bluuebunny/crossref_metadata_2025_split huggingface dataset:
Concomitant beta-blocker use is associated with a reduced rate of remission in patients with rheumatoid arthritis treated with disease-modifying anti-rheumatic drugs: a post hoc multicohort analysis
Authors: Abuhelwa Ahmad Y. , Foster David J. R. , Manning-Bennett Arkady , Sorich Michael J. , Proudman Susanna , Wiese Michael D. , Hopkins Ashley M. 
Published: April 2021

Background: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease associated with increased risk of cardiovascular disease (CVD). Treatment for CVD may involve pharmacological agents that antagonise beta adrenergic receptors. These receptors may play an important role in immunology, and the effects of beta-blockers (BB) in RA is unknown. The aim of this study was to investigate the association between BB use and remission in patients with RA initiating tocilizumab +/− conventional synthetic (cs-) DMARD therapy. Methods: Data was pooled from five randomised trials investigating tocilizumab and/or csDMARD treatment in RA (primarily methotrexate). The association between BB use and remission according to the Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) was assessed by Cox proportional hazard analysis. Sensitivity analysis in patients with pre-existing CVD and an exploratory analysis of the impact of other CVD drugs were conducted. Results: Data were available from 5502 participants, 594 (10.8%) of whom were using systemic BB. BB use was associated with less frequent SDAI remission in the total [adjusted hazard ratio (HR) 0.70, 95% confidence interval (CI) 0.57–0.87, p = 0.001] and CVD cohort [adjusted HR 0.72 (0.57–0.90, p = 0.005)]. The association was consistent between trials (interaction p = 0.44) and treatment arms (interaction p = 0.06). No significant association between remission and β1-receptor selectivity was identified ( p = 0.16), and the association was independent from other cardiovascular drug use. Similar associations between BB use and CDAI remission were observed. Conclusion: In a large, pooled cohort of RA patients initiating csDMARDs and/or tocilizumab, BB use was independently associated with less frequent remission.
Retrospective study of clinical characteristics and viral etiologies of patients with viral pneumonia in Beijing
Authors: Zhao Xiang , Meng Yao , Li Duo , Feng Zhaomin , Huang Weijuan , Li Xiyan , Wei Hejiang , Zeng Xiaoxu , Wang Dayan 
Published: April 2021

AimsThe virus is common in patients with viral pneumonia. However, the viral etiology and clinical features of patients with viral pneumonia in China remain unclear. The main purpose of this study was to analyze the viral causes and epidemiology of patients with viral pneumonia in Beijing, which can significantly improve the pertinence and accuracy of clinical treatment of the disease.MethodsFirstly, 1539 respiratory specimens of pneumonia (oropharyngeal swabs, nasopharyngeal swabs, saliva samples and bronchoalveolar lavage fluid) were collected from 19 hospitals in Beijing from September 2015 to August 2018. Then, TaqMan low‐density microfluidic chip technology was used to detect viral pneumonia specimens in 1539 respiratory tract specimens of pneumonia and determine the types of viral bacteria in them. Lastly, the analysis of demographic, clinical and etiological data of patients with viral pneumonia was performed.ResultsThe results showed that among the 1539 respiratory tract specimens with pneumonia, 760 were detected as viral pneumonia specimens, with a positive rate of 49.4%. Among which, 467 were infected with mono‐viral and 293 were infected with multi‐viral. Influenza A virus (Flu A), mycoplasma pneumoniae (MPn), Ebola virus (EBV) and herpes simplex virus type 1 (HSV‐1) were the major viral components in the samples of these patients. Furthermore, these viral species were significantly associated with sample sources, onset season and certain clinical characteristics.DiscussionOur findings may provide corresponding treatment strategies for viral pneumonia patients infected with specific viruses.
Inspiratory flow patterns with dry powder inhalers of low and medium flow resistance in patients with pulmonary arterial hypertension
Authors: Faria‐Urbina Mariana , Ung Keith T. , Lawler Laurie , Zisman Lawrence S. , Waxman Aaron B. 
Published: April 2021

Inhalation profiles to support use of dry powder inhalers for drug delivery in patients with pulmonary arterial hypertension have not been reported. We aimed to evaluate the inspiratory flow pattern associated with low and medium flow resistance dry powder inhaler devices (RS01‐L and RS01‐M, respectively) in patients with pulmonary arterial hypertension. This single‐center study enrolled patients with pulmonary arterial hypertension associated with connective tissue disease (n = 10) and idiopathic pulmonary arterial hypertension (n = 10) to measure the following inhalation parameters: inspiratory effort (kPa), peak inspiratory flow rate (L/min), inhaled volume (L), and flow increase rate (L/s2) using the two devices. We identified a trend toward higher mean pulmonary artery pressure in the idiopathic pulmonary arterial hypertension group (50 ± 13 mmHg vs. 40 ± 11 mmHg in pulmonary arterial hypertension associated with connective tissue disease; p = 0.077). On average, peak inspiratory flow rate was higher with RS01‐L vs. RS01‐M (84 ± 19.7 L/min vs. 70.4 ± 13.2 L/min; p = 0.015). In the overall group, no differences between RS01‐L and RS01‐M were observed for inhaled volume, inspiratory effort, or flow increase rate. Inhaled volume with RS01‐L was higher in pulmonary arterial hypertension associated with connective tissue disease vs. idiopathic pulmonary arterial hypertension patients: 1.6 ± 0.4 L vs. 1.3 ± 0.2 L; p = 0.042. For the RS01‐L, inhaled volume correlated with forced expiratory volume in one second (r = 0.460, p = 0.030) and forced vital capacity (r = 0.507, p = 0.015). In patients with pulmonary arterial hypertension associated with connective tissue disease using RS01‐L, both inspiratory effort and flow increase rate were highly correlated with pulmonary vascular compliance (r = 0.903, p = 0.0001 and r = 0.906, p = 0.0001; respectively); while with RS01‐M, inspiratory effort was highly correlated with pulmonary vascular compliance (r = 0.8, p = 0.001). Our data suggest that the use of RS01‐L and RS01‐M dry powder inhaler devices allowed adequate inspiratory flow in pulmonary arterial hypertension patients. The correlation between flow increase rate and pulmonary vascular compliance in pulmonary arterial hypertension associated with connective tissue disease deserves further investigation.
Study of clinical characteristics, risk factors and outcomes for tuberculosis post allogeneic stem cell transplant: never count it out
Authors: Kapoor Jyotsna , Mirgh Sumeet Prakash , Khushoo Vishvdeep , Mehta Pallavi , Ahmed Rayaz , Bansal Nitin , Bhurani Dinesh , Agrawal Narendra 
Published: April 2021

Background: Allogeneic stem cell transplant (AlloSCT) recipients remain at a higher risk of developing tuberculosis (TB), especially in endemic populations. We conducted a retrospective study to identify the incidence, clinical presentation, and risk factors for active TB among our alloSCT recipients. Methods: Records of all patients transplanted between 1 January 2012 and 31 July 2020 were reviewed. Patients were followed up for outcome until 30 September 2020. None of the patients received prophylactic anti-tubercular drugs. Proven diagnosis of active TB was considered if Mycobacterium tuberculosis (MTB) was cultured from clinical samples or acid-fast bacilli (AFB) or MTB demonstrated on Ziehl-Neelsen (ZN) staining or histopathology or XPERT MTB, while probable diagnosis of TB was considered if histopathology findings were suggestive of caseation necrosis/epithelioid cell granulomas without any evidence of malignancy or lymphocyte rich exudative effusions (pleural/pericardial) without an alternative cause. Results: Among 381 alloSCT recipients, 15 patients (3.9%) developed TB at median of 246 (74–279) days post AlloSCT, after being symptomatic for a median of 22 (7–60) days, amounting to a cumulative incidence of 4.9%. All patients were started on four-drug anti tubercular therapy, ATT [Rifampicin, Isoniazid, Ethambutol, Pyrazinamide (RHEZ)], of which five patients developed hepatotoxicity at a median of 12 days after start of ATT, leading to drug modification. At last follow up, TB was cured in 13 (86.67%) patients, one succumbed to disease relapse, while others are still on treatment. Age ⩾ 30 years, immunosuppression for graft versus host disease (GvHD) > 6 months, prior use of tyrosine kinase inhibitors (TKI) and chronic GvHD on univariate analysis and immunosuppression for GvHD > 6 months on multivariate analysis were found to be associated with development of TB. Conclusion: A high index of suspicion with timely workup and treatment of TB is the key in AlloSCT recipients, especially in endemic TB populations.
Feasibility of Colocating a Nutrition Education Program into a Medical Clinic Setting to Facilitate Pediatric Obesity Prevention
Authors: Shilts Mical K. , Diaz Rios L. Karina , Panarella Katherine H. , Styne Dennis M. , Lanoue Louise L. , Drake Christiana M. , Ontai Lenna , Townsend Marilyn S. 
Published: April 2021

Purpose: Within a medical clinic environment, pediatric obesity prevention education for families faces challenges. Existing long-term government-funded nutrition education programs have the expertise and staff to deliver. The purpose is to determine feasibility of colocating the Expanded Food and Nutrition Education Program (EFNEP) into a medical clinic setting to support pediatric obesity prevention. Methods: Physicians from a large university teaching and research hospital (n = 73) and 4 small Medicaid-serving community clinics (n = 18) in the same geographic area in northern California were recruited and trained in the patient-referral protocol for a primary prevention intervention provided by EFNEP. The 8-week intervention deployed in the medical clinics, included general nutrition, physical activity and parenting topics anchored with guided goal setting and motivational modeling. Referral, enrollment, and attendance data were collected for 2 years. Parent and physician feasibility surveys, parent interviews and parent risk assessment tools were administered. Paired-sample t-test analysis was conducted. Results: Twenty intervention series with parents of patients (n = 106) were conducted at 5 clinics. Physicians (n = 92) generated 686 referrals. Every 6 referrals generated 1 enrolled parent. Physicians (91%, n = 34) reported the intervention as useful to families. Parents (n = 82) reported improved child behaviors for sleep, screen time, physical activity, and food and beverage offerings ( P < .0001) and at family mealtime ( P < .001). Focus group interviews (n = 26) with 65 participants indicated that parents (97%) reacted positively to participating in the intervention with about a third indicating the classes were relevant to their needs. Conclusion: The intervention is a feasible strategy for the 5 medical clinics. Physicians referred and parents enrolled in the intervention with both physicians and parents indicating positive benefits. Feasibility is contingent upon physician awareness of the intervention and motivation to refer patients and additional EFNEP and clinic staff time to enroll and keep parents engaged.
Description of the Nature of Musculoskeletal Shoulder Injuries in a Cohort of Commercial Truck Drivers: A Retrospective Cross-Sectional Study
Authors: Combs Bryan , Fazeli Pariya L , Brown David A. , Gallagher Sean , Jones Allison , Romeo Bruce , Heaton Karen 
Published: April 2021

Background: Commercial truck drivers (CTDs) are significantly affected by shoulder injuries; however, little is known about the unique mechanisms of injury (MOIs), specific injuries, or possible preventive measures among this group of workers. This study characterized the MOIs, musculoskeletal disorders (MSDs), and factors associated with MSDs of the shoulder among a group of CTDs. Methods: A retrospective medical record review was conducted of CTDs between 21 and 65 years of age who were seen for MSDs of the shoulder between 2007 and 2015. Results: A total of 130 CTDs were included, who were aged 21 to 65 years. Commercial truck drivers were most often injured during a fall (35%) or while using chains, tarps, or straps (31%). The two most common MSDs were unspecified sprains/strains (58%) and rotator cuff tears (24%). Age was found to be associated with all MSDs ( p = .001) and an increased risk of developing rotator cuff tears ( p =.005). Seventy-four percent of CTDs who experienced a rotator cuff tear were 46 years of age or older. Conclusion/Application to Practice: This study highlights the course of the injury in terms of diagnostics such as magnetic resonance imaging (MRI) and referral for surgery and describes the occupational activities associated with CTDs. These findings can inform employer injury prevention programs, patient and health care provider education, and future interventional research.
Free Food at Work: A Concept Analysis
Authors: Horton Dias Cynthia , Dawson Robin M. , Abshire Demetrius A. , Harris Diane , Wirth Michael D. 
Published: April 2021

Background: Employees who spend substantial amounts of time in a workplace away from home are likely to acquire and consume food during work hours. Reportedly, free food at work is a common occurrence in various workplace settings such as business offices and hospitals. Little is known about the nutritional quality, prevalence, or health impact of free food at work. Furthermore, free food at work as a theoretical concept has not been previously analyzed or defined, but it is necessary to differentiate free food from other food sources in the workplace. Methods: A concept analysis of free food at work was conducted using the 8-step Walker and Avant framework. A literature review in June and July 2020 provided the basis to delineate the concept and identify its defining attributes including antecedents, consequences, and empirical referents. Findings: Free food at work is defined as food that is available for consumption in the workplace at no financial cost to employees. Critical attributes of free food at work include nutritional value, quantity, frequency, and location within the workplace. Antecedents are sources and reasons for free food provision. Consequences include influence on consumption, behaviors, attitudes, emotions, and health outcomes. Additional measurable aspects of the concept and implications are discussed. Conclusion/Application to Professional Practice: The concept of free food at work was analyzed; defining attributes and empirical referents were discussed and presented in a conceptual model to encourage further study and theory development. Identifying the health impact of free food at work is an issue requiring consideration for workplace health-promoting programs.
An Effective Surgical Method for Terminal Syringomyelia: Terminal Ventriculostomy-Associated “V”-Type Ostomy
Authors: Sun Mengchun , Tao Benzhang , Gao Gan , Li Shiqiang , Li Teng , Shang Aijia 
Published: April 2021

Study Design: Retrospective cohort study. Objectives: We aimed to evaluate the effectiveness of terminal ventriculostomy in treating tethered cord syndrome (TCS) combined with terminal syringomyelia (TS) and describe “V”-type ostomy as an effective surgical method to avoid relapsing syringomyelia based on terminal ventriculostomy. Methods: We retrospectively analyzed the clinical and radiological data of 28 patients admitted to the Department of Neurosurgery, PLA General Hospital who had been diagnosed with TCS combined with TS and underwent terminal ventriculostomy-associated “V”-type ostomy between January 2011 and January 2016. We classified patients’ clinical outcomes into 4 levels according to the Spinal Bifida Neurological Scale: markedly improved, improved, stable, and deteriorated. The size of the syrinx cavity was quantified using the syrinx index, and there was a difference in syrinx cavity size between pre-operation and post-operation. Results: Twenty-eight patients were followed up for 36 months. We found that each syrinx cavity shrunk by at least 50%. More than 90% of patients had achieved “markedly improved” and “improved” outcomes during the follow-up visit. Moreover, no patient relapsed for up to 36 months post-surgery. Conclusion: Terminal ventriculostomy has a beneficial effect on TS, particularly on the syrinx cavity extending to the filum terminale. For this special cavity, we advocate the use of terminal ventriculostomy-associated “V”-type ostomy to avoid potential relapse. As a safe, convenient, and persistently effective approach, terminal ventriculostomy-associated “V”-type ostomy can be considered a promising alternative method for treating TCS combined with TS in clinical practice.
Reliability of Radiologic Assessments of Clinically Relevant Growth Remaining in Knee MRI of Children and Adolescents With Patellofemoral Instability: Data From the JUPITER Cohort
Authors: Fabricant Peter D. , Heath Madison R. , Veerkamp Matthew , Gruber Simone , Green Daniel W. , Strickland Sabrina M. , Wall Eric J. , Mintz Douglas N. , Emery Kathleen H. ,   JUPITER Study Group, Brady Jacqueline M. , Ellis Henry B. , Farr Jack , Heyworth Benton E. , Koh Jason L. , Kramer Dennis , Magnussen Robert A. , Redler Lauren H. , Sherman Seth L. , Tompkins Marc , Wilson Philip L. , Shubin Stein Beth E. , Parikh Shital N. 
Published: April 2021

Background: Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on a patient’s skeletal maturity. To be clinically useful, radiologic assessments of skeletal maturity must demonstrate acceptable interrater reliability and accuracy. Purpose: The purpose of this study was to examine the interrater reliability among surgeons of varying experience levels and specialty training backgrounds when evaluating the skeletal maturity of the distal femur and proximal tibia of children and adolescents with patellofemoral instability. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Six fellowship-trained orthopaedic surgeons (3 pediatric orthopaedic, 2 sports medicine, and 1 with both) who perform a high volume of patellofemoral instability surgery examined 20 blinded knee radiographs and magnetic resonance images in random order. They assessed these images for clinically relevant growth (open physis) or clinically insignificant growth (closing/closed physis) remaining in the distal femoral and proximal tibial physes. Fleiss’ kappa was calculated for each measurement. After initial ratings, raters discussed consensus methods to improve reliability and assessed the images again to determine if training and new criteria improved interrater reliability. Results: Reliability for initial assessments of distal femoral and proximal tibial physeal patency was poor (kappa range, 0.01-0.58). After consensus building, all assessments demonstrated almost-perfect interrater reliability (kappa, 0.99 for all measurements). Conclusion: Surgical decision making and preoperative planning for children and adolescents with patellofemoral instability rely heavily on radiologic assessment of skeletal maturity. This study found that initial interrater reliability of physeal patency and clinical decision making was unacceptably low. However, with the addition of new criteria, a consensus-building process, and training, these variables became highly reliable.
Evaluation of Risk Factors of Cardiovascular Diseases in Shimoga Population
Authors: Parameshwara S. , Manjula B. , Bhaktha Geetha , Gurupadappa K. , Ranjith Kumar G.K. 
Published: April 2021

Background: The morbidity and mortality rate is increasing due to cardiovascular disease around the globe. This may be due to drastic changes in lifestyle, food habits, work, stress, genetic factors, and environmental conditions. The present study is undertaken to evaluate the risk factors of cardiovascular disease (CVD) in Shimoga region. Objective: Evaluation of risk factors of CVD in patients who admitted for treatment in McGann Teaching District Hospital, Shimoga. Methods: A retrospective study was conducted in Mc Gann's Teaching District Hospital, Shimoga from October 2017 to March 2018. Data about sociodemographic parameters such as age, sex, height, weight, smoking, the status of diabetes mellitus, type of occupation, and diet, tobacco, and alcohol consumption were retrieved from the medical record section and statistical analysis was done using Statistical Package for the Social Sciences (SPSS). Results: Out of 262 CVD cases, 60% were male and 40% were female. Based on the body mass index (BMI), 1.9% were underweight, 40.1% were normal, 34.4% were overweight, and 23.7% were obese. Sedentary (64.9%) lifestyle was significantly higher when compared to moderate (2.3%) and heavy (32.8%). Diabetes, smoking, tobacco, and alcohol consumption were seen to be significant while food custom was not significant among the study population ( P < .05). Conclusion: In our study, a higher percentage of CVD patients falls under normal BMI when compared to other studies. This may be due to lifestyle, socioeconomic status, ethnicity, and family heredity. Further extensive studies should be carried out to find the main cause of CVD in Shimoga population.
Endoscopic Repair of the Proximal Hamstring
Authors: DeFroda Steven F. , Kester Benjamin S. , Newhouse Alexander C. , Wichman Daniel M. , Suppaiksorn Sunikom , Nho Shane J. 
Published: April 2021

Background: Proximal hamstring injuries are increasingly common. While open repair with suture anchors placed in the ischial tuberosity has long been the gold standard technique for surgical management, endoscopic techniques can allow for smaller incisions, reduced wound complications, and an expedited recovery. Indications: Patients with full-thickness 3-tendon proximal hamstring tears, 2-tendon tears with retraction >2 cm, or partial tears that remain symptomatic despite conservative management are considered for surgery. High-demand patients are often treated acutely, and low-demand patients may be offered surgery after a conservative management period. Technique Description: In the prone position, 2 arthroscopic portals are created in the gluteal fold. Fluoroscopy is used to verify safe portal placement, and the sciatic nerve is visualized along with the retracted tendon origin. The ischial tuberosity is identified, and the hamstring origin is debrided and decorticated. An accessory portal is created for suture anchor placement. Two double-loaded anchors are placed in the tuberosity, the sutures of which are used to repair the hamstring tendons using a horizontal mattress configuration. Patients undergo a stepwise postoperative physical therapy protocol. Results: An 85% return to sport rate can be expected following all hamstring repairs, with some studies reporting as high as 95% after endoscopic repair. Compared with nonoperative treatment, proximal hamstring repair overall results in higher patient satisfaction and return to sport. While large studies have yet to report on outcomes compared with the traditional open technique, the smaller incisions look to reduce wound complications and postoperative pain. Discussion/Conclusion: Recent advancements in endoscopic techniques have allowed for adequate visualization and robust repair of proximal hamstring avulsions. We present our endoscopic technique of the proximal hamstring, which, compared with the traditional open repair, can decrease perioperative complications and accelerate recovery.