bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ex vivo biomechanical comparison of four Center of Rotation Angulation Based Leveling Osteotomy fixation methods
Authors: Whitney Melody E. , Butler James R. , Dycus David L. , Teer Landon B. , Elder Steve H. , Priddy Lauren B. , Wills Robert W. 
Published: August 2021

AbstractObjectiveTo compare the strength of four constructs used to secure an osteotomy in a Center of Rotation Angulation (CORA)‐Based Leveling Osteotomy (CBLO) in an ex vivo model.Study designEx vivo study.Sample populationThirty‐two canine tibiae from 17 skeletally mature cadavers weighing between 18 and 33.2 kg.MethodsThirty‐two paired tibiae with patella and patellar tendon were collected. Each tibia was randomly allocated to a construct group: plate and pin (Plate), plate with countersink compression screw (HCS), plate with tension band (TB), or plate with HCS and TB (HCSTB). Samples were loaded by distraction until failure. The stiffness, yield load, and ultimate load were compared between each fixation method.ResultsNo difference in stiffness of the constructs was detected between groups (p = .6937). Yield load for the HCSTB group (1211.06 N) was greater than the TB group (1016.41 N), the HCS group (907.20 N), and the Plate group (787.73 N) (p = .0069). The ultimate load for the HCSTB group (1387.82 N) was greater than the TB group (1076.36 N), HCS group (926.62 N), and the Plate group (774.35 N) (p = .0004).ConclusionsCBLO fixation augmented with a TB and HCS provided a stronger construct that withstood a greater yield load and ultimate load than either augmentation strategy alone.Clinical significanceAugmenting a CBLO fixation with a TB and a HCS can provide increased construct strength.
Inclusive Physical Education: A Critical Discourse Analysis of the Ontario Secondary School Health and Physical Education Curriculum
Authors: Selkirk Enid K. , Missiuna Cheryl , Moll Sandra , Rosenbaum Peter , Campbell Wenonah 
Published: August 2021

Purpose: Education policies require inclusive practices across student learning environments internationally. In Canada, provinces and territories oversee their own curriculum development. This study presents a critical discourse analysis of how inclusive education is addressed within Ontario’s 2015 Health and Physical Education Curriculum, Grades 9–12. Method: Fairclough and Chouliaraki’s approach to critical discourse analysis, which encompasses structural, linguistic, and interdiscursive analysis, was used to show how language is interwoven within ideologies of physical education to represent inclusivity. Results: Three discourses were identified: (a) the discourse of equity and inclusion, (b) the discourse of opportunity, and (c) the discourse of positive outcomes. The curriculum reflects inclusivity through overt language and intention, holding the possibility for choice and opportunities beyond traditional notions of physical education. Discussion: Concerns included whether ideals presented in the curriculum reflect the realities of “discourse in action.” Transformative discourses within physical education should emerge from the student voice.
Novel CSL bounds from the noise-induced radiation emission from atoms
Authors: Donadi Sandro , Piscicchia Kristian , Del Grande Raffaele , Curceanu Catalina , Laubenstein Matthias , Bassi Angelo 
Published: August 2021

AbstractWe study spontaneous radiation emission from matter, as predicted by the Continuous Spontaneous Localization (CSL) collapse model. We show that, in an appropriate range of energies of the emitted radiation, the largest contribution comes from the atomic nuclei. Specifically, we show that in the energy range $$E\sim 10\,-\,10^{5}$$

E
∼
10

-

10
5

keV the contribution to the radiation emission from the atomic nuclei grows quadratically with the atomic number of the atom, overtaking the contribution from the electrons, which grows only linearly. This theoretical prediction is then compared with the data from a dedicated experiment performed at the extremely low background environment of the Gran Sasso underground National Laboratory, where the radiation emitted form a sample of Germanium was measured.As a result, we obtain the strongest bounds on the CSL parameters for $$r_C\le 10^{-6}$$

r
C

≤

10

-
6

m, improving the previous ones by more than an order of magnitude.
Prevalence and Incidence of Heart Failure Among Urban Patients in China: A National Population-Based Analysis
Authors: Wang Hua , Chai Ke , Du Minghui , Wang Shengfeng , Cai Jian-Ping , Li Yingying , Zeng Ping , Zhu Wanrong , Zhan Siyan , Yang Jiefu 
Published: August 2021

Background:
Large-scale and population-based studies of heart failure (HF) incidence and prevalence are scarce in China. The study sought to estimate the prevalence, incidence, and cost of HF in China.

Methods:
We conducted a population-based study using records of 50.0 million individuals ≥25 years old from the national urban employee basic medical insurance from 6 provinces in China in 2017. Incident cases were individuals with a diagnosis of HF (International Classification of Diseases code, and text of diagnosis) in 2017 with a 4-year disease-free period (2013–2016). We calculated standardized rates by applying age standardization to the 2010 Chinese census population.

Results:
The age-standardized prevalence and incidence were 1.10% (1.10% among men and women) and 275 per 100 000 person-years (287 among men and 261 among women), respectively, accounting for 12.1 million patients with HF and 3.0 million patients with incident HF ≥25 years old. Both prevalence and incidence increased with increasing age (0.57%, 3.86%, and 7.55% for prevalence and 158, 892, and 1655 per 100 000 person-years for incidence among persons who were 25–64, 65–79, and ≥80 years of age, respectively). The inpatient mean cost per-capita was $4406.8 and the proportion with ≥3 hospitalizations among those hospitalized was 40.5%. The outpatient mean cost per-capita was $892.3.

Conclusions:
HF has placed a considerable burden on health systems in China, and strategies aimed at the prevention and treatment of HF are needed.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: ChiCTR2000029094.
LAMP2
Cardiomyopathy: Consequences of Impaired Autophagy in the Heart
Authors: Alcalai Ronny , Arad Michael , Wakimoto Hiroko , Yadin Dor , Gorham Joshua , Wang Libin , Burns Elia , Maron Barry J. , Roberts William C. , Konno Tetsuo , Conner David A. , Perez‐Atayde Antonio R. , Seidman Jon G. , Seidman Christine E. 
Published: August 2021

Background

Human mutations in the X‐linked lysosome‐associated membrane protein‐2 (
LAMP2
) gene can cause a multisystem Danon disease or a primary cardiomyopathy characterized by massive hypertrophy, conduction system abnormalities, and malignant ventricular arrhythmias. We introduced an
in‐frame LAMP2 gene exon 6 deletion
mutation (denoted L2
Δ6
) causing human cardiomyopathy, into mouse
LAMP2
gene, to elucidate its consequences on cardiomyocyte biology. This mutation results in
in‐frame
deletion of 41 amino acids, compatible with presence of some defective LAMP2 protein.

Methods and Results

Left ventricular tissues from L2
Δ6
and wild‐type mice had equivalent amounts of
LAMP2
RNA, but a significantly lower level of LAMP2 protein. By 20 weeks of age male mutant mice developed left ventricular hypertrophy which was followed by left ventricular dilatation and reduced systolic function. Cardiac electrophysiology and isolated cardiomyocyte studies demonstrated ventricular arrhythmia, conduction disturbances, abnormal calcium transients and increased sensitivity to catecholamines. Myocardial fibrosis was strikingly increased in 40‐week‐old L2
Δ6
mice, recapitulating findings of human LAMP2 cardiomyopathy. Immunofluorescence and transmission electron microscopy identified mislocalization of lysosomes and accumulation of autophagosomes between sarcomeres, causing profound morphological changes disrupting the cellular ultrastructure. Transcription profile and protein expression analyses of L2
Δ6
hearts showed significantly increased expression of genes encoding activators and protein components of autophagy, hypertrophy, and apoptosis.

Conclusions
We suggest that impaired autophagy results in cardiac hypertrophy and profound transcriptional reactions that impacted metabolism, calcium homeostasis, and cell survival. These responses define the molecular pathways that underlie the pathology and aberrant electrophysiology in cardiomyopathy of Danon disease.
Clinical Risk Score for the Prediction of Incident Atrial Fibrillation: Derivation in 7 220 654 Taiwan Patients With 438 930 Incident Atrial Fibrillations During a 16‐Year Follow‐Up
Authors: Chao Tze‐Fan , Chiang Chern‐En , Chen Tzeng‐Ji , Liao Jo‐Nan , Tuan Ta‐Chuan , Chen Shih‐Ann 
Published: August 2021

Background
Although several risk schemes have been proposed to predict new‐onset atrial fibrillation (AF), clinical prediction models specific for Asian patients were limited. In the present study, we aimed to develop a clinical risk score (Taiwan AF score) for AF prediction using the whole Taiwan population database with a long‐term follow‐up.

Methods and Results
Among 7 220 654 individuals aged ≥40 years without a past history of cardiac arrhythmia identified from the Taiwan Health Insurance Research Database, 438 930 incident AFs occurred after a 16‐year follow‐up. Clinical risk factors of AF were identified using Cox regression analysis and then combined into a clinical risk score (Taiwan AF score). The Taiwan AF score included age, male sex, and important comorbidities (hypertension, heart failure, coronary artery disease, end‐stage renal disease, and alcoholism) and ranged from −2 to 15. The area under the receiver operating characteristic curve of the Taiwan AF scores in the predictions of AF are 0.857 for the 1‐year follow‐up, 0.825 for the 5‐year follow‐up, 0.797 for the 10‐year follow‐up, and 0.756 for the 16‐year follow‐up. The annual risks of incident AF were 0.21%/year, 1.31%/year, and 3.37%/year for the low‐risk (score −2 to 3), intermediate‐risk (score 4 to 9), and high‐risk (score ≥10) groups, respectively. Compared with low‐risk patients, the hazard ratios of incident AF were 5.78 (95% CI, 3.76–7.75) for the intermediate‐risk group and 8.94 (95% CI, 6.47–10.80) for the high‐risk group.

Conclusions
We developed a clinical AF prediction model, the Taiwan AF score, among a large‐scale Asian cohort. The new score could help physicians to identify Asian patients at high risk of AF in whom more aggressive and frequent detections and screenings may be considered.
Percutaneous Coronary Intervention Outcomes Based on Decision‐Making Capacity
Authors: Singh Jarmanjeet , Kassis Nicholas , Ahuja Keerat R. , Sheth Chirag , Verma Beni R. , Saxena Saket , Krishnaswamy Amar , Ellis Stephen , Khatri Jaikirshan , Menon Venu , Kapadia Samir R. 
Published: August 2021

Background
Long‐term outcomes of percutaneous coronary intervention (PCI) based on patients’ decision‐making ability have not been studied. Our objective was to assess long‐term outcomes after PCI in patients who provided individual versus surrogate consent.

Methods and Results

Data were collected retrospectively for patients who underwent PCI at Cleveland Clinic between January 1, 2015 and December 31, 2016. Inclusion criteria consisted of hospitalized patients aged ≥20 years who had PCI. Patients with outpatient PCI, or major surgery 30 days before or 90 days after PCI, were excluded. Patients who underwent PCI with surrogate consent versus individual consent were matched using the propensity analysis. Kaplan–Meier, log rank,
t
‐statistic, and χ
2
tests were used for statistical analysis. The study was approved by the Institutional Review Board at Cleveland Clinic, Ohio. Of 3136 patients who underwent PCI during the study period, 183 had surrogate consent. Propensity matching yielded 149 patients from each group. Two‐year all‐cause mortality was significantly higher in the surrogate consent group (38 [25.5%] versus 16 [10.7%] deaths, log‐rank
χ
2
=10.16,
P
<0.001). The 2‐year major adverse cardiac events rate was also significantly higher in the surrogate consent group (60 versus 36 events, log‐rank
χ
2
=8.36,
P
=0.003).

Conclusions
Patients with surrogate consent had significantly higher all‐cause mortality and higher major adverse cardiac events when compared with patients with individual consent. This study emphasizes the fact that patients with an inability to give consent are at high risk and may need special attention in postprocedural and postdischarge care.
Prognostic Value of Angiogenic Markers in Pregnant Women With Chronic Hypertension
Authors: Binder Julia , Palmrich Pilar , Kalafat Erkan , Pateisky Petra , Öztürk Ebru , Mittelberger Johanna , Khalil Asma 
Published: August 2021

Background
Women with chronic hypertension face a 5‐ to 6‐fold increased risk of developing preeclampsia compared with normotensive women. Angiogenic markers, especially soluble fms‐like kinase 1 (sFlt‐1) and placental growth factor (PlGF), were identified as clinically useful markers predicting the development of preeclampsia, but data on the prediction of superimposed preeclampsia are scarce. Therefore, we aimed to evaluate the predictive value of the sFlt‐1/PlGF ratio for delivery because of superimposed preeclampsia in women with chronic hypertension.

Methods and Results

This retrospective study included 142 women with chronic hypertension and suspected superimposed preeclampsia. Twenty‐seven women (19.0%) delivered because of maternal indications only, 17 women (12.0%) because of fetal indications primarily, and 98 women (69.0%) for other reasons. Women who both delivered because of maternal indications and for fetal indications had a significantly higher sFlt‐1/PlGF ratio (median 99.9 and 120.2 versus 7.3, respectively,
P
<0.001 for both) and lower PlGF levels (median 73.6 and 53.3 versus 320.0 pg/mL, respectively,
P
<0.001 for both) compared with women who delivered for other reasons. SFlt‐1/PlGF ratio and PlGF were strong predictors for delivery because of superimposed preeclampsia, whether for maternal or fetal indications (
P
<0.05). Half of women with angiogenic imbalance (sFlt‐1/PlGF ratio ≥85 or PlGF levels <100 pg/mL) delivered because of maternal or fetal indications within 1.6 weeks (95% CI, 1.0–2.4 weeks).

Conclusions
Angiogenic marker imbalance in women with suspected superimposed preeclampsia can predict delivery because of maternal and fetal indications related to superimposed preeclampsia and is associated with a significantly shorter time to delivery interval.
Factor V Leiden and the Risk of Bleeding in Patients With Acute Coronary Syndromes Treated With Antiplatelet Therapy: Pooled Analysis of 3 Randomized Clinical Trials
Authors: Mahmoodi Bakhtawar K. , Eriksson Niclas , Ross Stephanie , Claassens Daniel M. F. , Asselbergs Folkert W. , Meijer Karina , Siegbahn Agneta , James Stefan , Pare Guillaume , Wallentin Lars , ten Berg Jurriën M. 
Published: August 2021

Background
Whether factor V Leiden is associated with lower bleeding risk in patients with acute coronary syndromes using (dual) antiplatelet therapy has yet to be investigated.

Methods and Results

We pooled data from 3 randomized clinical trials, conducted in patients with acute coronary syndromes, with adjudicated bleeding outcomes. Cox regression models were used to obtain overall and cause‐specific hazard ratios (HRs) to account for competing risk of atherothrombotic outcomes (ie, composite of ischemic stroke, myocardial infarction, and cardiovascular death) in each study. Estimates from the individual studies were pooled using fixed effect meta‐analysis. The 3 studies combined included 17 623 patients of whom 969 (5.5%) were either heterozygous or homozygous (n=23) carriers of factor V Leiden. During 1 year of follow‐up, a total of 1289 (7.3%) patients developed major (n=559) or minor bleeding. Factor V Leiden was associated with a lower risk of combined major and minor bleeding (adjusted cause‐specific HR, 0.75; 95% CI, 0.56–1.00;
P
=0.046; I
2
=0%) but a comparable risk of major bleeding (adjusted cause‐specific HR, 0.93; 95% CI, 0.62–1.39;
P
=0.73; I
2
=0%). Adjusted pooled cause‐specific HRs for the association of factor V Leiden with atherothrombotic events alone and in combination with bleeding events were 0.75 (95% CI, 0.55–1.02;
P
=0.06; I
2
=0%) and 0.75 (95% CI, 0.61–0.92;
P
=0.007; I
2
=0%), respectively.

Conclusions
Given that the lower risk of bleeding conferred by factor V Leiden was not counterbalanced by a higher risk of atherothrombotic events, these findings warrant future assessment for personalized medicine such as selecting patients for extended or intensive antiplatelet therapy.
Decision Threshold for Kryptor sFlt‐1/PlGF Ratio in Women With Suspected Preeclampsia: Retrospective Study in a Routine Clinical Setting
Authors: Andersen Lise Lotte Torvin , Helt Annemarie , Sperling Lene , Overgaard Martin 
Published: August 2021

Background
The objective was to evaluate predictive performance and optimal decision threshold of the Kryptor soluble fms‐like tyrosine kinase‐1 (sFlt‐1)/placental growth factor (PlGF) ratio when implemented for routine management of women presenting with symptoms of preeclampsia.

Methods and Results
Observational retrospective study of a cohort of 501 women with suspected preeclampsia after 20 weeks of gestation. Women referred to maternity ward for observation of preeclampsia had an sFlt‐1/PlGF ratio test included in routine diagnostic workup. Maternal and offspring characteristic data included maternal risk factors, outcomes, delivery mode, and indication for suspected preeclampsia. Biochemical measurements to determine sFlt‐1/PlGF ratio were performed using the BRAHMS/Kryptor sFlt‐1/PlGF ratio immunoassays. Results were analyzed by area under receiver‐operating characteristic curve. Preeclampsia occurred in 150 of 501 (30%) of symptomatic women with an sFlt‐1/PlGF ratio determined before the time of diagnosis. Area under receiver‐operating characteristic curve for diagnosis of early‐onset preeclampsia within 1 and 4 weeks was 0.98 (95% CI, 0.96–1.00) and 0.95 (95% CI, 0.92–0.98), respectively. For late‐onset preeclampsia, predictive performance within 1 and 4 weeks was lower: 0.90 (95% CI, 0.85–0.94) and 0.85 (95% CI, 0.80–0.90), respectively. The optimal single sFlt‐1/PlGF ratio threshold for all preeclampsia and late‐onset preeclampsia within 1 and 4 weeks was 66. The negative and positive predictive values for ruling out and ruling in developing preeclampsia within 1 week were 96% and 70%, respectively.

Conclusions
The Kryptor sFlt‐1/PlGF ratio is a useful clinical tool ruling out and in preeclampsia within 1 week. Prediction within 4 weeks is superior for early‐onset preeclampsia. A single decision threshold of 66 is indicated for use in clinical routine.
Characteristics of Bicuspid Aortic Valve Disease and Stenosis: The National Echo Database of Australia
Authors: Lim Michelle S. , Strange Geoff , Playford David , Stewart Simon , Celermajer David S. 
Published: August 2021

Background
Bicuspid aortic valve (BAV) is the most common congenital heart disease in adults but is clinically heterogeneous. We aimed to describe the echocardiographic characteristics of BAV and compare patients with BAV with moderate‐to‐severe aortic stenosis (AS) with those with tricuspid aortic valve (TAV) stenosis.

Methods and Results

Using the National Echo Database of Australia, patients in whom BAV was identified were studied. Those with moderate‐to‐severe AS (mean gradient >20 mm Hg [BAV‐AS]) were compared with those with TAV and moderate‐to‐severe AS (TAV‐AS). Of 264 159 adults whose aortic valve morphology was specified, 4783 (1.8%) had confirmed BAV (aged 49.6±17.4 years, 69% men). Of these, 42% had no AS, and 46% had no aortic regurgitation. Moderate‐to‐severe AS was detected in a greater proportion of patients with BAV with a recorded mean gradient (n=1112, 34%) compared with those with TAV (n=4377, 4%;
P
<0.001). Patients with BAV‐AS were younger (aged 55.3±16.7 years versus 77.3±11.0 years;
P
<0.001), and where measured had larger ascending aortic diameters (37±8 mm versus 35±5 mm;
P
<0.001). Age and sex‐adjusted mortality risk was significantly lower in patients with BAV‐AS (hazard ratio, 0.53; 95% CI, 0.45–0.63;
P
<0.001).

Conclusions
In this large study of patients across the spectrum of BAV disease, the largest proportion had no significant valvulopathy or aortopathy. Compared with those with TAV‐AS, patients with BAV were more likely to have moderate‐to‐severe AS, have larger ascending aortas, and were over 2 decades younger at the time of AS diagnosis. Despite this, patients with BAV appear to have a more favorable prognosis when AS develops, compared with those with TAV‐AS.

Registration

URL:
www.anzctr.org.au/
; Unique identifier: ACTRN12617001387314.
Redo Surgical Mitral Valve Replacement Versus Transcatheter Mitral Valve in Valve From the National Inpatient Sample
Authors: Zia Khan Muhammad , Zahid Salman , Khan Muhammad U. , Kichloo Asim , Jamal Shakeel , Mannan Khan Minhas Abdul , Ullah Waqas , Sattar Yasar , Balla Sudarshan 
Published: August 2021

Background
Redo mitral valve surgery is required in up to one‐third of patients and is associated with significant mortality and morbidity. Valve‐in‐valve transcatheter mitral valve replacement (ViV TMVR) is less invasive and could be considered in those at prohibitive surgical risk. Studies on comparative outcomes of ViV TMVR and redo surgical mitral valve replacement (SMVR) remain limited. Our study aimed to investigate the real‐world outcomes of the above procedures using the National Inpatient Sample database.

Methods and Results

We analyzed National Inpatient Sample data using the
International Classification of Diseases, Tenth Revision, Clinical Modification
(
ICD‐10‐CM
) from September 2015 to December 2018. A total of 495 and 2250 patients underwent redo ViV TMVR and SMVR, respectively. The patients who underwent ViV TMVR were older (77 versus 68 years,
P
<0.01). Adjusted mortality was higher in the redo SMVR group compared with the ViV TMVR group (7.6% versus <2.8%,
P
<0.01). Perioperative complications were higher among patients undergoing redo SMVR including blood transfusions (38% versus 7.6%,
P
<0.01) and acute kidney injury (36.7% versus 13.9%,
P
<0.01). Cost of care was higher (USD$57 172 versus USD$52 579,
P
<0.01), length of stay was longer (10 versus 3 days,
P
<0.01), and discharge to home was lower (20.3% versus 64.6%,
P
<0.01) in the SMVR group compared with the ViV TMVR group.

Conclusions
ViV TMVR is associated with lower mortality, periprocedural morbidity, and resource use compared with patients undergoing redo SMVR. ViV TMVR may be a viable option for some patients with mitral prosthesis dysfunction. Studies evaluating long‐term outcomes and durability of ViV TMVR are needed. A patient‐centered approach by the heart team, local institutional expertise, and careful preprocedure planning can help decision‐making about the choice of intervention for the individual patient.