bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of weight-based insulin titration (WIT) and glucose-based insulin titration using basal-bolus algorithm in hospitalized patients with type 2 diabetes: a multicenter, randomized, clinical study
Authors: Zhang Xiaodan , Zhang Tong , Xiang Guangda , Wang Wenbo , Li Yanli , Du Tao , Zhao Yunjuan , Mosha Singla Sethiel , Li Wangen 
Published: September 2020

IntroductionSubcutaneous administration of insulin is the preferred method for achieving glucose control in non-critically ill patients with diabetes. Glucose-based titration protocols were widely applied in clinical practice. However, most of these algorithms are experience-based and there is considerable variability and complexity. This study aimed to compare the effectiveness and safety of a weight-based insulin titration algorithm versus glucose-based algorithm in hospitalized patients with type 2 diabetes mellitus (T2DM).Research design and methodsThis randomized clinical trial was carried out at four centers in the South, Central and North China. Inpatients with T2DM were randomly assigned (1:1) to receive weight-based and glucose-based insulin titration algorithms. The primary outcome was the length of time for reaching blood glucose (BG) targets (fasting BG (FBG) and 2-hour postprandial BG (2hBG) after three meals). The secondary outcome included insulin dose for achieving glycemic control and the incidence of hypoglycemia during hospitalization.ResultsBetween January 2016 and June 2019, 780 patients were screened, and 575 completed the trial (283 in the weight-based group and 292 in the glucose-based group). The lengths of time for reaching BG targets at four time points were comparable between two groups. FBG reached targets within 3 days and 2hBG after three meals within 4 days. There is no significant difference in insulin doses between two groups at the end of the study. The total daily dosage was about 1 unit/kg/day, and the ratio of basal-to-bolus was about 2:3 in both groups. The incidence of hypoglycemia was similar in both groups, and severe hypoglycemia was not detected in either of the groups.ConclusionsWeight-based insulin titration algorithm is equally effective and safe in hospitalized patients with T2DM compared with glucose-based algorithm.Trial registration numberNCT03220919.
Waiting times in emergency departments: exploring the factors associated with longer patient waits for emergency care in England using routinely collected daily data
Authors: Paling Steven , Lambert Jennifer , Clouting Jasper , González-Esquerré Júlia , Auterson Toby 
Published: September 2020

BackgroundLong lengths of stay (also called waiting times) in emergency departments (EDs) are associated with higher patient mortality and worse outcomes.ObjectiveTo add to the literature using high-frequency data from a large number of hospitals to analyse factors associated with long waiting times, including exploring non-linearities for 'tipping points'.MethodsMultivariate ordinary least squares regressions with fixed effects were used to analyse factors associated with the proportion of patients in EDs in England waiting more than 4 hours to be seen, treated and admitted or discharged. Daily situation reports (Sitrep), hospital episode statistics and electronic staffing records data over 90 days between December 2016 and February 2017 were used for all 138 English NHS healthcare providers with a major ED.ResultsHigher inpatient bed occupancy was correlated with longer ED waiting times, with a non-linear association. In a full hospital, with 100% bed occupancy, the proportion of patients who remained in the ED for more than 4 hours was 9 percentage points higher (95% CI 7.5% to 11.1%) than with an 85% occupancy level. For each percentage point change in the following factors, the proportion of ED stays over 4 hours also increased: more inpatients with hospital length of stay over 21 days (0.07%, 95% CI 0.008% to 0.13%); higher emergency admissions (0.08%, 95% CI 0.06% to 0.10%); and lower discharges relative to admissions on the same day (0.04%, 95% CI 0.02% to 0.06%), the following day (0.05%, 95% CI 0.03% to 0.06%) and at 2 days (0.05%, 95% CI 0.04% to 0.07%).ConclusionsThese results suggest that tackling patient flow and capacity in the wider hospital, particularly very high bed occupancy levels and patient discharge, is important to reduce ED waiting times and improve patient outcomes.
Crop, genotype, and field environmental conditions shape bacterial and fungal seed epiphytic microbiomes
Authors: Morales Moreira Zayda P. , Helgason Bobbi L. , Germida James J. 
Published: September 2020

Seeds are reproductive structures able to carry and transfer microorganisms that play an important role in plant fitness. Genetic and external factors are reported to be partly responsible for the plant microbiome assemblage, but their contribution in seeds is poorly understood. In this study, wheat, canola, and lentil seeds were analyzed to characterize diversity, structure, and persistence of seed-associated microbial communities. Five lines and 2 generations of each crop were subjected to high-throughput amplicon sequencing of the 16S rRNA and internal transcribed spacer (ITS) regions. Bacterial and fungal communities differed most by crop type (30% and 47% of the variance), while generation explained an additional 10% and 15% of the variance. The offspring (i.e., generation harvested in 2016 at the same location) exhibited a higher number of common amplicon sequence variants (ASVs) and less variability in microbial composition. Additionally, in every sample analyzed, a “core microbiome” was detected consisting of 5 bacterial and 12 fungal ASVs. Our results suggest that crop, genotype, and field environmental conditions contributed to the seed-associated microbial assemblage. These findings not only expand our understanding of the factors influencing the seed microbiome but may also help us to manipulate and exploit the microbiota naturally carried by seeds.
Dynamical system analysis of three-form field dark energy model with baryonic matter
Authors: Chakraborty Soumya , Mishra Sudip , Chakraborty Subenoy 
Published: September 2020

AbstractA cosmological model having matter field as (non) interacting dark energy (DE) and baryonic matter and minimally coupled to gravity is considered in the present work with flat FLRW space time. The DE is chosen in the form of a three-form field while radiation and dust (i.e; cold dark matter) are the baryonic part. The cosmic evolution is studied through dynamical system analysis of the autonomous system so formed from the evolution equations by suitable choice of the dimensionless variables. The stability of the non-hyperbolic critical points are examined by Center manifold theory and possible bifurcation scenarios have been examined.
Concomitant Proton Pump Inhibitor Use and Survival in Urothelial Carcinoma Treated with Atezolizumab
Authors: Hopkins Ashley M. , Kichenadasse Ganessan , Karapetis Christos S. , Rowland Andrew , Sorich Michael J. 
Published: September 2020

Abstract

Purpose:
Emerging evidence indicates that gut microbiota dysbiosis can reduce the effectiveness of immune checkpoint inhibitors (ICI). Proton pump inhibitors (PPI) are known to induce gut microbiota changes. However, little is known on the effects of PPIs on outcomes with ICI therapy, and it has not been explored in urothelial cancer treatment.

Experimental Design:
Individual–participant data from the advanced urothelial cancer trials, IMvigor210 (single-arm atezolizumab trial, n = 429) and IMvigor211 (phase III randomized trial of atezolizumab vs. chemotherapy, n = 931) were pooled in a Cox proportional hazard analysis assessing the association between PPI use and overall survival (OS) and progression-free survival (PFS). PPI use was defined as any PPI administration between 30 days prior and 30 days after treatment initiation.

Results:
Of the 1,360 participants, 471 (35%) received a PPI within the 60-day window. PPI use was associated with significantly worse OS [HR (95% confidence interval (CI)) = 1.52 (1.27–1.83), P &lt; 0.001] and PFS [1.38 (1.18–1.62), P &lt; 0.001] with atezolizumab, but not chemotherapy (P &gt; 0.05). In the randomized cohort of IMvigor211, the OS treatment effect [HR (95% CI)] of atezolizumab versus chemotherapy was 1.04 (0.81–1.34) for PPI users, compared with 0.69 (0.56–0.84) for PPI nonusers (Pinteraction = 0.013). Similar associations were noted in the PD-L1 IC2/3 population.

Conclusions:
This study indicates PPI use is a negative prognostic marker in advanced urothelial carcinoma treated with ICI therapy, but not chemotherapy. Furthermore, the analysis suggests PPIs influence the magnitude of ICI efficacy, and this warrants further investigation.
9p21.3 Coronary Artery Disease Locus Identifies Patients With Treatment Benefit From Bariatric Surgery in the Nonrandomized Prospective Controlled Swedish Obese Subjects Study
Authors: Jacobson Peter , Peltonen Markku , Svensson Per-Arne , Taube Magdalena , Andersson-Assarsson Johanna C. , Sjoholm Kajsa , Bouchard Claude , Carlsson Björn , Carlsson Lena M.S. 
Published: September 2020

Background:
Sequence variation at chromosome 9p21.3 accounts for 20% of myocardial infarctions (MIs) in several populations. Whereas the risk conferred by the 9p21.3 locus appears to act independently of traditional risk factors, studies suggest that the association between 9p21.3 and MI is modified by glucose homeostasis and lifestyle. We examined if the 9p21.3 variant rs1333049, along with the previously identified predictor fasting insulin, modifies the preventive effect of bariatric surgery on MI incidence.

Methods:
rs1333049 was genotyped in 1852 patients treated by bariatric surgery and 1803 controls given usual care in the SOS study (Swedish Obese Subjects). MI incidence was determined using national registers. Median follow-up was 21 years (interquartile range 18–24 years).

Results:

Overall, 366 MIs occurred during follow-up. Among rs1333049 risk-allele carriers (CC+GC), the incidence of MI was reduced in the surgery group compared with the control group (hazard ratio=0.72 [95% CI, 0.57–0.92],
P
=0.008). By contrast, noncarriers (GG) showed no significant differences in MI incidence between the treatment groups (hazard ratio=1.28 [0.86–1.90],
P
=0.227; interaction between treatment and the risk-allele
P
=0.016). In addition, carriers with higher fasting insulin (above the median [17 mmol/L]) experienced significantly higher MI incidence than carriers with lower fasting insulin (hazard ratio=0.58 [0.42–0.78],
P
<0.001, interaction
P
=0.031).

Conclusions:
In the SOS cohort, patients with the chromosome 9p21.3 rs1333049 risk allele together with high fasting insulin levels benefitted from bariatric surgery in terms of reduced incidence of MI.

Registration:

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT01479452.
Treatment of Psoriasis With Biologic Therapy Is Associated With Improvement of Coronary Artery Plaque Lipid-Rich Necrotic Core
Authors: Choi Harry , Uceda Domingo E. , Dey Amit K. , Abdelrahman Khaled M. , Aksentijevich Milena , Rodante Justin A. , Elnabawi Youssef A. , Reddy Aarthi , Keel Andrew , Erb-Alvarez Julie , Teague Heather , Playford Martin P. , Zhou Wunan , Chen Marcus Y. , Gelfand Joel M. , Bluemke David A. , Buckler Andrew , Mehta Nehal N. 
Published: September 2020

Background:
Lipid-rich necrotic core (LRNC), a high-risk coronary plaque feature assessed by coronary computed tomography angiography, is associated with increased risk of future cardiovascular events in patients with subclinical, nonobstructive coronary artery disease. Psoriasis is a chronic inflammatory condition that is associated with increased prevalence of high-risk coronary plaque and risk of cardiovascular events. This study characterized LRNC in psoriasis and how LRNC modulates in response to biologic therapy.

Methods:
Consecutive biologic naïve psoriasis patients (n=209) underwent coronary computed tomography angiography at baseline and 1-year to assess changes in LRNC using a novel histopathologically validated software (vascuCAP Elucid Bioimaging, Boston, MA) before and after biologic therapy over 1 year.

Results:

Study participants were middle-aged, predominantly male with similar cardiometabolic and psoriasis status between treatment groups. In all participants at baseline, LRNC was associated with Framingham risk score (β [standardized β]=0.12 [95% CI, 0.00–0.15];
P
=0.045), and psoriasis severity (β=0.13 [95% CI, 0.01–0.26];
P
=0.029). At 1-year, participants receiving biologic therapy had a reduction in LRNC (mm
2
; 3.12 [1.99–4.66] versus 2.97 [1.84–4.35];
P
=0.028), while those who did not receive biologic therapy over 1 year demonstrated no significant change with nominally higher LRNC (3.12 [1.82–4.60] versus 3.34 [2.04–4.74];
P
=0.06). The change in LRNC was significant compared with that of the nonbiologic treated group (ΔLRNC, −0.22 mm
2
versus 0.14 mm
2
,
P
=0.004) and remained significant after adjusting for cardiovascular risk factors and psoriasis severity (β=−0.09 [95% CI, −0.01 to −0.18];
P
=0.033).

Conclusions:
LRNC was associated with psoriasis severity and cardiovascular risk factors in psoriasis. Additionally, there was favorable modification of LRNC in those on biologic therapy. This study provides evidence of potential reduction in LRNC with treatment of systemic inflammation. Larger, longer follow-up prospective studies should be conducted to understand how changes in LRNC may translate into a reduction in future cardiovascular events in psoriasis.
A Comparison of Scan Speedup Strategies and Their Effect on Rapid-Scan Weather Radar Data Quality
Authors: Mahre Andrew , Yu Tian-You , Bodine David J. 
Published: September 2020

AbstractAs the existing NEXRAD network nears the end of its life cycle, intense study and planning are underway to design a viable replacement system. Ideally, such a system would offer improved temporal resolution compared to NEXRAD, without a loss in data quality. In this study, scan speedup techniques—such as beam multiplexing (BMX) and radar imaging—are tested to assess their viability in obtaining high-quality rapid updates for a simulated long-range weather radar. The results of this study—which uses a Weather Research and Forecasting (WRF) Model–simulated supercell case—show that BMX generally improves data quality for a given scan time or can provide a speedup factor of 1.69–2.85 compared to NEXRAD while maintaining the same level of data quality. Additionally, radar imaging is shown to improve data quality and/or decrease scan time when selectively used; however, deleterious effects are observed when imaging is used in regions with sharp reflectivity gradients parallel to the beam spoiling direction. Consideration must be given to the subsequent loss of sensitivity and beam broadening. Finally, imaging is shown to have an effect on the radar-derived mesocyclone strength (ΔV) of a simulated supercell. Because BMX and radar imaging are most easily achieved with an all-digital phased array radar (PAR), these results make a strong argument for the use of all-digital PAR for high-resolution weather observations. It is believed that the results from this study can inform decisions about possible scanning strategies and design of a NEXRAD replacement system for high-resolution weather radar data.
Predictive Factors for Surgical Site Infections in Patients Undergoing Surgery for Breast Carcinoma
Authors: Pastoriza Jessica , McNelis John , Parsikia Afshin , Lewis Erin , Ward Marie , Marini Corrado P. , Castaldi Maria T. 
Published: September 2020

Introduction Operative interventions for breast cancer are generally classified as clean surgeries. Surgical site infections (SSIs), while rare, do occur. This study sought to identify risk factors for SSI, using the National Surgical Quality Improvement Program (NSQIP). Methods NSQIP’s participant use data files (PUF) between 2012 and 2015 were examined. Female patients with invasive breast cancer who underwent surgery were identified through CPT and ICD9 codes. Non-SSI and SSI groups were compared and the statistical differences were addressed through propensity score weighting. Multivariate logistic regression testing was used to identify predictors of SSI. Results This study examined 30 544 lumpectomies and 23 494 mastectomies. SSI rate was 1126/54 038 patients (2.1%). In the weighted dataset, mastectomy, diabetes, smoking, COPD, ASA class-severe, BMI >35 kg/m2, and length of stay (LOS) >1 day were associated with an increased odds ratio (OR) of SSI. The OR for SSI was highest after mastectomy with reconstruction (OR 2.626, P < .001; 95% CI 2.073-3.325). Postoperative variables associated with an increased OR of SSIs included systemic infection, unplanned reoperation wound dehiscence, and renal failure. Conclusion Mastectomy, diabetes, smoking, COPD, ASA class-severe, BMI >35 kg/m2, length of stay (LOS) >1 day are associated with an increased OR for SSIs following breast surgery.
Simple Versus Radical Resection for Duodenal Adenocarcinoma: A Propensity Score Matched Analysis of National Cancer Database
Authors: Platoff Rebecca M. , Kellish Alec S. , Hakim Abraham , Gaughan John P. , Atabek Umur M. , Spitz Francis R. , Hong Young K. 
Published: September 2020

Background Duodenal adenocarcinoma treatment consists of either simple or radical surgical resection. Existing evidence suggests similar survival outcomes between the two but is limited by small numbers and single-institution analysis. We aim to compare survival after partial versus radical resection for duodenal adenocarcinoma using the National Cancer Database (NCDB). Methods Using NCDB results from 2004 to 2014, we compared patients with duodenal adenocarcinoma undergoing partial resection (n = 1247) and radical resection (n = 1240) by age, sex, facility type, facility location, cancer stage, cancer grade, lymph node sampling, node status, tumor size, margin status, neoadjuvant therapy, and adjuvant therapy using chi-square analysis. Survival was compared using propensity matching. Results Patients undergoing partial resection had overall earlier cancer stage, more favorable tumor grade, and were less likely to undergo lymph node sampling and neoadjuvant therapy. When overall survival was compared between the 2 propensity-matched groups, the median survival was 46.7 months after partial resection and 43.2 months after radical resection ( P = .329), and overall survival was similar between the 2 groups ( P = .894). The use of adjuvant therapy demonstrated improved survival over either surgery alone ( P < .0001, P = .0037). Conclusion Partial resection did not demonstrate worse survival outcomes than radical resection for duodenal adenocarcinoma. The use of adjuvant therapy in addition to surgery demonstrated improved survival regardless of surgery type and played a larger role in survival than the type of surgery. Our findings provide evidence to support the continued use of both partial and radical surgical resections to treat duodenal malignancy.
Association of Clinicopathological Features With Outcome in Chondrosarcomas of the Head and Neck
Authors: Asioli Sofia , Ruengwanichayakun Poosit , Zoli Matteo , Guaraldi Federica , Sollini Giacomo , Greco Paolo , Facco Carla , Gibertoni Dino , Jiménez Brayan Vega , Benini Stefania , Turri‐Zanoni Mario , Pasquini Ernesto , Mazzatenta Diego , Foschini Maria Pia , Righi Alberto 
Published: September 2020

ObjectiveThe aim of this study is to assess the association between clinical and radiological features as well as of isocitrate dehydrogenase 1 and 2 (IDH 1,2) mutations with outcome in head and neck chondrosarcomas.Study DesignRetrospective study.SettingTertiary referral center.MethodsClinical, histological, and molecular data of patients with head and neck chondrosarcomas treated by surgery were collected.ResultsForty‐six patients were included. The mean age at diagnosis was 56 years (range, 17‐78). The tumor originated from the skull base (52.2%), facial bones (28.2%), or laryngotracheal area (19.6%). At last follow‐up (median 52.5 months), 38 patients were alive, 30 of which were disease free, whereas 8 had died, 4 of disease progression and 4 of other causes. Fourteen (30.4%) had local recurrence and 2 (4.3%) had lung metastasis. All cases were negative for cytokeratin AE1/AE3, brachyury, and IDH1 at immunohistochemistry, while Sanger sequencing identified IDH1/2 point mutations, typically IDH1 R132C, in 9 (37.5%) tumors arising from the skull base. Margin infiltration on the surgical specimen negatively affected the outcome, whereas no correlation was identified with IDH mutation status.ConclusionsAn adequate margin positively affects survival. IDH mutation status does not affect patient outcome.
A modified Gritti-Stokes amputation technique as a solution for recurring aseptic loosening of a knee arthroplasty: A single-patient case study
Authors: van Rooij Willemijn MJ , Maas-van Weert Karin CM , van Kempen Robin WTM , de Laat Fred A , Geertzen Jan HB 
Published: September 2020

Case Description:
A 56-year-old man with persistent knee pain and poor physical functioning due to recurring loosening of a (revised) total knee arthroplasty, was treated with a modified Gritti-Stokes amputation.

Objectives:
to describe the modified Gritti-Stokes amputation technique as an ultimate therapy for failed total knee arthroplasty and to assess the functional outcome for one patient 1 year post-surgery.

Study design:
a single patient case study.

Treatment:
a modified Gritti-Stokes amputation, with removal of the overlying cartilage and subchondral surfaces of both the patella and femur after removing the total knee arthroplasty.

Outcomes:
After rehabilitation, the patient has a fully end-bearing residual limb, is able to walk without pain (with a prosthesis) and perform his daily activities.

Conclusions:
In cases of recurring loosening of a (revised) total knee arthroplasty, a modified Gritti-Stokes amputation can create an end-bearing residual limb without pain and with good functional outcome.