bluuebunny/crossref_metadata_2025_split huggingface dataset:
Randomized, Controlled Trial Comparing Mitral Valve Repair With Leaflet Resection Versus Leaflet Preservation on Functional Mitral Stenosis
Authors: Chan Vincent , Mazer C. David , Ali Faeez Mohamad , Quan Adrian , Ruel Marc , de Varennes Benoit E. , Gregory Alexander J. , Bouchard Denis , Whitlock Richard P. , Chu Michael W.A. , Dokollari Aleksander , Mesana Thierry , Bhatt Deepak L. , Latter David A. , Zuo Fei , Tsang Wendy , Teoh Hwee , Jüni Peter , Leong-Poi Howard , Verma Subodh 
Published: October 2020

Background:
Equipoise exists between the use of leaflet resection and preservation for surgical repair of mitral regurgitation caused by prolapse. We therefore performed a randomized, controlled trial comparing these 2 techniques, particularly in regard to functional mitral stenosis.

Methods:
One hundred four patients with degenerative mitral regurgitation surgically amenable to either leaflet resection or preservation were randomized at 7 specialized cardiac surgical centers. Exclusion criteria included anterior leaflet or commissural prolapse, as well as a mixed cause for mitral valve disease. Using previous data, we determined that a sample size of 88 subjects would provide 90% power to detect a 5–mm Hg difference in mean mitral valve gradient at peak exercise, assuming an SD of 6.7 mm with a 2-sided test with α=5% and 10% patient attrition. The primary end point was the mean mitral gradient at peak exercise 12 months after repair.

Results:

Patient age, proportion who were female, and Society of Thoracic Surgeons risk score were 63.9±10.4 years, 19%, and 1.4±2.8% for those who were assigned to leaflet resection (n=54), and 66.3±10.8 years, 16%, and 1.9±2.6% for those who underwent leaflet preservation (n=50). There were no perioperative deaths or conversions to replacement. At 12 months, moderate mitral regurgitation was observed in 3 subjects in the leaflet resection group and 2 in the leaflet preservation group. The mean transmitral gradient at 12 months during peak exercise was 9.1±5.2 mm Hg after leaflet resection and 8.3±3.3 mm Hg after leaflet preservation (
P
=0.43). The participants had similar resting peak (8.3±4.4 mm Hg versus 8.4±2.6 mm Hg;
P
=0.96) and mean resting (3.2±1.9 mm Hg versus 3.1±1.1 mm Hg;
P
=0.67) mitral gradients after leaflet resection and leaflet preservation, respectively. The 6-minute walking distance was 451±147 m for those in the leaflet resection versus 481±95 m for the leaflet preservation group (
P
=0.27).

Conclusions:
In this adequately powered randomized trial, repair of mitral prolapse with either leaflet resection or leaflet preservation was associated with similar transmitral gradients at peak exercise at 12 months postoperatively. These data do not support the hypothesis that a strategy of leaflet resection (versus preservation) is associated with a risk of functional mitral stenosis.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier NCT02552771.
“Rehabilitating” Pilgrimage in Scotland: Heritage, Protestant Pilgrimage, and Caledonian Caminos
Authors: Bowman Marion 
Published: October 2020

Abstract
Caminoization and the heritagization of religion are significant factors in the development of “new” pilgrimage in Scotland this century, helping to produce pragmatic and distinctive reworkings of pilgrimage in what was, traditionally, a predominantly Protestant milieu. Here I review the pre- and post-Reformation context of Scottish pilgrimage, outline significant influences and agents in “new” Scottish pilgrimage ideas and praxis (including the Scottish Pilgrim Routes Forum), and give a detailed account of the development of the Fife Pilgrim Way (officially launched in July 2019) as an example par excellence of how pilgrimage currently is being operationalized and reframed, influenced by both Caminoization and heritagization. This analysis shows that Scotland’s contemporary “rehabilitation” of pilgrimage is driven by multiple agents and agendas (religious, civic, economic, and societal), and that its roots lie inter alia in Scotland’s complex identity politics, Celticism, sectarianism, pro-European sentiments, and a pragmatic reassessment of and reengagement with Scotland’s fragmented pilgrimage past.
Unwrapping the Memory Box
Authors: Roy Sajal , Zafarullah Habib , Das Arunima Kishore 
Published: October 2020

Abstract
The Sundarbans, the largest mangrove forest in the world, has been undergoing significant ecological changes due to climate change-related weather events since the late 1990s. This forest, situated in south-west Bangladesh, provides livelihood services to 3.5 million people. The livelihood provision of the Sundarbans forest has been invented due to climate-induced disasters, such as cyclones, sea-level rise, salinisation, heat waves, and flooding. Considering the impacts of cyclones Aila and Sidr, this autoethnographic study closely examines the long-established perceptions of women and men about the resources of the Sundarbans. While doing so, this study uses feminist political ecology as a theoretical framework. This study examines how these two cyclones transformed lives and gendered livelihoods of the villagers of Shora in the Sundarbans forest.
The potential role of the eGFR in differentiating between true and pseudohyperkalaemia
Authors: Morris Thomas G , Lamba Sushmita , Fitzgerald Thomas , Roulston Gary , Johnstone Helen , Mirzazadeh Mehdi 
Published: October 2020

Background Differentiating between true and pseudohyperkalaemia is essential for patient management. The common causes of pseudohyperkalaemia include haemolysis, blood cell dyscrasias and EDTA contamination. One approach to differentiate between them is by checking the renal function, as it is believed that true hyperkalaemia is rare with normal function. This is logical, but there is limited published evidence to support it. The aim of this study was to investigate the potential role of the estimated glomerular filtration rate in differentiating true from pseudohyperkalaemia. Methods GP serum potassium results >6.0 mmol/L from 1 January 2017 to 31 December 2017, with a repeat within seven days, were included. Entries were retrospectively classified as true or pseudohyperkalaemia based on the potassium reference change value and reference interval. If the initial sample had a full blood count, it was classified as normal/abnormal to remove blood cell dyscrasias. Different estimated glomerular filtration rate cut-points were used to determine the potential in differentiating true from pseudohyperkalaemia. Results A total of 272 patients were included with potassium results >6.0 mmol/L, with 145 classified as pseudohyperkalaemia. At an estimated glomerular filtration rate of 90 ml/min/1.73 m2, the negative predictive value was 81% (95% CI: 67–90%); this increased to 86% (95% CI: 66–95%) by removing patients with abnormal full blood counts. When only patients with an initial potassium ≥6.5 mmol/L were included (regardless of full blood count), at an estimated glomerular filtration rate of 90 ml/min/1.73 m2, the negative predictive value was 100%. Lower negative predictive values were seen with decreasing estimated glomerular filtration rate cut-points. Conclusion Normal renal function was not associated with true hyperkalaemia, making the estimated glomerular filtration rate a useful tool in predicting true from pseudohyperkalaemia, especially for potassium results ≥6.5 mmol/L.
Optical coherence tomography: assessment of coronary artery disease and guide to percutaneous coronary intervention
Authors: Iftikhar Imran , Javed Nismat , Khan Hamid Sharif , Malik Jahanzeb , Rehman Adeel ur , Baig Mirza Adnan 
Published: October 2020

Background and aims Angiographic guidance for percutaneous coronary intervention (PCI) has significant limitations in interpretation. The superior spatial resolution of optical coherence tomography (OCT) can provide meaningful clinical benefits, although limited data is available on Asian populations. This study aimed to determine whether OCT can provide additional advantages and useful clinical information beyond that obtained by angiography alone in decision making for PCI. Methods This was an observational study based on a single tertiary cardiac center in Pakistan, which includes 67 patients who underwent coronary angiogram and stenting. Their pre and post stenting OCT findings were recorded. Any additional intervention was also recorded. The data were analysed using IBM SPSS software version 26.0. Results The mean age was 55.00 ± 9.00 years. Majority of the patients were males (65.7%). On angiography, there was an equal number of stable and ruptured plaques (38.8%). Post stenting results showed 29.9% under deployed stents and 34.3% were either undersized or mal-apposed. Out of 67 patients, 50 (74.6%) needed re-intervention after PCI. Among different procedures, post-dilatation was most common. Conclusion The main OCT benefit is in borderline lesions on CA, in whom OCT identifies significant coronary stenosis and leads to PCI indication in patients. In the post-PCI context, OCT leads to an indication of PCI optimisation in half of the coronary lesions.
Racial Disparities in Patient Activation: The Role of Economic Diversity
Authors: Holt Jeana M. , Winn Aaron , Cusatis Rachel , Talsma AkkeNeel , Crotty Bradley H. 
Published: October 2020

The Patient Activation Measure (PAM) assesses a person’s level of knowledge, skills, and confidence to self-manage their day-to-day health. We conducted a mediation analysis to examine potential direct effects of race on significantly lower baseline PAM scores in Black than in White participants (p<0.001) who were a subset of 184 adults who participated in a randomized controlled trial. In the mediation analysis, using natural indirect effects, the continuous outcome was the PAM score. The mediators were income, education, ability to pay bills, and health literacy; race (Black or White) was the “exposure.” The results indicate that income (p=0.025) and difficulty paying monthly bills (p=0.04) mediated the relationship between race and baseline PAM score, whereas health literacy (p=0.301) and education (p=0.436) did not. Researchers must further investigate the role of economic diversity as an underlying mechanism of patient activation and differences in outcomes. Clinical Trial Registration: Avoiding Health Disparities When Collecting Patient Contextual Data for Clinical Care and Pragmatic Research: NCT03766841 https://clinicaltrials.gov/ct2/show/NCT03766841?term=crotty&draw=2&rank=1
Outcomes After Isolated Acute Anterior Cruciate Ligament Reconstruction Are Inferior in Patients With an Associated Anterolateral Ligament Injury
Authors: Sobrado Marcel Faraco , Giglio Pedro Nogueira , Bonadio Marcelo Batista , Helito Paulo Victor Partezani , Guimarães Tales Mollica , Pécora José Ricardo , Gobbi Riccardo Gomes , Helito Camilo Partezani 
Published: October 2020

Background: Isolated reconstruction of the anterior cruciate ligament (ACL) does not reestablish the normal knee biomechanics in cases of associated injuries to the anterolateral structures. Studies evaluating the potential clinical effect of anterolateral ligament (ALL) injury on the treatment of ACL injuries are necessary to validate the findings of biomechanical studies. Purpose: To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed using magnetic resonance imaging. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL group) or absence (no-ALL group) of ALL injury on preoperative magnetic resonance imaging scans. Both groups underwent anatomic reconstruction of the ACL with autologous hamstring tendon grafts. The Lysholm and subjective IKDC scores (International Knee Documentation Committee), KT-1000 arthrometer and pivot-shift test results, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury, and presence of knee hyperextension were evaluated. Results: A total of 182 patients were evaluated. Postoperative mean ± SD follow-up was 33.6 ± 7.1 and 36.1 ± 8.1 months for the ALL and no-ALL groups, respectively. No significant differences were found between the groups in terms of age, sex, knee hyperextension, duration of injury before reconstruction, follow-up time, or associated meniscal injuries. In the preoperative evaluation, the pivot-shift grade was similar, and the ALL group had worse KT-1000 arthrometer values (7.9 ± 1.2 mm vs 7.2 ± 1.1 mm; P < .001). In the postoperative evaluation, patients in the no-ALL group had a lower reconstruction failure rate (10.2% vs 1.4%; P = .029) and better clinical outcomes according to the IKDC subjective (85.5 ± 10.7 vs 89.1 ± 6.6; P = .035) and Lysholm scores (85.9 ± 10.1 vs 92.0 ± 6.3; P < .001). There was no postoperative difference in the KT-1000 or pivot-shift results. Conclusion: Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 2 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores.
Can We Identify Why Athletes Fail to Return to Sport After Hip Arthroscopy for Femoroacetabular Impingement Syndrome? A Systematic Review and Meta-analysis
Authors: Weber Alexander E. , Bolia Ioanna K. , Mayfield Cory K. , Ihn Hansel , Kang Hyunwoo P. , Bedi Asheesh , Nho Shane Jay , Philippon Marc J. 
Published: October 2020

Background: No previous systematic review has focused on the athletes who fail to return to sport after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Purpose: To review the literature on the athletes who fail to return to sport after hip arthroscopy for FAIS to determine the rate of nonreturning athletes and explore the reasons for their inability to return to sport after arthroscopic FAI surgery. Study Design: Systematic review and meta-analysis. Methods: Three electronic databases were searched for eligible articles. Two reviewers independently screened the titles, abstracts, and full-text articles using prespecified criteria. Eligible articles were those that clearly stated the rate of athletes who did not return to sport after hip arthroscopy for FAIS. Data collected were the rate of patients who did not return to sport, the level of competition (high level, recreational, or mixed), the type of sport, comments on patients who did not return to sport, the rate of subsequent hip surgeries (total hip replacement or revision hip arthroscopy) in nonreturning athletes, and the reported reason for not returning to sport. A random-effects model was used for meta-analysis. Results: Twenty studies were eligible for inclusion, and 1093 athletes were analyzed. The weighted rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12.1% (95% CI, 7.7-17.4). Only 2 studies (2/20;10%) reported the age of the athletes who did not return, while sex was reported in 3 studies (3/20;15%). The estimated proportion of athletes who did not return to sport because of hip-related issues was significantly greater than the percentage of athletes who did not return for reasons unrelated to their hip (74.3% vs 22.3%; P < .0001). Persistent hip pain was the most commonly reported factor (52/110 patients; 47.2%) associated with failure to return to sport. Whether the nonreturning athletes underwent any subsequent hip procedure after hip arthroscopy for FAIS was reported in only 4 out of 20 studies (20%). There was evidence of publication bias and study heterogeneity. Conclusion: The estimated rate of athletes who did not return to sport after hip arthroscopy for FAIS was 12%, with the majority of athletes being unable to return because of persistent hip pain. There is a severe lack of evidence on the athlete characteristics and clinical course of the nonreturning athletes, and the rate of subsequent hip procedures is unknown. The outcomes and reasons for athletes not returning to sport should be reported in detail to improve patient care.
A Hybrid Transtibial Technique Combines the Advantages of Anteromedial Portal and Transtibial Approaches: A Prospective Randomized Controlled Trial
Authors: Trofa David P. , Saltzman Bryan M. , Corpus Keith T. , Connor Patrick M. , Fleischli James E. , Piasecki Dana P. 
Published: October 2020

Background: The anteromedial (AM) portal and transtibial (TT) approaches are 2 common anterior cruciate ligament (ACL) femoral tunnel drilling techniques, each with unique benefits and disadvantages. A hybrid TT (HTT) technique using medial portal guidance of a flexible TT guide wire has recently been described that may combine the strengths of both the AM portal and the TT approaches. Hypothesis: The HTT technique will achieve anatomic femoral tunnel apertures similar to the AM portal technique, with improved femoral tunnel length and orientation. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 30 consecutive patients with primary ACL tears were randomized to undergo the TT, AM portal, or HTT technique for femoral tunnel positioning at the time of reconstruction. All patients underwent 3-dimensional computed tomography of the operative knee at 6 weeks postoperatively. Femoral and tibial tunnel aperture positions and tunnel lengths, as well as graft bending angles in the sagittal and coronal planes, were measured. Results: Tibial tunnel lengths and aperture positions were identical between the 3 groups. The AM portal and HTT techniques achieved identical femoral aperture positions in regard to both height ( P = .629) and depth ( P = .582). By contrast, compared with the AM portal and HTT techniques, femoral apertures created with the TT technique were significantly higher ( P < .001 and P < .001, respectively) and shallower ( P = .014 and P = .022, respectively) in the notch. The mean femoral tunnel length varied significantly between the groups, measuring 35.2, 41.6, and 54.1 mm for the AM portal, HTT, and TT groups, respectively ( P < .001). Last, there was no difference between the mean coronal ( P = .190) and sagittal ( P = .358) graft bending angles between the TT and HTT groups. By contrast, compared with the TT and HTT techniques, femoral tunnels created with the AM portal technique were significantly more angulated in the coronal plane (17.7° [ P < .001] and 12.5° [ P = .006], respectively) and sagittal plane (13.5° [ P < .001] and 10.5° [ P = .013], respectively). Conclusion: This prospective randomized controlled trial found that the HTT technique achieved femoral aperture positions equally as anatomic as the AM portal technique but produced longer, less angulated femoral tunnels, which may help reduce graft strain and mismatch. As such, this hybrid approach may represent a beneficial combination of both the TT and the AM portal techniques. Registration: NCT02795247 (ClinicalTrials.gov identifier)
Postoperative Subchondral Bone Marrow Lesion Is Associated With Graft Extrusion After Lateral Meniscal Allograft Transplantation
Authors: Song Ju-Ho , Bin Seong-Il , Kim Jong-Min , Lee Bum-Sik 
Published: October 2020

Background: Adverse effects of graft extrusion after meniscal allograft transplantation (MAT) are difficult to assess and can be determined only in the long term using a simple radiograph. Recently, subchondral bone marrow lesions (BMLs) detected on magnetic resonance imaging (MRI) scans have been used to evaluate the outcomes or prognoses of various knee surgeries. However, whether subchondral BMLs on MRI scans reflect the effects of allograft extrusion remains unclear. Hypothesis: Subchondral BML in the lateral compartment of the knee joint on postoperative MRI scans would be associated with graft extrusion after lateral MAT. Study Design: Case-control study; Level of evidence, 3. Methods: Overall, 170 patients with lateral MAT between 2008 and 2013 were classified into extrusion (≥3 mm) and nonextrusion (<3 mm) groups based on findings on MRI scans obtained 3 to 6 months postoperatively. Subchondral BMLs in the lateral compartment were evaluated on the latest MRI scans. To exclude any bone marrow signal changes other than those caused by allograft extrusion, the latest MRI scans were compared with those obtained 3 to 6 months postoperatively. Only subchondral BMLs that occurred after that time point were counted. The association between allograft extrusion and subchondral BML was assessed using chi-square analysis. Logistic regression analysis was performed to control other related factors, including age, sex, body mass index, time from previous meniscectomy, alignment, and cartilage status at the time of MAT. Clinical outcomes according to subchondral BML were evaluated using the Lysholm score. Results: Of the 170 patients, 20 (11.8%) had subchondral BML on the latest MRI scans at a mean 53.6 ± 31.2 months postoperatively, with 14 and 6 patients in the extrusion and nonextrusion groups, respectively. Chi-square analysis showed a significant association between allograft extrusion and subchondral BMLs ( P = .025). Logistic regression analysis showed that extrusion and age were significant factors associated with subchondral BML ( P = .011 and .004, respectively). However, no differences were observed in the Lysholm scores in accordance with the subchondral BML ( P = .248). Conclusion: Subchondral BMLs on postoperative MRI scans were associated with graft extrusion after lateral MAT. However, there was no difference in clinical outcomes according to subchondral BML.
Association Between Albumin Level and Mortality Among Cardiac Intensive Care Unit Patients
Authors: Padkins Mitchell , Breen Thomas , Anavekar Nandan , Barsness Gregory , Kashani Kianoush , Jentzer Jacob C. 
Published: October 2020

Purpose: To study the effect of hypoalbuminemia on short- and long-term mortality in Cardiac Intensive Care Unit (CICU) patients. Methods: We reviewed 12,418 unique CICU patients from 2007 to 2018. Hypoalbuminemia was defined as an admission albumin level <3.5 g/dL. Predictors of hospital mortality were identified using multivariable logistic regression. Results: We included 2,680 patients (22%) with a measured admission albumin level. The median age was 68 (39% females). Admission diagnoses included acute coronary syndrome, heart failure, cardiac arrest, and cardiogenic shock. The median albumin level was 3.4 g/dL and 55% of patients had hypoalbuminemia. Hospital mortality occurred in 16%, and patients with hypoalbuminemia had higher hospital mortality (21% vs. 9%, adjusted OR 2.64, 95% CI 2.09-3.34, p < 0.001). Albumin level was inversely associated with hospital mortality (adjusted OR 0.60 per 1 g/dL higher albumin level, 95% CI 0.47-0.75, p <0.001), with a stepwise increase in the hospital mortality at lower albumin levels. Post-discharge mortality was higher in hospital survivors with hypoalbuminemia, and increased as a function of lower albumin levels. Conclusion: Hypoalbuminemia is common in CICU patients and associated with higher short- and long-term mortality. Progressively lower serum albumin was incrementally associated with higher hospital and post-discharge mortality.