bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of race day injury in young professional jockeys in Great Britain from 2007 to 2018: a retrospective cohort study
Authors: Davies Madeleine , Jackson Kate A , Mackinnon Anna Louise , Turner Alison , Kuznik Kerry , Hill Jerry , Newton Julia L , Sanchez Santos Maria 
Published: August 2021

IntroductionThere are limited injury data in professional horse racing, particularly by sex.ObjectivesTo describe injury incidence, characteristics and falls in male and female, flat and jump jockeys in Great Britain.Design and settingRetrospective cohort study of professional jockeys in Britain.Participants245 jockeys licensed between 2007 and 2017.Primary and secondary outcome measuresThe primary outcome measure was injury on a race day. Injury incidence (per 1000 rides; per 1000 falls) was derived. Incidence-rate ratios (IRR) were calculated to compare incidence between flat and jump racing, male and female jockeys, and male flat and male jump jockeys for: (i) injury incidence, (ii) fall incidence and (iii) injuries per fall.Results234 British professional jockeys were included. Jockeys were on average 19.5±2.0 years old at licence date, 79.9% male and 58.1% flat. The time of follow-up (racing in the study) was 3.7 (SD=2.3) years. There were 278 injuries, occurring in-race (81.7%), in the stalls (10.8%) or parade ring (6.1%). After one injury was removed to preserve anonymity, 57.2% were soft tissue injuries, 25.3% fractures and 10.5% concussion. There were 1634 falls, with 92% in male jump racing. The injury incidence was higher in jump racing (5.1 vs 1.0/1000 jockey rides). The falls incidence was 1.8/1000 rides in flat and 46.2/1000 rides in jump racing (IRR 0.04, 95% CI 0.03 to 0.04). There were over five times higher injuries/1000 falls in flat than jump racing (IRR 5.56, 95% CI 4.05 to 7.53). Male flat jockeys fell less than female flat (IRR 0.57, 95% CI 0.35 to 0.97).ConclusionMost injuries occurred in-race and were soft tissue injuries. Jump jockeys fell more often than flat, and female flat jockeys fell more often than male flat. Flat jockeys injured more frequently when falling. No sex differences were seen for injuries per fall.
Does robotic-assisted unicompartmental knee arthroplasty have lower complication and revision rates than the conventional procedure? A systematic review and meta-analysis
Authors: Sun Yifeng , Liu Wei , Hou Jian , Hu Xiuhua , Zhang Wenqiang 
Published: August 2021

ObjectiveWe conducted this systematic review and meta-analysis of studies on patients who underwent unicompartmental knee arthroplasty (UKA) to compare the complication rates, revision rates and non-implant-specific complications between robotic-assisted and conventional UKA.DesignSystematic review and meta-analysis.Data sourcesThe PubMed, Embase, Web of Science and Cochrane databases were searched up to 30 June 2020.Eligibility criteriaCase–control studies comparing robotic-assisted and conventional UKA.Data extraction and synthesisData from all eligible articles were independently extracted by two authors. We analysed the differences in outcomes between robotic-assisted and conventional UKA by calculating the corresponding 95% CIs and pooled relative risks (RRs). Heterogeneity was assessed using the χ2and I2tests. All analyses were performed using the ‘metafor’ package of R V.3.6.2 software.ResultsA total of 16 studies involving 50 024 patients were included in the final meta-analysis. We found that robotic-assisted UKA had fewer complications (RR: 0.52, 95% CI: 0.28 to 0.96, p=0.036) and lower revision rates (RR: 0.42, 95% CI: 0.20 to 0.86, p=0.017) than conventional UKA. We observed no significant differences in non-implant-specific complications between the two surgical techniques (RR: 0.80, 95% CI: 0.61 to 1.04, p=0.96). No publication bias was found in this meta-analysis.ConclusionsThis study provides evidence that robotic-assisted UKA has fewer complications and lower revision rates than conventional UKA; however, owing to important limitations, the results lack reliability, and more studies are required.PROSPERO registration numberCRD42021246927.
Shared decision-making in the ICU from the perspective of physicians, nurses and patients: a qualitative interview study
Authors: Wubben Nina , van den Boogaard Mark , van der Hoeven JG , Zegers Marieke 
Published: August 2021

ObjectiveTo identify views, experiences and needs for shared decision-making (SDM) in the intensive care unit (ICU) according to ICU physicians, ICU nurses and former ICU patients and their close family members.DesignQualitative study.SettingTwo Dutch tertiary centres.Participants19 interviews were held with 29 participants: seven with ICU physicians from two tertiary centres, five with ICU nurses from one tertiary centre and nine with former ICU patients, of whom seven brought one or two of their close family members who had been involved in the ICU stay.ResultsThree themes, encompassing a total of 16 categories, were identified pertaining to struggles of ICU physicians, needs of former ICU patients and their family members and the preferred role of ICU nurses. The main struggles ICU physicians encountered with SDM include uncertainty about long-term health outcomes, time constraints, feeling pressure because of having final responsibility and a fear of losing control. Former patients and family members mainly expressed aspects they missed, such as not feeling included in ICU treatment decisions and a lack of information about long-term outcomes and recovery. ICU nurses reported mainly opportunities to strengthen their role in incorporating non-medical information in the ICU decision-making process and as liaison between physicians and patients and family.ConclusionsInterviewed stakeholders reported struggles, needs and an elucidation of their current and preferred role in the SDM process in the ICU. This study signals an essential need for more long-term outcome information, a more informal inclusion of patients and their family members in decision-making processes and a more substantial role for ICU nurses to integrate patients’ values and needs in the decision-making process.
Early diagnosis of coeliac disease in the Preventive Youth Health Care Centres in the Netherlands: study protocol of a case finding study (GLUTENSCREEN)
Authors: Meijer-Boekel Caroline , van den Akker M.Elske , van Bodegom Leti , Escher Johanna , van Geloven Nan , van Overveld Floris , Rings Edmond H H.M , Smit Lucy , de Vries Martine Charlotte , Mearin M. Luisa 
Published: August 2021

IntroductionCoeliac disease (CD) occurs in 1% of the population, develops early in life and is severely underdiagnosed. Undiagnosed and untreated disease is associated with short-term and long-term complications. The current healthcare approach is unable to solve the underdiagnosis of CD and timely diagnosis and treatment is only achieved by active case finding. Aim: to perform a case finding project to detect CD children who visit the Youth Health Care Centres (YHCCs) in a well-described region in the Netherlands to evaluate whether it is feasible, cost-effective and well accepted by the population.Methods/analysisProspective intervention cohort study. Parents of all children aged 12 months and 4 years attending the YHCCs for a regular visit are asked whether their child has one or more CD-related symptoms from a standardised list. If so, they will be invited to participate in the case finding study. After informed consent, a point of care test (POCT) to assess CD-specific antibodies against tissue transglutaminase (TG2A) is performed onsite the YHCCs. If the POCT is positive, CD is highly suspected and the child will be referred to hospital for definitive diagnosis according to the Guideline Coeliac Disease of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition guideline.Main outcomesIncidence rate of new CD diagnoses in the study region in comparison to the one in the same age diagnosed by standard of care in the rest of the Netherlands.Feasibility and cost-effectiveness of active CD case finding at the YHCCs. All costs of active case finding, diagnostics and treatment of CD and the potential short-term and long-term consequences of the disease will be calculated for the setting with and without case finding.Ethical acceptability: by questionnaires on parental and healthcare professionals’ satisfaction.A statistical analysis plan was prepared and is published on the GLUTENSCREEN website (Statistical-Analysis-Plan-11-5-2021_def.pdf (glutenscreen.nl) and added as annex 1).Ethics and disseminationThe Medical Ethics Committee Leiden approved this study. If we prove that case finding at the YHCC is feasible, cost-effective and well accepted by the population, implementation is recommended.Trial registration numberNL63291.058.17.
Stroke in patients with secundum atrial septal defect and sequelae after transcatheter closure
Authors: Dolgner Stephen J , Steinberg Zachary Louis , Jones Thomas K , Reisman Mark , Buber Jonathan 
Published: August 2021

ObjectiveTo evaluate the frequency of and risk factors for stroke as a presenting feature in adult patients with secundum atrial septal defect (ASD); rates of post-closure atrial fibrillation (AF) and stroke were also assessed.MethodsWe retrospectively reviewed adult patients who presented with an ASD between 2002 and 2018, excluding those with known atrial arrhythmias. Risk factors for stroke were identified using multivariable logistic regression. Post-closure stroke was evaluated using survival analysis stratified by the presence of post-procedure AF.ResultsOf 346 patients with ASD (median age 44 years), 34 (10%) presented with a history of stroke. Independent risk factors included elevated body mass index over 25 (OR: 18.2; 95% CI: 4.0 to 82.2; p<0.001), smoking (OR: 9.5; 95% CI: 3.8 to 23.9; p<0.001) and a prominent Eustachian valve (OR: 9.2; 95% CI: 3.4 to 25.2; p<0.001). A scoring system based on these three parameters provided robust stroke risk stratification. During a median follow-up of 12 months after closure, 12 patients (4%) experienced AF and 4 patients (1%) had a new stroke. AF was highly associated with development of stroke post-closure (p<0.001).ConclusionsIn this study population, the incidence of stroke prior to ASD closure among patients without atrial arrhythmias was 10%. Risk factors included obesity, smoking and prominent Eustachian valve anatomy. Lifestyle changes should be recommended for at-risk patients, and it may be reasonable to consider ASD closure in the absence of haemodynamic indications in patients at increased risk of stroke.
Moderate excess alcohol consumption and adverse cardiac remodelling in dilated cardiomyopathy
Authors: Tayal Upasana , Gregson John , Buchan Rachel , Whiffin Nicola , Halliday Brian P , Lota Amrit , Roberts Angharad M , Baksi A John , Voges Inga , Jarman Julian W E , Baruah Resham , Frenneaux Michael , Cleland John G F , Barton Paul , Pennell Dudley J , Ware James S , Cook Stuart A , Prasad Sanjay K 
Published: August 2021

ObjectiveThe effect of moderate excess alcohol consumption is widely debated and has not been well defined in dilated cardiomyopathy (DCM). There is need for a greater evidence base to help advise patients. We sought to evaluate the effect of moderate excess alcohol consumption on cardiovascular structure, function and outcomes in DCM.MethodsProspective longitudinal observational cohort study. Patients with DCM (n=604) were evaluated for a history of moderate excess alcohol consumption (UK government guidelines; >14 units/week for women, >21 units/week for men) at cohort enrolment, had cardiovascular magnetic resonance and were followed up for the composite endpoint of cardiovascular death, heart failure and arrhythmic events. Patients meeting criteria for alcoholic cardiomyopathy were not recruited.ResultsDCM patients with a history of moderate excess alcohol consumption (n=98, 16%) had lower biventricular function and increased chamber dilatation of the left ventricle, right ventricle and left atrium, as well as increased left ventricular hypertrophy compared with patients without moderate alcohol consumption. They were more likely to be male (alcohol excess group: n=92, 94% vs n=306, 61%, p=<0.001). After adjustment for biological sex, moderate excess alcohol was not associated with adverse cardiac structure. There was no difference in midwall myocardial fibrosis between groups. Prior moderate excess alcohol consumption did not affect prognosis (HR 1.29, 95% CI 0.73 to 2.26, p=0.38) during median follow-up of 3.9 years.ConclusionDCM patients with moderate excess alcohol consumption have adverse cardiac structure and function at presentation, but this is largely due to biological sex. Alcohol may contribute to sex-specific phenotypic differences in DCM. These findings help to inform lifestyle discussions for patients with DCM.
Pembrolizumab for patients with leptomeningeal metastasis from solid tumors: efficacy, safety, and cerebrospinal fluid biomarkers
Authors: Naidoo Jarushka , Schreck Karisa C , Fu Wei , Hu Chen , Carvajal-Gonzalez Alexander , Connolly Roisin M , Santa-Maria Cesar A , Lipson Evan J , Holdhoff Matthias , Forde Patrick M , Douville Christopher , Riemer Joanne , Barnes Amanda , Redmond Kristin J , Kleinberg Lawrence , Page Brandi , Aygun Nafi , Kinzler Kenneth W , Papadopoulos Nickolas , Bettegowda Chetan , Venkatesan Arun , Brahmer Julie R , Grossman Stuart A 
Published: August 2021

BackgroundThe benefit of immune checkpoint inhibitors (ICIs) in patients with leptomeningeal metastases (LMM) is unknown.MethodsWe undertook a phase II trial of pembrolizumab in patients with LMM from solid tumors. Eligible patients had radiologic/cytologic LMM and Eastern Cooperative Oncology Group performance status 0–1. Pembrolizumab was administered intravenously at 200 mg q3W until disease progression/unacceptable toxicity. The primary endpoint was central nervous system (CNS) response after four cycles, defined radiologically/cytologically/clinically. Serial cerebrospinal fluid (CSF) was assessed for tumor-derived DNA (t-DNA) aneuploidy and cytokines.ResultsThirteen of a planned 16 patients were treated between April 2017 and December 2019. The study closed early for poor accrual. Median age was 57 years (range: 22–79). Sixty-two percent of patients had tumors not traditionally ICI-responsive (hormone-receptor (HR)-positive breast carcinoma=39%; high-grade glioma=23%), while 38% had ICI-responsive tumors (non-small cell lung cancer (NSCLC)=23%, head and neck carcinoma=8%, cutaneous squamous carcinoma (CSC)=8%). CNS response was observed in 38% of patients at 12 weeks (95% CI 13.9% to 68.4%) by pre-defined criteria and LM-RANO, and 2 achieved durable complete responses (CSC=1, overall survival (OS) 3+ years; NSCLC=1, OS 9 months). Median CNS progression-free survival and OS was 2.9 months (95% CI 1.3 to NR) and 4.9 months (95% CI 3.7 to NR), respectively. Grade 3+ treatment-related adverse events occurred in 15% of patients. Sensitivity for LMM detection by t-DNA and cytopathology was 84.6% (95% CI 54.6% to 98.1%) and 53.9% (95% CI 25.1% to 80.8%), respectively. Pre-therapy and on-therapy CSF cytokine analysis demonstrated complete responders clustered together.ConclusionsPembrolizumab conferred a 38% CNS response rate in patients with LMM, a tolerable safety profile, and deep responses in selected patients with ICI-responsive tumors. CSF t-DNA may be sensitive for LMM detection, and immunologic subsets of CNS response warrant further study.Trial registration numberNCT03091478
Lessons learnt from syphilis-infected blood donors: a timely reminder of missed opportunities
Authors: Harvala Heli , Reynolds Claire , Fabiana Alvin , Tossell Joanne , Bulloch Gillian , Brailsford Susan , Blackmore Stuart , Pomeroy Louise 
Published: August 2021

ObjectiveDue to the increased number of syphilis infections diagnosed in the UK and beyond, we reviewed our data on blood donors infected with syphilis in the UK and Ireland between 2016 and 2019.MethodsData were extracted from the surveillance database for all blood donors confirmed positive for syphilis in the UK and Ireland between 2016 and 2019, together with the total number of donations tested during that period. Data on positive cases included gender, age group, reported treatment, symptoms and confirmatory results. All cases were divided into recently acquired within 24 months and past syphilis infection. We also reviewed the information on symptoms characteristic of syphilis reported by blood donors with an untreated syphilis infection during the postdonation discussions.ResultsScreening of 8 246 600 blood donations for treponemal antibodies identified 316 blood donors with confirmed syphilis infection in the UK and Ireland between 2016 and 2019 (1.6 per 100 000 donations). 42% of them (133 of 316) were classed as a recent infection based on their donation testing results, previous donation date and clinical history provided, and they were hence considered potentially infectious. Most of these blood donors (202 of 316, 64%) had not been previously diagnosed or treated for syphilis, although 50 of them reported symptoms consistent with syphilis infection and 19 had been misdiagnosed despite seeking medical help.ConclusionsThis observational study shows that syphilis infection remains undiagnosed, especially among heterosexual men, and that infectious syphilis is often missed as a differential diagnosis even when donors have presented with genital or oral ulceration, rashes in the genital area and lymphadenopathy. Considering the recent resurgence of syphilis infections in the UK and beyond and our generally expanding sexual networks, it is important to consider syphilis in differential diagnosis even if specific risk factors have not been identified.
Anatomical Phase Extraction (APE) Method: A Novel Method to Correct Detrimental Effects of Tissue-Inhomogeneity in Referenceless MR Thermometry—Preliminary Ex Vivo Investigation
Authors: Huang Chien-Feng Judith , Lin Win-Li , Hwang San-Chao , Yao Ching , Chang Hsu , Kuo Li-Wei 
Published: August 2021

Purpose. We present a novel background tissue phase removing method, called anatomical phase extraction (APE), and to investigate the accuracy of temperature estimation and capability of reducing background artifacts compared with the conventional referenceless methods. Methods. Susceptibility variance was acquired by subtracting pretreatment baseline images taken at different locations (nine pretreatment baselines are acquired and called

φ

1

to

φ

9

). The susceptibility phase data

φ

S

was obtained using the Wiener deconvolution algorithm. The background phase data

φ

T

was isolated by subtracting

φ

S

from the whole phase data. Finally,

φ

T

was subtracted from the whole phase data before applying the referenceless method. As a proof of concept, the proposed APE method was performed on ex vivo pork tenderloin and compared with other two referenceless temperature estimation approaches, including reweighted

ℓ

1 referenceless (RW-

ℓ

1) and

ℓ

2 referenceless methods. The proposed APE method was performed with four different baselines combination, namely, (

φ

1

,

φ

5

,

φ

2

,

φ

4

), (

φ

3

,

φ

5

,

φ

2

,

φ

6

), (

φ

7

,

φ

5

,

φ

8

,

φ

4

), and (

φ

9

,

φ

5

,

φ

8

,

φ

6

), and called APE experiment 1 to 4, respectively. The multibaseline method was used as a standard reference. The mean absolute error (MAE) and two-sample

t

-test analysis in temperature estimation of three regions of interest (ROI) between the multibaseline method and the other three methods, i.e., APE, RW-

ℓ

1, and

ℓ

2, were calculated and compared. Results. Our results show that the mean temperature errors of the APE method-experiment 1, APE method-experiment 2, APE method-experiment 3, APE method-experiment 4, and RW-

ℓ

1 and

ℓ

2 referenceless method are 1.02°C, 1.04°C, 1.00°C, 1.00°C, 4.75°C, and 13.65°C, respectively. The MAEs of the RW-

ℓ
1

and

ℓ
2

referenceless methods were higher than that of APE method. The APE method showed no significant difference (

p
>
0.05

), compared with the multibaseline method. Conclusion. The present work demonstrates the use of the APE method on referenceless MR thermometry to improve the accuracy of temperature estimation during MRI guided high-intensity focused ultrasound for ablation treatment.
The OncoMasTR Test Predicts Distant Recurrence in Estrogen Receptor–Positive, HER2-Negative Early-Stage Breast Cancer: A Validation Study in ABCSG Trial 8
Authors: Filipits Martin , Rudas Margaretha , Kainz Verena , Singer Christian F. , Fitzal Florian , Bago-Horvath Zsuzsanna , Greil Richard , Balic Marija , Regitnig Peter , Halper Stefan , Hulla Wolfgang , Egle Daniel , Barron Stephen , Loughman Tony , O'Leary Des , Gallagher William M. , Hlauschek Dominik , Gnant Michael , Dubsky Peter 
Published: August 2021

Abstract

Purpose:
To validate the clinical performance of the OncoMasTR Risk Score in the biomarker cohort of Austrian Breast and Colorectal Cancer Study Group (ABCSG) Trial 8.

Experimental Design:
We evaluated the OncoMasTR test in 1,200 formalin-fixed, paraffin-embedded (FFPE) surgical specimens from postmenopausal women with estrogen receptor (ER)–positive, human epidermal growth factor receptor 2 (HER2)–negative primary breast cancer with 0 to 3 involved lymph nodes in the prospective, randomized ABCSG Trial 8. Time to distant recurrence (DR) was analyzed by Cox models.

Results:
The OncoMasTR Risk Score categorized 850 of 1,087 (78.2%) evaluable patients as “low risk”. At 10 years, the DR rate for patients in the low-risk group was 5.8% versus 21.1% for patients in the high-risk group (P &lt; 0.0001, absolute risk reduction 15.3%). The OncoMasTR Risk Score was highly prognostic for prediction of DR in years 0 to 10 in all patients [HR 1.91, 95% confidence interval (CI) 1.62–2.26, P &lt; 0.0001; C-index 0.73], in patients that were node negative (HR 1.79, 95% CI, 1.43–2.24, P &lt; 0.0001; C-index 0.72), and in patients with 1 to 3 involved lymph nodes (HR 1.93, 95% CI, 1.44–2.58, P &lt; 0.0001; C-index 0.71). The OncoMasTR Risk Score provided significant additional prognostic information beyond clinical parameters, Ki67, Nottingham Prognostic Index, and Clinical Treatment Score.

Conclusions:
OncoMasTR Risk Score is highly prognostic for DR in postmenopausal women with ER-positive, HER2-negative primary breast cancer with 0 to 3 involved lymph nodes. In combination with prior validation studies, this fully independent validation in ABCSG Trial 8 provides level 1B evidence for the prognostic capability of the OncoMasTR Risk Score.