bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peripheral Blood Cytopenia and Risk of Cardiovascular Disease and Mortality
Authors: Gangaraju Radhika , Koh Insu , Irvin Marguerite R. , Lange Leslie , Houghton Damon E. , Herrera Diego Adrianzen , Safford Monika , Cushman Mary , Bhatia Smita , Zakai Neil A. 
Published: September 2021

Background
Individual blood cell count abnormalities have been associated with cardiovascular disease and increased mortality. In this study, we defined a “cytopenia phenotype,” reflecting bone marrow hypoproliferation, to determine if peripheral blood cytopenia is associated with increased cardiovascular disease and mortality risk.

Methods and Results

Study participants were derived from a biracial observational cohort study, REGARDS (Reasons for Geographic and Racial Differences in Stroke), that enrolled 30 239 Black and White participants aged ≥45 years between 2003 and 2007. Median follow up was ≈9 years. The current study included 19 864 participants from REGARDS study (37.9% men, 40% Black participants) who have complete blood count available at study enrollment. We defined a cytopenia phenotype based on age‐, sex‐, and race‐adjusted lowest fifth percentile of blood counts. Multivariable Cox proportional hazards models estimated the hazard ratios (HR) and 95% CI of cytopenia for mortality and incident cardiovascular disease in adjusted models. Mean age of the study participants was 64 years (SD:9.7). The prevalence of cytopenia was 1.9% (n=378). Cytopenia was associated with increased risk of all‐cause mortality (HR, 1.73; 95% CI, 1.34–2.22) and cardiovascular disease mortality (HR, 1.56; 95% CI, 1.11–2.29). Cytopenia was associated with stroke risk in Black but not White participants (HR, 1.96 versus 0.86;
P
‐interaction for race=0.08) and was not associated with coronary heart disease risk.

Conclusions
We defined a cytopenia phenotype with clinical implications for mortality and stroke risk in a large biracial and geographically diverse population. Whether generated through somatic mutations or decreased organ function, cytopenia was associated with mortality risk and was a race‐specific risk factor for stroke.
Invasive Hemodynamic Monitoring in Cardiogenic Shock Is Associated With Lower In‐Hospital Mortality
Authors: Osman Mohammed , Syed Moinuddin , Patel Brijesh , Munir Muhammad Bilal , Kheiri Babikir , Caccamo Marco , Sokos George , Balla Sudarshan , Basir Mir Babar , Kapur Navin K. , Mamas Mamas A. , Bianco Christopher M. 
Published: September 2021

Background
There is increasing utilization of cardiogenic shock treatment algorithms. The cornerstone of these algorithms is the use of invasive hemodynamic monitoring (IHM). We sought to compare the in‐hospital outcomes in patients who received IHM versus no IHM in a real‐world contemporary database.

Methods and Results

Patients with cardiogenic shock admitted during October 1, 2015 to December 31, 2018, were identified from the National Inpatient Sample. Among this group, we compared the outcomes among patients who received IHM versus no IHM. The primary end point was in‐hospital mortality. Secondary end points included vascular complications, major bleeding, need for renal replacement therapy, length of stay, cost of hospitalization, and rate of utilization of left ventricular assist devices and heart transplantation. Propensity score matching was used for covariate adjustment. A total of 394 635 (IHM=62 565; no IHM=332 070) patients were included. After propensity score matching, 2 well‐matched groups were compared (IHM=62 220; no IHM=62 220). The IHM group had lower in‐hospital mortality (24.1% versus 30.6%,
P
<0.01), higher percentages of left ventricular assist devices (4.4% versus 1.3%,
P
<0.01) and heart transplantation (1.3% versus 0.7%,
P
<0.01) utilization, longer length of hospitalization and higher costs. There was no difference between the 2 groups in terms of vascular complications, major bleeding, and the need for renal replacement therapy.

Conclusions
Among patients with cardiogenic shock, the use of IHM is associated with a reduction in in‐hospital mortality and increased utilization of advanced heart failure therapies. Due to the observational nature of the current study, the results should be considered hypothesis‐generating, and future prospective studies confirming these findings are needed.
Clinical Impact of Intraprocedural Stent Thrombosis During Percutaneous Coronary Intervention in Patients Treated With Potent P2Y12 inhibitors ‐ a VALIDATE‐SWEDEHEART Substudy
Authors: Bergman Sofia , Mohammad Moman A. , James Stefan K. , Angerås Oskar , Wagner Henrik , Jensen Jens , Scherstén Fredrik , Fröbert Ole , Koul Sasha , Erlinge David 
Published: September 2021

Background
The clinical importance of intraprocedural stent thrombosis (IPST) during percutaneous coronary intervention in the contemporary era of potent oral P2Y12 inhibitors is not established. The aim of this study was to assess IPST and its association with clinical outcome in patients with myocardial infarction undergoing percutaneous coronary intervention with contemporary antithrombotic medications.

Methods and Results

The VALIDATE‐SWEDEHEART study (Bivalirudin Versus Heparin in ST‐Segment and Non–ST‐Segment Elevation Myocardial Infarction in Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies Registry Trial) included 6006 patients with myocardial infarction, treated with potent P2Y12 inhibitors during percutaneous coronary intervention. IPST, defined as a new or worsening thrombus related to a stent deployed during the procedure, was reported by the interventional cardiologist in 55 patients (0.9%) and was significantly associated with ST‐segment elevation myocardial infarction presentation, longer stents, bailout glycoprotein IIb/IIIa inhibitors, and final Thrombolysis in Myocardial Infarction flow <3. The primary composite end point included cardiovascular death, myocardial infarction, out‐of‐laboratory definite stent thrombosis and target vessel revascularization within 30 days. Secondary end points were major bleeding and the individual components of the primary composite end point. Patients with versus without IPST had significantly higher rates of the primary composite end point (20.0% versus 4.4%), including higher rates of cardiovascular death, target vessel revascularization, and definite stent thrombosis, but not myocardial infarction or major bleeding. By multivariable analysis, IPST was independently associated with the primary composite end point (hazard ratio, 3.82; 95% CI, 2.05–7.12;
P
<0.001).

Conclusions
IPST is a rare but dangerous complication during percutaneous coronary intervention, independently associated with poor prognosis, even in the current era of potent antiplatelet agents. Future treatment studies are needed to reduce the rate of IPST and to improve the poor outcome among these patients.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02311231.
Multimodal Pretraining Unmasked: A Meta-Analysis and a Unified Framework of Vision-and-Language BERTs
Authors: Bugliarello Emanuele , Cotterell Ryan , Okazaki Naoaki , Elliott Desmond 
Published: September 2021

Abstract
Large-scale pretraining and task-specific fine- tuning is now the standard methodology for many tasks in computer vision and natural language processing. Recently, a multitude of methods have been proposed for pretraining vision and language BERTs to tackle challenges at the intersection of these two key areas of AI. These models can be categorized into either single-stream or dual-stream encoders. We study the differences between these two categories, and show how they can be unified under a single theoretical framework. We then conduct controlled experiments to discern the empirical differences between five vision and language BERTs. Our experiments show that training data and hyperparameters are responsible for most of the differences between the reported results, but they also reveal that the embedding layer plays a crucial role in these massive models.
Subantarctic Mode Water and its long-term change in CMIP6 models
Authors: Hong Yu , Du Yan , Xia Xingyue , Xu Lixiao , Zhang Ying , Xie Shang-Ping 
Published: September 2021

AbstractThe Subantarctic Mode Water (SAMW) is a major water mass in the South Indian and Pacific oceans and plays an important role in the ocean uptake and anthropogenic heat and carbon. The characteristics, formation, and long-term evolution of the SAMW are investigated in the “historical” and “SSP245” scenario simulations of the sixth Coupled Models Intercomparison Project (CMIP6). Defined by the low potential vorticity, the simulated SAMW is consistently thinner, shallower, lighter, and warmer than in observations, due to biases in the winter mixed layer properties and spatial distribution. The biases are especially large in the South Pacific Ocean. The winter mixed layer bias can be attributed to unrealistic heat loss and stratification in the models. Nevertheless, the SAMW is presented better in the CMIP6 than CMIP5, regarding its volume, location, and physical characteristics. In warmer climate, the simulated SAMW in the South Indian Ocean consistently becomes lighter in density, with a reduced volume and a southward shift in the subduction region. The reduced heat loss, instead of the increased Ekman pumping induced by the poleward intensified westerly wind, dominates in the SAMW change. The winter mixed layer shoals in the northern outcrop region and the SAMW subduction shifts southward where the mixed layer remains deep. The projected reduction of the SAMW volume is likely to impact the heat and freshwater redistribution in the Southern Ocean.
An Analysis of 2016–18 Tornadoes and National Weather Service Tornado Warnings across the Contiguous United States
Authors: Bentley Evan S. , Thompson Richard L. , Bowers Barry R. , Gibbs Justin G. , Nelson Steven E. 
Published: September 2021

AbstractPrevious work has considered tornado occurrence with respect to radar data, both WSR-88D and mobile research radars, and a few studies have examined techniques to potentially improve tornado warning performance. To date, though, there has been little work focusing on systematic, large-sample evaluation of National Weather Service (NWS) tornado warnings with respect to radar-observable quantities and the near-storm environment. In this work, three full years (2016–18) of NWS tornado warnings across the contiguous United States were examined, in conjunction with supporting data in the few minutes preceding warning issuance, or tornado formation in the case of missed events. The investigation herein examines WSR-88D and Storm Prediction Center (SPC) mesoanalysis data associated with these tornado warnings with comparisons made to the current Warning Decision Training Division (WDTD) guidance. Combining low-level rotational velocity and the significant tornado parameter (STP), as used in prior work, shows promise as a means to estimate tornado warning performance, as well as relative changes in performance as criteria thresholds vary. For example, low-level rotational velocity peaking in excess of 30 kt (15 m s−1), in a near-storm environment, which is not prohibitive for tornadoes (STP > 0), results in an increased probability of detection and reduced false alarms compared to observed NWS tornado warning metrics. Tornado warning false alarms can also be reduced through limiting warnings with weak (<30 kt), broad (>1 n mi; 1 n mi = 1.852 km) circulations in a poor (STP = 0) environment, careful elimination of velocity data artifacts like sidelobe contamination, and through greater scrutiny of human-based tornado reports in otherwise questionable scenarios.
Propensity matched analysis of minimally invasive versus conventional isolated aortic valve replacement
Authors: Oo Shwe , Khan Amilah , Chan Jeremy , Juneja Sanjay , Caputo Massimo , Angelini Gianni , Rajakaruna Cha , Vohra Hunaid A 
Published: September 2021

Objective: To analyse the early and mid-term outcome of patients undergoing conventional aortic valve replacement (AVR) versus minimally invasive via hemi-sternotomy aortic valve replacement (MIAVR). Methods: A single centre retrospective study involving 653 patients who underwent isolated aortic valve replacement (AVR) either via conventional AVR ( n = 516) or MIAVR ( n = 137) between August 2015 and March 2020. Using pre-operative characteristics, patients were propensity matched (PM) to produce 114 matched pairs. Assessment of peri-operative outcomes, early and mid-term survival and echocardiographic parameters was performed. Results: The mean age of the PM conventional AVR group was 71.5 (±8.9) years and the number of male ( n = 57) and female ( n = 57) patients were equal. PM MIAVR group mean age was 71.1 (±9.5) years, and 47% of patients were female ( n = 54) and 53% male ( n = 60). Median follow-up for PM conventional AVR and MIAVR patients was 3.4 years (minimum 0, maximum 4.8 years) and 3.4 years (minimum 0, maximum 4.8 years), respectively. Larger sized aortic valve prostheses were inserted in the MIAVR group (median 23, IQR = 4) versus conventional AVR group (median 21, IQR = 2; p = 0.02, SMD = 0.34). Cardiopulmonary bypass (CPB) time was longer with MIAVR (94.4 ± 19.5 minutes) compared to conventional AVR (83.1 ± 33.3; p = 0.0001, SMD = 0.41). Aortic cross-clamp (AoX) time was also longer in MIAVR (71.6 ± 16.5 minutes) compared to conventional AVR (65.0 ± 52.8; p = 0.0001, SMD = 0.17). There were no differences in the early post-operative complications and mortality between the two groups. Follow-up echocardiographic data showed significant difference in mean aortic valve gradients between conventional AVR and MIAVR groups (17.3 ± 8.2 mmHg vs 13.0 ± 5.1 mmHg, respectively; p = 0.01, SMD = −0.65). There was no significant difference between conventional AVR and MIAVR in mid-term survival at 3 years (88.6% vs 92.1%; log-rank test p = 0.31). Conclusion: Despite the longer CPB and AoX times in the MIAVR group, there was no significant difference in early complications, mortality and mid-term survival between MIAVR and conventional AVR.
Is implant sonication useful when screening for infection in conversion of prior hip fracture fixation to total hip arthroplasty?
Authors: Palmowski Yannick , Pumberger Matthias , Perka Carsten , Hardt Sebastian , Hipfl Christian 
Published: September 2021

Objective To examine sonication results in presumed aseptic conversion total hip arthroplasty (THA) after hip fracture fixation and to evaluate its implications on the treatment outcome. Methods This retrospective cohort study reviewed the data from presumed aseptic patients that underwent conversion of prior internal fixation of proximal femoral fractures to THA between 2012 and 2018. Microbiological analysis was performed using sonication of osteosynthesis material and tissue samples. Treatment outcome including the occurrence of periprosthetic joint infection (PJI) was recorded. Results A total of 32 patients were included in the study. Of these, five patients (15.6%) had positive intraoperative cultures. The mean follow-up following conversion THA was 43.0 months (range, 19.0–91.5 months). Sonication was positive in three patients (9.4%), all of whom were deemed contaminated and did not develop PJI. Tissue cultures were positive in two patients (6.3%). One patient with Enterococcus faecalis received antibiotic treatment and did not develop PJI. Another patient with growth of Cutibacterium acnes that was initially classified as a contaminant later developed acute PJI caused by the same pathogen. Overall, PJI occurred in two patients (6.3%) after conversion THA. Conclusion Sonication of internal fixation devices did not add diagnostic value in clinically aseptic conversion THA. Further studies are needed to better understand the relevance of unexpected positive cultures, and to develop diagnostic criteria for the management of these patients.
Infant with Clefts Observation Outcomes Instrument (iCOO): A New Outcome for Infants and Young Children with Orofacial Clefts
Authors: Edwards Todd C. , Heike Carrie L. , Kapp-Simon Kathleen A. , Jones Salene M. , Leroux Brian G. , Stueckle Laura P. , Bellucci Claudia Crilly , Rosenberg Janine M. , Albert Meredith , Aspinall Cassandra L. , Patrick Donald L. 
Published: September 2021

Objective We evaluated the measurement properties for item and domain scores of the Infant with Clefts Observation Outcomes Instrument (iCOO). Design Cross-sectional (before lip surgery) and longitudinal study (preoperative baseline and 2 days and 2 months after lip surgery). Setting Three academic craniofacial centers and national online advertisements. Participants Primary caregivers with an infant with cleft lip with or without cleft palate (CL  ±  P) scheduled to undergo primary lip repair. There were 133 primary caregivers at baseline, 115 at 2 days postsurgery, and 112 at 2 months postsurgery. Main Outcome Measure(s) Caregiver observation items ( n = 61) and global impression of health and function items ( n = 8) across eight health domains. Results Mean age at surgery was 6.0 months (range 2.7-11.8 months). Five of eight iCOO domains have scale scores, with Cronbach’s alphas ranging from 0.67 to 0.87. Except for the Facial Skin and Mouth domain, iCOO scales had acceptable intraclass correlation coefficients (ICCs) ranging from 0.76 to 0.84. The internal consistency of the Global Impression items across all domains was 0.90 and had acceptable ICCs (range 0.76-0.91). Sixteen out of 20 (nonscale) items had acceptable ICCs (range 0.66-0.96). As anticipated, iCOO scores 2 days postoperatively were generally lower than baseline and scores 2 months postsurgery were consistent with baseline or higher. The iCOO took approximately 10 min to complete. Conclusions The iCOO meets measurement standards and may be used for assessing the impact of cleft-related treatments in clinical research and care. More research is needed on its use in various treatment contexts.
Postoperative Use of Ketorolac Improves Pain Management and Decreases Narcotic Use Following Primary Cleft Palate Surgery
Authors: Dudley Samuel , Spence Matthew , Frederick Robert , Stocks Rosemary 
Published: September 2021

Objective To study the efficacy and safety profile of ketorolac in cleft palate surgery. Design Retrospective analysis of patients who underwent primary cleft palate surgery and received either postoperative ketorolac or opioids. Setting Tertiary care children's hospital. Patients, Participants Eighty-nine patients enrolled who were all younger than 36 months of age, not dependent on a gastrostomy tube, with no history of bleeding disorders, and had undergone their primary cleft palate procedure by one specific surgeon between January 2010 and June 2019. Interventions n/a. Main Outcome Measure Morphine equivalent dose (MED), Face, Legs, Activity, Cry, Consolability (FLACC) score, length of stay (LOS), total oral intake (mL), total oral intake/LOS, and postoperative adverse events between ketorolac and no ketorolac groups. Results MED, FLACC score, and LOS were significantly lower in the ketorolac group compared to the no ketorolac group. One patient in the ketorolac group had a bleeding event. Conclusions Use of ketorolac significantly decreased narcotic usage and pain scores as reported by the FLACC score. Moreover, postoperative bleeding was rare in both ketorolac and no ketorolac groups.
Differences in antibiotic prescriptions between direct-to-consumer telehealth and telehealth in the emergency department
Authors: Yao Peter , Gogia Kriti , Clark Sunday , Hsu Hanson , Sharma Rahul , Greenwald Peter 
Published: September 2021

Background Telemedicine, which allows physicians to assess and treat patients via real-time audiovisual conferencing, is a rapidly growing modality for providing medical care. Antibiotic stewardship is one important measure of care quality, and research on antibiotic prescribing for acute respiratory infections in direct-to-consumer telemedicine has yielded mixed results. We compared antibiotic prescription rates for acute respiratory infections in two groups treated by telemedicine: (1) patients treated via a direct-to-consumer telemedicine application and (2) patients treated via telemedicine while physically inside the emergency department. Methods We included direct-to-consumer telemedicine and emergency department telemedicine visits for patients 18 years and older with physician-coded International Classification of Diseases, Tenth Revision acute respiratory infection diagnoses between November 2016 and December 2018. Patients in both groups were seen by the same emergency department faculty working dedicated telemedicine shifts. We compared antibiotic prescribing rates for direct-to-consumer telemedicine and emergency department telemedicine visits before and after adjustment for age, sex, and diagnosis. Results We identified a total of 468 acute respiratory infection visits: 191 direct-to-consumer telemedicine visits and 277 emergency department telemedicine visits. Overall, antibiotics were prescribed for 47% of visits (59% of direct-to-consumer telemedicine visits vs 39% of emergency department telemedicine visits; odds ratio 2.23; 95% confidence interval 1.53–3.25; P < 0.001). The difference in antibiotic prescribing rates remained significant after adjustment for age, sex, and diagnosis (odds ratio 2.49; 95% confidence interval 1.65–3.77; P < 0.001). Conclusion Patients seen by the same group of physicians for acute respiratory infection were significantly more likely to be prescribed antibiotics by direct-to-consumer telemedicine care compared with telemedicine care in the emergency department. This work suggests that contextual factors rather than evaluation over video may contribute to differences in antibiotic stewardship for direct-to-consumer telemedicine encounters.
Prognostic Value of Podoplanin in Various Tumors
Authors: Wang Xiaohang , Wang Xueying , Carvalho Vladmir , Wang Qianqian , Li Tingting , Wang Jinbang , Chen Yang , Ni Chengming , Liu Subo , Zhang Jiaxin 
Published: September 2021

Background: The prognostic significance of podoplanin (PDPN) in tumor cells for cancer patients’ survival remains controversial. Therefore, we performed this meta-analysis to clarify the relationship between the podoplanin-positive tumor cells and cancer prognosis. Method: Eligible studies were identified by searching the Pubmed and EBSCO online databases up to August 2019. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to evaluate the correlation between podoplanin expression and overall survival (OS) and/or disease-free survival (DFS) and odds ratios (ORs) with 95% CIs severed as the summarized statistics for clinicopathological characteristic. Results: A total of 2155 patients from 21 eligible studies were included. The results revealed that high expression of podoplanin was associated with a poor survival rate in cancer patients. Further subgroup analysis stratified by tumor type showed that podoplanin-positive tumor cell infiltration had a negative prognostic effect associated with survival in esophageal cancer and oropharyngeal cancer. In addition, high expression of these cells was significantly associated with N stage, T stage, TNM stage and vascular invasion. Conclusion: Our study suggests the over-expression of podoplanin might be a significant prognostic indicator for patients with esophageal and oropharyngeal cancer.