Six months of resistance training was able to significantly reduce blood pressure (BP), IL-6, C-reactive protein, ATP levels as well as NTPDase and adenosine deaminase activities in hypertensive group. Physical training was also able to increase IL-10 levels in hypertensive group. A positive correlation was found between BP, enzyme activities and levels of ATP and IL-6. A negative correlation was found between BP and IL-10. Positive correlation was found between NTPDase and IL-6 levels (P < 0.05) as well as ATP levels and IL-6 levels.

Conclusion:
Our findings demonstrated the relationship between purinergic signaling and inflammation in hypertension and suggests that resistance training serve as tool to reduce inflammation in hypertensive woman by modulating purinergic system.
HUMAN AMNIOTIC MEMBRANE TO TREAT MACULAR HOLES THAT FAILED TO CLOSE, SULFUR HEXAFLUORIDE ENDOTAMPONADE VERSUS AIR ENDOTAMPONADE
Authors: Caporossi Tomaso , Tartaro Ruggero , Finocchio Lucia , Pacini Bianca , De Angelis Lorenzo , Bacherini Daniela , Rizzo Stanislao 
Published: July 2020

Background/Purpose:
To determinate the efficacy of the human amniotic membrane plugs with sulfur hexafluoride versus human amniotic membrane plug with air as endotamponade to treat macular holes that failed to close after vitrectomy plus internal limiting membrane peeling. Multimodal imaging was focused to evaluate preoperative features and postoperative changes.

Methods:
Prospective interventional comparative study. Twenty eyes of 20 patients affected with macular hole that failed to close were divided into 2 groups: 10 eyes received an amniotic membrane plug with 20% sulfur hexafluoride tamponade and 10 eyes received an amniotic membrane plug with air tamponade. All eyes were studied using multimodal advanced diagnostic tools, such as spectral-domain optical coherence tomography, optical coherence tomography angiography, microperimetry, and adaptive optics to investigate the postoperative results.

Results:
In both groups, all macular holes were found successfully closed after 12 months. Mean preoperative best-corrected visual acuity was 20/400 in the SF6 group and 20/250 in air group. Final mean best-corrected visual acuity was 20/63 in both groups. The superficial capillary plexus, studied using optical coherence tomography angiography, showed a statistically significant difference between the treated and the fellow eyes. Adaptive optics images revealed the presence of a photoreceptor cell mosaic in the area of the amniotic membrane plug.

Conclusion:
The human amniotic membrane combined with air endotamponade demonstrated its effectiveness to seal macular holes that failed to close after vitrectomy plus internal limiting membrane peeling. Advanced multimodal diagnostic imaging helped us to better understand the modifications associated with the use of the amniotic membrane in these cases.
A Case of Annular Iris Cyst Diagnosed With the Help of Ultrasound Biomicroscopy
Authors: Segi Ashwin , Maheshwari Devendra , Dabke Shylesh , Rao Sanjana , Kadar Mohideen A. , Rengappa Ramakrishna 
Published: July 2020

Purpose:
To report a case of annular iris cyst presenting as a secondary angle closure managed with Nd:YAG laser iridotomy.

Design:
Case report.

Methods:
Institutional review board exemption for this case report was obtained from the institutional ethics committee, Aravind eye hospital, Tirunelveli. All research adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained.
A 45-year-old woman presented with a 2-week history of sudden onset of pain and redness in the right eye. Slit-lamp biomicroscopy showed corneal edema, with the shallow anterior chamber, convex bowing of iris, irregular shape of the pupil, and glaucomflecken on the clear lens. Ultrasound biomicroscopy revealed an annular iris cyst of the iris pigment epithelium. Nd:YAG laser iridotomy was done to drain the cyst and relieve the angle closure.

Results:
Laser treatment resulted in the collapse of the cyst, confirmed by ultrasound biomicroscopy and disappearance of the subject symptoms.

Conclusion:
Iris cysts are usually benign in nature. An annular iris cyst is a rare presentation. They can present with a secondary angle closure as in our report. Correct diagnosis and timely intervention bring about a desirable result. With this report, the authors aim to catalog and familiarize ophthalmologists with a rare ocular pathology and its management.
COVID-19 and cataract surgery backlog in Medicare beneficiaries
Authors: Aggarwal Shruti , Jain Punya , Jain Amit 
Published: July 2020

Purpose:
To forecast the volume of cataract surgery in Medicare beneficiaries in the United States in 2020 and to estimate the surgical backlog that may be created due to COVID-19.

Setting:
Medicare Beneficiaries, United States.

Design:
Epidemiologic modeling.

Methods:
Baseline trends in cataract surgery among Medicare beneficiaries were assessed by querying the Medicare Part B Provider Utilization National Summary data. It was assumed that once the surgical deferment is over, there will be a ramp-up period; this was modeled using a stochastic Monte Carlo simulation. Total surgical backlog 2 years postsuspension was estimated. Sensitivity analyses were used to test model assumptions.

Results:
Assuming cataract surgeries were to resume in May 2020, it would take 4 months under an optimistic scenario to revert to 90% of the expected pre-COVID forecasted volume. At 2-year postsuspension, the resulting backlog would be between 1.1 and 1.6 million cases. Sensitivity analyses revealed that a substantial surgical backlog would remain despite potentially lower surgical demand in the future.

Conclusions:
Suspension of elective cataract surgical care during the COVID-19 surge might have a lasting impact on ophthalmology and will likely result in a cataract surgical patient backlog. These data may aid physicians, payers, and policymakers in planning for postpandemic recovery.
Machine learning suggests sleep as a core factor in chronic pain
Authors: Miettinen Teemu , Mäntyselkä Pekka , Hagelberg Nora , Mustola Seppo , Kalso Eija , Lötsch Jörn 
Published: July 2020

Abstract
Patients with chronic pain have complex pain profiles and associated problems. Subgroup analysis can help identify key problems. We used a data-based approach to define pain phenotypes and their most relevant associated problems in 320 patients undergoing tertiary pain management. Unsupervised machine learning analysis of parameters “pain intensity,” “number of pain areas,” “pain duration,” “activity pain interference,” and “affective pain interference,” implemented as emergent self-organizing maps, identified 3 patient phenotype clusters. Supervised analyses, implemented as different types of decision rules, identified “affective pain interference” and the “number of pain areas” as most relevant for cluster assignment. These appeared 698 and 637 times, respectively, in 1000 cross-validation runs among the most relevant characteristics in an item categorization approach in a computed ABC analysis. Cluster assignment was achieved with a median balanced accuracy of 79.9%, a sensitivity of 74.1%, and a specificity of 87.7%. In addition, among 59 demographic, pain etiology, comorbidity, lifestyle, psychological, and treatment-related variables, sleep problems appeared 638 and 439 times among the most important characteristics in 1000 cross-validation runs where patients were assigned to the 2 extreme pain phenotype clusters. Also important were the parameters “fear of pain,” “self-rated poor health,” and “systolic blood pressure.” Decision trees trained with this information assigned patients to the extreme pain phenotype with an accuracy of 67%. Machine learning suggested sleep problems as key factors in the most difficult pain presentations, therefore deserving priority in the treatment of chronic pain.