bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incident aortic root dilatation in the general population: findings from the Pamela study
Authors: Cuspidi Cesare , Facchetti Rita , Quarti-Trevano Fosca , Dell’Oro Raffaella , Tadic Marijana , Mancia Giuseppe , Grassi Guido 
Published: November 2021

Aim:
We sought to assess the long-term changes in aortic root diameter in a population-based sample, focusing on new-onset aortic root dilatation, as well as on the demographic and clinical variables independently related to this dynamic process.

Methods:
A total of 1122 participants with measurable echocardiographic parameters at baseline and after a 10-year follow-up were included in the analysis. Sex-specific upper limits of normality for absolute aortic root diameter, aortic root diameter indexed to body surface area (BSA) and to height were derived from 712 healthy normotensive PAMELA participants.

Results:
Over the 10-year follow-up, new aortic root dilatation occurred in 3.4% (aortic root /BSA), 4.4% (aortic root /height) and 7.3% (absolute aortic root), respectively. No substantial relationship was observed between baseline office and ambulatory blood pressure (BP) or their changes over time and incident aortic root /BSA and aortic root /height dilatation. Baseline aortic root diameter and left ventricular mass index (LVMI) emerged as important predictors of aortic root dilation, regardless of the diagnostic criteria used. This was also the case for the 10-year change in LVMI. The strength of association between nonhemodynamic variables and new-onset aortic root dilatation was variable, depending on the definition of the aortic phenotype.

Conclusion:
The incidence of aortic root dilatation in a general middle-aged population is a relatively infrequent but not so rare event and scarcely influenced by both office and out-office BP. On the contrary, it is strongly related to LVMI (and its variations over time). From a clinical perspective, this underlines that LVH prevention and regression can reduce the risk of aortic root dilatation in the community.
Automated detection of squint as a sensitive assay of sex-dependent calcitonin gene–related peptide and amylin-induced pain in mice
Authors: Rea Brandon J. , Davison Abigail , Ketcha Martin-Junior , Smith Kylie J. , Fairbanks Aaron M. , Wattiez Anne-Sophie , Poolman Pieter , Kardon Randy H. , Russo Andrew F. , Sowers Levi P. 
Published: November 2021

Abstract
We developed an automated squint assay using both black C57BL/6J and white CD1 mice to measure the interpalpebral fissure area between the upper and lower eyelids as an objective quantification of pain. The automated software detected a squint response to the commonly used nociceptive stimulus formalin in C57BL/6J mice. After this validation, we used the automated assay to detect a dose-dependent squint response to a migraine trigger, the neuropeptide calcitonin gene–related peptide, including a response in female mice at a dose below detection by the manual grimace scale. Finally, we found that the calcitonin gene–related peptide amylin induced squinting behavior in female mice, but not males. These data demonstrate that an automated squint assay can be used as an objective, real-time, continuous-scale measure of pain that provides higher precision and real-time analysis compared with manual grimace assessments.
The effects of acupuncture and related techniques on patients with rheumatoid arthritis: A systematic review and meta-analysis
Authors: Lu Ho-Lin , Chang Ching-Mao , Hsieh Po-Chun , Wang Jia-Chi , Kung Yen-Ying 
Published: November 2021

Background:
One new type of acupuncture and related techniques (ACNRT) is increasingly used by rheumatoid arthritis (RA) patients to control their disease and improve their quality of life. However, the efficacy of using ACNRT in combination with western medicine (WM) for this purpose remains unknown.

Methods:
Randomized controlled trials of ACNRT and WM treatments for RA from January 1, 2000, to January 31, 2021, were searched for in the databases PubMed, Embase, Medline, and the Cochrane Central Register of Controlled Trials, as well as in three Chinese databases: China National Knowledge Infrastructure, Wanfang Data, and Airiti Library. The primary outcomes consisted of inflammatory markers including C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and rheumatoid factor. The secondary outcomes were clinical characteristics including pain visual analog scale (VAS) score, Disease Activity Score (DAS-28), swollen joints count (SJC), tender joints count (TJC), morning stiffness, and the results of a health assessment questionnaire. The three types of ACNRT used in the focal trials were acupuncture, moxibustion, and electro-acupuncture. Two qualified researchers extracted data from these trials’ results and independently assessed their risk of bias. Statistical analyses were performed using Comprehensive Meta-Analysis V3 software.

Results:
A total of 12 RCTs with 874 patients met the inclusion criteria. As compared with the patients who received WM treatment alone, those who were given integrated ACNRT/WM treatment showed greater reductions in CRP (weighted mean difference [WMD]: −6.299; 95% CI: −9.082 to −3.517), ESR (WMD: −6.563; 95% CI: −8.604 to -4.522), VAS (WMD: −1.089; 95% CI: −1.575 to −0.602), DAS-28 (WMD: −0.633; 95% CI: −1.006 to −0.259), SJC (WMD: −1.921; 95% CI: −3.635 to −0.207), and TJC (WMD: −1.491; 95% CI: −2.941 to −0.042).

Conclusion:
This meta-analysis of RA provides reliable evidence in favor of ACNRT plus WM. However, longer term, high-quality, repeatable, multicenter randomized controlled trials with larger sample sizes are needed.
Nutrition support for acute kidney injury 2020-consensus of the Taiwan AKI task force
Authors: Hung Kai-Yin , Chen Shu-Tzu , Chu Yu-Ying , Ho Guanjin , Liu Wei-Lun 
Published: November 2021

Background:
We used evidence-based medicine to suggest guidelines of nutritional support for Taiwanese patients with acute kidney injury (AKI).

Methods:
Our panel reviewed the medical literature in group meetings to reach a consensus on answering clinical questions related to the effects of the nutritional status, energy/protein intake recommendations, timing of enteral, and parenteral nutrition supplementation.

Results:
Markers of the nutritional status of serum albumin, protein intake, and nitrogen balance had positive relationships with low mortality. A forest plot of the comparison of mortality between a body mass index (BMI) of <18.5 and ≥18.5 kg/m2 was produced using data from seven observational studies which showed that a lower BMI was associated with higher mortality. The energy recommendation of 20–30 kcal/kg body weight (BW)/day was determined to be valid for all stages of AKI. The protein recommendation for noncatabolic AKI patients is 0.8–1.0 g/kg BW/day, and 1.2–2.0 g/kg BW/day is the same as that for the underlying disease that is causing AKI. Protein intake should be at least 1.5 g/kg BW/day and up to 2.5 g/kg BW/day in patients receiving continuous renal replacement therapy. Considering that patients with AKI often have other critical comorbid situations, early enteral nutrition (EN) is suggested, and parenteral nutrition is needed when >60% energy and protein requirements cannot be met via the enteral route in 7–10 days. Low energy intake is suggested in critically ill patients with AKI, which should gradually be increased to meet 80%–100% of the energy target.

Conclusion:
By examining evidence-based research, we provide practicable nutritional guidelines for AKI patients.
Tissue selecting technique for adult women with low rectovaginal fistula
Authors: Ju Man , Wang Xiuli , Xia Chaofeng , Ju Yingdong 
Published: November 2021

Background:
This study aimed to assess the effect of tissue selecting technique (TST) on low rectovaginal fistula (RVF) repair.

Methods:
Patients with low RVF were included in the prospective study from August 2009 and January 2013 in xx hospital. Patients assigned to the TST or control groups based on the different surgical methods. Surgical success, complications, and quality of life were evaluated. Patients were followed up for 1–3 years.

Results:
A total of 81 patients were included in the study. Foutry-one were in the TST group, and 40 were in the control group. Surgery was successful in 100% of patients who underwent TST, and in 95% of patients who underwent the classical perineal approach. Less patients experienced pain (72% vs 90%, p = 0.04) and edema (6% vs 25%, p < 0.001) in the TST group compared with the control group. In addition, the QOL score was significantly higher in the TST group (122 ± 21 vs 111 ± 12, p = 0.02).

Conclusion:
The TST stapler approach appears to be appropriate for the treatment of low RVF in adults.
Implications of Phase Changes in Extracochlear Electrocochleographic Recordings During Cochlear Implantation
Authors: Suntinger Katharina , Huber Alexander , Röösli Christof , Sijgers Leanne , Veraguth Dorothe , Pfiffner Flurin , Dalbert Adrian 
Published: November 2021

Objective:
To assess the prevalence and implications of phase changes in extracochlear electrocochleography (ECochG) recordings during cochlear implantation.

Materials and Methods:
Extracochlear ECochG recordings were performed before and after insertion of the cochlear implant (CI) electrode by a recording electrode placed on the promontory. Acoustic stimuli were tone bursts at 250, 500, 750, and 1,000 Hz. The pure tone average (PTA) was determined before and approximately 4 weeks after surgery.

Results:
Extracochlear ECochG recordings in 69 ears of 68 subjects were included. At 250 Hz, the mean phase change was 43° (n = 50, standard deviation (SD) 44°), at 500 Hz 36° (n = 64, SD 36°), at 750 Hz 33° (n = 42, SD 39°), and at 1,000 Hz 22° (n = 54, SD 27°). Overall, in 48 out of 210 ECochG recordings a phase change of ≥45° (23%) was detectable. Ears with an amplitude drop >3 dB and a phase change ≥45° (n = 3) had a complete or near complete loss of residual cochlear function in all cases. A phase change of ≥90° in one recording was not associated with a larger amplitude change of the ECochG signal (1.9 dB vs. −0.9 dB, p = 0.1052, n = 69), but with a significantly larger postoperative hearing loss (17 dB vs. 26 dB, p = 0.0156, n = 69).

Conclusions:
Phase changes occur regularly in extracochlear ECochG recordings during cochlear implantation. Phase changes of ≥90° with or without amplitude changes in the ECochG signal are associated with a larger postoperative hearing loss and could therefore represent an independent marker for cochlear trauma or changes of inner ear mechanics relevant for the postoperative hearing outcome.
Insertion Depth and Cochlear Implant Speech Recognition Outcomes: A Comparative Study of 28- and 31.5-mm Lateral Wall Arrays
Authors: Canfarotta Michael W. , Dillon Margaret T. , Brown Kevin D. , Pillsbury Harold C. , Dedmon Matthew M. , O’Connell Brendan P. 
Published: November 2021

Objectives:
1) To compare speech recognition outcomes between cochlear implant (CI) recipients of 28- and 31.5-mm lateral wall electrode arrays, and 2) to characterize the relationship between angular insertion depth (AID) and speech recognition.

Study Design:
Retrospective review.

Setting:
Tertiary academic referral center.

Patients:
Seventy-five adult CI recipients of fully inserted 28-mm (n = 28) or 31.5-mm (n = 47) lateral wall arrays listening with a CI-alone device.

Interventions:
Cochlear implantation with postoperative computed tomography.

Main Outcome Measures:
Consonant-nucleus-consonant (CNC) word recognition assessed with the CI-alone at 12 months postactivation.

Results:
The mean AID of the most apical electrode contact for the 31.5-mm array recipients was significantly deeper than the 28-mm array recipients (628° vs 571°, p < 0.001). Following 12 months of listening experience, mean CNC word scores were significantly better for recipients of 31.5-mm arrays compared with those implanted with 28-mm arrays (59.5% vs 48.3%, p = 0.004; Cohen's d = 0.70; 95% CI [0.22, 1.18]). There was a significant positive correlation between AID and CNC word scores (r = 0.372, p = 0.001), with a plateau in performance observed around 600°.

Conclusions:
Cochlear implant recipients implanted with a 31.5-mm array experienced better speech recognition than those with a 28-mm array at 12 months postactivation. Deeper insertion of a lateral wall array appears to confer speech recognition benefit up to ∼600°, with a plateau in performance observed thereafter. These data provide preliminary evidence of the insertion depth necessary to optimize speech recognition outcomes for lateral wall electrode arrays among CI-alone users.
Use of Auditory Training and Its Influence on Early Cochlear Implant Outcomes in Adults
Authors: Dornhoffer James R. , Reddy Priyanka , Ma Cheng , Schvartz-Leyzac Kara C. , Dubno Judy R. , McRackan Theodore R. 
Published: November 2021

Objective:
Assess associations between postcochlear implant (CI) auditory training and early outcomes related to speech recognition and CI quality of life (CIQOL).

Study Design:
Longitudinal, prospective cohort.

Setting:
Tertiary academic center.

Patients:
Seventy-two adults undergoing cochlear implantation for bilateral severe-to-profound hearing loss.

Interventions:
Self-reported use of three categories of auditory training post-CI activation: (1) face-to-face training (e.g., speech pathologist), (2) passive home-based training (e.g., listening to audiobooks), and (3) computer-based training (e.g., interactive software).

Main Outcome Measures:
Change in Consonant-Nucleus-Consonant phoneme (CNCp), CNC word (CNCw), AzBio sentences in quiet, and CIQOL-35 Profile global and domain scores from pre-CI to 3-month post-CI.

Results:
Of 72 patients, 52 (72.2%) used an auditory training resource. Of all patients, 18.4% used face-to-face training, 58.3% passive home-based training, and 33.3% computer-based training. At 3 months post-CI, use of any training was associated with greater improvement in speech recognition (d-range = 0.57–0.85) and global and domain-specific CIQOL scores, except entertainment (d-range = −0.33 to 0.77). Use of computer-based training demonstrated the greatest effect, with larger improvements in speech recognition (CNCp: d = 0.69[0.03,1.35]; CNCw: d = 0.80[0.14,1.46]; AzBio: d = 1.11[0.44,1.77]) and global and all domain-specific CIQOL scores (d-range = 0.05–1.35). Controlling for age, sex, household income, and use of multiple training resources, computer-based training remained the strongest positive predictor of speech recognition and CIQOL improvement, with significant associations with CNCp (ß = 33.07[1,43,64.719]), AzBio (ß = 33.03[5.71,60.35]), and CIQOL-global (ß = 10.92[1.15,20.70]) score improvement.

Conclusions:
Our findings provide preliminary evidence-based recommendations for use of specific auditory training resources for new adult CI recipients. Auditory training, especially self-directed computer software, resulted in improved speech recognition and CIQOL outcomes after 3 months and are widely available for CI users.
Evaluation of the Quality of Online Information on Sudden Sensorineural Hearing Loss
Authors: Simani Liam , Oron Yahav , Handzel Ophir , Eta Rani Abu , Warshavsky Anton , Horowitz Gilad , Muhanna Nidal , Ungar Omer J. 
Published: November 2021

Objective:
To evaluate the quality of leading Internet resources of information on sudden sensorineural hearing loss (SSNHL).

Study Design:
Cross-sectional descriptive design.

Settings:
An online search by means of the Google search engine.

Methods:
An online search was conducted using terms related to SSNHL. We defined “quality” according to scaled readability measures (Flesch Reading Ease [FRE] and Flesch-Kincaid Grade-Level [FKGL]), as well as “understandability” and “actionability” (Patient Education Materials Assessment Tool), and Clinical Practice Guideline (CPG) adherence. Scoring was performed by two independent physicians.

Results:
The 10 most frequently encountered patient education websites were analyzed. The average FRE score was “fairly difficult” (mean 57.28, median 55.55, range 46.4–71.8) and the average FKGL score was “standard” (mean 9th grade, median 9th grade, range 5th–10th grade). Nine websites were understandable (mean 83%, median 84%, range 69–100%), and seven had good actionability scores (mean 73%, median 75%, range 50–100%). Most websites conformed with the CPG for patient education at a reasonable level (mean 5.6, median 5.5, range 3–7). Notably, all websites encouraged seeking medical help.

Conclusion:
Internet resources for patient education on SSNHL vary in quality and are generally understandable to the average layman. There is still much room for better, more comprehensive and easier-to-read information to improve patients’ medical knowledge about their condition.

Level of Evidence: 1
Characterization and Development of Universal Ventricular Assist Device: Computational Fluid Dynamics Analysis of Advanced Design
Authors: Goodin Mark S. , Showalter Michael S. , Horvath David J. , Kuban Barry D. , Flick Christine R. , Polakowski Anthony R. , Fukamachi Kiyotaka , Karimov Jamshid H. 
Published: November 2021

We are developing a universal, advanced ventricular assist device (AVAD) with automatic pressure regulation suitable for both left and right ventricular support. The primary goal of this computational fluid dynamics (CFD) study was to analyze the biventricular performance of the AVAD across its wide range of operating conditions.
An AVAD CFD model was created and validated using in vitro hydraulic performance measurements taken over conditions spanning both left ventricular assist device (LVAD) and right ventricular assist device (RVAD) operation. Static pressure taps, placed throughout the pump, were used to validate the CFD results. The CFD model was then used to assess the change in hydraulic performance with varying rotor axial positions and identify potential design improvements. The hydraulic performance was simulated and measured at rotor speeds from 2,300 to 3,600 revolutions/min and flow rates from 2.0 to 8.0 L/min. The CFD-predicted hydraulic pressure rise agreed well with the in vitro measured data, within 6.5% at 2300 rpm and within 3.5% for the higher rotor speeds. The CFD successfully predicted wall static pressures, matching experimental values within 7%. High degree of similarity and circumferential uniformity in the pump’s flow fields were observed over the pump operation as an LVAD and an RVAD. A secondary impeller axial clearance reduction resulted in a 10% decrease in peak flow residence time and lower static pressures on the secondary impeller. These lower static pressures suggest a reduction in the upwards rotor forces from the secondary impeller and a desired increase in the pressure sensitivity of the pump.
The CFD analyses supported the feasibility of the proposed AVAD’s use as an LVAD or an RVAD, over a wide range of operating conditions. The CFD results demonstrated the operability of the pump in providing the desired circumferential flow similarity over the intended range of flow/speed conditions and the intended functionality of the AVAD’s automated pressure regulation.
Advanced respiratory monitoring in mechanically ventilated patients with coronavirus disease 2019-associated acute respiratory distress syndrome
Authors: Somhorst Peter , Gommers Diederik , Endeman Henrik 
Published: November 2021

Purpose of review
To summarize the current knowledge about the application of advanced monitoring techniques in coronavirus disease 2019 (COVID-19).

Recent findings
Due to the heterogeneity between patients, management of COVID-19 requires daily monitoring of and/or aeration and inspiratory effort. Electrical impedance tomography can be used to optimize positive end-expiratory pressure, monitor the response to changes in treatment or body position and assess pulmonary perfusion and ventilation/perfusion matching. Lung ultrasound is more readily available and can be used to measure and monitor recruitment, provide an indication of diaphragm function and pulmonary perfusion disturbances. Esophageal pressure measurements enable the calculation of the transpulmonary pressure and inspiratory effort in order to prevent excessive stress on the lung. While esophageal pressure measurements are the golden standard in determining inspiratory effort, alternatives like P
0.1, negative pressure swing during a single airway occlusion and change in central venous pressure are more readily available and capable of diagnosing extreme inspiratory efforts.

Summary
Although there is little data on the effectiveness of advanced monitoring techniques in COVID-19, regular monitoring should be a central part of the management of COVID-19-related acute respiratory distress syndrome (C-ARDS).
Current status of the assessment of sarcopenia, frailty, physical performance and functional status in chronic kidney disease patients
Authors: Otobe Yuhei , Rhee Connie M. , Nguyen Matthew , Kalantar-Zadeh Kamyar , Kopple Joel D. 
Published: November 2021

Purpose of review
Low physical function, frailty, and sarcopenia are common complications of chronic kidney disease (CKD). In this article, we review the epidemiology and pathogenesis of low physical function, as well as its associations with adverse outcomes in CKD patients. Additionally, we present various traditional and novel methods for assessment of physical function in CKD patients.

Recent findings
In nondialysis dependent (NDD) and dialysis-dependent CKD patients, the prevalence of low physical function, frailty, and sarcopenia are substantially higher than in the general population. The potential mechanisms of low physical function, frailty, and sarcopenia in CKD patients are due to various factors including underlying kidney disease, co-existing comorbidities, and certain therapeutic interventions utilized in CKD. Increasing evidence has also uncovered the ill effects of impaired physical function on clinical outcomes in CKD patients.

Summary
Routine assessment of physical function is an under-utilized yet important component in the management of CKD patients. Future studies are needed to determine how prescription of exercise and increased daily physical activity can be tailored to optimize the health and well-being of NDD and dialysis-dependent CKD patients in pursuit of successful aging.
Novel monitoring of renal function and medication levels in saliva and capillary blood of patients with kidney disease
Authors: Beshay Manal , Rhee Connie M. , Kalantar-Zadeh Kamyar 
Published: November 2021

Purpose of review
Serum creatinine, urea, and cystatin C are the main biomarkers used to estimate glomerular filtration rates in persons with and without chronic kidney disease (CKD). Frequent measurements of these assays are needed to identify patients with earlier stages of CKD, detect episodes of acute kidney injury (AKI), and monitor for CKD progression. However, the cumbersome, time-consuming nature of conventional laboratory-based kidney function assays limit more frequent monitoring and greater patient self-management.

Recent findings
Noninvasive salivary assessments of creatinine, cystatin C, and urea make it feasible to conduct frequent monitoring of kidney function in point-of-care settings, as well as in nonclinical-care settings such as at home. Additionally, fingerstick sampling can offer an alternative route of blood testing that is suitable for home-based assessments. In this review, we provide an overview of emerging data on various salivary vs. fingerstick blood assessment methods for kidney function; their accuracy in comparison to ‘gold-standard’ laboratory-based methods; and their respective strengths and limitations in the clinical setting.

Summary
A practical, cost-effective, minimally invasive, multimarker assessment platform has the potential to circumvent the limitation of conventional laboratory blood-based testing approaches, and thereby address a major unmet need in the management of CKD patients.