bluuebunny/crossref_metadata_2025_split huggingface dataset:
Male–female differences in acute thoracic aortic dissection: a systematic review and meta-analysis
Authors: Meccanici Frederike , Gökalp Arjen L , Thijssen Carlijn G E , Mokhles Mostafa M , Bekkers Jos A , van Kimmenade Roland , Verhagen Hence J , Roos-Hesselink Jolien W , Takkenberg Johanna J M 
Published: September 2021

Abstract

OBJECTIVES
This study aims to systematically review published literature on male–female differences in presentation, management and outcomes in patients diagnosed with acute thoracic aortic dissection (AD).

METHODS
A systematic literature search was conducted for studies published between 1 January 1999 and 19 October 2020 investigating mortality and morbidity in adult patients diagnosed with AD. Patient and treatment characteristics were compared with odds ratios (ORs) and standardized mean differences and a meta-analysis using a random-effects model was performed for early mortality. Overall survival and reoperation were visualized by pooled Kaplan–Meier curves.

RESULTS
Nine studies investigating type A dissections (AD-A), 1 investigating type B dissections (AD-B) and 3 investigating both AD-A and AD-B were included encompassing 18 659 patients. Males were younger in both AD-A (P &lt; 0.001) and AD-B (P &lt; 0.001), and in AD-A patients males had more distally extended dissections [OR 0.57, 95% confidence interval (CI) 0.46–0.70; P &lt; 0.001]. Longer operation times were observed for males in AD-A (standardized mean difference 0.29, 95% CI 0.17–0.41; P &lt; 0.001) while male patients were less often treated conservatively in AD-B (OR 0.65, 95% CI 0.58–0.72; P &lt; 0.001). The pooled early mortality risk ratio for males versus females was 0.94 (95% CI 0.84–1.06, P = 0.308) in AD-A and 0.92 (95% CI 0.83–1.03, P = 0.143) in AD-B. Pooled overall mortality in AD-A showed no male–female difference, whereas male patients had more reinterventions during follow-up.

CONCLUSIONS
This systematic review shows male–female differences in AD patient and treatment characteristics, comparable early and overall mortality and inconsistent outcome reporting. As published literature is scarce and heterogeneous, large prospective studies with standardized reporting of male–female characteristics and outcomes are clearly warranted. Improved knowledge of male–female differences in AD will help shape optimal individualized care for both males and females.

Clinical registration number
PROSPERO, ID number: CRD42020155926.
Epidemiology of Occupational Electrical Injuries
Authors: Salehi Seyed Hamid , Sadat Azad Yasaman , Bagheri Tooran , Ghadimi Tayyeb , Rahbar Arya , Ehyaei Parvin , Momeni Mahnoush 
Published: September 2021

Abstract
Electrical injuries are an uncommon but very destructive type of burn, with serious complications and disabilities for the victims. This study was conducted due to the importance of understanding the epidemiology of electrical accidents in planning to prevent their occurrence. This is a retrospective cross-sectional study that was performed on patients with electrical burns referred to Shahid Motahari Educational and Medical Center from 2017 to 2018. Patients’ information was entered in the researcher-made information registration form, including demographic and accident-related information. In this study, most of the accidents occurred in the workplace with high-voltage electricity. Contact with overhead cables and wires was the most common cause of injury. Excision and graft surgeries were the most common type of surgery. The variables of sex, age, length of hospital stay, and type of job had a significant relationship with the type of voltage (P &lt; .05). The difference between the ratio of men to women and the length of hospitalization in the group of injured with high-voltage electricity was greater and most of these patients were construction workers. The variables of sex, nationality, length of hospital stay, and cause of the accident had a significant relationship with the type of job (P &lt; .05). Construction workers are the main group at risk of electrical damage in Iran. Therefore, it is recommended to conduct more extensive studies in the field of recognizing and implementing practical methods of preventing electrical injuries, especially in high-risk work environments.
Molecular Alterations in Meningioangiomatosis Causing Epilepsy
Authors: Dono Antonio , Pothiawala Azim Z , Lewis Cole T , Bhattacharjee Meenakshi B , Ballester Leomar Y , Tandon Nitin 
Published: September 2021

Abstract
Meningioangiomatosis (MA) is a rare process at the intersection of cerebral developmental and neoplastic disorders that often results in epilepsy. We evaluated molecular alterations in MA to characterize its biology and pathogenesis. We searched a comprehensive institutional database for patients with MA treated between 2004 and 2019. Demographic, clinical, surgical, and radiographical data were collected. MA and associated meningioma tissues were evaluated using a next-generation sequencing assay interrogating 1425 cancer-related genes. We studied 5 cases: 3 with MA and 2 with MA associated with a meningioma. Of the MAs associated with a meningioma, 1 had deletions in the NF2 gene in both the MA and the meningioma components, whereas the other had an NF2 deletion in only the MA component. Additional mutations were identified in the MA components, suggesting that MA arises from the meningioma rather than the meningioma resulting from a transformation of the MA. The 3 cases of pure MA showed variants of unknown significance with no alterations in known oncogenic drivers. Our findings provide a starting point to a better understanding of the pathogenesis of this rare lesion. Our study indicates that MA-meningiomas have a neoplastic nature that differs from the hamartomatous/developmental nature of pure MA.
Tick-borne encephalitis (TBE) in Switzerland: does the prolongation of vaccine booster intervals result in an increased risk of breakthroughs?
Authors: Schmidt Axel J , Altpeter Ekkehardt , Graf Simone , Steffen Robert 
Published: September 2021

Abstract

Background
In 2006, the Swiss Federal Office of Public Health (FOPH) decided recommending a prolongation of vaccine booster intervals after the third dose for the prevention of tick-borne encephalitis (TBE) from 3 to 10 years.

Methods
To ascertain whether this amendment resulted in an increased rate of vaccine breakthroughs, we conducted a retrospective analysis of surveillance data collected 2000–19 by mandatory reporting to the Swiss FOPH. Fractions of breakthroughs [with 95% confidence intervals (CIs)]—0–3 years vs &gt;3–10 years after the third vaccination dose—were compared across time periods and age groups.

Results
Among 3205 notified TBE cases, known vaccination status was reported in 2562 (79.9%), including 103 patients with ≥3 vaccine doses (4.0%). Among those, there were 39 patients who had received the last dose within 3 years and 48 patients in the &gt;3–10 years group. During the 2010–19 period in which the new booster strategy was implemented there were 23 and 38 breakthroughs, respectively, and the annual breakthrough rate was 7.7 (95% CI 5.0–11.7) cases during the first 3 years after the last dose, and 5.4 (95% CI 3.9–7.5) cases in following 7 years. We observed no significant trend of TBE breakthroughs with increasing age. Increasing numbers of TBE and of vaccine breakthroughs over time have been associated with spreading endemicity and higher vaccination coverage in Switzerland.

Conclusions
There is no indication that extended booster intervals resulted in an increased rate of breakthroughs, but there was a marked public health benefit with respect to increased acceptability of TBE immunization in the general population.
Clinical Management of Hospitalized Coronavirus Disease 2019 Patients in the United States
Authors: Mozaffari Essy , Chandak Aastha , Zhang Zhiji , Liang Shuting , Gayle Julie , Thrun Mark , Gottlieb Robert L , Kuritzkes Daniel R , Sax Paul E , Wohl David A , Casciano Roman , Hodgkins Paul , Haubrich Richard 
Published: September 2021

Abstract

Background
The objective of this study was to characterize hospitalized coronavirus disease 2019 (COVID-19) patients and describe their real-world treatment patterns and outcomes over time.

Methods
Adult patients hospitalized on May 1, 2020–December 31, 2020 with a discharge diagnosis of COVID-19 were identified from the Premier Healthcare Database. Patient and hospital characteristics, treatments, baseline severity based on oxygen support, length of stay (LOS), intensive care unit (ICU) utilization, and mortality were examined.

Results
The study included 295657 patients (847 hospitals), with median age of 66 (interquartile range, 54–77) years. Among each set of demographic comparators, the majority were male, white, and over 65. Approximately 85% had no supplemental oxygen charges (NSOc) or low-flow oxygen (LFO) at baseline, whereas 75% received no more than NSOc or LFO as maximal oxygen support at any time during hospitalization. Remdesivir (RDV) and corticosteroid treatment utilization increased over time. By December, 50% were receiving RDV and 80% were receiving corticosteroids. A higher proportion initiated COVID-19 treatments within 2 days of hospitalization in December versus May (RDV, 87% vs 40%; corticosteroids, 93% vs 62%; convalescent plasma, 68% vs 26%). There was a shift toward initiating RDV in patients on NSOc or LFO (68.0% [May] vs 83.1% [December]). Median LOS decreased over time. Overall mortality was 13.5% and it was highest for severe patients (invasive mechanical ventilation/extracorporeal membrane oxygenation [IMV/ECMO], 53.7%; high-flow oxygen/noninvasive ventilation [HFO/NIV], 32.2%; LFO, 11.7%; NSOc, 7.3%). The ICU use decreased, whereas mortality decreased for NSOc and LFO.

Conclusions
Clinical management of COVID-19 is rapidly evolving. This large observational study found that use of evidence-based treatments increased from May to December 2020, whereas improvement in outcomes occurred over this time-period.
New Drugs 2021, Part 2
Authors: Hussar Daniel A. 
Published: September 2021

Abstract:
The second of a two-part series, this article describes eight recently approved drugs, including the first drug approved for the treatment of SARS-CoV-2, a first-in-class HIV attachment inhibitor, and a new intravenous injection indicated for the treatment of acute pain in adults for whom other treatments are ineffective.
Characterizing Substance Use Disorders Among Transgender Adults Receiving Care at a Large Urban Safety Net Hospital
Authors: Braun Hannan M. , Jones Emily K. , Walley Alexander Y. , Siegel Jennifer , Streed Carl G. 
Published: September 2021

Objectives
In the midst of the opioid crisis, increasing attention has been given to assessing and addressing substance use disorders (SUDs) among transgender and gender diverse (TGD) populations. As electronic health records begin to more uniformly collect gender identity data, clinicians and public health professionals are better able to examine the prevalence of SUDs and the receipt of SUD treatment services in these populations.

Methods
We utilized cross-sectional electronic health records data from January 2005 to December 2019 from a large safety-net hospital in Massachusetts. A cohort of TGD patients was identified using self-reported gender identity data as well as diagnostic and procedures codes associated with receipt of gender-affirming care (n = 2000). We calculated odds of SUD diagnosis and receipt of medications for SUD among TGD patients.

Results
Among a cohort of 2000 TGD patients, 8.8% had a SUD diagnosis. SUD diagnoses were more common among older, Black, and transmasculine patients, as well as those holding public health insurance. SUD diagnoses were less likely among those reporting college-level education. Of those with an opioid use disorder (OUD), 46% were prescribed an FDA-approved medication for OUD.

Conclusions
SUD diagnoses among TGD patients were associated with demographic, socioeconomic, and gender-related factors. We found a modestly lower prevalence of non-tobacco SUD among our cohort of TGD patients than the national average of 7.4%. Despite a relatively better receipt of prescription treatment services than the national average, the low rate of treatment overall represents a missed opportunity to address SUDs in these vulnerable populations.
Impact of Cost Information on Parental Decision Making: A Randomized Clinical Trial Evaluating Cast Versus Splint Selection for Pediatric Distal Radius Buckle Fractures
Authors: Lawrence J. Todd R. , MacAlpine Elle M. , Buczek Matthew J. , Horn B. David , Williams Brendan A. , Manning Kassidy , Shah Apurva S. 
Published: September 2021

Background:
Price transparency purports to help patients make high-value health care decisions, however, there is little data to support this. The pediatric distal radius buckle fracture (DRBF) has 2 equally efficacious but not equally priced treatment options (cast and splint), serving as an excellent potential model for studying price transparency. This study uses the DRBF model to assess the impact of up-front cost information on a family’s treatment decisions when presented with clinically equivalent treatment options for a low-risk injury.

Methods:
Participants age 4 to 14 presenting with an acute DRBF to a hospital-based pediatric orthopaedic clinic were recruited for this randomized controlled trial. Participants were randomized into cost-informed or cost-blind cohorts. All families received standardized information about the injury and treatment options. Cost-informed families received additional cost information. Both groups were allowed to freely choose a treatment. Families were surveyed regarding their decision factors. Cost-blinded families were subsequently presented with the cost information and could change their decision. Independent samples t tests and χ2 tests were utilized to evaluate differences.

Results:
A total of 127 patients were enrolled (53% cost-informed, 47% cost-blind). The 2 groups did not significantly differ in demographics. Immobilization selection did not differ between groups, with 48% of the cost-informed families selecting the more expensive option (casting), compared with 47% of the cost-blind families. Cost was the least influential factor in the decision-making process according to participant survey, influencing only 9% of families. Only one family changed their decision after receiving cost information, from a splint to a cast.

Conclusion:
Families appear to be cost-insensitive when making medical treatment decisions for low-risk injuries for their child. Price transparency alone may not help families arrive at a decision to pursue high-value treatment in low-risk orthopaedic injuries.

Level of Evidence:
Level I.
Lumbar Spine Surgery and What We Lost in the Era of the Coronavirus Pandemic
Authors: Arnold Paul M. , Owens Linda , Heary Robert F. , Webb Andrew G. , Whiting Mark D. , Vaccaro Alexander R. , Iyer Ravishankar K. , Harrop James S. 
Published: September 2021

Study Design:
This was a survey of the surgeon members of the Lumbar Spine Research Society (LSRS).

Objective:
The purpose of this study was to assess trends in surgical practice and patient management involving elective and emergency surgery in the early months of the coronavirus pandemic.

Summary of Background Data:
The novel coronavirus has radically disrupted medical care in the first half of 2020. Little data exists regarding the exact nature of its effect on spine care.

Methods:
A 53-question survey was sent to the surgeon members of the LSRS. Respondents were contacted via email 3 times over a 2-week period in late April. Questions concentrated on surgical and clinical practice patterns before and after the pandemic. Other data included elective surgical schedules and volumes, as well as which emergency cases were being performed. Surgeons were asked about the status of coronavirus disease 2019 (COVID-19) virus testing. Circumstances for performing surgical intervention on patients with and without testing as well as patients testing positive were explored.

Results:
A total of 43 completed surveys were returned of 174 sent to active surgeons in the LSRS (25%). Elective lumbar spine procedures decreased by 90% in the first 2 months of the pandemic, but emergency procedures did not change. Patients with “stable” lumbar disease had surgeries deferred indefinitely, even beyond 8 weeks if necessary. In-person outpatient visits became increasingly rare events, as telemedicine consultations accounted for 67% of all outpatient spine appointments. In total, 91% surgeons were under some type of confinement. Only 11% of surgeons tested for the coronavirus on all surgical patients.

Conclusions:
Elective lumbar surgery was significantly decreased in the first few months of the coronavirus pandemic, and much of outpatient spine surgery was practiced via telemedicine. Despite these constraints, spine surgeons performed emergency surgery when indicated, even when the COVID-19 status of patients was unknown.

Level of Evidence:
Level IV.
Evaluating the Balance Between Privacy and Access in Digital Information Sharing
Authors: Beesley Sarah J. , Powell Alex , Groat Danielle , Butler Jorie , Hopkins Ramona O. , Rozenblum Ronen , Aboumatar Hanan , Butler Allison M. , Sugarman Jeremy , Francis Leslie , Brown Samuel M. 
Published: September 2021

OBJECTIVES:
Access to personal health records in an ICU by persons involved in the patient’s care (referred to broadly as “family members” below) has the potential to increase engagement and reduce the negative psychologic sequelae of such hospitalizations. Currently, little is known about patient preferences for information sharing with a designated family member in the ICU. We sought to understand the information-sharing preferences of former ICU patients and their family members and to identify predictors of information-sharing preferences.

DESIGN:
We performed an internet survey that was developed by a broad, multidisciplinary team of stakeholders. Formal pilot testing of the survey was conducted prior to internet survey administration to study subjects.

SETTING:
Internet survey.

Subjects:
Subjects included English-speaking adults who had an ICU experience or a family member with ICU experience between 2013 and 2016. We used panel sampling to ensure an ethnically representative sample of the U.S. population.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
One thousand five hundred twenty surveys were submitted, and 1,470 were included in analysis. The majority of respondents (93.6%) stated that they would want to share present and past medical history, either all or that related to their ICU stay, with a designated family member of their choosing. The majority (79%) would also want their designated family member to be able to access that information from a home computer. Although most respondents preferred to share all types of information, they indicated varying levels of willingness to share specific types of more sensitive information. Information-sharing preferences did not differ by age, sex, ethnicity, or type of prior experience in the ICU (i.e., patient or family member).

CONCLUSIONS:
In the context of an ICU admission, sharing personal health information with a person of the patient’s choosing appears desirable for most patients and family members. Policies and implementation of regulations should take this into consideration.
Exogenous Nicotinamide Adenine Dinucleotide Attenuates Postresuscitation Myocardial and Neurologic Dysfunction in a Rat Model of Cardiac Arrest
Authors: Su Chenglei , Xiao Yan , Zhang Guozhen , Liang Lian , Li Hui , Cheng Cheng , Jin Tao , Bradley Jennifer , Peberdy Mary A. , Ornato Joseph P. , Mangino Martin J. , Tang Wanchun 
Published: September 2021

OBJECTIVES:
To investigate the therapeutic potential and underlying mechanisms of exogenous nicotinamide adenine dinucleotide+ on postresuscitation myocardial and neurologic dysfunction in a rat model of cardiac arrest.

DESIGN:
Thirty-eight rats were randomized into three groups: 1) Sham, 2) Control, and 3) NAD. Except for the sham group, untreated ventricular fibrillation for 6 minutes followed by cardiopulmonary resuscitation was performed in the control and NAD groups. Nicotinamide adenine dinucleotide+ (20 mg/kg) was IV administered at the onset of return of spontaneous circulation.

SETTING:
University-affiliated research laboratory.

SUBJECTS:
Sprague-Dawley rats.

INTERVENTIONS:
Nicotinamide adenine dinucleotide+.

MEASUREMENTS AND MAIN RESULTS:
Hemodynamic and myocardial function were measured at baseline and within 4 hours following return of spontaneous circulation. Survival analysis and Neurologic Deficit Score were performed up to 72 hours after return of spontaneous circulation. Adenosine triphosphate (adenosine triphosphate) level was measured in both brain and heart tissue. Mitochondrial respiratory chain function, acetylation level, and expression of Sirtuin3 and NADH dehydrogenase (ubiquinone) 1 alpha subcomplex, 9 (NDUFA9) in isolated mitochondrial protein from both brain and heart tissue were evaluated at 4 hours following return of spontaneous circulation. The results demonstrated that nicotinamide adenine dinucleotide+ treatment improved mean arterial pressure (at 1 hr following return of spontaneous circulation, 94.69 ± 4.25 mm Hg vs 89.57 ± 7.71 mm Hg; p < 0.05), ejection fraction (at 1 hr following return of spontaneous circulation, 62.67% ± 6.71% vs 52.96% ± 9.37%; p < 0.05), Neurologic Deficit Score (at 24 hr following return of spontaneous circulation, 449.50 ± 82.58 vs 339.50 ± 90.66; p < 0.05), and survival rate compared with that of the control group. The adenosine triphosphate level and complex I respiratory were significantly restored in the NAD group compared with those of the control group. In addition, nicotinamide adenine dinucleotide+ treatment activated the Sirtuin3 pathway, down-regulating acetylated-NDUFA9 in the isolated mitochondria protein.

CONCLUSIONS:
Exogenous nicotinamide adenine dinucleotide+ treatment attenuated postresuscitation myocardial and neurologic dysfunction. The responsible mechanisms may involve the preservation of mitochondrial complex I respiratory capacity and adenosine triphosphate production, which involves the Sirtuin3-NDUFA9 deacetylation.