bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treat-to-target in axial spondyloarthritis: an observational study in daily practice
Authors: Beckers Esther , Boonen Annelies , Webers Casper , ten Klooster Peter , Vonkeman Harald , Efdé Monique , van Tubergen Astrid 
Published: June 2021

AbstractObjectivesTo evaluate the extent to which internationally agreed treat-to-target recommendations were applied in clinical practice in patients with axial spondyloarthritis.MethodsData were used from a web-based patient registry for monitoring SpA in daily practice in the Netherlands. The extent to which treat-to-target was applied was evaluated through four indicators: the proportion of patients (i) with ≥1 Ankylosing Spondylitis Disease Activity Score (ASDAS) assessed during a 1-year period, (ii) having inactive disease/low disease activity (i.e. ASDAS &lt; 2.1), (iii) in whom re-evaluation of ASDAS within recommended intervals occurred, and (iv) with high disease activity (HDA, i.e. ASDAS ≥ 2.1) in whom treatment was adapted ≤6 weeks after obtaining ASDAS ≥ 2.1. Patients with HDA with treatment adaptations were compared with patients with HDA without treatment adaptations.ResultsIn 185 out of 219 patients (84%), disease activity was monitored with ≥1 ASDAS during a 1-year period, of whom 71 (38%) patients had a score below the target (ASDAS &lt; 2.1) at first measurement. Re-evaluation of ASDAS ≤3 months occurred in 11% and 23% of the patients with inactive disease/low disease activity and HDA, respectively. Treatment adaptation occurred in 19 out of 114 patients (17%) with HDA. Patients in whom treatment was adapted had significantly higher ASDAS (P &lt; 0.01), CRP levels (P &lt; 0.05) and physician global assessment (P &lt; 0.05) compared with patients without treatment adaptations.ConclusionsTreat-to-target was applied to a limited extent in clinical practice in patients with axial spondyloarthritis. Available disease activity scores seemed not to be used for determining the frequency of re-evaluation nor treatment adaptation.
Early prediction of clinical response to anti-TNF treatment using multi-omics and machine learning in rheumatoid arthritis
Authors: Yoosuf Niyaz , Maciejewski Mateusz , Ziemek Daniel , Jelinsky Scott A , Folkersen Lasse , Müller Malin , Sahlström Peter , Vivar Nancy , Catrina Anca , Berg Louise , Klareskog Lars , Padyukov Leonid , Brynedal Boel 
Published: June 2021

AbstractObjectivesAdvances in immunotherapy by blocking TNF have remarkably improved treatment outcomes for Rheumatoid arthritis (RA) patients. Although treatment specifically targets TNF, the downstream mechanisms of immune suppression are not completely understood. The aim of this study was to detect biomarkers and expression signatures of treatment response to TNF inhibition.MethodsPeripheral blood mononuclear cells (PBMCs) from 39 female patients were collected before anti-TNF treatment initiation (day 0) and after 3 months. The study cohort included patients previously treated with MTX who failed to respond adequately. Response to treatment was defined based on the EULAR criteria and classified 23 patients as responders and 16 as non-responders. We investigated differences in gene expression in PBMCs, the proportion of cell types and cell phenotypes in peripheral blood using flow cytometry and the level of proteins in plasma. Finally, we used machine learning models to predict non-response to anti-TNF treatment.ResultsThe gene expression analysis in baseline samples revealed notably higher expression of the gene EPPK1 in future responders. We detected the suppression of genes and proteins following treatment, including suppressed expression of the T cell inhibitor gene CHI3L1 and its protein YKL-40. The gene expression results were replicated in an independent cohort. Finally, machine learning models mainly based on transcriptomic data showed high predictive utility in classifying non-response to anti-TNF treatment in RA.ConclusionsOur integrative multi-omics analyses identified new biomarkers for the prediction of response, found pathways influenced by treatment and suggested new predictive models of anti-TNF treatment in RA patients.
Self-oriented neural circuitry predicts other-oriented adaptive risks in adolescence: a longitudinal study
Authors: Kwon Seh-Joo , Turpyn Caitlin C , Prinstein Mitchell J , Lindquist Kristen A , Telzer Eva H 
Published: June 2021

Abstract
Adolescence is marked by changes in decision-making and perspective-taking abilities. Although adolescents make more adaptive decisions with age, little is understood about how adolescents take adaptive risks that impact others and how this behavior changes developmentally. Functional coupling between reward [e.g., ventral striatum (VS)] and ‘social brain’ [e.g. temporal parietal junction (TPJ)/ posterior superior temporal sulcus (pSTS), medial prefrontal cortex (mPFC)] systems may be differentially shape adaptive risks for the self and other. A total of 173 participants completed between one and three sessions across three waves [a total of 433 behavioral and 403 functional magnetic resonance imaging (fMRI) data points]. During an fMRI scan, adolescents completed a risky decision-making task where they made risky decisions to win money for themselves and their parent. The risky decisions varied in their expected value (EV) of potential reward. Results show that from the 6th through 9th grades, adolescents took increasingly more adaptive risks for themselves than for their parent. Additionally, greater VS–TPJ/pSTS and VS–mPFC connectivity that tracks EV when making risky decisions for themselves in 6th grade, but a lower VS–mPFC connectivity in 9th grade, predicted greater adaptive risk-taking for their parent. This study contributes to our understanding of the self as a neural proxy for promoting adaptive social behaviors in youth.
When death is literally the deadline: the “cut-off” point for assessing detriment in proprietary estoppel
Authors: Leung Samuel Yee Ching , Au-Yeung Bennett 
Published: June 2021

Abstract
Throughout the brief history of proprietary estoppel, it has been rare to find a case where it was argued that the promisor passed away before the promisee suffers sufficient detriment. Rarer still, to find this promise made jointly by co-owners as tenants-in-common of a property. In Cheung Lai Mui v Cheung Wai Shing [2021], the Hong Kong Court of Final Appeal found the “cut-off” point for assessing detriment in such a case to be the death of the last surviving co-owner—but why should it be? This article explores the theoretical interactions between proprietary estoppel, unconscionability and co-ownership in seeking to answer this question.
Prevalence and genotype distribution of human papillomavirus among 29 263 women from the Longgang community of Shenzhen
Authors: Chen Tingting , Cai Songtao , Lin Jinbo , Yang Xue , He Xuesen , Tu Changqing , Yang Chunxia 
Published: June 2021

Abstract

Background
Human papillomavirus (HPV) vaccination and screening have been demonstrated to be effective methods for controlling cervical cancer. To provide evidence for effective targeted interventions, we investigated the HPV prevalence and genotypic distribution in women of different age groups in the Longgang community of Shenzhen, China.

Methods
A total of 29 263 women were enrolled in the Longgang District Central Hospital from January 2018 to October 2020. Cervical specimens were collected at enrolment. We used a polymerase chain reaction diagnostic kit to detect the genotypes of HPV.

Results
The prevalence of overall, high-risk, probable high-risk (PHR) and low-risk HPV infection was 8.2% (95% confidence interval [CI] 7.9 to 8.5), 6.9% (95% CI 6.6 to 7.2), 0.9% (95% CI 0.8 to 1.1) and 1.6% (95% CI 1.5 to 1.8), respectively. High-risk HPV genotype infections accounted for 84.4% (95% CI 82.8 to 85.8) of the overall HPV infections. The five most predominant genotypes were HPV-52, HPV-16, HPV-58, HPV-53 and HPV-51.

Conclusion
Our study found that the prevalence of HPV infection increased with age and women 55–59 y of age presented the highest HPV prevalence. As a PHR subtype, HPV-53 has a higher infection rate in women. HPV-52, HPV-16 and HPV-58 are common infection genotypes.
Repeat Pediatric Trisomy 21 Radiographic Exam: Does Atlantoaxial Instability Develop Over Time?
Authors: Bauer Jennifer M. , Dhaliwal Virkamal K. , Browd Samuel R. , Krengel Walter F. 
Published: June 2021

Background:
Atlantoaxial instability (AAI) is common in pediatric patients with Trisomy 21 and can lead to spinal cord injury during sports, trauma, or anesthetized neck manipulation. Children with Trisomy 21 therefore commonly undergo radiographic cervical spine screening, but recommendations on age and timing vary. The purpose of this study was to determine if instability develops over time.

Methods:
We performed a retrospective review for all pediatric Trisomy 21 patients receiving at least 2 cervical spine radiographic series between 2008 and 2020 at our institution. Atlantodens interval (ADI) and space available for the cord at C1 (SAC) were measured; bony abnormalities such as os odontoidium, and age and time between radiographs were noted. AAI was determined by ADI ≥6 mm or SAC ≤14 mm based on our groups’ prior study. Those who developed instability were compared with those who did not.

Results:
A total of 437 cervical spine radiographic series from 192 patients were evaluated, with 160 included. Mean age at first radiograph was 7.4±4.4 years, average ADI was 3.1 mm (±1.2), and SAC was 18.1 mm (±2.6). The average time between first and last radiographs was 4.3 years (±1.8), with average final ADI 3.2 mm (±1.4) and SAC 18.9 mm (±2.9). Seven patients (4%) had instability: 4 were unstable on their initial studies and 3 (1.6%) on subsequent imaging. Os odontoideum was found in 5 (71%) unstable spines and 3 (2%) stable spines (P<0.0001); only 1 patient that became unstable on subsequent radiograph did not have an os. There was no specific age cut-off or surveillance time period after which one could be determined no longer at risk.

Conclusions:
Trisomy 21 patients have a 4.4% overall rate of AAI in our series with a 1.6% rate of progression to instability over ∼4 years. Given this nearly 1 in 23 risk of instability, we recommend initial surveillance radiograph for all children over 3 years with Trisomy 21; repeat asymptomatic surveillance should continue in those with os odontoideum given their high instability risk.

Level of Evidence:
Level II—diagnostic study.
Generalization in Clinical Prediction Models: The Blessing and Curse of Measurement Indicator Variables
Authors: Futoma Joseph , Simons Morgan , Doshi-Velez Finale , Kamaleswaran Rishikesan 
Published: June 2021

OBJECTIVE:
Specific factors affecting generalizability of clinical prediction models are poorly understood. Our main objective was to investigate how measurement indicator variables affect external validity in clinical prediction models for predicting onset of vasopressor therapy.

DESIGN:
We fit logistic regressions on retrospective cohorts to predict vasopressor onset using two classes of variables: seemingly objective clinical variables (vital signs and laboratory measurements) and more subjective variables denoting recency of measurements.

SETTING:
Three cohorts from two tertiary-care academic hospitals in geographically distinct regions, spanning general inpatient and critical care settings.

PATIENTS:
Each cohort consisted of adult patients (age greater than or equal to 18 yr at time of hospitalization), with lengths of stay between 6 and 600 hours, and who did not receive vasopressors in the first 6 hours of hospitalization or ICU admission. Models were developed on each of the three derivation cohorts and validated internally on the derivation cohort and externally on the other two cohorts.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The prevalence of vasopressors was 0.9% in the general inpatient cohort and 12.4% and 11.5% in the two critical care cohorts. Models utilizing both classes of variables performed the best in-sample, with C-statistics for predicting vasopressor onset in 4 hours of 0.862 (95% CI, 0.844–0.879), 0.822 (95% CI, 0.793–0.852), and 0.889 (95% CI, 0.880–0.898). Models solely using the subjective variables denoting measurement recency had poor external validity. However, these practice-driven variables helped adjust for differences between the two hospitals and led to more generalizable models using clinical variables.

CONCLUSIONS:
We developed and externally validated models for predicting the onset of vasopressors. We found that practice-specific features denoting measurement recency improved local performance and also led to more generalizable models if they are adjusted for during model development but discarded at validation. The role of practice-specific features such as measurement indicators in clinical prediction modeling should be carefully considered if the goal is to develop generalizable models.
Systematic Approach for Management and Prevention of Boxy Breast
Authors: Abdelkader Rasha , El-Noamany Sameh , Raafat Sarah 
Published: June 2021

Background:
Although a boxy breast is a common aesthetic problem following breast reduction and mastopexy, literature regarding this deformity is scarce. It is vaguely described as a definitive postreduction deformity. To address this complication, it is important to fully analyze the problem, understand and predict its causes, and then try to prevent it.

Methods:
This study included two groups. Group 1 included 14 patients presenting with boxy postoperative breasts. Revision surgeries were conducted for all patients, and the first algorithm was created for quantifying breast surgery in revision cases. Group 2 included 37 cases of primary mammaplasty reduction/mastopexy performed between 2016 and 2019. All the patients in this group were treated as per the study algorithm.

Results:
Patient satisfaction was measured on a scale of one to 10, with one being extremely dissatisfied and 10 being extremely satisfied. The results indicated overall satisfaction, with average scores of 9.5 and 9.1 in groups 1 and 2, respectively; the scores of surgeon satisfaction were 8.2 and 8.6, respectively.

Conclusions:
The proposed algorithm, preoperative markings, intraoperative techniques, and postoperative orientation may help achieve optimal results and prevent undesired deformities or asymmetry. Applying a flexible and simplified algorithm provided a more objective plan, which enabled surgeons to attain more satisfactory results. Following a preset quantified plan supported and shortened learning curves and objectively addressed the common postoperative complication, breast boxing.
Effect of Perioperative Intravenous Iron Supplementation for Complex Cardiac Surgery on Transfusion Requirements
Authors: Song Jong Wook , Soh Sarah , Shim Jae-Kwang , Lee Sak , Lee Seung Hyun , Kim Hye Bin , Kim Min-Yu , Kwak Young Lan 
Published: June 2021

Objectives:
We investigated whether routine perioperative intravenous iron replenishment reduces the requirement for packed erythrocytes (pRBC) transfusion.

Summary of Background Data:
Patients undergoing complex cardiac surgery are at high risk of developing postoperative iron deficiency anemia, thus requiring transfusion, which is associated with adverse outcomes.

Methods:
Patients were randomized to receive either ferric derisomaltose 20 mg/kg (n = 103) or placebo (n = 101) twice during the perioperative period: 3 days before and after the surgery. The primary endpoint was the proportion of patients who received pRBC transfusion until postoperative day (POD) 10. Hemoglobin, reticulocyte count, serum iron profile, hepcidin, and erythropoietin were serially measured.

Results:
pRBC was transfused in 60.4% and 57.2% of patients in the control and iron group, respectively (P = 0.651). Hemoglobin concentration at 3 weeks postoperatively was higher in the iron group than in the control group (11.6 ± 1.5 g/dL vs 10.9 ± 1.4 g/dL, P < 0.001). The iron group showed higher reticulocyte count [205 (150–267)×103/μL vs 164 (122–207)×103/μL, P = 0.003] at POD 10. Transferrin saturation and serum ferritin were significantly increased in the iron group than in the control group (P < 0.001). Serum hepcidin was higher in the iron group than in the control group at POD 3 [106.3 (42.9–115.9) ng/mL vs 39.3 (33.3–43.6) ng/mL, P < 0.001]. Erythropoietin concentration increased postoperatively in both groups (P = 0.003), with no between-group difference.

Conclusions:
Intravenous iron supplementation during index hospitalization for complex cardiac surgery did not minimize pRBC transfusion despite replenished iron store and augmented erythropoiesis, which may be attributed to enhanced hepcidin expression.
Financial Incentives to Improve Patient Follow-up and Weight Loss After Bariatric Surgery
Authors: Chao Grace F. , Kullgren Jeffrey T. , Ross Rachel , Bonham Aaron J. , Ghaferi Amir A. 
Published: June 2021

Objective:
To examine effects of a financial incentives program on follow-up and weight loss after bariatric surgery.

Summary Background Data:
Consistent follow-up may improve weight loss and other health outcomes after bariatric surgery. Yet, rates of follow-up after surgery are often low.

Methods:
Patients from 3 practices within a statewide collaborative were invited to participate in a 6-month financial incentives program. Participants received incentives for attending postoperative appointments at 1, 3, and 6 months which doubled when participants weighed less than their prior visit. Participants were matched with contemporary patients from control practices by demographics, starting body mass index and weight, surgery date, and procedure. Preintervention estimates used matched historic patients from the same program and control practices with the criteria listed above. Patients between the 2 historic groups were additionally matched on surgery date to ensure balance on matched variables. We conducted differ-ence-in-differences analyses to examine incentives program effects. Follow-up attendance and percent excess weight loss were measured postoperative months 1, 3, 6, and 12.

Results:
One hundred ten program participants from January 1, 2018 to July 31, 2019 were matched to 203 historic program practice patients (November 20 to December 27, 2017). The control group had 273 preinter-vention patients and 327 postintervention patients. In difference-in-differ-ences analyses, the intervention increased follow-up rates at 1 month (+14.8%, P<0.0001), 3months (+29.4%, P<0.0001), and 6 months (+16.4%, P<0.0001), but not at 12 months. There were no statistically significant differences in excess weight loss.

Conclusions:
A financial incentives program significantly increased follow-up after bariatric surgery for up to 6 months, but did not increase weight loss. Our study supports use of incentivized approaches as one way to improve postoperative follow-up, but may not translate into greater weight loss without additional supports.
Gender Bias in the Evaluation of Surgical Performance
Authors: Antonoff Mara B. , Feldman Hope , Luc Jessica G. Y. , Iaeger Paula I. , Rubin M. Laura , Li Liang , Vaporciyan Ara A. 
Published: June 2021

Objective:
The study aims to determine the influence of trainee gender on assessments of coronary anastomosis performance.

Summary of Background Data:
Understanding the impact of gender bias on the evaluation of trainees may enable us to identify and utilize assessment tools that are less susceptible to potential bias.

Methods:
Cardiothoracic surgeons were randomized to review the video performance of trainees who were described by either male or female pronouns. All participants viewed the same video of a coronary anastomosis and were asked to grade technique using either a Checklist or Global Rating Scale (GRS). Effect of trainee gender on scores by respondent demographic was evaluated using regression analyses. Inter-rater reliability was assessed using the Cronbach’s alpha.

Results:
103 cardiothoracic surgeons completed the Checklist (trainee gender: male n=50, female n=53) and 112 completed the GRS (trainee gender: male n=56, female n=56). For the Checklist, male cardiothoracic surgeons who were in practice <10 years (P = 0.036) and involved in training residents (P = 0.049) were more likely to score male trainees higher than female trainees. The GRS demonstrated high inter-rater reliability across male and female trainees by years and scope of practice for the respondent (alpha >0.900) when compared to the Checklist assessment tool.

Conclusions:
Early career male surgeons may exhibit gender bias against women when evaluating trainee performance of coronary anastomoses. The GRS demonstrates higher interrater reliability and robustness against gender bias in the assessment of technical performance than the Checklist, and such scales should be emphasized in educational evaluations.
Robot-assisted Versus Conventional Minimally Invasive Esophagectomy for Resectable Esophageal Squamous Cell Carcinoma
Authors: Yang Yang , Li Bin , Yi Jun , Hua Rong , Chen Hezhong , Tan Lijie , Li Hecheng , He Yi , Guo Xufeng , Sun Yifeng , Yu Bentong , Li Zhigang 
Published: June 2021

Objective:
To compare perioperative and long-term outcomes of robot-assisted minimally invasive esophagectomy (RAMIE) and conventional minimally invasive esophagectomy (MIE) in the treatment for patients with esophageal squamous cell carcinoma (ESCC).

Summary Background Data:
RAMIE has emerged as an alternative to traditional open or thoracoscopic approaches. Efficacy and safety of RAMIE and MIE in the surgical treatment for ESCC remains uncertain given the lack of high-level clinical evidence.

Methods:
The RAMIE trial was designed as a prospective, multicenter, randomized, controlled clinical trial that compares the efficacy and safety of RAMIE and MIE in the treatment of resectable ESCC. From August 2017 to December 2019, eligible patients were randomly assigned to receive either RAMIE or MIE performed by experienced thoracic surgeons from 6 high-volume centers in China. Intent-to-treat analysis was performed.

Results:
Significantly shorter operation time was taken in RAMIE (203.8 vs 244.9 min, P<0.001). Compared with MIE, RAMIE showed improved efficiency of thoracic lymph node dissection in patients who received neoadjuvant therapy (15 vs 12, P = 0.016), as well as higher achievement rate of lymph node dissection along the left recurrent laryngeal nerve (79.5% vs 67.6%, P = 0.001). No difference was found in blood loss, conversion rate, and R0 resection. The 90-day mortality was 0.6% in each group. Overall complications were similar in RAMIE (48.6%) compared with MIE (41.8%) (RR, 1.16; 95% CI, 0.92–1.46; P = 0.196). Besides, the rate of major complications (Clavien-Dindo classification ≥ III) was also comparable (12.2% vs 10.2%, P = 0.551). RAMIE showed similar incidences of pulmonary complications (13.8% vs 14.7%; P = 0.812), anastomotic leakage (12.2% vs 11.3%; P = 0.801), and vocal cord paralysis (32.6% vs 27.1%, P = 0.258) to MIE.

Conclusions:
Early results demonstrate that both RAMIE and MIE are safe and feasible for the treatment of ESCC. RAMIE can achieve shorter operative duration and better lymph node dissection in patients who received neoadjuvant therapy. Long-term results are pending for further follow-up investigations.

Trial Registration:
ClinicalTrial.gov Identifier: NCT03094351.