bluuebunny/crossref_metadata_2025_split huggingface dataset:
Private Payer–Negotiated Prices for Outpatient Otolaryngologic Surgery
Authors: Wang Annette A. , Xiao Roy , Sethi Rosh K.V. , Rathi Vinay K. , Scangas George A. 
Published: September 2021

In January 2021, the Centers for Medicare & Medicaid Services began requiring hospitals to publish price transparency files listing all prices negotiated with payers. We performed a cross‐sectional analysis of payer‐negotiated prices for commonly performed outpatient otolaryngology surgery at all hospitals scored by the US News & World Report in otolaryngology. We compared prices among hospitals (across‐center ratios) and among payers at the same hospital (within‐center ratios). Price disclosure rates were low overall for otolaryngologic surgery (maximum, 26.7% for bronchoscopy). Across‐center ratios ranged from 3.5 (adjacent tissue transfer/rearrangement <10 cm2; raw median price range, $1384‐$7047) to 18.6 (cochlear implant placement; raw median price range, $2417‐$60,255). Median within‐center ratios ranged between 2.7 (intraoperative navigation) and 5.4 (total thyroidectomy). Although price variation may signal opportunities for cost savings, patients may have limited ability to comparison shop due to hospital nondisclosure. Further investigation is necessary to examine the factors affecting price variation for otolaryngologic procedures.
Projected climate change impacts on tropical life zones in Costa Rica
Authors: Birkel Christian , Dehaspe Joni , Chavarría-Palma Andrés , Venegas-Cordero Nelson , Capell Rene , Durán-Quesada Ana María 
Published: September 2021

Efforts to protect tropical ecosystems aim at implementing biological corridors across the national territory of Costa Rica. However, potential near-future climate change challenges the effectiveness of such conservation measures. For this purpose, we developed near-future climate change scenarios at high spatial resolution using open-access global data from the Copernicus Climate Data Store (CDS). These projections resulted from downscaling (to a 1km2 national grid) and quantile-mapping bias-correction of the Essential Climate Variables Global Circulation Model (ECV_GCM) ensemble mean from the CDS using a moderate Representative Concentration Pathway 4.5 (RCP4.5). Projections were evaluated with limited local station data and applied to generate future ecosystem indicators (Holdridge Life Zones, HLZs). We show significantly increasing temperatures of 2.6°C with a spatial variability of ± 0.4°C for Costa Rica until 2040 with local differences (higher temperatures projected for the southern Costa Rican Caribbean). The future mean annual precipitation showed slightly wetter conditions (120 ± 43 mm/year) and most prominently in the Costa Rican Caribbean and south Pacific, but no significant drying in the north of Costa Rica by 2040. The bias-corrected climate data were aggregated to decadal and 30-year average (1971–2040) life zone ecosystem indicators that could potentially show ecosystem shifts. Changes in the life zones are most likely due to warmer temperatures and to a lesser extent caused by projected wetter conditions. Shifts are more likely to occur at higher elevations with a potential loss of the sub-tropical rainforest ecosystem. The projections support diminishing tropical dry forests and slightly increasing tropical rain and wet forests in the biological corridors of the driest and wettest regions, respectively. A countrywide spatial uniformity of dominating tropical moist forests (increase from 24% to 49%) at the expense of other HLZs was projected by 2040.
The time sequence of brain MRI findings in spontaneous intracranial hypotension
Authors: Chen Shu-Ting , Wu Jr-Wei , Wang Yen-Feng , Lirng Jiing-Feng , Hseu Shu-Shya , Wang Shuu-Jiun 
Published: September 2021

Objectives To investigate the time sequence of brain magnetic resonance imaging findings of spontaneous intracranial hypotension. Methods We retrospectively reviewed the medical records and brain magnetic resonance imaging findings of consecutive patients with spontaneous intracranial hypotension hospitalized between January 2007 and December 2017. Patients were divided into quartiles based on intervals between initial spontaneous intracranial hypotension symptom onset and brain magnetic resonance imaging scan. Six categorical and five continuous brain magnetic resonance imaging findings were assessed, including venous distension sign, enlarged pituitary gland, diffuse pachymeningeal enhancement, mid-brain pons deformity, subdural fluid collection, flattening of pons, midbrain-pons angle, descent of cerebral aqueduct, mamillopontine distance, distance of suprasellar cistern, and distance of prepontine cistern. In addition, we also calculated the neuroimaging scores with a score ≥5 classified as ‘high probability of spontaneous intracranial hypotension' and a score ≥3 as ‘intermediate-to-high probability.' Then, we analyzed the linkage between the onset-neuroimaging interval and brain magnetic resonance imaging findings, as well as different neuroimaging scores. Results A total of 173 patients (57 males and 116 females) were included in the analysis, and the range of onset-neuroimaging interval was 1 to 89 days (median [interquartile range]  =  17 [7 to 30 days]). We divided the patients into quartiles based on their onset-neuroimaging interval (the first quartile: 0–6 days; the second quartile: 7–16 days; the third quartile: 17–29 days; the fourth quartile: ≥30 days). Among brain magnetic resonance imaging findings, the incidence of venous distension sign was high (>75%), with no difference among quartiles (p = 0.876). The incidence of diffuse pachymeningeal enhancement (p = 0.001), severe midbrain-pons deformity (p = 0.001), and subdural fluid collection (<0.001) followed a significant stepwise increase from the first quartile to fourth quartile. Patients with shorter onset-neuroimaging intervals were less likely to have neuroimaging scores ≥5 (<17 vs. ≥17 days: 72.9% vs. 86.4%; odds ratio = 2.3 [95% CI 1.1–5.1], p = 0.028), but not neuroimaging scores ≥3 (<17 vs. ≥17 days: 92.9% vs. 92.0%, p = 0.824). Conclusions The emergence of brain magnetic resonance imaging findings of spontaneous intracranial hypotension depended on disease duration and appeared sequentially. When using brain magnetic resonance imaging findings or neuroimaging scores for diagnostic purposes, the onset–neuroimaging interval should be considered.
Outcomes and Complications of Open vs Posterior Arthroscopic Subtalar Arthrodesis: A Prospective Randomized Controlled Multicenter Study
Authors: Rungprai Chamnanni , Jaroenarpornwatana Aekachai , Chaiprom Nusorn , Phisitkul Phinit , Sripanich Yantarat 
Published: September 2021

Background: Open subtalar arthrodesis is the standard treatment for subtalar arthritis. Posterior arthroscopic subtalar arthrodesis (PASTA) has recently gained increasing popularity due to a shorter recovery time and better cosmesis. However, studies comparing outcomes and complications between these 2 techniques are limited. Methods: In total, 56 patients with subtalar joint arthritis were prospectively randomized to 2 parallel groups to receive either PASTA (n = 28 patients) or open subtalar arthrodesis (n = 28 patients). The minimum follow-up period was 12 months. Primary outcome was union rate confirmed on postoperative computed tomography (CT) scan. Secondary outcomes were union time; visual analog scale (VAS), Short Form–36 (SF-36), and Foot and Ankle Ability Measure (FAAM) scores; tourniquet time; and complications. Results: Union time (9.4 vs 12.8 weeks) and recovery time (time to return to activities of daily living [8.4 vs 10.8 weeks], work [10.6 vs 12.9 weeks], and sports [24.9 vs 32.7 weeks]) were significantly shorter with PASTA than with the open technique ( P < .05 all). Both techniques led to significant improvements in all functional outcomes (FAAM, SF-36, and VAS scores; P < .01 all); however, there was no significant difference between the techniques in these outcomes ( P > .05 all). Other outcomes, including tourniquet time (55.8 vs 67.2 min), union rate (96.3% vs 100%), and complication rate, were not significantly different between the techniques. Conclusion: Both open and PASTA techniques led to significant improvements in pain and function in patients with isolated subtalar joint arthritis. Although short-term functional outcomes and complication rates were not significantly different between the techniques, the PASTA technique was better at shortening the union and recovery times. Level of Evidence: Level I, prospective multicenter randomized controlled trial.
Multicenter, Open-Label, 2-Arm, Pilot Trial for Safe Reduction of Basal Insulin Dose Combined with SGLT2 Inhibitor in Type 1 Diabetes Mellitus: Study Protocol for a RISING-STAR Trial
Authors: Hamaguchi Masahide , Hashimoto Yoshitaka , Tanaka Toru , Hasegawa Goji , Ishii Michiyo , Okada Hiroshi , Mitsuhashi Kazuteru , Kitagawa Noriyuki , Ushigome Emi , Yamazaki Masahiro , Fukui Michiaki 
Published: September 2021

Background: The safe method of instructing insulin dose reduction in combination with SGLT2 inhibitors, dapagliflozin for patients with type 1 diabetes mellitus has not been clarified. In this study, we conducted a stratified, 2-arm, parallel comparative study with the primary endpoint of decreasing the frequency of hypoglycemia by instructing basal insulin dose reduction. Methods: The study has a multicenter, open-label, 2-arm design; 60 type 1 diabetes mellitus patients are being recruited from 7 hospitals. Study subjects have been stratified into 2 groups based on the ratio of basal insulin daily dose (Basal) to total daily insulin dose (TDD). The subjects whose Basal/TDD ratio is <0.4 are instructed not to reduce Basal but to reduce bolus insulin dose by 10% (group A), and subjects with a Basal/TDD ratio >0.4 will be instructed to reduce Basal by 10% (group B). The primary outcome is the daily frequency of hypoglycemia during the intervention period (SGLT2 inhibitor administration), as determined by self-monitoring of blood glucose. We aimed to confirm a greater reduction in frequency of hypoglycemia in group B (reduced Basal), than in group A (non-reduction of Basal and reduced insulin effect levels by 10%). Baseline hypoglycemia was set at 7 ± 6 times/month. The minimum sample size required to achieve a significance of .05 for a 1-sided t-test with a statistical power at 80% is determined. When the sample size is 26 patients in 1 group, the percentage increase in hypoglycemia exceeds 60%, and the sample size is considered sufficient. Discussion: In this pilot study, we assumed that, given a sufficient Basal, hypoglycemia would be more frequent in patients with type 1 diabetes when combined with SGLT2 inhibitors, provided the Basal was not reduced.
Counseling on Complementary Methods in the Treatment of Side Effects of Oncological Therapies: A Project of the Breast and Bowel Center Nahe at the Hospital Sankt Marienwoerth Bad Kreuznach
Authors: Muecke Ralph , Gosenheimer Robert , Schulz Christoph , Heim Gabor , Schmitz Volker , Harvey Christina , Zosel-DeIturri Annette , Nissen Arnold , Hemberger Ulrike , Romeis Verena , Lochhas Gabriele , Metzmann Ute , Bussmann Matthias , Paschold Markus 
Published: September 2021

Background: Increasingly, patients with cancer are asking for additional, complementary therapy options for treating the side effects of oncological therapy. Thus, the members of the Breast and Bowel Center Nahe at the Sankt Marienwörth Hospital Bad Kreuznach decided to define the content of this type of counseling for patients before treatment. Methods: In 2018, a team of internal oncologists, gynecological oncologists, radio-oncologists, nutritionists, psycho-oncologists, and study nurses met several times to define the content of counseling. To inform the team, an intensive literature review was conducted. Results: Counseling content was determined for complementary treatment options for the most frequent side effects of oncological therapies. Counseling sessions were formulated as frontal lectures (slide presentations), given at regular intervals for patients and relatives. These lectures were highly appreciated by patients. Conclusion: These counseling sessions increased patient understanding of both useful complementary measures and harmful measures they should not use.
Controlled Differentiation of Mesenchymal Stem Cells into Hyaline Cartilage in miR-140-Activated Collagen Hydrogel
Authors: Rajagopal Karthikeyan , Arjunan Porkizhi , Marepally Srujan , Madhuri Vrisha 
Published: September 2021

Objective Hypertrophic cartilage formation is a major setback in mesenchymal stem cells (MSCs)–mediated cartilage repair, and overcoming it requires optimization of differentiation. Here, we tested the miR-140 activated collagen hydrogel for the chondrogenic differentiation of MSCs and to produce hyaline cartilage. Methods Bone marrow MSCs isolated from 3 patients were pretreated with miR-140 and then chondrogenic differentiated. The 3-dimensional (3D) transfection potential of 5 different transfection reagents (Polyethylenimine, Lipofectamine, TransIT-X2, Amide:Cholesterol-based liposomes [AmC] and AmC pegylated with Tocofersolan [AmCTOC]) was compared and the reagent that showed higher green fluorescent protein (GFP) expression was selected. Finally, the collagen hydrogel was activated using miR-140-transfection complex and sustained delivered to MSCs during chondrogenic differentiation. After differentiation, the outcome was assessed by reverse transcription–polymerase chain reaction (RT-PCR), histology, immunohistochemistry, and compared with scrambled miRNA treated control. Results Pretreatment of MSCs with miR-140 significantly increased the expression of cartilage-specific genes ( COL2A1, SOX9, and ACAN) with reduced hypertrophic chondrocyte ( COL10A1) marker expression and better safranin-O staining than the control. The AmCTOC liposome showed a significant increase in 3D transfection of GFP expressing plasmid than the others. Furthermore, the knockdown of GAPDH using siRNA in HEK cells and expression of GFP mRNA in human bone marrow MSCs confirmed the 3D-transfection efficiency of AmCTOC. The sustained delivery of miR-140 using activated matrix formed a hyaline cartilage-like tissue with minimal COL10A1 expression in RT-PCR and immunohistochemistry. Conclusion Our results demonstrated the therapeutic potential of miR-140-activated hydrogel for MSCs-based cartilage tissue engineering, which could also be used for endogenous stem cells–mediated cartilage repair.
Increasing utility of Google Trends in monitoring cardiovascular disease
Authors: Senecal Conor , Mahowald Madeline , Lerman Lilach , Lopes-Jimenez Francisco , Lerman Amir 
Published: September 2021

Introduction Cardiovascular disease is the most common cause of morbidity and mortality in the United States. Patients are increasingly using internet search to find health-related information, including searches for cardiovascular diseases and risk factors. We sought to evaluate the change in the state by state correlation of cardiovascular disease and risk factors with Google Trends search volumes. Methods Data on cardiovascular disease hospitalizations and risk factor prevalence were obtained from the publically available Centers for Disease Control and Prevention website from 2006 to 2018. Google Trends data were obtained for matching conditions and time periods. Simple linear regression was performed to evaluate for an increase in correlation over time. Results Hospitalizations for six separate cardiovascular disease conditions showed moderate to strong correlation with online search data in the last period studied (heart failure (0.58, p < .001), atrial fibrillation (0.57, p < .001), coronary heart disease (0.58, p < .001), myocardial infarction (0.70, p < .001), stroke (0.62, p < .001), cardiac dysrhythmia (0.46, p < .001)) in the United States. All diseases studied showed a positive increase in correlation throughout the time period studied ( p < .05). All five of the cardiovascular risk factors studied showed strong correlation with online search data; diabetes ( R = 0.78, p < .001), cigarette use ( R = 0.79, p < .001), hypertension ( R = 0.81, p < .001), high cholesterol ( R = 0.59, p < .001), and obesity ( p = 0.80, p < .001) in the United States. Three of the five risk factors showed an increasing correlation over time. Conclusion The prevalence of and hospitalizations for cardiovascular conditions in the United States strongly correlate with online search volumes in the United States when analyzed by state. This relationship has progressively strengthened or been strong and stable over recent years for these conditions. Google Trends represents an increasingly valuable tool for evaluating the burden of cardiovascular disease and risk factors in the United States.
In Vitro Testing of 2 Adjustable-Loop Cortical Suspensory Fixation Systems Versus Interference Screw for Anterior Cruciate Ligament Reconstruction
Authors: Garcés Gerardo L. , Martel Oscar , Yánez Alejandro , Manchado-Herrera Ignacio , Motta Luci M. 
Published: September 2021

Background: It is not clear whether the mechanical strength of adjustable-loop suspension devices (ALDs) in anterior cruciate ligament (ACL) reconstruction is device dependent and if these constructs are different from those of an interference screw. Purpose: To compare the biomechanical differences of 2 types of ALDs versus an interference screw. Study Design: Controlled laboratory study. Methods: ACL reconstruction was performed on porcine femurs and bovine extensor tendons with 3 types of fixation devices: interference screw, UltraButton (UB) ALD, and TightRope (TR) ALD (n = 10 for each). In addition to specimen testing, isolated testing of the 2 ALDs was performed. The loading protocol consisted of 3 stages: preload (static 150 N load for 5 minutes), cyclic load (50-250 N at 1 Hz for 1000 cycles), and load to failure (crosshead speed 50 mm/min). Displacement at different cycles, ultimate failure load, yield load, stiffness, and failure mode were recorded. Results: In specimen testing, displacement of the ALDs at the 1000th cycle was similar (3.42 ± 1.34 mm for TR and 3.39 ± 0.92 mm for UB), but both were significantly lower than that of the interference screw (7.54 ± 3.18 mm) ( P < .001 for both). The yield load of the UB (547 ± 173 N) was higher than that of the TR (420 ± 72 N) ( P = .033) or the interference screw (386 ± 51 N; P = .013), with no significant difference between the latter 2. In isolated device testing, the ultimate failure load of the TR (862 ± 64 N) was significantly lower than that of the UB (1879 ± 126 N) ( P < .001). Conclusion: Both ALDs showed significantly less displacement in cyclic loading at ultimate failure than the interference screw. The yield load of the UB was significantly higher than that of the other 2. The ultimate failure occurred at a significantly higher load for UB than it did for TR in isolated device testing. Clinical Relevance: Both UB and TR provided stronger fixation than an interference screw. Although difficult to assess, intrinsic differences in the mechanical properties of these ALDs may affect clinical outcomes.
Return to Performance After Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers: A Case-Control Assessment of Advanced Analytics, Velocity, Spin Rates, and Pitch Movement
Authors: Fury Matthew S. , Oh Luke S. , Linderman Shannon E. , Wright-Chisem Joshua , Fury Jacob N. , Scarborough Donna M. , Berkson Eric M. 
Published: September 2021

Background: There are limited data on the performance or pitching metrics of Major League Baseball (MLB) pitchers who returned to play after ulnar collateral ligament reconstruction (UCLR). Purpose: To describe MLB pitcher performance after return from primary UCLR, compare the velocity and pitch characteristics against the preoperative season, and determine if performance analytics can predict successful return to pitching after UCLR. Study Design: Case-control study; Level of evidence, 3. Methods: This study included 63 pitchers who underwent primary UCLR between 2015 and 2019. Publicly available advanced analytics and pitch metrics from the first 2 postoperative seasons were compared with the preoperative (index) season as well as with an uninjured control group. Results: Overall, 57% of the pitchers successfully returned to the MLB level. Although they threw significantly fewer pitches ( P = .012) and innings ( P = .022) in postoperative year 1 as compared with the index season, there were no significant differences in pitch velocity, release extension, perceived velocity, or performance as measured by advanced analytics. Also, as compared with the index season, returners demonstrated increased postoperative spin rates on curveballs ( P = .001) and sliders ( P = .010), and curveball horizontal movement was significantly increased ( P = .007); however, horizontal movement was significantly decreased for 4-seam fastballs ( P = .026), changeups ( P = .005), and sinkers ( P = .019). The vertical movement on 4-seam fastballs was greater ( P < .001) in postoperative year 1, and the vertical movement on curveballs ( P = .031) and sinkers ( P = .010) was greater in postoperative year 2 when compared with the index season. Pitchers who failed to return to the MLB level had a lower preoperative strikeout percentage ( P = .047), fewer strikeouts per 9 innings pitched ( P = .046), fewer wins above replacement ([WAR]; P = .026), and lower player value ( P = .030) than the pitchers who returned. Conclusion: Pitchers returning to the MLB level after UCLR demonstrated changes in pitch movement profiles and spin rates postoperatively, but there were no differences in velocity or many advanced analytics upon return. Pitchers with lower strikeout metrics, fewer WAR, and less player value before surgery may have an elevated risk of failing to return to the MLB level.