bluuebunny/crossref_metadata_2025_split huggingface dataset:
Time trends in the relation between blood pressure and dementia in 85-year-olds
Authors: Ribbe Mats , Kern Silke , Wetterberg Hanna , Rydén Lina , Zettergren Anna , Guo Xinxin , Skoog Ingmar 
Published: June 2021

Objectives:
Blood pressure has decreased in the general population. We aimed to examine whether this is true also among the very old, and among persons with and without dementia. Further, we aimed to investigate how common undetected and untreated hypertension is in the very old, both among people with and without dementia.

Method:
Blood pressure was measured in representative population samples of 85-year-olds living in Gothenburg, Sweden, examined 1986–1987 (n = 484) and 2008–2010 (n = 571). Dementia was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, edition 3 revised, by the same medical doctor at both examinations.

Results:
Both systolic and diastolic blood pressure were lower in 85-year-olds examined 2008–2010 than in those examined 1986–1987, both among those with and without dementia. Participants with dementia had lower systolic blood pressure than those without dementia in both cohorts, and blood pressure levels related to dementia severity. Despite this, hypertension (≥140/90 mmHg) was found in almost half (46.5%) of those with dementia in 2008–2010.

Conclusion:
Our findings show that time-trends of lower blood pressure in western populations also applies to the very old, and that individuals with dementia continue to have lower blood pressure compared to the rest of the population. The latter finding suggests that the pathophysiological processes in dementia affect blood pressure regulating regions in the brain independent of time trends. Still, hypertension is common in dementia and needs to be detected and treated.
Effects of hormone replacement therapy on endothelial function, arterial stiffness and myocardial deformation in women with Turner syndrome
Authors: Peppa Melpomeni , Pavlidis George , Mavroeidi Ioanna , Katogiannis Konstantinos , Varoudi Maria , Thymis John , Kostelli Gavriella , Vlastos Dimitrios , Plotas Panagiotis , Bamias Aristotelis , Parissis John , Ikonomidis Ignatios 
Published: June 2021

Objectives:
Turner syndrome (TS) is associated with increased cardiovascular risk. We investigated whether hormone replacement therapy (HRT) affects endothelial function, arterial stiffness and myocardial deformation in women with TS.

Methods:
Twenty-five women with TS were studied in the estrogen phase of the HRT and two months after discontinuation of HRT. The following measurements were made: flow-mediated dilation (FMD) of the brachial artery, pulse wave velocity (PWV-Complior) and central systolic blood pressure (cSBP), carotid intima-media thickness (cIMT), aortic (Ao) elastic indexes – namely Ao strain, distensibility, stiffness index and pressure strain modulus (E
p) – and left ventricular (LV) global longitudinal strain (GLS) using speckle-tracking echocardiography. Ten healthy female of similar age and BMI served as a control group.

Results:
Compared to controls, women with TS on HRT had higher PWV (9.1 ± 2.4 vs. 7.5 ± 0.5 m/s), cSBP (130 ± 15 vs. 121 ± 6 mmHg), cIMT (0.66 ± 0.06 vs. 0.55 ± 0.05 mm), aortic stiffness index, E
p and LA strain, and lower FMD (7.2 ± 4 vs. 10.5 ± 2.3%), Ao strain, Ao distensibility and GLS (−18.8 ± 2.7 vs. −21.9 ± 1.5%) (P < 0.05 for all comparisons). Two months after discontinuation of HRT, all women increased FMD (11.7 ± 6 vs. 7.2 ± 4%) and reduced PWV (7.8 ± 1.7 vs. 9.1 ± 2.4 m/s) and cSBP (123 ± 14 vs. 130 ± 15 mmHg). There were no statistically significant changes in BMI, cIMT and GLS (P > 0.05 for all comparisons). The percentage decrease of cSBP was associated with the percentage decrease of PWV (r = 0.54) and reversely related with the percentage increase of FMD (r = −0.57; P < 0.05 for all comparisons).

Conclusions:
HRT in women with TS may deteriorate endothelial function contributing to increased arterial stiffness and central arterial blood pressure.
Synergistic harmful interaction between sustained physical inactivity and hypertension/diabetes mellitus on the risk of all-cause mortality: a retrospective observational cohort study
Authors: Lee Chang-Hoon , Han Kyung-Do , Yoo Juhwan , Kwak Min-Sun 
Published: June 2021

Objective:
Hypertension, diabetes mellitus and physical inactivity can cause cardiovascular complications or premature death. However, it has not been clarified whether those major comorbidities and physical activity interact in affecting health outcomes. The aim of this study is to evaluate the potential interaction between temporal physical activity profiles and hypertension or diabetes mellitus on the risk for all-cause mortality.

Methods:
This study used Korea National Health Insurance Service (KNHIS) database and included about 6.5 million participants who underwent health screening in 2009 and 2011. Physical activity was evaluated as 2-year change based on self-reported survey using 7-day recall method, and grouped as remained active, inactive-to-active, active-to-inactive, or remained inactive. Participants were categorized into groups according to the presence of hypertension/diabetes mellitus. Outcome included all-cause mortality.

Results:
In total, 6 554 082 participants (48.4 ± 13.3 years; 56.7% men) were included. During a median 6.4-year follow-up, 83 241 deaths occurred. Compared with the ‘remained active’ group, other groups had a higher mortality risk after adjustment for covariates [adjusted hazard ratio (aHR) 1.17, 95% CI 1.13–1.21 in the ‘inactive-to-active’ group, aHR 1.28, 95% CI 1.24–1.32 in the ‘active-to-inactive’ group, aHR 1.52, 95% CI 1.48–1.57 in the ‘remained inactive’ group). Hypertension and diabetes mellitus were significant effect modifiers in the association between physical activity and the risk of all-cause mortality (P for interaction <0.001). The harmful effects of persistent physical inactivity on all-cause mortality were the most obvious in those with both hypertension and diabetes mellitus among groups.

Conclusion:
Sustained physical inactivity was associated with increased risk of all-cause mortality in those with hypertension or diabetes mellitus more strongly than in those without. Physicians should emphasize sustained physical activity even more in patients with hypertension or diabetes mellitus.
Blood pressure in adults with cerebral palsy: a systematic review and meta-analysis of individual participant data
Authors: Noten Suzie , van den Berg-Emons Rita J.G. , Thorpe Deborah E. , Heyn Patricia C. , Marciniak Christina M. , McPhee Patrick G. , Lamberts Robert P. , Langerak Nelleke G. , Verschuren Olaf , Salokivi Tommi , Morrison Katherine M. , Peterson Mark D. , Limsakul Chonnanid , Stam Henk J. , Papageorgiou Grigorios , Versmissen Jorie , Van Der Slot Wilma M.A. 
Published: June 2021

Objectives:
This systematic review and meta-analysis was designed to determine the overall mean blood pressure and prevalence of hypertension among a representative sample of adults living with cerebral palsy by combining individual participant data. Additional objectives included estimating variations between subgroups and investigating potential risk factors for hypertension.

Methods:
Potential datasets were identified by literature searches for studies published between January 2000 and November 2017 and by experts in the field. Samples of adults with cerebral palsy (n ≥ 10, age ≥ 18 years) were included if blood pressure data, cerebral palsy-related factors (e.g. cerebral palsy subtype), and sociodemographic variables (e.g. age, sex) were available. Hypertension was defined as at least 140/90 mmHg and/or use of antihypertensive medication.

Results:
We included data from 11 international cohorts representing 444 adults with cerebral palsy [median (IQR) age of the sample was 29.0 (23.0–38.0); 51% men; 89% spastic type; Gross Motor Function Classification System levels I–V]. Overall mean SBP was 124.9 mmHg [95% confidence interval (CI) 121.7–128.1] and overall mean DBP was 79.9 mmHg (95% CI 77.2–82.5). Overall prevalence of hypertension was 28.7% (95% CI 18.8–39.8%). Subgroup analysis indicated higher blood pressure levels or higher prevalence of hypertension in adults with cerebral palsy above 40 years of age, men, those with spastic cerebral palsy or those who lived in Africa. BMI, resting heart rate and alcohol consumption were risk factors that were associated with blood pressure or hypertension.

Conclusion:
Our findings underscore the importance of clinical screening for blood pressure in individuals with cerebral palsy beginning in young adulthood.
Guidelines for the diagnosis and treatment of pancreatic cancer in China (2021)
Authors: Yang Yinmo , Bai Xueli , Bian Dapeng , Cai Shouwang , Chen Rufu , Cao Feng , Dai Menghua , Fang Chihua , Fu Deliang , Ge Chunlin , Guo Xiaochao , Hao Chunyi , Hao Jihui , Huang Heguang , Jian Zhixiang , Jin Gang , Li Fei , Li Haimin , Li Shengping , Li Weiqin , Li Yixiong , Li Hongzhen , Liang Tingbo , Liu Xubao , Lou Wenhui , Miao Yi , Mou Yiping , Peng Chenghong , Qin Renyi , Shao Chenghao , Sun Bei , Tan Guang , Tian Xiaodong , Wang Huaizhi , Wang Lei , Wang Wei , Wang Weilin , Wei Junmin , Wu Heshui , Wu Wenming , Wu Zheng , Xu Jingyong , Yan Changqing , Yin Xiaoyu , Yu Xianjun , Yuan Chunhui , Zhang Taiping , Zhang Jixin , Zhou Jun , Zhao Yupei 
Published: June 2021

Abstract
The incidence of pancreatic cancer has been rising worldwide, and its clinical diagnosis and treatment remain a great challenge. To present the update and improvements in the clinical diagnosis and treatment of pancreatic cancer in recent years, Chinese Pancreatic Association, the Chinese Society of Surgery, Chinese Medical Association revised the Guidelines for the Diagnosis and Treatment of Pancreatic Cancer in China (2014) after reviewing evidence-based and problem-oriented literature published during 2015–2021, mainly focusing on highlight issues regarding diagnosis and surgical treatment of pancreatic cancer, conversion strategies for locally advanced pancreatic cancer, treatment of pancreatic cancer with oligo metastasis, adjuvant and neoadjuvant therapy, standardized processing of surgical specimens and evaluation of surgical margin status, systemic treatment for unresectable pancreatic cancer, genetic testing, as well as postoperative follow up of patients with pancreatic cancer. Forty recommendation items were finally proposed based on the above issues, and the quality of evidence and strength of recommendations were graded using the Grades of Recommendation, Assessment, Development, and Evaluation system. This guideline aims to standardize the clinical diagnosis and therapy, especially surgical treatment of pancreatic cancer in China, and further improve the prognosis of patients with pancreatic cancer.
Genetic evaluation in children with short stature
Authors: Zhou Elaine , Hauser Benjamin Roland , Jee Youn Hee 
Published: June 2021

Purpose of review
Short stature is a common clinical manifestation in children. Yet, a cause is often unidentifiable in the majority of children with short stature by a routine screening approach. The purpose of this review is to describe the optimal genetic approach for evaluating short stature, challenges of genetic testing, and recent advances in genetic testing for short stature.

Recent findings
Genetic testing, such as karyotype, chromosomal microarray, targeted gene sequencing, or exome sequencing, has served to identify the underlying genetic causes of short stature. When determining which short stature patient would benefit from genetic evaluation, it is important to consider whether the patient would have a single identifiable genetic cause. Specific diagnoses permit clinicians to predict responses to growth hormone treatment, to understand the phenotypic spectrum, and to understand any associated co-morbidities.

Summary
The continued progress in the field of genetics and enhanced capabilities provided by genetic testing methods expands the ability of physicians to evaluate children with short stature for underlying genetic defects. Continued effort is needed to elaborate new genetic causes of linear growth disorders, therefore, we expand the list of known genes for short stature, which will subsequently increase the rate of genetic diagnosis for children with short stature.
Pancreas Academy
Authors: Han Samuel , Akshintala Venkata S. , Coté Gregory A. , Abu-El-Haija Maisam ,   on behalf of the Collaborative Alliance for Pancreatic Education and Research
Published: June 2021

Abstract
The Collaborative Alliance for Pancreatic Education and Research developed Pancreas Academy as a lecture-based conference with the goal of providing practical guidance in the diagnosis and management of pancreatic diseases for health care providers. Since its inception in 2017, attendance at Pancreas Academy has steadily grown every year, with trainees accounting for the largest proportion of attendees. The proportion of advanced practice providers and pediatric specialists attending the conference, although relatively low, has also risen each year. Despite the growth in the conference, this report highlights the need for continued outreach to primary care providers, nonphysicians, and nongastroenterologists to provide health care providers at all levels pragmatic and essential knowledge in caring for patients with pancreatic diseases.
Data Analysis of Plastic Surgery Instrument Trays Yields Significant Cost Savings and Efficiency Gains
Authors: Wood Benjamin C. , Konchan Sarah , Gay Samuel , Rath Sandeep , Deshpande Vinayak , Knowles Martyn 
Published: June 2021

Purpose
Inpatient surgery costs have risen 30% over the past 5 years, and the operating room accounts for up to 60% of total hospital operational expense. On average, only 13.0% to 21.9% of instruments opened for a case are used, contributing to significant avoidable reprocessing, repurchase, and labor expense.

Methods
A comprehensive review of 40 major instrument trays at UNC Rex Hospital was conducted using a technology service (OpFlow; Operative Flow Technologies, Raleigh, NC). Among the full scope of the project, the general plastics tray and breast reconstruction tray were evaluated for the plastic surgery service line over a 3-month period. Intraoperative data collection was performed on the exact instruments used across a standard breadth of cases. Data analytics were conducted stratifying instrument usage concordance among surgeons by tray and procedure type. After a surgeon-led review of the proposed new tray configurations, the optimized versions were implemented via a methodical change management process.

Results
A total of 183 plastic surgery cases were evaluated across 17 primary surgeons. On average, the instrument usage per tray was 15.8% for the general plastics tray and 23.5% for the breast reconstruction tray. After stakeholder review, 32 (45.1%) of 71 instruments were removed from the general plastics tray and 40 (36.7%) of 109 were removed from the breast reconstruction tray, resulting in a total reduction of 2652 instruments. This resulted in a decrease of 81,696 instrument sterilization cycles annually. The removal of the instruments yielded an estimated cost avoidance of US $163,800 for instrument repurchase and US $69,441 in annual resterilization savings. The instrument volume reduction is projected to save 383.5 hours of sterile processing personnel time in tray assembly annually.

Conclusions
An analytics-driven method applying empirical data on actual case-based instrument usage has implications for better efficiency, improved quality, and cost avoidance related to instrument repurchase and sterile processing. Given increasing cost constraints and the transition to value-based care models, leveraging a technology-based solution enables meaningful change in the sterile processing department as a source for cost reduction and quality of care improvement.
Objective Analysis of Fronto-Orbital Dysmorphology in Unilateral Coronal Craniosynostosis
Authors: Dvoracek Lucas A. , Bykowski Michael R. , Foglio Aaron , Ayyash Ali , Pfaff Miles J. , Losee Joseph E. , Goldstein Jesse A. 
Published: June 2021

Abstract
Correction (and over-correction) of asymmetries of the orbital shape and brow position in unilateral coronal craniosynostosis (UCS) is critical to successful fronto-orbital advancement. Here we quantify and three-dimensionally assess fronto-orbital irregularities in UCS patients compared to controls.
Twenty-three patients with UCS evaluated at the Children's Hospital of Pittsburgh between 2006 and 2016 were age and gender-matched to controls. Computed tomography scans were reconstructed and evaluated for orbital metrics. A three-dimensional heat map of orbital regions was generated and evaluated for shape differences.
Brow protrusion of the orbit ipsilateral to the synostotic suture did not differ significantly from healthy controls. Orbital height was significantly increased while orbital width was decreased on the UCS ipsilateral side compared to the contralateral side and controls. The ipsilateral cornea was overprojected relative to the brow and the infraorbital rim, but similar to controls relative to the lateral rim. The contralateral orbit had increased brow protrusion with decreased orbital height. The cornea was underprojected relative to the brow, but overprojected relative to the lateral orbital rim and similar to controls at the infraorbital rim. Three-dimensional comparison demonstrated significant overprojection of the contralateral brow, with some more mild and inconsistent underprojection of the lateral aspect of the ipsilateral brow.
Key orbital and brow differences exist between the affected and unaffected sides in UCS. This study provides quantitative data that further characterize the orbital dysmorphology observed in UCS and identifies unique aspects of the diagnosis that should be taken into consideration during surgical planning.
Acute Care Utilization and Costs Up to 4 Years After Index Sleeve Gastrectomy or Roux-en-Y Gastric Bypass
Authors: Callaway Kim Katherine , Argetsinger Stephanie , Wharam James Frank , Zhang Fang , Arterburn David E. , Fernandez Adolfo , Ross-Degnan Dennis , Wallace Jamie , Lewis Kristina H. 
Published: June 2021

Objective:
To compare acute care utilization and costs following sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB).

Summary Background Data:
Comparing postbariatric emergency department (ED) and inpatient care use patterns could assist with procedure choice and provide insights about complication risk.

Methods:
We used a national insurance claims database to identify adults undergoing SG and RYGB between 2008 and 2016. Patients were matched on age, sex, calendar-time, diabetes, and baseline acute care use. We used adjusted Cox proportional hazards to compare acute care utilization and 2-part logistic regression models to compare annual associated costs (odds of any cost, and odds of high costs, defined as ≥80th percentile), between SG and RYGB, overall and within several clinical categories.

Results:
The matched cohort included 4263 SG and 4520 RYGB patients. Up to 4 years after surgery, SG patients had slightly lower risk of ED visits [adjusted hazard ratio (aHR): 0.90; 95% confidence interval (CI): 0.85,0.96] and inpatient stays (aHR: 0.80; 95% CI: 0.73,0.88), especially for events associated with digestive-system diagnoses (ED aHR: 0.68; 95% CI: 0.62,0.75; inpatient aHR: 0.61; 95% CI: 0.53,0.72). SG patients also had lower odds of high ED and high total acute costs (eg, year-1 acute costs adjusted odds ratio (aOR) 0.77; 95% CI: 0.66,0.90) in early follow-up. However, observed cost differences decreased by years 3 and 4 (eg, year-4 acute care costs aOR 1.10; 95% CI: 0.92,1.31).

Conclusions:
SG may have fewer complications requiring emergency care and hospitalization, especially as related to digestive system disease. However, any acute care cost advantages of SG may wane over time.
Precise oculocentric mapping of transcranial magnetic stimulation-evoked phosphenes
Authors: Silva Andrew E. , Tsang Katelyn , Hasan Syeda Javeria , Thompson Benjamin 
Published: June 2021

Objective
Transcranial magnetic stimulation (TMS)–evoked phosphenes are oculocentric; their perceived location depends upon eye position. We investigated the accuracy and precision of TMS-evoked phosphene oculocentric mapping.

Methods
We evoked central phosphenes by stimulating early visual cortical areas with TMS, systematically examining the effect of eye position by asking participants to report the location of the evoked phosphene. We tested whether any systematic differences in the precision or accuracy of responses occurred as a function of eye position.

Results
Perceived phosphene locations map veridically to eye position, although there are considerable individual differences in the reliability of this mapping.

Conclusions
Our results emphasize the need to carefully control eye movements when carrying out phosphene localization studies and suggest that individual differences in the reliability of the reported position of individual phosphenes must be considered.
Antibody longevity and cross-neutralizing activity following SARS-CoV-2 wave 1 and B.1.1.7 infections
Authors: Dupont Liane , Snell Luke B. , Graham Carl , Seow Jeffrey , Merrick Blair , Lechmere Thomas , Hallett Sadie R. , Charalampous Themoula , Alcolea-Medina Adela , Huettner Isabella , Maguire Thomas J. A. , Acors Sam , Almeida Nathalia , Cox Daniel , Dickenson Ruth E. , Galao Rui Pedro , Jimenez-Guardeño Jose M. , Kouphou Neophytos , Lista Marie Jose , Pickering Suzanne , Ortega-Prieto Ana Maria , Wilson Harry , Winstone Helena , Fairhead Cassandra , Su Jia , Nebbia Gaia , Batra Rahul , Neil Stuart , Shankar-Hari Manu , Edgeworth Jonathan D. , Malim Michael H. , Doores Katie J. 
Published: June 2021

AbstractAs SARS-CoV-2 variants continue to emerge globally, a major challenge for COVID-19 vaccination is the generation of a durable antibody response with cross-neutralizing activity against both current and newly emerging viral variants. Cross-neutralizing activity against major variants of concern (B.1.1.7, P.1 and B.1.351) has been observed following vaccination, albeit at a reduced potency, but whether vaccines based on the Spike glycoprotein of these viral variants will produce a superior cross-neutralizing antibody response has not been fully investigated. Here, we used sera from individuals infected in wave 1 in the UK to study the long-term cross-neutralization up to 10 months post onset of symptoms (POS), as well as sera from individuals infected with the B.1.1.7 variant to compare cross-neutralizing activity profiles. We show that neutralizing antibodies with cross-neutralizing activity can be detected from wave 1 up to 10 months POS. Although neutralization of B.1.1.7 and B.1.351 is lower, the difference in neutralization potency decreases at later timepoints suggesting continued antibody maturation and improved tolerance to Spike mutations. Interestingly, we found that B.1.1.7 infection also generates a cross-neutralizing antibody response, which, although still less potent against B.1.351, can neutralize parental wave 1 virus to a similar degree as B.1.1.7. These findings have implications for the optimization of vaccines that protect against newly emerging viral variants.