bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tobacco Use Status as a Function of Transgender Identity: The Mediating Role of Psychological Distress
Authors: Kittaneh Ahmad A , Patel Sweta , Sidhu Natasha K , Lechner William V , Kenne Deric R 
Published: March 2021

Aim: The current study examined differences between individuals identifying as transgender and people identifying as cisgender in terms of (1) psychological distress (eg, anxiety, depression, and suicidal ideation), (2) rates of combustible and e-cigarette use, and (3) the potential for elevated psychological distress stemming from transgender identification to be associated with increased rates of smoking and vaping. Method: This was a secondary analysis of data from a study examining behavioral health, perceptions and behaviors associated with alcohol and other drug use, and mental health status at a large mid-western university. Differences in current use of cigarette and e-cigarette products were examined between self-identified transgender (n = 253) and cisgender (n = 18 371) respondents. Results: Overall, 17.2% (n = 2727) of the sample endorsed past 30-day use of cigarettes or e-cigarettes. Results demonstrated a significant effect of gender identity, with individuals identifying as transgender reporting higher odds of using cigarettes or e-cigarettes (AOR = 2.82, 95% CI 1.26-6.31). Regression analyses revealed significant effects of transgender identity on symptoms of anxiety ( b = 3.45, 95% CI = 1.64, 5.25, P < .001.); depression, ( b = 4.14, 95% CI = 2.21, 6.07, P < .001); and suicidal ideation, ( b = 2.51, 95% CI = 1.48, 3.55, P < .001.), respectively. Finally, we observed significant indirect effects of transgender identity on cigarette and e-cigarette product use via increased symptoms of depression (indirect effect = 0.13, 95% CI [0.07, 0.19], P < .05), and suicidal ideation (indirect effect = 0.22, 95% CI [0.15, 0.28], P < .05), but not symptoms of anxiety. Discussion: This is the first study of our knowledge to examine the association between psychological symptoms and smoking and vaping products with transgender identity. The results of this study support previous findings that transgender individuals are at risk for elevated substance use and extend the literature by demonstrating this this risk is associated with elevated psychological distress.
Delphi Consensus Recommendations on Management of Dosing, Adverse Events, and Comorbidities in the Treatment of Idiopathic Pulmonary Fibrosis with Nintedanib
Authors: Rahaghi Franck , Belperio John A , Fitzgerald John , Gulati Mridu , Hallowell Robert , Highland Kristin B , Huie Tristan J , Kim Hyun J , Kolb Martin , Lasky Joseph A , Southern Brian D , Swigris Jeffrey J , de Andrade Joao A 
Published: March 2021

Purpose: Nintedanib is an approved treatment for idiopathic pulmonary fibrosis (IPF), which slows disease progression. Management of patients with IPF receiving nintedanib can be complicated by tolerability issues, comorbidities, and concomitant medications. We developed consensus recommendations on the management of dosing, adverse events and comorbidities in patients with IPF treated with nintedanib. Methods: A modified Delphi process using 3 questionnaires was used to survey 14 pulmonologists experienced in using nintedanib. Panelists rated their agreement with statements on a Likert scale from −5 (strongly disagree) to +5 (strongly agree). Consensus was predefined as a mean score of ⩽−2.5 or ⩾+2.5 with a standard deviation not crossing zero. Results: The panelists’ recommendations were largely aligned with clinical trial data, real-world evidence, and the prescribing information, and provided additional guidance regarding minimizing gastrointestinal effects, periodic monitoring for liver dysfunction, caution with respect to concomitant administration of cytochrome P450 3A4 and P-glycoprotein 1 inhibitors and inducers and anticoagulants, and management of comorbidities. The panelists unanimously agreed that adverse event management should be individualized, based on careful consideration of the risks and benefits of each possible intervention and discussion with the patient. Conclusions: These consensus recommendations provide additional guidance on the appropriate management of IPF with nintedanib, for use alongside evidence-based literature and the prescribing information.
The value of imaging and clinical outcomes in a phase II clinical trial of a lysophosphatidic acid receptor antagonist in idiopathic pulmonary fibrosis
Authors: Kim Grace Hyun J. , Goldin Jonathan G. , Hayes Wendy , Oh Andrea , Soule Benjamin , Du Shuyan 
Published: March 2021

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic lung disease characterized by worsening dyspnea and lung function and has a median survival of 2–3 years. Forced vital capacity (FVC) is the primary endpoint used most commonly in IPF clinical trials as it is the best surrogate for mortality. This study assessed quantitative scores from high-resolution computed tomography (HRCT) developed by machine learning as a secondary efficacy endpoint in a 26-week phase II study of BMS-986020 – an LPA1 receptor antagonist – in patients with IPF. Methods: HRCT scans from 96% (137/142) of randomized subjects were utilized. Quantitative lung fibrosis (QLF) scores were calculated from the HRCT images. QLF improvement was defined as ⩾2% reduction in QLF score from baseline to week 26. Results: In the placebo arm, 5% of patients demonstrated an improvement in QLF score at week 26 compared with 15% and 27% of patients in the BMS-986020 600 mg once daily (QD) and twice daily (BID) arms, respectively [ versus placebo: p = 0.08 (600 mg QD); p = 0.0098 (600 mg BID)]. Significant correlations were found between changes in QLF and changes in percent predicted FVC, diffusing capacity for carbon monoxide (DLCO), and shortness of breath at week 26 ( ρ = −0.41, ρ = −0.22, and ρ = 0.27, respectively; all p < 0.01). Conclusions: This study demonstrated the utility of quantitative HRCT as an efficacy endpoint for IPF in a double-blind, placebo-controlled clinical trial setting. The reviews of this paper are available via the supplemental material section.
Cycling-Related Injuries During COVID-19 Lockdown: A North London Experience
Authors: Mumtaz Shadaab , Cymerman James , Komath Deepak 
Published: March 2021

Objectives: There has been a notable surge in cycling injuries during the COVID-19(SARS-CoV-2 virus) pandemic. Cycling in general increased during lockdown as a leisure & fitness activity along with reduction in the use of public transport for commuting. We investigated the bicycle-related maxillofacial injuries & associations presenting through our emergency department(ED) which covers more than 1.6 million of London population. Study Design/Methods: A retrospective observational study was undertaken in the Barnet General Hospital (“hub”) which receives all maxillofacial referrals from 6 “spoke” hospitals & other urgent primary/community care practices in North London area between 16 March 2020 & 16 July 2020. All data corresponding to cycling injuries during the lockdown period was analyzed with the aid of trauma database/trust-wide electronic patient records. Results: Twenty-two patients (6.7%) with cycling-related injuries out of a total of 322 patients who attended during the 4 months study period with maxillofacial emergencies were identified. Average age of patient cohort was 35.4 years, mainly consisting of adult males (77%). Seven patients had minor head injury and 1 patient suffered traumatic brain injury. About 59% patients did not wear a protective helmet & 3 patients had heavy alcohol/recreational drug intoxication during the accidents. Four patients needed inpatient admission and treatment under general anesthesia. Conclusions: Based on our humble study, we advocate the need for robust road & personal safety measures with mandatory government legislations, policing of drug intoxication & encouragement of physical & mental health improvement measures during these unprecedented times & beyond.
Clinical experience of using virtual 3D modelling for pre and intraoperative guidance during robotic-assisted partial nephrectomy
Authors: Berger Lorenz , Gulamhusein Aziz , Hyde Eoin , Gibb Matt , Kuusk Teele , Neves Joana , Silva Pedro , Marchetti Marta , Barod Ravi , Tran Maxine , Patki Prasad , Bex Axel , Ourselin Sebastien , Dasgupta Prokar , Mumtaz Faiz 
Published: March 2021

Objective: Surgical planning for robotic-assisted partial nephrectomy is widely performed using two-dimensional computed tomography images. It is unclear to what extent two-dimensional images fully simulate surgical anatomy and case complexity. To overcome these limitations, software has been developed to reconstruct three-dimensional models from computed tomography data. We present the results of a feasibility study, to explore the role and practicality of virtual three-dimensional modelling (by Innersight Labs) in the context of surgical utility for preoperative and intraoperative use, as well as improving patient involvement. Methods: A prospective study was conducted on patients undergoing robotic-assisted partial nephrectomy at our high volume kidney cancer centre. Approval from a research ethics committee was obtained. Patient demographics and tumour characteristics were collected. Surgical outcome measures were recorded. The value of the three-dimensional model to the surgeon and patient was assessed using a survey. The prospective cohort was compared against a retrospective cohort and cases were individually matched using RENAL (radius, exophytic/endophytic, nearness to collecting system or sinus, anterior/posterior, location relative to polar lines) scores. Results: This study included 22 patients. Three-dimensional modelling was found to be safe for this prospective cohort and resulted in good surgical outcome measures. The mean (standard deviation) console time was 158.6 (35) min and warm ischaemia time was 17.3 (6.3) min. The median (interquartile range) estimated blood loss was 125 (50–237.5) ml. Two procedures were converted to radical nephrectomy due to the risk of positive margins during resection. The median (interquartile range) length of stay was 2 (2–3) days. No postoperative complications were noted and all patients had negative surgical margins. Patients reported improved understanding of their procedure using the three-dimensional model. Conclusion: This study shows the potential benefit of three-dimensional modelling technology with positive uptake from surgeons and patients. Benefits are improved perception of vascular anatomy and resection approach, and procedure understanding by patients. A randomised controlled trial is needed to evaluate the technology further. Level of evidence: 2b
Use of pedicled dartos flap wrap around technique in elaborarted perineal repair of complex pelvic fracture urethral distraction defect
Authors: Hardev Bhatyal , Ankur Arya , Vineet Narang 
Published: March 2021

Objectives: To describe the use of a pedicled dartos flap between the pubic bone and bulbar urethra after elaborate perineal urethroplasty in complex pelvic fracture urethral distraction defect. This is to prevent the risk of entrapment of the anastomotic area within a fibrous scar and hence prevent the risk of urethral stricture recurrence. Our objective is also to theorise the entity of bulbar urethral entrapment to describe the trapping of the bulbar urethra by fibrosis after extensive bone resection in complex cases of pelvic fracture urethral distraction defect. Methods: Ten patients with complex pelvic fracture urethral distraction defect underwent perineal urethroplasty at our institution from 2017 to 2019. Urethroplasty was done using the elaborated perineal approach in the standard fashion. Pedicled fibrofatty tissue along with dartos from the scrotum was used to separate the site of urethral anastomosis from the bare pubic bone and fill the dead space. Results: All patients are asymptomatic with no stricture recurrence in follow-up. Conclusions: Vascularised pedicle flap should become an important tenant in the elaborated perineal repair of complex pelvic fracture urethral distraction defect. It provides an ideal option in this scenario by decreasing the risk of urethral stricture recurrence without adding morbidity and minimum extra operative time. Level of evidence: Not applicable.
One-year experience of government-funded magnetic resonance imaging prior to prostate biopsy: A case for omitting biopsy in men with a negative magnetic resonance imaging
Authors: El-Khoury Hanna J , Sathianathen Niranjan J , Jiao Yuxin , Farzan Reza , Gyomber Dennis , Niall Owen , Satasivam Prassannah 
Published: March 2021

Objectives: This study aimed to characterise the accuracy of multiparametric magnetic resonance imaging (mpMRI) as an adjunct to prostate biopsy, and to assess the effect of the new Australian Medicare rebate on practice at a metropolitan public hospital. Patients and methods: We identified patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsy at a single institution over a two-year period. Patients were placed into two groups, depending upon whether their consent was obtained before or after the introduction of the Australian Medicare rebate for mpMRI. We extracted data on mpMRI results and TRUS-guided biopsy histopathology. Descriptive statistics were used to demonstrate baseline patient characteristics as well as MRI and histopathology results. Results: A total of 252 patients were included for analysis, of whom 128 underwent biopsy following the introduction of the Medicare rebate for mpMRI. There was a significant association between Prostate Imaging Reporting and Data System v2 (PI-RADS) classification and the diagnosis of clinically significant prostate cancer ( p<0.01). Only one man with PI-RADS ⩽2 was found to have clinically significant prostate cancer. Four men with a PI-RADS 3 lesion were found to have clinically significant cancer. A PI-RADS 4 or 5 lesion was significantly associated with the diagnosis of clinically significant cancer on multivariable analysis. Conclusion: mpMRI is an important adjunct to biopsy in the diagnosis of clinically significant prostate cancer. Our findings support the safety of omitting/delaying prostate biopsy in men with negative mpMRI. Level of evidence: Level 3 retrospective case-control study.
The Relationship Between Market Environment Dimensions and Availability of Malaria Pills in Uganda
Authors: Nagitta Oluka Pross , Mkansi Marcia , Kajjumba George William 
Published: March 2021

Introduction This study sought to examine the contribution of relationship building (in terms of collaboration, information sharing and supply chain interdependence) on the availability of malaria treatment pills in public hospitals in Sub-Saharan Africa using data from Uganda. Methods By means of a cross-sectional survey research design, the study used a questionnaire strategy to collect quantitative data. Out of the 320 questionnaires that were distributed in 40 public hospitals, 283 were answered and returned, which yielded an 88% response rate. Structural equation modelling (SEM) was used to establish the relationship between measured variables and latent constructs. Results Drawing on the survey results, the confirmatory factor analysist and the Structural Equation Modelling clearly demonstrate that relationship building (in terms of collaboration, information sharing and supply chain interdependence) significantly influences the availability of Artemisinin-based combination therapies in public general hospitals in Uganda. Conclusion Policy-makers should focus on developing cheaper information technology tools to exchange information regarding stock levels, forecasting, quantification, orders, and dispensing. This study developed a measurement model for an inter-hospital relationship, using relational view theory, and it employs dimensions in terms of information sharing and supply chain interdependence to predict and explain the availability of malaria pills in government hospitals.
Annular Defects Impair the Mechanical Stability of the Intervertebral Disc
Authors: Chen Jun-Xin , Li Yun-He , Wen Jian , Li Zhen , Yu Bin-Sheng , Huang Yong-Can 
Published: March 2021

Study Design: A biomechanical study. Objectives: The purpose of this study was to investigate the effects of cruciform and square incisions of annulus fibrosus (AF) on the mechanical stability of bovine intervertebral disc (IVD) in multiple degrees of freedom. Methods: Eight bovine caudal IVD motion segments (bone-disc-bone) were obtained from the local abattoir. Cruciform and square incisions were made at the right side of the specimen’s annulus using a surgical scalpel. Biomechanical testing of three-dimensional 6 degrees of freedom was then performed on the bovine caudal motion segments using the mechanical testing and simulation (MTS) machine. Force, displacement, torque and angle were recorded synchronously by the MTS system. P value <.05 was considered statistically significant. Results: Cruciform and square incisions of the AF reduced both axial compressive and torsional stiffness of the IVD and were significantly lower than those of the intact specimens ( P < .01). Left-side axial torsional stiffness of the cruciform incision was significantly higher than a square incision ( P < .01). Neither incision methods impacted flexional-extensional stiffness or lateral-bending stiffness. Conclusions: The cruciform and square incisions of the AF obviously reduced axial compression and axial rotation, but they did not change the flexion-extension and lateral-bending stiffness of the bovine caudal IVD. This mechanical study will be meaningful for the development of new approaches to AF repair and the rehabilitation of the patients after receiving discectomy.
The effects of chitosan addition to glass ionomer cement on microhardness and surface roughness
Authors: Soygun Koray , Soygun Arzu , Dogan Muharrem Cem 
Published: March 2021

Objective: The aim of this study was to investigate the surface microhardness and roughness properties of a modified glass ionomer cement formed by adding different ratios of Chitosan, when exposed to saliva and acid erosive gastric acid cycle environments. Methods: Chitosan was added to conventional glass ionomer liquid at volumes of 5% and 10%. The chitosan-modified glass ionomer was used for the experimental group, and traditional glass ionomer formed the control group. All the groups were separated into two subgroups. One of these subgroups was subjected to a gastric acid erosive cycle. The other subgroup was immersed in artificial saliva. Microhardness, surface roughness with optical profilometer and AFM measurements of all the samples were taken. Qualitative surface topographic evaluations were made using a SEM. The data were analyzed by Kruskal-Wallis and Mann Whitney U-test for pairwise comparisons of the groups at the 0.05 level of significance. Results: The addition of chitosan to GIC had a positive effect on the microhardness values. The gastric acid erosive cycle application negatively affected the microhardness and surface roughness properties of the sample groups. Conclusion: The chitosan-modified glass ionomer cement samples showed clinically acceptable surface roughness values. Although the results of the addition of the biopolymer, chitosan, to GIC are promising, there is a need for further in-vivo studies.
Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management
Authors: Maffulli Nicola , Oliva Francesco , Maffulli Gayle D. , Migliorini Filippo 
Published: March 2021

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.
Immunosuppression use in early systemic sclerosis may be increasing over time
Authors: Park Ryan , Nevskaya Tatiana , Baron Murray , Pope Janet E 
Published: March 2021

Background: Immunosuppression remains the main treatment for progressing skin involvement, interstitial lung disease and inflammatory joint or muscle disease in systemic sclerosis. This study investigated the pattern and trends in immunosuppressive agents used in early systemic sclerosis (diagnosed before and after 2007) to determine whether the changes in the preferred type, timing and combination of immunosuppression took place over the past decade. Methods: In total, 397 Canadian Scleroderma Research Group database patients (183 diffuse cutaneous systemic sclerosis and 214 limited cutaneous systemic sclerosis) who had baseline and follow-up visits within 3 years (mean: 1.8 ± 0.8) after disease onset were included: 82% females, age at diagnosis 53 ± 13 years. Bivariate, chi-square, analysis of variance and adjusted regression analyses were used. Results: In total, 115 diffuse cutaneous systemic sclerosis patients (63%) and 62 limited cutaneous systemic sclerosis (29%) received immunosuppressive drugs, most commonly methotrexate, followed by mycophenolate mofetil and cyclophosphamide. In diffuse cutaneous systemic sclerosis, immunosuppressants were prescribed after 2007 more often (74% vs 50%, p = 0.001), especially methotrexate ( p = 0.02) and mycophenolate mofetil ( p = 0.04), and earlier (peak at 2 years after onset). Immunosuppressive therapy was associated with male gender, interstitial lung disease, anti-Scl70 positivity, ACA negativity and inflammatory joint disease in limited cutaneous systemic sclerosis and with ACA negativity and a higher modified Rodnan skin score in diffuse cutaneous systemic sclerosis. Multivariate regression analysis showed that the use of immunosuppressants after 2007 was predicted only by ACA negativity in limited cutaneous systemic sclerosis and by younger age in diffuse cutaneous systemic sclerosis. Conclusion: Over the past decade, there has been a trend to prescribe immunosuppressants more often and earlier in diffuse cutaneous systemic sclerosis patients, regardless of modified Rodnan skin score. Methotrexate is being more frequently used, and mycophenolate mofetil has gained favour over cyclophosphamide. Autoantibody status was the most consistent predictor of immunosuppressive therapy.