bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic Value of Preoperative Absolute Lymphocyte Count in Children With Tetralogy of Fallot
Authors: Wu Xie , Luo Qipeng , Su Zhanhao , Li Yinan , Wang Hongbai , Yuan Su , Yan Fuxia 
Published: May 2021

Background
Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Absolute lymphocyte count (ALC) is a low‐cost and easy‐to‐obtain inflammatory indicator; however, its association with the prognosis of patients with TOF remains unknown. This study aimed to determine the prognostic value of preoperative ALC in children with TOF.

Methods and Results

This retrospective study included 707 patients aged <6 years who underwent corrective operations for TOF between January 2016 and December 2018 in Fuwai Hospital, China. The end points were mortality, extracorporeal membrane oxygenation placement, postoperative hospital stay >30 days, and severe postoperative complications; patients were grouped on the basis of prognosis: poor prognosis (n=76) and good prognosis (n=631). Univariable and multivariable logistic regression analyses were performed to identify the independent risk factors for poor prognosis, on which a risk scoring system was based. The receiver operating characteristic curve was used to assess model performance. Using another model without ALC, the effect of the addition of ALC was assessed. Results suggested that ALC was an independent factor with a cutoff point of 4.36×10
9
/L. The addition of ALC improved the area under the curve from 0.771 to 0.781 (
P
<0.001). To avoid reverse causality and further control for confounding factors, the patients were further divided on the basis of ALC level, and a propensity score matching was performed; 117 paired patients were identified for further analysis. Low ALC levels had an odds ratio of 3.500 (95% CI, 1.413–8.672).

Conclusions
Low preoperative ALC represents an independent predictor of poor prognosis in children with TOF.
Circulating Mature PCSK9 Level Predicts Diminished Response to Statin Therapy
Authors: Kuyama Naoto , Kataoka Yu , Takegami Misa , Nishimura Kunihiro , Harada‐Shiba Mariko , Hori Mika , Ogura Masatsune , Otsuka Fumiyuki , Asaumi Yasuhide , Noguchi Teruo , Tsujita Kenichi , Yasuda Satoshi 
Published: May 2021

Background
Statin‐mediated efficacy of lowering low‐density lipoprotein (LDL) cholesterol varies in each individual, and its diminished response is associated with worse outcomes. However, there is no established approach to predict hyporesponse to statins. PCSK9 (proprotein convertase subxilisin/kexin type 9) is a serine‐protease associated with LDL metabolism, which circulates as mature and furin‐cleaved PCSK9. Since mature PCSK9 more potently degrades the LDL receptor, its evaluation may enable the identification of statin hyporesponders.

Methods and Results

We analyzed 101 statin‐naive patients with coronary artery disease who commenced a statin. PCSK9 subtypes at baseline and 1 month after statin use were measured by ELISA. Hyporesponse to statins was defined as a percent reduction in LDL cholesterol <15%. The relationship between each PCSK9 subtype level and hyporesponse to statins was investigated. Statins significantly lowered LDL cholesterol level (percent reduction, 40%±21%), whereas 11% of study participants exhibited a hyporeseponse to statins. Multivariable logistic regression analysis demonstrated that baseline mature PCSK9 level was an independent predictor for hyporesponse to statins even after adjusting clinical characteristics (mature PCSK9 per 10‐ng/mL increase: odds ratio [OR], 1.12; 95% CI, 1.01–1.24 [
P
=0.03]), whereas furin‐cleaved level was not (per 10‐ng/mL increase: OR, 1.37; 95% CI, 0.73–2.58 [
P
=0.33]). Receiver operating characteristic curve analysis identified mature PCSK9 level of 228 ng/mL as an optimal cutoff to predict hyporesponse to statins (area under the curve, 0.73 [sensitivity, 0.91; specificity, 0.56]).

Conclusions
Baseline mature PCSK9 level >228 ng/mL is associated with hyporesponse to statins. This finding suggests that mature PCSK9 might be a potential determinant of hyporesponse to statins.
Sex Differences in the Associations of Visceral Adipose Tissue and Cardiometabolic and Cardiovascular Disease Risk: The Framingham Heart Study
Authors: Kammerlander Andreas A. , Lyass Asya , Mahoney Taylor F. , Massaro Joseph M. , Long Michelle T. , Vasan Ramachandran S. , Hoffmann Udo 
Published: May 2021

Background
Men and women are labeled as obese on the basis of a body mass index (BMI) using the same criterion despite known differences in their fat distributions. Subcutaneous adipose tissue and visceral adipose tissue (VAT), as measured by computed tomography, are advanced measures of obesity that closely correlate with cardiometabolic risk independent of BMI. However, it remains unknown whether prognostic significance of anthropometric measures of adiposity versus VAT varies in men versus women.

Methods and Results
In 3482 FHS (Framingham Heart Study) participants (48.1% women; mean age, 50.8±10.3 years), we tested the associations of computed tomography–based versus anthropometric measures of fat with cardiometabolic and cardiovascular disease (CVD) risk. Mean follow‐up was 12.7±2.1 years. In men, VAT, as compared with BMI, had a similar strength of association with incident cardiometabolic risk factors (eg, adjusted odds ratio [OR], 2.36 [95% CI, 1.84–3.04] versus 2.66 [95% CI, 2.04–3.47] for diabetes mellitus) and CVD events (eg, adjusted hazard ratio [HR], 1.32 [95% CI, 0.97–1.80] versus 1.74 [95% CI, 1.14–2.65] for CVD death). In women, however, VAT, when compared with BMI, conferred a markedly greater association with incident cardiometabolic risk factors (eg, adjusted OR, 4.51 [95% CI, 3.13–6.50] versus 2.33 [95% CI, 1.88–3.04] for diabetes mellitus) as well as CVD events (eg, adjusted HR, 1.85 [95% CI, 1.26–2.71] versus 1.19 [95% CI, 1.01–1.40] for CVD death).

Conclusions
Anthropometric measures of obesity, including waist circumference and BMI, adequately capture VAT‐associated cardiometabolic and cardiovascular risk in men but not in women. In women, abdominal computed tomography–based VAT measures permit more precise assessment of obesity‐associated cardiometabolic and cardiovascular risk.
Impact of Uncontrolled Hypertension at 3 Months After Intracerebral Hemorrhage
Authors: Biffi Alessandro , Teo Kay‐Cheong , Castello Juan Pablo , Abramson Jessica R. , Leung Ian Y. H. , Leung William C. Y. , Wang Yujie , Kourkoulis Christina , Myserlis Evangelos Pavlos , Warren Andrew D. , Henry Jonathan , Chan Koon‐Ho , Cheung Raymond T. F. , Ho Shu‐Leong , Anderson Christopher D. , Gurol M. Edip , Viswanathan Anand , Greenberg Steven M. , Lau Kui‐Kai , Rosand Jonathan 
Published: May 2021

Background
Survivors of intracerebral hemorrhage (ICH) are at high risk for recurrent stroke, which is associated with blood pressure control. Because most recurrent stroke events occur within 12 to 18 months of the index ICH, rapid blood pressure control is likely to be crucial. We investigated the frequency and prognostic impact of uncontrolled short‐term hypertension after ICH.

Methods and Results

We analyzed data from Massachusetts General Hospital (n=1305) and the University of Hong Kong (n=523). We classified hypertension as controlled, undertreated, or treatment resistant at 3 months after ICH and determined the following: (1) the risk factors for uncontrolled hypertension and (2) whether hypertension control at 3 months is associated with stroke recurrence and mortality. We followed 1828 survivors of ICH for a median of 46.2 months. Only 9 of 234 (4%) recurrent strokes occurred before 3 months after ICH. At 3 months, 713 participants (39%) had controlled hypertension, 755 (41%) had undertreated hypertension, and 360 (20%) had treatment‐resistant hypertension. Black, Hispanic, and Asian race/ethnicity and higher blood pressure at time of ICH increased the risk of uncontrolled hypertension at 3 months (all
P
<0.05). Uncontrolled hypertension at 3 months was associated with recurrent stroke and mortality during long‐term follow‐up (all
P
<0.05).

Conclusions
Among survivors of ICH, >60% had uncontrolled hypertension at 3 months, with undertreatment accounting for the majority of cases. The 3‐month blood pressure measurements were associated with higher recurrent stroke risk and mortality. Black, Hispanic, and Asian survivors of ICH and those presenting with severe acute hypertensive response were at highest risk for uncontrolled hypertension.
Risk Stratification of Patients With NonObstructive Coronary Artery Disease Using Resistive Reserve Ratio
Authors: Toya Takumi , Ahmad Ali , Corban Michel T. , Ӧzcan Ilke , Sara Jaskanwal D. , Sebaali Faten , Escaned Javier , Lerman Lilach O. , Lerman Amir 
Published: May 2021

Background
Resistive reserve ratio (RRR), or the ratio of baseline to hyperemic microvascular resistance, has prognostic implications in predicting clinical outcomes in patients with obstructive coronary artery disease. However, its value in patients with angina or ischemia with nonobstructive coronary artery disease is unknown.

Methods and Results

We included 1692 patients with nonobstructive coronary artery disease who underwent invasive coronary vasoreactivity testing. Abnormal coronary flow reserve (CFR, the ratio of hyperemic and baseline resting flow velocities) and RRR were defined as <2.5 and <2.62, respectively. The mortality rate was marginally higher in patients with abnormal CFR (428 patients [25%]) than those with normal CFR (38 [9%] versus 81 [6%];
P
=0.08), and was significantly higher in patients with abnormal RRR (716 patients [42%]) than those with normal RRR (70 [10%] versus 49 [5%],
P
=0.0002) over the median follow‐up of 11.3 years. Patients with abnormal CFR had marginally lower survival than those with normal CFR (log‐rank
P
=0.08). In contrast, patients with abnormal RRR had significantly lower survival than those with normal RRR (log‐rank
P
=0.001). Abnormal RRR was associated with shorter time to death even after adjustment for other covariates (adjusted hazard ratio, 1.63; 95% CI, 1.11–2.38;
P
=0.01).

Conclusions
In patients with no obstructive coronary artery disease, RRR was superior to CFR in predicting long‐term survival. An RRR <2.62 was associated with 1.6 times increased risk of death in patients with nonobstructive coronary artery disease. Indices of coronary microcirculatory resistive reserve comprising flow‐ and pressure‐derived values may reflect underlying microvascular pathology more faithfully than flow‐alone indices like CFR.
Temporal Trends, Clinical Characteristics, and Outcomes of Emergent Coronary Artery Bypass Grafting for Acute Myocardial Infarction in the United States
Authors: Patlolla Sri Harsha , Kanwar Ardaas , Cheungpasitporn Wisit , Doshi Rajkumar P. , Stulak John M. , Holmes David R. , Bell Malcolm R. , Singh Mandeep , Vallabhajosyula Saraschandra 
Published: May 2021

Background
There are limited contemporary data on the use of emergent coronary artery bypass grafting (CABG) in acute myocardial infarction.

Methods and Results

Adult (aged >18 years) acute myocardial infarction admissions were identified using the National (Nationwide) Inpatient Sample (2000–2017) and classified by tertiles of admission year. Outcomes of interest included temporal trends of CABG use; age‐, sex‐, and race‐stratified trends in CABG use; in‐hospital mortality; hospitalization costs; and hospital length of stay. Of the 11 622 528 acute myocardial infarction admissions, emergent CABG was performed in 1 071 156 (9.2%). CABG utilization decreased overall (10.5% [2000] to 8.7% [2017]; adjusted odds ratio [OR], 0.98 [95% CI, 0.98–0.98];
P
<0.001), in ST‐segment–elevation myocardial infarction (10.2% [2000] to 5.2% [2017]; adjusted OR, 0.95 [95% CI, 0.95–0.95];
P
<0.001) and non–ST‐segment–elevation myocardial infarction (10.8% [2000] to 10.0% [2017]; adjusted OR, 0.99 [95% CI, 0.99–0.99];
P
<0.001), with consistent age, sex, and race trends. In 2012 to 2017, compared with 2000 to 2005, admissions receiving emergent CABG were more likely to have non–ST‐segment–elevation myocardial infarction (80.5% versus 56.1%), higher rates of noncardiac multiorgan failure (26.1% versus 8.4%), cardiogenic shock (11.5% versus 6.4%), and use of mechanical circulatory support (19.8% versus 18.7%). In‐hospital mortality in CABG admissions decreased from 5.3% (2000) to 3.6% (2017) (adjusted OR, 0.89; 95% CI, 0.88–0.89 [
P
<0.001]) in the overall cohort, with similar temporal trends in patients with ST‐segment–elevation myocardial infarction and non–ST‐segment–elevation myocardial infarction. An increase in lengths of hospital stay and hospitalization costs was seen over time.

Conclusions
Utilization of CABG has decreased substantially in acute myocardial infarction admissions, especially in patients with ST‐segment–elevation myocardial infarction. Despite an increase in acuity and multiorgan failure, in‐hospital mortality consistently decreased in this population.
Contemporary National Patterns of Eligibility and Use of Novel Cardioprotective Antihyperglycemic Agents in Type 2 Diabetes Mellitus
Authors: Nargesi Arash A. , Jeyashanmugaraja Gini P. , Desai Nihar , Lipska Kasia , Krumholz Harlan , Khera Rohan 
Published: May 2021

Background
SGLT‐2 (sodium glucose transporter‐2) inhibitors and GLP‐1RAs (glucagon‐like peptide‐1 receptor agonists) effectively lowered cardiovascular risk in large clinical trials for patients with type 2 diabetes mellitus at high risk for these complications, and have been recommended by guidelines. To evaluate the contemporary landscape in which these recommendations would be implemented, we examined the use of these medications according to clinical guideline practice.

Methods and Results
In the National Health and Nutrition Examination Survey for 2017 to 2018, we defined compelling indications for SGLT‐2 inhibitors by the presence of atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease, and for GLP‐1RAs by the presence of established or high‐risk atherosclerotic cardiovascular disease, based on large clinical trials that have been incorporated in guideline recommendations of the American College of Cardiology and American Diabetes Association. We then evaluated use of these medications among patients with physician‐diagnosed type 2 diabetes mellitus. All analyses incorporated complex survey design to produce nationally representative estimates. A total 1104 of 9254 sampled individuals had type 2 diabetes mellitus, representing 10.6% (95% CI, 9.7%–11.6%) of the US population or 33.2 million adults nationally. Of these, 52.6% (95% CI, 47.7%–57.5%) had an indication for SGLT‐2 inhibitors, 32.8% (95% CI, 28.8%–37.2%) for GLP‐1RAs, and 26.6% (95% CI, 22.2%–31.7%) for both medications. During 2017 to 2018, 4.5% (95% CI, 2.4%–8.2%) were treated with SGLT‐2 inhibitors and 1.5% (95% CI, 0.7%–3.2%) with GLP‐1RAs. Atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease were not independently associated with SGLT‐2 inhibitor or GLP‐1RA use in patients with diabetes mellitus.

Conclusions
Despite a large number of patients being eligible for guideline‐recommended cardiorenal protective therapies, there are substantial gaps in the use of SGLT‐2 inhibitors and GLP‐1RAs, limiting their public health benefits.
Missions and the Construction of Gender in the Middle East
Authors: Gabry-Thienpont Séverine , Neveu Norig 
Published: May 2021

Abstract
The introduction to this special issue considers interdisciplinary approaches to the study of gender within missions to the Middle East, from the nineteenth century to the present. By highlighting the piecemeal nature of existing historical and anthropological research, it throws light on the transnational dynamics and gendered constructions of missionary activity, along with its nationalist dimensions. The studies presented here examine long-term gendered constructions of missionary activities in ways that encompass both femininities and masculinities, along with constructions of womanhood and manhood. By putting the question of gender at the heart of their works, the contributors to this special issue affirm the centrality of gendered approaches for understanding the social, cultural and religious relationships between missionaries and local peoples whom they encountered.
When the Physician Becomes an Apostle
Authors: Langhendries Maarten , Wils Kaat 
Published: May 2021

Abstract
Missionary medicine, especially healthcare offered by Catholic missions, is a rather neglected field in the study of colonial medicine. In addition, the potential of analytical tools such as the circulation of knowledge or attention for professional identities has not been fully explored yet. In this study of physicians in the Belgian Congo, we argue that a new professional identity – or persona – of the Catholic colonial doctor arose as a result of Catholic religious doctrine, missionary politics and biomedical developments. The persona of the mission’s main healthcare provider, with a strong commitment to curative medicine, was a metropolitan professional identity shaped by older missionary narratives. In colonial day-to-day reality, however, where tensions between physicians, missionaries and state officials abounded, this discursive identity proved difficult to maintain.
“Have You Ever Been Told That God Loves You?”
Authors: Aupiais Armand 
Published: May 2021

Abstract
This article focuses on the division of religious labour according to both gender and marital situation, based on an ethnographic survey in a Pentecostal church with a mixed membership in Istanbul (Turkey). Following the description of religious labour throughout its six areas, this research shows that celibacy is made relatively invisible inside the church, where the emphasis is on conjugality and family, while the latter bonds are de-emphasised in the outside world, where singles are at the forefront. “Love” appears as a multifaceted reality, encompassing not only justifications but the very output of religious labour, inside and outside the faith community.
American Missionaries in Egypt, Gender Relations, and the Professional and Social Formation of Women, 1854–1967
Authors: Sharkey Heather J. 
Published: May 2021

Abstract
This article considers the impact that the American Presbyterian mission in Egypt (1854–1967) exerted on American and Egyptian women, by expanding career opportunities and roles in church life and promoting new ideas about gender relations, sexuality, and family. It uses American women doctors and Egyptian Bible Women as case studies for female professionalism. Questioning the premise that influence moved one way, from American missionaries towards Egyptians, this study rejects triumphalist narratives about American progress in the gender domain; develops the story of missionary encounters as a bumpy two-way street; and shows how American and Egyptian women struggled to seize opportunities amid persistent gender discrimination. The article discusses the dearth of sources about these women, a shortfall that widens the gender gap in historical representation, requiring us to read between the lines.
Masculinity, Industrial Education and Fascism in Egypt
Authors: Turiano Annalaura 
Published: May 2021

Abstract
Starting from the premise that school is a ‘major site of masculinity formation’ (Connell, 1996), this article studies the construction of boyhood in the industrial schools of the Salesian mission in Egypt between 1900 and 1939. Analysis of the teaching tools and methods, and of the processes of conformity used in these schools run by Italian missionaries, reveals that they became forums for confrontation and negotiation between different models of masculinity. This article uses the case study of the Salesian schools to shed new light on the interconnections between missionary programmes, fascist imperialism and schooling strategies of the pupils and their families. Ultimately, it seeks to demonstrate how missionary schools contributed to the gendered construction of technical expertise and industrial education in Egypt.
The Right to Freedom of Thought in the United Kingdom
Authors: Cranmer Frank 
Published: May 2021

Abstract
The United Kingdom is bound by international obligations to uphold “the right to freedom of thought, conscience and religion” and domestic legislation reflects those obligations. The courts have held that to be protected, a belief must genuine, must not be a mere opinion, must attain a certain level of cogency, seriousness and importance and must be “worthy of respect in a democratic society”. How this plays out, however, in areas such as education, children’s rights and employment is highly sensitive to the specific facts of each case – which are often inconsistent, as the article explains. Much of the article examines the decisions of the courts in individual cases. It concludes with a discussion of the possible trajectory of domestic political debate at a time when there have been repeated calls for a “British Bill of Rights” and the Westminster Government is questioning more generally the constitutional role of the judiciary.
Adverse birth outcomes and associated factors among mothers who delivered in Bale zone hospitals, Oromia Region, Southeast Ethiopia
Authors: Degno Sisay , Lencha Bikila , Aman Ramato , Atlaw Daniel , Mekonnen Ashenafi , Woldeyohannes Demelash , Tekalegn Yohannes , Hailu Sintayehu , Woldemichael Bedasa , Nigussie Ashebir 
Published: May 2021

Objective Adverse birth outcomes, which include stillbirth, preterm birth, low birthweight, congenital abnormalities, and stillbirth, are the leading cause of neonatal and infant mortality worldwide. We assessed adverse birth outcomes and associated factors among mothers who gave birth in Bale zone hospitals, Oromia, Southeast Ethiopia. Methods We used systematic random sampling in this cross-sectional study. We identified factors associated with adverse birth outcomes using bivariate analysis and multivariable logistic regression analysis. Results The proportion of adverse birth outcomes among participants was 21%. Of 576 births, 70 (12.2%) were low birthweight, 49 (8.5%) were preterm birth, 45 (7.8%) were stillbirth, and 18 (3.1%) infants had congenital anomalies. Inadequate antenatal care (adjusted odds ratio [AOR] = 6.58, 95% confidence interval [CI] 3.25–13.32), multiple pregnancy (AOR  =  4.74, 95% CI 1.55–14.45), premature rupture of membranes in the current pregnancy (AOR = 2.31, 95% CI 1.26–4.21), hemoglobin level  < 11 g/dL (AOR = 3.22, 95% CI 1.85–5.58), and mid-upper arm circumference less than 23 cm (AOR = 5.93, 95% CI 3.49–10.08) were all significantly associated with adverse birth outcomes. Conclusions Approximately one in five study participants had adverse birth outcomes. Increasing antenatal care uptake, ferrous supplementation during pregnancy, and improving the quality of maternal health services are recommended.