bluuebunny/crossref_metadata_2025_split huggingface dataset:
HLA-DRB1 risk alleles for RA are associated with differential clinical responsiveness to abatacept and adalimumab: data from a head-to-head, randomized, single-blind study in autoantibody-positive early RA
Authors: Rigby William , Buckner Jane H. , Louis Bridges S. , Nys Marleen , Gao Sheng , Polinsky Martin , Ray Neelanjana , Bykerk Vivian 
Published: September 2021

Abstract
Background
Certain risk alleles associated with autoantibody-positive rheumatoid arthritis (RA) have been linked to poorer prognoses. In patients with autoantibody-positive RA, abatacept shows differential efficacy to tumor necrosis factor inhibitors. Our aim was to investigate the relationship between clinical response to abatacept and to adalimumab and presence of risk alleles encoding human leukocyte antigen (HLA)-DRB1 shared epitope (SE) in RA.

Methods
In this head-to-head study, biologic-naïve adults with early (≤ 12 months), moderate-to-severe RA and inadequate response to methotrexate (MTX-IR), autoantibody-positive for both anti-cyclic citrullinated peptide 2 and rheumatoid factor, were randomized 1:1 to receive subcutaneous abatacept 125 mg weekly or subcutaneous adalimumab 40 mg every 2 weeks for 24 weeks with stable, weekly oral MTX. An open-label period to 48 weeks followed, during which adalimumab-treated patients were switched to abatacept. Patients were genotyped for HLA-DRB1 alleles and classified as SE-positive (≥ 1 SE allele) or SE-negative (no SE alleles). Efficacy was assessed at weeks 24 and 48.

Results
Forty patients each received abatacept (9 SE-negative, 30 SE-positive, one unknown) or adalimumab (9 SE-negative, 31 SE-positive). Mean age and disease duration were 46.0 years and 5.5 months, respectively. At week 24, a greater percentage of abatacept patients achieved 50% improvement in ACR criteria (ACR50) compared with adalimumab patients (73% vs 45%, respectively) and estimate of difference (95% confidence interval [CI]), 28 (5, 48). In SE-positive patients, ACR50 estimate of difference (95% CI) was 32 (7, 55). During the open-label period, responses were sustained in the abatacept non-switch group and showed trends toward further improvement in the adalimumab-to-abatacept switch group at week 48, in both the overall and the SE-positive subpopulation. No new safety signals were identified.

Conclusions
In MTX-IR patients with early, autoantibody-positive RA, abatacept resulted in numerically higher efficacy responses versus adalimumab after 24 weeks, with more pronounced treatment differences in SE-positive patients. After 48 weeks, responses were sustained in patients who continued abatacept while those who switched to abatacept showed further clinical improvement, overall, and in SE-positive patients. This supports co-stimulation blockade as an effective treatment strategy for patients with early, autoantibody-positive RA, particularly among SE-positive patients.

Trial registration
NIH US National Library of Medicine, NCT02557100. Registered on September 23, 2015.
Risk of rheumatoid arthritis diagnosis in statin users in a large nationwide US study
Authors: Peterson Madeline N. , Dykhoff Hayley J. , Crowson Cynthia S. , Davis John M. , Sangaralingham Lindsey R. , Myasoedova Elena 
Published: September 2021

Abstract
Objective
To evaluate the association between statin use and the risk of developing rheumatoid arthritis (RA) in a large, US case-control study.

Methods
Using the OptumLabs Data Warehouse, RA cases were identified as patients aged ≥18 years with ≥2 RA diagnoses between January 1, 2010 and June 30, 2019 and ≥1 prescription fills for methotrexate within 1 year of the first RA diagnosis. The first RA diagnosis was the index date. Cases were matched 1:1 to controls on age, sex, region, year of index date, and length of baseline coverage. Statin users were defined by having ≥2 statin prescription fills at least 90 days pre-index. Patients identified as statin users were further classified by statin user status (current or former), statin use duration, and intensity of statin exposure. Odds ratios for RA risk with statin use were estimated using logistic regression.

Results
16,363 RA cases and 16,363 matched controls were identified. Among RA cases, 5509 (33.7%) patients were statin users compared to 5164 (31.6%) of the controls. Statin users had a slightly increased risk of RA compared to non-users (OR 1.12, 95% CI 1.06–1.18), and former statin users had an increased RA risk compared to current users (OR 1.21, 95% CI 1.13–1.28). However, risk was eliminated following adjustment for hyperlipidemia. The risk estimates for statin use duration and intensity did not reach significance.

Conclusion
This study demonstrates no significant increase in the risk of developing RA for statin users compared to non-users after adjustment for hyperlipidemia in addition to other relevant confounders. However, more information from prospective studies would be necessary to further understand this relationship.
HbA1C variability among type 2 diabetic patients: a retrospective cohort study
Authors: Akselrod Dikla , Friger Michael , Biderman Aya 
Published: September 2021

Abstract
Background
Studies have found that HbA1C variability is an independent risk factor for diabetic complications in type 2 diabetic patients. This study aims to find factors contributing to higher HbA1C variability in the community.

Methods
The study was conducted in the southern district of Israel, in Clalit Health Services (CHS). The study population was type 2 diabetic individuals aged 40–70 years in 2005, with a follow-up period of 11 years, until 2015. The definition of HbA1C variability was done by the standard deviation from the average HbA1C value of the entire study period, which was calculated for each participant. The study population was divided into two groups, “variability group” with HbA1C SD > 1.2, and “comparison group” of participants with HbA1C SD ≤ 1.2. In the univariate analysis we used X2 or Fisher test for categorical variables and independent t-test for numeric continuous variables. In the multivariate analysis we used logistic regression as well as assessing for possible interactions. Statistical analysis was ascribed for p < 0.05. All the data was drawn from the computerized medical system used by all primary care physicians and nurses in CHS working in the community.

Results
The study population included 2866 participants, the average age was 58.6 years, 43.3% men and 56.7% women. Each participant had an average of 20.9 HbA1C measures in their computerized medical record during the 11 years of follow up. The mean HbA1C value was 7.8%. We found 632 patients (22%) with a high variability, whereas 2234 (78%) had a low variability of HbA1C. In the “variability group” there was a higher percentage of smokers, BMI ≥ 30 and a higher rate of visits to diabetic clinics compared to the “no variability” group. In the “variability group” we found a much higher use of insulin and ACE inhibitors. The highest frequency of variability was between HbA1c values of 8.1–8.5. The multivariate analysis showed that HbA1C variability was associated with insulin use (OR = 4.1, p < 0.001), with age (OR = 0.939, p < 0.001), and Ischemic heart disease (OR = 1.258, p = 0.03). BMI ≥ 30 was almost statistically significant (OR = 1.206, p = 0.063). Gender was statistically insignificant.

Conclusions
In conclusion, HbA1C variability might be used as an additional marker in Diabetes Mellitus type 2, reflecting the disease complexity characteristics and the patient’s lifestyle profile.
Current ankle sprain prevention and management strategies of netball athletes: a scoping review of the literature and comparison with best-practice recommendations
Authors: Rowe Patrick L. , Bryant Adam L. , Paterson Kade L. 
Published: September 2021

Abstract
Background
Ankle sprains are the most commonly reported injury in netball. Approximately four in five netball athletes will sustain an ankle sprain, up to half will go on to sustain recurrent ankle sprains, and nine in ten report perceived ankle instability. Historically, prevention and management strategies of ankle sprains and injuries have been investigated for a variety of sports, however, no literature reviews have investigated these in netball athletes, or compared these with current best-practice within the literature. Therefore, this scoping review aims to understand how netball athletes currently prevent and manage ankle sprains and to compare these approaches with best-practice recommendations.

Methods
A literature search was conducted using MEDLINE, CINAHL, and SPORTDiscus databases using keywords to capture studies with data or information related to the prevention and management of ankle sprains and injuries in netball.

Results
The search strategy captured 982 studies across all databases, with 30 netball studies included in this scoping review. Studies suggest netball athletes are not commonly referred to health professionals, do not undertake adequate rehabilitation, and almost immediately return to court following an ankle sprain or injury. Current best-practices suggest injury prevention programs and external ankle support effectively reduce ankle sprains and injuries; however, poor compliance and implementation may be a significant barrier. Currently, there is a lack of evidence that netball-specific footwear reduces the risk of ankle sprains.

Conclusion
The findings suggest netball athletes do not implement current best-practice prevention and management strategies following an ankle sprain. This is despite evidence of the effectiveness of injury prevention programs, external ankle support, and adequate rehabilitation in reducing ankle sprain rates. Current-best practice prevention and management of ankle sprains should be considered by clinicians, coaches, and athletes to reduce the prevalence and chronicity of ankle sprains in netball.
Mitigating the noisy solution impact of mixed Gibbs sampling detector in high-order modulation large-scale MIMO systems
Authors: Mussi Alex M. , Abrão Taufik 
Published: September 2021

AbstractA neighborhood-restricted mixed Gibbs sampling (MGS)-based approach is proposed for low-complexity high-order modulation large-scale multiple-input multiple-output (LS-MIMO) detection. The proposed LS-MIMO detector applies a neighborhood limitation (NL) on the noisy solution from the MGS at a distanced— thus, namedd-simplified MGS (d-sMGS) — in order to mitigate its impact, which can be harmful when a high-order modulation is considered. Numerical simulation results considering 64-QAM demonstrated that the proposed detection method can substantially improve the MGS algorithm convergence, whereas no extra computational complexity per iteration is required. The proposedd-sMGS-based detector suitable for high-order modulation LS-MIMO further exhibits improved performance × complexity tradeoff when the system loading is high, i.e., when$\frac {K}{N}\geq 0.75$KN≥0.75. Also, with increasing the number of dimensions, i.e., increasing number of antennas and/or modulation order, a smaller restriction of 2-sMGS was shown to be a more interesting choice than 1-sMGS.
Prevalence and predictors of hepatitis B virus (HBV) infection in east Africa: evidence from a systematic review and meta-analysis of epidemiological studies published from 2005 to 2020
Authors: Kafeero Hussein Mukasa , Ndagire Dorothy , Ocama Ponsiano , Kudamba Ali , Walusansa Abdul , Sendagire Hakim 
Published: September 2021

AbstractBackgroundThe epidemiology of hepatitis B virus (HBV) in the general population in east Africa is not well documented. In this meta-analysis, we examined 37 full published research articles to synthesise up-to-date data on the prevalence and predictors of the HBV burden for the effective prevention and management of the virus in our region.MethodsWe examined 37 full published research articles found using PubMed, Scopus, African Journal Online (AJOL), and Google Scholar between May and October 2020. Dichotomous data on HBV prevalence and predictors of infection were extracted from the individual studies. The HBV prevalence, test of proportion, relative risk, and I2statistics for heterogeneity were calculated using MedCalc software version 19.1.3. Begg’s tests was used to test for publication bias. Sources of heterogeneity were analysed through sensitivity analysis, meta-regression, and sub-group analysis at 95% CI.P < 0.05 was considered significant for all analyses.ResultsThe prevalence of HBV was generally high (6.025%), with publications from Kenya (8.54%), Uganda (8.454%) and those from between 2011 and 2015 (8.759%) reporting the highest prevalence (P < 0.05). Blood transfusion, scarification, promiscuity, HIV seropositivity, and being male were independent predictors significantly associated with HBV infection (P < 0.05), with the male sex being the most strongly associated predictor of HBV infection. Meta-regressions for the pooled HBV prevalence and sample size, as well as the year of publication, lacked statistical significance (P > 0.05). Omitting the study with the largest sample size slightly increased pooled HBV prevalence to 6.149%, suggesting that the studies are robust. Begg’s test showed no evidence of publication bias for overall meta-analysis (p > 0.05).ConclusionThe burden of HBV is still high, with the male sex, blood transfusion, body scarification, and HIV seropositivity being potential predictors of infection. Thus, it is important to scale up control and prevention measures targeting persons at high risk.
Large- and small-scale movement and distribution of acoustically tagged lake sturgeon (Acipenser fulvescens) in eastern Lake Erie
Authors: Withers Jonah L. , Takade-Heumacher Helen , Davis Lori , Neuenhoff Rachel , Albeke Shannon E. , Sweka John A. 
Published: September 2021

Abstract
Background
Defining the spatial distribution, home range, and movement patterns of lake sturgeon (Acipenser fulvescens) is important to managers and decision-makers given the large migration potential and potamodromous behavior exhibited by the species. A remnant population of lake sturgeon remains in the far eastern basin of Lake Erie and although recent efforts have estimated the population size, described the age distribution, and identified a primary spawning site no study to date has examined the spatial distribution or movements of individuals within this population. Between 2014 and 2018, we acoustically tagged 59 adult lake sturgeon, captured in the Buffalo Harbor area, and monitored their large-scale movements throughout Lake Erie with the Great Lakes Acoustic Telemetry System and small-scale movements with a Vemco Positioning System in the Buffalo Harbor area. After dividing Lake Erie into seven sections, we ran a multi-state mark–recapture model to examine the movement rates into and out of the eastern most section of the lake. Within a heavily utilized lake section, in the Buffalo Harbor area, we identified home ranges with our Vemco Positioning System for each season and year using averaged Brownian bridge movement models.

Results
Although some sturgeon demonstrated large-scale movements, traversing the entirety of Lake Erie, the majority of individuals spent their time in the eastern basin of the lake. Home ranges appeared to vary among seasons, but were consistent across years with lake sturgeon selecting the northeastern, rocky, and shallow area of our array during pre-spawning and spawning seasons and leaving our array, or selecting a trough running along the northwestern portion of our array comprising sand and bedrock, in the summer and fall seasons.

Conclusions
Documenting these large-scale movements aligns with previous findings that lake sturgeon on either end of the lake are genetically similar and demonstrates lake sturgeon in the eastern basin exhibit strong philopatry. Our small-scale movement models provide managers with spatial reference points, in the form of utilization distributions, indicating heavily used areas by lake sturgeon within seasons. Future studies should examine what parameters are driving site selection in these areas.
How FGF23 shapes multiple organs in chronic kidney disease
Authors: Leifheit-Nestler Maren , Haffner Dieter 
Published: September 2021

AbstractChronic kidney disease (CKD) is associated with distinct alterations in mineral metabolism in children and adults resulting in multiple organ dysfunctions. Children with advanced CKD often suffer from impaired bone mineralization, bone deformities and fractures, growth failure, muscle weakness, and vascular and soft tissue calcification, a complex which was recently termed CKD-mineral and bone disorder (CKD-MBD). The latter is a major contributor to the enhanced cardiovascular disease comorbidity and mortality in these patients. Elevated circulating levels of the endocrine-acting phosphaturic hormone fibroblast growth factor (FGF) 23 are the first detectable alteration of mineral metabolism and thus CKD-MBD. FGF23 is expressed and secreted from osteocytes and osteoblasts and rises, most likely due to increased phosphate load, progressively as kidney function declines in order to maintain phosphate homeostasis. Although not measured in clinical routine yet, CKD-mediated increased circulating levels of FGF23 in children are associated with pathological cardiac remodeling, vascular alterations, and increased cognitive risk. Clinical and experimental studies addressing other FGF23-mediated complications of kidney failure, such as hypertension and impaired bone mineralization, show partly conflicting results, and the causal relationships are not always entirely clear. This short review summarizes regulators of FGF23 synthesis altered in CKD and the main CKD-mediated organ dysfunctions related to high FGF23 levels.
Dangers of residual confounding: a cautionary tale featuring cognitive ability, socioeconomic background, and education
Authors: Sorjonen Kimmo , Falkstedt Daniel , Wallin Alma Sörberg , Melin Bo , Nilsonne Gustav 
Published: September 2021

Abstract
Background
Cognitive ability and socioeconomic background (SEB) have been previously identified as determinants of achieved level of education. According to a “discrimination hypothesis”, higher cognitive ability is required from those with lower SEB in order to achieve the same level of education as those with higher SEB. Support for this hypothesis has been claimed from the observation of a positive association between SEB and achieved level of education when adjusting for cognitive ability. We propose a competing hypothesis that the observed association is due to residual confounding.

Methods
To adjudicate between the discrimination and the residual confounding hypotheses, data from the 1997 National Longitudinal Survey of Youth (NLSY97, N = 8984) was utilized, including a check of the logic where we switched predictor and outcome variables.

Results
The expected positive association between SEB and achieved level of education when adjusting for cognitive ability (predicted by both hypotheses) was found, but a positive association between cognitive ability and SEB when adjusting for level of education (predicted only by the residual confounding hypothesis) was also observed.

Conclusions
These results highlight the potential use of reversing predictors and outcomes to test the logic of hypothesis testing, and support a residual confounding hypothesis over a discrimination hypothesis in explaining associations between SEB, cognitive ability, and educational outcome.
Suture granuloma with hydronephrosis caused by ileostomy closure after rectal cancer surgery: a case report
Authors: Takano Yasuhiro , Haruki Koichiro , Tsukihara Shu , Abe Tadashi , Koyama Muneyuki , Ito Daisuke , Kanno Hironori , Son Kyonsu , Hanyu Nobuyoshi , Eto Ken 
Published: September 2021

Abstract
Background
Suture granuloma with hydronephrosis after abdominal surgery is extremely rare. We herein report a successfully treated case of suture granuloma with hydronephrosis caused by ileostomy closure after rectal cancer surgery.

Case presentation
A 63-year-old male underwent laparoscopic low anterior resection with covering ileostomy. Two months after primary operation, ileostomy closure was performed with two layered hand-sewn suture (Albert–Lembert method) using absorbable suture. In that operation, marginal blood vessels in the mesentery were ligated with silk suture. The patient had remained in remission with no evidence of tumor recurrence, however, 2 years and 5 months after primary surgery, a contrast-enhanced computed tomography (CT) scan showed a mass-forming lesion on the right external iliac artery (43 × 26 mm) and hydronephrosis. Positron emission tomography/computed tomography (PET/CT) showed a mass-forming lesion without high accumulation, which obstructed the right ureter. Recurrence could not be ruled out due to the rapid appearance of tumor and hydronephrosis in the short-term period. Thus, the patient underwent laparotomy. The tumor located in the mesentery near the anastomosis of ileostomy closure and it was strongly adherent to the retroperitoneum, which obstructed the right ureter. The adhesion between the tumor and ureter was carefully dissected and tumor resection with partial small bowel resection was then performed with preservation of the ureter using ureteral stents. Pathological examination of the tumor revealed fibrous proliferation of foreign body granuloma. In the resected tumor, sutures with foreign giant cells were found. Therefore, we diagnosed the tumor as silk suture granuloma, which was caused by the silk suture used to ligate blood vessels of the mesentery at the ileostomy closure. The patient remained well with no evidence of tumor recurrence as 5 years after the primary operation of rectal cancer.

Conclusions
Suture granuloma is a rare surgery-related complication in the postoperative surveillance of patients with colorectal cancer. If suture granuloma mimicking local recurrence is a differential diagnosis, it would be important to consider to avoid unnecessary extended resection.