bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Empagliflozin as an Add-On Therapy on Decongestion and Renal Function in Patients With Diabetes Hospitalized for Acute Decompensated Heart Failure
Authors: Tamaki Shunsuke , Yamada Takahisa , Watanabe Tetsuya , Morita Takashi , Furukawa Yoshio , Kawasaki Masato , Kikuchi Atsushi , Kawai Tsutomu , Seo Masahiro , Abe Makoto , Nakamura Jun , Yamamoto Kyoko , Kayama Kiyomi , Kawahira Masatsugu , Tanabe Kazuya , Fujikawa Kei , Hata Masahisa , Fujita Yohei , Umayahara Yutaka , Taniuchi Satsuki , Sanada Shoji , Shintani Ayumi , Fukunami Masatake 
Published: March 2021

Background:
Empagliflozin reduces the risk of hospitalization for heart failure in patients with type 2 diabetes and cardiovascular disease. We sought to elucidate the effect of empagliflozin as an add-on therapy on decongestion and renal function in patients with type 2 diabetes admitted for acute decompensated heart failure.

Methods:
The study was terminated early due to COVID-19 pandemic. We enrolled 59 consecutive patients with type 2 diabetes admitted for acute decompensated heart failure. Patients were randomly assigned to receive either empagliflozin add-on (n=30) or conventional glucose-lowering therapy (n=29). We performed laboratory tests at baseline and 1, 2, 3, and 7 days after randomization. Percent change in plasma volume between admission and subsequent time points was calculated using the Strauss formula.

Results:

There were no significant baseline differences in left ventricular ejection fraction and serum NT-proBNP (N-terminal pro-B-type natriuretic peptide), hematocrit, or serum creatinine levels between the 2 groups. Seven days after randomization, NT-proBNP level was significantly lower in the empagliflozin group than in the conventional group (
P
=0.040), and hemoconcentration (≥3% absolute increase in hematocrit) was more frequently observed in the empagliflozin group than in the conventional group (
P
=0.020). The decrease in percent change in plasma volume between baseline and subsequent time points was significantly larger in the empagliflozin group than in the conventional group 7 days after randomization (
P
=0.017). The incidence of worsening renal function (an increase in serum creatinine ≥0.3 mg/dL) did not significantly differ between the 2 groups.

Conclusions:
In this exploratory analysis, empagliflozin achieved effective decongestion without an increased risk of worsening renal function as an add-on therapy in patients with type 2 diabetes with acute decompensated heart failure.

Registration:

URL:
https://www.umin.ac.jp/ctr/index.htm
; Unique identifier: UMIN000026315.
Supervised and Unsupervised Neural Approaches to Text Readability
Authors: Martinc Matej , Pollak Senja , Robnik-Šikonja Marko 
Published: March 2021

Abstract
We present a set of novel neural supervised and unsupervised approaches for determining the readability of documents. In the unsupervised setting, we leverage neural language models, whereas in the supervised setting, three different neural classification architectures are tested. We show that the proposed neural unsupervised approach is robust, transferable across languages, and allows adaptation to a specific readability task and data set. By systematic comparison of several neural architectures on a number of benchmark and new labeled readability data sets in two languages, this study also offers a comprehensive analysis of different neural approaches to readability classification. We expose their strengths and weaknesses, compare their performance to current state-of-the-art classification approaches to readability, which in most cases still rely on extensive feature engineering, and propose possibilities for improvements.
Summer Extreme Cyclone Impacts on Arctic Sea Ice
Authors: Lukovich Jennifer V. , Stroeve Julienne C. , Crawford Alex , Hamilton Lawrence , Tsamados Michel , Heorton Harry , Massonnet François 
Published: March 2021

AbstractIn this study the impact of extreme cyclones on Arctic sea ice in summer is investigated. Examined in particular are relative thermodynamic and dynamic contributions to sea ice volume budgets in the vicinity of Arctic summer cyclones in 2012 and 2016. Results from this investigation illustrate that sea ice loss in the vicinity of the cyclone trajectories during each year was associated with different dominant processes: thermodynamic processes (melting) in the Pacific sector of the Arctic in 2012, and both thermodynamic and dynamic processes in the Pacific sector of the Arctic in 2016. Comparison of both years further suggests that the Arctic minimum sea ice extent is influenced by not only the strength of the cyclone, but also by the timing and location relative to the sea ice edge. Located near the sea ice edge in early August in 2012, and over the central Arctic later in August in 2016, extreme cyclones contributed to comparable sea ice area (SIA) loss, yet enhanced sea ice volume loss in 2012 relative to 2016. Central to a characterization of extreme cyclone impacts on Arctic sea ice from the perspective of thermodynamic and dynamic processes, we present an index describing relative thermodynamic and dynamic contributions to sea ice volume changes. This index helps to quantify and improve our understanding of initial sea ice state and dynamical responses to cyclones in a rapidly warming Arctic, with implications for seasonal ice forecasting, marine navigation, coastal community infrastructure, and designation of protected and ecologically sensitive marine zones.
Effects of Wave–Current Interactions on Bay–Shelf Exchange
Authors: Song Dehai , Wu Wen , Li Qiang 
Published: March 2021

AbstractBay–shelf exchange is critical to coastal systems because it promotes self-purification or pollution dilution of the systems. In this study, the effects of wave–current interactions on bay–shelf exchange are explored in a micromesotidal system—Daya Bay in southern China. Waves can enlarge the shear-induced seaward transport and reduce the residual-current-induced landward transport, which benefits the bay–shelf exchange; however, tides work oppositely and slow the wave-induced bay–shelf exchange through vertical mixing and reduced shear-induced exchange. Five wave–current interactions are compared, and it is found that the depth-dependent wave radiation stress (WRS) contributes most to the bay–shelf exchange, followed by the wave dissipation as a source term in the turbulence kinetic energy equation, and the mean current advection and refraction of wave energy (CARWE). The vertical transfer of wave-generated pressure to the mean momentum equation (also known as the form drag) and the combined wave–current bottom stress (CWCBS) play minor roles in the bay–shelf exchange. The bay–shelf exchange is faster under southerly wind than under northerly wind because the bay is facing southeast; synoptic events such as storms enhance the bay–shelf exchange. The CARWE terms are dominant in both seasonal and synoptic variations of the bay–shelf exchange because they can considerably change the distribution of significant wave height. The WRS changes the bay–shelf exchange mainly through altering the flow velocity, whereas the wave dissipation on turbulence alters the vertical mixing. The form drag and the CWCBS have little impact on the bay–shelf exchange or its seasonal and synoptic variations.
Lymph or Chyle Leak After Neck Dissection in Patients With Thyroid Carcinoma: Results of a Study on 1724 Patients
Authors: Wang Xi , Wang Shunlan , Li Chunqiao , Ruan Yan , Li Yin , Liu Jing , Guo Zhuming 
Published: March 2021

Background To discuss the prevention and treatment of lymph or chyle leak following neck dissection in patients with thyroid carcinoma. Methods A total of 1724 patients with thyroid carcinoma received neck dissection in the Sun Yat-sen University Cancer Center between November 2009 and October 2014. The incidence and management of leak were analyzed. Results A total of 92 (5.34%) patients developed leak, 28 (1.62%) developed lymph leak, 59 (3.42%) developed chyle leak, and 5 (.29%) developed chylothorax. Medical management to stop postoperative lymph or chyle leak included pressure dressing, reoperation, fasting, or low-fat diet therapy. Conclusions Lymph or chyle leak may occur in thyroid carcinoma patients who underwent neck dissection. Clinicians should alert to leak when there were IV + VI region lymph node metastasis and should become aware of chylothorax after pressure dressing. A careful identification and ligation of lymphatic duct may be an effective way to avoid lymph or chyle leak.
Level of Knowledge, Understanding, and Impact of the COVID-19 Pandemic on Continuing Fixed Orthodontic Treatment in Adults: A Questionnaire Study
Authors: Ram RSVM Raghu , Ranganayakulu I , Viswanadh K Anand , Kumar TSS Manikanta , Chaitanya C Viswa , Sunil G. 
Published: March 2021

Objectives: To evaluate the level of knowledge, understanding, and impact of the coronavirus disease 2019 (COVID-19) pandemic on adult patients regarding their ongoing fixed orthodontic treatment. Subjects and Methods: A cross-sectional and descriptive survey was conducted on 108 adult patients undergoing fixed orthodontic treatment at GSL Dental College (GSLDC), India. All the candidates were aged 18 years and above, who were in lockdown due to the COVID-19 pandemic and devoid of treatment. Results: Among the patients 43.5% were male and 56.5% were female; 22.3% were not at all aware that the COVID-19 virus spreads quickly in a dental setup; 64.8% were definitely willing for their status disclosure and to undergo pretreatment screening; 71.3% were definitely willing to adhere to strict appointment timings for adequate sanitization of the clinical area; 60.2% thought that missed appointments during the COVID-19 pandemic would prolong their overall orthodontic treatment and affect their treatment outcome; and 51.9% were financially affected due to the pandemic. Conclusions: Not all adult orthodontic patients were in knowledge of COVID-19 cross infection. The majority were in a state of understanding and willing to follow infection-eradicating protocols. Patients’ view on overall orthodontic treatment was altered due to the psychological and financial impact of COVID-19.
Cell-Free Book-Shaped Decellularized Tendon Matrix Graft Capable of Controlled Release of BMP-12 to Improve Tendon Healing in a Rat Model
Authors: Xiao Han , Chen Yang , Li Muzhi , Shi Qiang , Xu Yan , Hu Jianzhong , Li Xing , Chen Can , Lu Hongbin 
Published: March 2021

Background: Achilles tendon (AT) defects often occur in traumatic and chronic injuries. Currently, no graft can satisfactorily regenerate parallel tendinous tissue at the defect site to completely restore AT function. Purpose: To develop a cell-free functional graft by tethering bone morphogenetic protein 12 (BMP-12) on a book-shaped decellularized tendon matrix (BDTM) and to determine whether this graft is more beneficial for AT defect healing than an autograft. Study Design: Controlled laboratory study. Methods: Canine patellar tendon was sectioned into a book shape and decellularized to fabricate a BDTM. The collagen-binding domain (CBD) was fused into the N-terminus of BMP-12 to synthesize a recombinant BMP-12 (CBD-BMP-12), which was tethered to the BDTM to prepare a cell-free functional graft (CBD-BMP-12/BDTM). After its tensile resistance, tenogenic inducibility, and BMP-12 release dynamics were evaluated, the efficacy of the graft for tendon regeneration was determined in a rat model. A total of 140 mature male Sprague-Dawley rats underwent AT tenotomy. The defect was reconstructed with reversed AT (autograft group), native BMP-12 tethered to an intact decellularized tendon matrix (IDTM; NAT-BMP-12/IDTM group), native BMP-12 tethered to a BDTM (NAT-BMP-12/BDTM group), CBD-BMP-12 tethered on an IDTM (CBD-BMP-12/IDTM group), and CBD-BMP-12 tethered on a BDTM (CBD-BMP-12/BDTM group). The rats were sacrificed 4 or 8 weeks after surgery to harvest AT specimens. Six specimens from each group at each time point were used for histological evaluation; the remaining 8 specimens were used for biomechanical testing. Results: In vitro CBD-BMP-12/BDTM was noncytotoxic, showed high biomimetics with native tendons, was suitable for cell adhesion and growth, and had superior tenogenic inducibility. In vivo the defective AT in the CBD-BMP-12/BDTM group regenerated more naturally than in the other groups, as indicated by more spindle-shaped fibroblasts embedded in a matrix of parallel fibers. The biomechanical properties of the regenerated AT in the CBD-BMP-12/BDTM group also increased more significantly than in the other groups. Conclusion: CBD-BMP-12/BDTM is more beneficial than autograft for healing AT defects in a rat model. Clinical Relevance: The findings of this study demonstrate that CBD-BMP-12/BDTM can serve as a practical graft for reconstructing AT defects.
Improving End of Life Cancer Outcomes Through Development and Implementation of a Spiritual Care Advocate Program
Authors: Cipriano-Steffens Toni , Cursio John F. , Hlubocky Fay , Sumner Marsha , Garnigan-Peters Deborah , Powell Judy , Arndt Nicole , Phillips Lee , Lassiter Rev. Herbert , Gilliam Marie , Petty Lou Ester , Pastor Rev. Scott Onque , Malec Monica , Fitchett George , Polite Blase 
Published: March 2021

Background: Explored whether increased support for spiritual concerns between the healthcare team and patients through the provision of a Spiritual Care Advocate (SCA) would improve end of life outcomes in a metastatic cancer population. Design: Newly diagnosed metastatic cancer patients were recruited at the University of Chicago Medical Center and received spiritual support from a Spiritual Care Advocate during chemotherapy treatments. The final sample consisted of 42 patients (58% of those approached) who completed the baseline survey and had known survival status. Measurement: Patients completed pre/post surveys measuring spiritual support and palliative quality of life. Baseline measurements of religious practice and externalizing religious health beliefs were also obtained. Receipt of aggressive EOL care was derived from the electronic medical record. Result: Median age was 61 years, with 48% Black, and predominantly male (62%). Of the 42 patients, 30 (70%) had died by the time of this analysis. Perceived spiritual support from the medical team increased in 47% of those who received non-aggressive EOL care and by 40% in those who received aggressive EOL care (p=0.012). Patient perceptions of spiritual support from the medical community increased from 27% at baseline to 63% (p=0.005) after the SCA intervention. Only 20% of recipients received aggressive treatments at end of life. Conclusion: The SCA model improved the perceived spiritual support between the healthcare team and patients. Although limited by a small sample size, the model was also associated with an improvement in EOL patients’ quality of life, spiritual wellbeing, and decreased aggressive EOL care.
New PAX2 Mutation Associated with Polycystic Kidney Disease: A Case Report
Authors: Forero-Delgadillo Jessica Maria , Ochoa Vanessa , Duque Natalia , Restrepo Jaime Manuel , Londoño Hernando , Nastasi-Catanese Jose Antonio , Pachajoa Harry 
Published: March 2021

Background: Congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of end stage renal disease in children. Diagnosis by genetic testing has proven challenging due to its genetic and phenotypic heterogeneity, as well as incomplete penetrance. We report a case on a 16-months old female with a history of renal cysts and a PAX2 mutation. Case presentation: The patient presented with a prenatal diagnosis of Potter sequence and a postnatal diagnosis of renal cysts. An ultrasound at 20 weeks gestation revealed right renal agenesis and possible left renal dysplasia. Post natal genetic analyses identified a novel mutation in PAX2. Conclusion: Cystic kidney disease is often underdiagnosed due to its variable expressivity and wide range of clinical manifestations; PAX2 genetic screening should be considered for all patients with CAKUT.
Economic Analysis and Surgical Outcomes of Outpatient Versus Inpatient Total Ankle Replacement Surgery
Authors: Akoh Craig C. , Chen Jie , Kadakia Rishin J. , Fletcher Amanda N. , Easley Mark E. , Adams Samuel B. , Nunley James A. , DeOrio James K. , Park Young-uk , Kim Hyong Nyun , Wang Juntao 
Published: March 2021

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: The utilization of total ankle replacement (TAR) for end-stage ankle osteoarthritis continues to increase in the United States. From 2011-2012, 47.5% of all TAR were covered by Medicare insurance, which represents a large insurance market share for inpatient ankle surgeries. However, there is a growing trend in orthopedics toward performing outpatient surgery. There have been studies that demonstrate the cost benefits and safety of outpatient TAR surgery. However, previous cost studies involve a single implant, small sample size, and lack clinical outcomes. Thus, we aim to compare the costs and clinical outcomes associated with TAR in the outpatient versus inpatient settings. Methods: We performed a retrospective study on 178 consecutive patients undergoing primary inpatient versus short-stay designation TAR during the 2016 and 2017 fiscal years. Patient demographics, concomitant procedures, perioperative complications, patient reported outcomes, and perioperative costs were collected. Results: The mean age of our cohort was 62.5 yo. The implant types were: Infinity (39.3%), Salto (38.2%), INBONE (15.2%), Vantage (7.3%), and STAR (3.4%). 47.8% of patients were covered under managed care and 42.1% under Medicare. There were no significant differences in medical comorbidities (p > 0.05) or concomitant surgeries (p=0.4574) between inpatient and outpatient groups. There was no difference in complications between inpatient and outpatient groups (p= 0.9652). Inpatients had a greater improvement in their SMFA function score compared to outpatients (p=0.0442). Both inpatient and outpatient cohorts significantly improved in all other reported patient reported outcomes at final follow-up (<0.0001) without a difference between groups (p >0.05). The total direct cost was higher for the inpatient group ($15,340.1) versus outpatient group ($13,002.6) (p<0.0001). Conclusion: While inpatient designation TAR were more comorbid, short-stay designation TAR were associated with a 15.5% reduction in perioperative costs, comparable complication rates, and similar final postoperative patient reported outcome scores compared to inpatient TAR. [Table: see text]
2020 Roger A. Mann Award Winner: Application of Computerized Adaptive Testing to the Foot and Ankle Ability Measure
Authors: O’Neil Joseph T. , Plummer Otho R. , Raikin Steven M. 
Published: March 2021

Category: Other Introduction/Purpose: Patient-reported outcome measures (PROMs) are an increasingly important tool for assessing the impact of treatments orthopaedic surgeons render to patients. They provide information directly reported by the patient pertaining to the perception of their own outcome, functional status, and quality of life. Despite their importance, they can present a burden for patients as well as for a busy outpatient clinic. The Foot and Ankle Ability Measure (FAAM) is a freely available validated anatomy-specific outcome measure consisting of 32 questions, and has been found to be reliable for patients with a wide spectrum of foot and ankle conditions. We examined the validity and utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the Foot and Ankle Ability Measure. Methods: A previously developed FAAM CAT system was applied to the responses of patients undergoing foot and ankle evaluation and treatment at a busy tertiary referral orthopaedic practice over a 3-year period (2017-2019). A total of 15,902 responses for the Activities of Daily Living (ADL) subscale and a total of 14,344 responses for the Sports subscale were analyzed. The accuracy of the CAT to replicate the full-form score was assessed using the mean and standard deviation of scores for both groups (FAAM versus CAT), frequency distributions of the scores and score differences for both groups, Pearson and intraclass correlation coefficients, and Bland-Altman assessments of patterns in score differences. Results: The CAT system required 11 questions to be answered for the ADL subscale in 85.1% of cases (compared to 22 questions for the FAAM) and 12 in 14.9% of cases. The number of questions answered on the Sports subscale was 6 in 66.4% of cases (compared to 10 for the FAAM) and 5 in 33.6% of cases. The mean difference between the full FAAM ADL subscale (out of 100 points) and CAT was 0.6266 of a point and scores were within 7.5 points in greater than 95% of cases. The mean difference between the FAAM Sports subscale (out of 100 points) and CAT was 0.5967 of a point and scores were within the minimal clinically important difference of 9 in greater than 95% of cases. Conclusion: The FAAM CAT was able to reduce the number of responses a patient would need to answer by nearly 50%, while still providing a valid outcome score. This measure can therefore be directly correlated with previously obtained full FAAM scores in addition to providing a foot/ankle-specific measure, which previously reported CAT systems are not able to do.