bluuebunny/crossref_metadata_2025_split huggingface dataset:
Smoking is associated with a higher complication and failure rate in arteriovenous grafts for haemodialysis: A multi-centre experience
Authors: Kler Aaron , Khambalia Hussein , Pondor Zulfikar , Donne Rosie , Giuffrida Giuseppe , Augustine Titus , Campbell Babatunde , van Dellen David 
Published: November 2021

Introduction: Arteriovenous grafts (AVG) for haemodialysis (HD) access are recommended as a second line modality due to higher morbidity and mortality rates than arteriovenous fistulae (AVF). Smoking is already established as a risk factor in lower extremity bypass graft failure used for peripheral vascular disease, but its effect on AVGs remains unclear. We aimed to investigate the relationship of smoking on AVG outcomes. Methods: A 3 year (01/08/2015–01/08/2018) multi-centre retrospective study was carried out on patients receiving an AVG for HD. Data included patient demographics, medical history, operation, type of graft, postoperative course and primary and secondary patency rates. Statistical analyses performed were Kaplan-Meier curves and Cox’s proportional hazard regression. Results: Fifty-five AVGs were performed (1052 AVF performed) in this period. The most common complication was thrombosis (38.9%). Primary patency at 6, 12 and 24 months were 55%, 45% and 44% respectively. Secondary patency at 6, 12 and 24 months were 63%, 56% and 54% respectively. Smoking was found to be a poor prognostic factor for primary (HR 3.734 (1.818–7.668 95% CI) p < 0.001) and secondary patency (HR 6.238 (2.729–14.257) p < 0.001). Smoking was also significantly associated with graft thrombosis (HR 5.741 (2.380–13.848 95% CI) p < 0.001). Discussion: Primary patency rates are lower than previous reports whilst secondary patency is equivalent. Smoking results in a greater risk of thrombosis and poorer primary and secondary patency. This is recognised in vascular surgical grafts, but has not been previously described in AVGs for HD access. Smoking is a modifiable risk factor and as AVGs are typically used for end-stage vascular access patients. Pre-operative strategies to promote smoking cessation, including patient education and prehabilitation should be employed to improve outcomes.
Distribution of wounding patterns in casualties from mass shooting events
Authors: Atia Andrew , Halligan Lauren , Brezina Libor , Levites Heather , Hollins Andrew , Blau Jared , Hernandez J Andres , Lohmeier Steven , Suresh Visakha , Powers David B 
Published: November 2021

Introduction The incidence and severity of public mass shootings, and mass casualty incidents (MCI), continues to rise. Understanding the wounding pattern and incidence of potentially preventable death after these incidents is key not only to Health System and Trauma Center emergency response planning but also to community outreach and initial emergency interventions. Methods A retrospective study of autopsy reports after events with at least 10 fatalities exclusive of the assailants identified via the Federal Bureau of Investigation database from 1 January 1999 to 31 December 2020 was performed. Sites of injury, identification of weaponry, and identification of potentially survivable wounds were compiled. Results Nine events including 203 victims were reviewed. Overall, 56% of gunshots were to the head/neck/face; 37% were to the chest; 43% were to the abdomen/torso/back; 31% were to the lower extremity; and 36% were to the upper extremity. On average, there were 29 fatalities per event. Conclusion Emergency response disaster care strategy should focus on immediate point of care at the site of wounding by both the civilian population and medical personnel, as well as rapid extrication of victims for definitive medical care. Review of these autopsy results indicates exsanguination, often treatable, is the primary cause of death—supporting community education efforts in hemorrhage control. The location of the wounding patterns seen in this study warrants primary integration of craniomaxillofacial, orthopedic trauma, neurotrauma, and surgical critical care/trauma surgical specialists into the initial response team for MCI.
The reliability of clinical assessment of distal radioulnar joint instability
Authors: Pickering Greg Thomas , Fine Nicola Francesca , Knapper Thomas David , Giddins Grey Edward Bence 
Published: November 2021

Accurate assessment of distal radioulnar joint (DRUJ) stability is increasingly recognized as an important part of clinical examination of the wrist. The ability of 30 specialist UK hand surgeons to clinically determine the stability of four volunteers’ wrists was assessed. Volunteers’ wrist stability had previously been confirmed with a validated measurement rig. Use of the wrist ballottement test as the primary examination technique yielded a positive predictive value of 81%, a negative predictive value of 55%, a specificity of 94% and a sensitivity of only 24%, for the detection of DRUJ instability. No correlation between background speciality (orthopaedic versus plastic surgery), nor years of clinical experience was found. Clinical assessment of DRUJ instability among experienced clinicians appears unreliable and instability is typically under recognized. Previous research to date using this clinical assessment method as a parameter of success is therefore brought into question. Level of evidence: IV
Utility of diffusion-weighted magnetic resonance imaging in predicting the treatment response of nasopharyngeal carcinoma
Authors: Tangyoosuk Thidaporn , Lertbutsayanukul Chawalit , Jittapiromsak Nutchawan 
Published: November 2021

Objective Predicting the treatment response in patients with nasopharyngeal carcinoma (NPC) is challenging. This study evaluated the utility of diffusion-weighted imaging (DWI) in predicting the treatment response in patients with NPC. Methods We prospectively enrolled 33 patients with newly diagnosed NPC who underwent magnetic resonance imaging with the propeller DWI and apparent diffusion coefficient (ADC) map before and at 5 weeks after chemoradiation. The following ADC values of the primary tumor were calculated: pre-treatment ADC (pre-ADC), pre-treatment ADC ratio (pre-ADC ratio), ADC change (▵ADC), ADC change ratio (▵ADC ratio), and percentage of ADC change (▵%ADC). The correlations between these parameters and treatment outcomes were explored, and the patients were classified as good responders (complete response) and poor responders (stable disease, partial response, or progressive disease) based on the Response Evaluation Criteria in Solid Tumors, version 1.1. Results The ▵ADC, ▵ADC ratio, and ▵%ADC were significantly lower in the poor-responder group ( n = 12) than in the good-responder group ( n = 21; p = 0.001, p = 0.002, and p = 0.004, respectively). There was no significant difference between groups in the pre-ADC and pre-ADC ratios ( p = 0.602 and p = 0.685, respectively). The optimal ▵ADC, ▵ADC ratio, and ▵%ADC cutoff values for predicting poor response were >0.65 mm2/sec, 0.28, and 60%, respectively (sensitivity: 83.3%, 75%, and 83.3%; specificity: 71.4%, 85.7%, and 71.4%, respectively). Conclusion The ▵ADC, ▵ADC ratio, and ▵%ADC obtained during the pre-treatment and mid-treatment periods could be potential biomarkers for predicting treatment response in patients with NPC.
Dental Emergencies: Perceived impact of the COVID-19 pandemic on the mental health and wellbeing of dental teams in the UK
Authors: Ellwood Fiona 
Published: November 2021

The burden of the COVID-19 pandemic has and continues to stretch the healthcare systems and the workforce alike, both nationally and internationally. This is equally true of the dental care systems and the dental workforce which had to respond and act promptly. This paper examines the perceived impact of the COVID-19 pandemic on the mental health and wellbeing of dental teams in the UK and provides insight into not only this impact, but the early signs of mental ill health commonly triggered by life events, anxiety and fear, and often exacerbated by stresses. A sample of an established body of literature and recognised sources are considered. Finally, extracts of common threads from meaningful conversations will be alluded to, shining a light on the current state of the mental health and wellbeing of many in dentistry and the need for intervention and longer-term plans. We are often reminded that this period in time is a marathon not a sprint, the same could perhaps be said about a national response to mental health and wellbeing, as it will take time, but the time to begin is now.
Siponimod (BAF312) penetrates, distributes, and acts in the central nervous system: Preclinical insights
Authors: Bigaud Marc , Rudolph Bettina , Briard Emmanuelle , Beerli Christian , Hofmann Andreas , Hermes Erwin , Muellershausen Florian , Schubart Anna , Gardin Anne 
Published: November 2021

Background Siponimod (BAF312), a selective S1P1/S1P5 agonist, reduces disability progression in secondary progressive MS. Recent observations suggest it could act via S1P1/S1P5-dependent anti-inflammatory and pro-myelination effects on CNS-resident cells. Objective Generate preclinical evidence confirming siponimod's CNS penetration and activity. Methods Siponimod's CNS penetration and distribution was explored in rodents and non-human primates (NHPs) using: Liquid Chromatography coupled to tandem Mass Spectrometry (LC-MS/MS), quantitative whole-body autoradiography (QWBA) using 14C-radiolabeled siponimod or non-invasive single-photon emission CT (SPECT) with a validated 123I-radiolabeled siponimod analog. Functional CNS activity was investigated by S1P1 receptor quantification in brain homogenates. Results In mice/rats, siponimod treatments achieved dose-dependent efficacy and dose-proportional increase in drug blood levels, with mean brain/blood drug-exposure ratio (Brain/BloodDER) of 6–7. Efficacy in rat brain tissues was revealed by a dose-dependent reduction in brain S1P1 levels. QWBA distribution analysis in rats indicated that [14C]siponimod related radioactivity could readily penetrate CNS, with particularly high uptakes in white matter of cerebellum, corpus callosum, and medulla oblongata versus lower exposures in other areas such as olfactory bulb. SPECT monitoring in NHPs revealed CNS distribution with a brain/bloodDER of ∼6, as in rodents. Conclusion Findings demonstrate siponimod's CNS penetration and distribution across species, with high translational potential to human.
Physician Executive Leadership Plus: An Approach to Business and Management Education for Medical Students
Authors: Beldick Stephanie R. , Ooi Gavyn , Shah Saloni A. , Morano Michael , Li Chris , Zimmerman Michael , Levine Leonard 
Published: November 2021

INTRODUCTION Physicians are looked upon to lead the healthcare team, a task that has grown increasingly complex and interdisciplinary, requiring a diverse extra-clinical skillset. Physician Executive Leadership (PEL) Plus is a student-run program that uniquely utilizes both didactic and real-world project-based approaches to deliver a business and management curriculum to medical students. METHODS We developed and implemented PEL Plus during the 2018-19 and 2019-20 academic years, geared at first- and second-year medical students. We provide an overview of this combined didactic and project-based curriculum, in addition to evaluating if the program was efficacious in teaching the desired skillset. We assessed short-term knowledge acquisition using multiple-choice questions, and investigated student perceptions of their learning and the program using Likert scales and narrative feedback. We also investigated the influence of student demographics on performance, in order to assess the appropriateness of our target audience. RESULTS 28 students completed PEL Plus over the two years (14 students/year). Average performance on multiple-choice questions showed statistically significant improvement after the majority of sessions. There were no statistically significant effects of demographics on performance in the majority of sessions. Students self-rated stronger understandings of lecture topics after each session, and analysis of narrative feedback demonstrated thematic categories centred on teaching style, new knowledge, lecture content/material, projects, networking, program structure, and generic statements. DISCUSSION PEL Plus is an innovative and effective approach to teaching business, leadership, and management skills in undergraduate medical education. Development of similar programs at other institutions will positively impact the broader medical student community.
Relations between language, non-verbal cognition, and conceptualization in non- or minimally verbal individuals with ASD across the lifespan
Authors: Slušná Dominika , Rodríguez Andrea , Salvadó Berta , Vicente Agustín , Hinzen Wolfram 
Published: November 2021

Background & aims Individuals with non- or minimally verbal autism (nvASD) are primarily characterized by a severe speech production deficit, with speech limited to no or only a few words by school age. Significant unclarity remains over variability in language profiles across the lifespan, the nature of the language impairment seen, and (dis-) associations between linguistic and nonverbal cognitive measures. Methods To address these questions, we recruited both a school-age and an adult group with nvASD (total N = 49) and investigated relations between expressive and receptive language, and between these and nonverbal intelligence quotient (NVIQ) and sense-making capacities (the ComFor test). Results Results revealed limited variation across this sample in receptive language, which in turn predicted expressive language levels. Importantly, an upward trend in verbal mental age (VMA) across increasing chronological age was seen in the youngsters (only). A radical dissociation between NVIQ and both expressive and receptive language transpired as well, and a subset of individuals with normal NVIQ were comparable in terms of any other cognitive aspect. Sense-making reached symbolic levels in 62.2% of the sample and loaded on both verbal and nonverbal factors. Conclusions These patterns inform theories of nvASD by revealing an impairment that is not conceptualizable as one of expressive language only, sharply limits learning opportunities across the lifespan, and cannot be compensated for by nonverbal cognition. Implications These findings stress the need to seize developmental opportunities that may disappear when youngsters turn into adults, via therapies that specifically target language as a central cognitive system comprising both production and comprehension.
ELN2017 risk stratification improves outcome prediction when applied to the prospective GIMEMA AML1310 protocol
Authors: Buccisano Francesco , Palmieri Raffaele , Piciocchi Alfonso , Arena Valentina , Candoni Anna , Melillo Lorella , Calafiore Valeria , Cairoli Roberto , de Fabritiis Paolo , Storti Gabriella , Salutari Prassede , Lanza Francesco , Martinelli Giovanni , Luppi Mario , Capria Saveria , Maurillo Luca , Del Principe Maria Ilaria , Paterno Giovangiacinto , Irno Consalvo Maria Antonietta , Ottone Tiziana , Lavorgna Serena , Voso Maria Teresa , Fazi Paola , Vignetti Marco , Arcese William , Venditti Adriano 
Published: November 2021

Abstract
The 2017 version of the European LeukemiaNet (ELN) recommendations, by integrating cytogenetics and mutational status of specific genes, divides patients with acute myeloid leukemia into 3 prognostically distinct risk categories: favorable (ELN2017-FR), intermediate (ELN2017-IR), and adverse (ELN2017-AR). We performed a post hoc analysis of the GIMEMA (Gruppo Italiano Malattie EMatologiche dell’Adulto) AML1310 trial to investigate the applicability of the ELN2017 risk stratification to our study population. In this trial, after induction and consolidation, patients in complete remission were to receive an autologous stem cell transplant (auto-SCT) if categorized as favorable risk or an allogeneic stem cell transplant (allo-SCT) if adverse risk. Intermediate-risk patients were to receive auto-SCT or allo-SCT based on the postconsolidation levels of measurable residual disease as measured by using flow cytometry. Risk categorization was originally conducted according to the 2009 National Comprehensive Cancer Network recommendations. Among 500 patients, 445 (89%) were reclassified according to the ELN2017 criteria: ELN2017-FR, 186 (41.8%) of 455; ELN2017-IR, 179 (40.2%) of 445; and ELN2017-AR, 80 (18%) of 455. In 55 patients (11%), ELN2017 was not applicable. Two-year overall survival (OS) was 68.8%, 51.3%, 45.8%, and 42.8% for the ELN2017-FR, ELN2017-IR, ELN2017-not classifiable, and ELN2017-AR groups, respectively (P &lt; .001). When comparing the 2 different transplant strategies in each ELN2017 risk category, a significant benefit of auto-SCT over allo-SCT was observed among ELN2017-FR patients (2-year OS of 83.3% vs 66.7%; P = .0421). The 2 transplant procedures performed almost equally in the ELN2017-IR group (2-year OS of 73.9% vs 70.8%; P = .5552). This post hoc analysis of the GIMEMA AML1310 trial confirms that the ELN2017 classification is able to accurately discriminate patients with different outcomes and who may benefit from different transplant strategies. This trial was registered as EudraCT number 2010-023809-36 and at www.clinicaltrials.gov as #NCT01452646.
Role of DNA methylation on the association between physical activity and cardiovascular diseases: results from the longitudinal multi-ethnic study of atherosclerosis (MESA) cohort
Authors: Shi Hangchuan , Ossip Deborah J. , Mayo Nicole L. , Lopez Daniel A. , Block Robert C. , Post Wendy S. , Bertoni Alain G. , Ding Jingzhong , Chen Si , Yan Chen , Xie Zidian , Hoeschele Ina , Liu Yongmei , Li Dongmei 
Published: November 2021

AbstractBackgroundThe complexity of physical activity (PA) and DNA methylation interaction in the development of cardiovascular disease (CVD) is rarely simultaneously investigated in one study. We examined the role of DNA methylation on the association between PA and CVD.ResultsThe Multi-Ethnic Study of Atherosclerosis (MESA) cohort Exam 5 data with 1065 participants free of CVD were used for final analysis. The quartile categorical total PA variable was created by activity intensity (METs/week). During a median follow-up of 4.0 years, 69 participants developed CVD. Illumina HumanMethylation450 BeadChip was used to provide genome-wide DNA methylation profiles in purified human monocytes (CD14+). We identified 23 candidate DNA methylation loci to be associated with both PA and CVD. We used the structural equation modeling (SEM) approach to test the complex relationships among multiple variables and the roles of mediators. Three of the 23 identified loci (corresponding to genesVPS13D,PIK3CDandVPS45) remained as significant mediators in the final SEM model along with other covariates. Bridged by the three genes, the 2nd PA quartile (β = − 0.959; 95%CI: − 1.554 to − 0.449) and the 3rd PA quartile (β = − 0.944; 95%CI: − 1.628 to − 0.413) showed the greatest inverse associations with CVD development, while the 4th PA quartile had a relatively weaker inverse association (β = − 0.355; 95%CI: − 0.713 to − 0.124).ConclusionsThe current study is among the first to simultaneously examine the relationships among PA, DNA methylation, and CVD in a large cohort with long-term exposure. We identified three DNA methylation loci bridged the association between PA and CVD. The function of the identified genes warrants further investigation in the pathogenesis of CVD.
Acceptance of seasonal influenza vaccination and associated factors among pregnant women in the context of COVID-19 pandemic in China: a multi-center cross-sectional study based on health belief model
Authors: Wang Ruitong , Tao Liyuan , Han Na , Liu Jihong , Yuan Chuanxiang , Deng Lixia , Han Chunhua , Sun Fenglan , Chi Liqun , Liu Min , Liu Jue 
Published: November 2021

Abstract
Background
Seasonal influenza can circulate in parallel with coronavirus disease (COVID-19) in winter. In the context of COVID-19 pandemic, the risk of co-infection and the burden it poses on healthcare system calls for timely influenza vaccination among pregnant women, who are the priority population recommended for vaccination. We aimed to evaluate the acceptance of influenza vaccination and associated factors among pregnant women during COVID-19 pandemic, provide evidence to improve influenza vaccination among pregnant women, help reduce the risk of infection and alleviate the burden of healthcare system for co-infected patients.

Methods
We conducted a multi-center cross-sectional study among pregnant women in China. Sociodemographic characteristics, health status, knowledge on influenza, attitude towards vaccination, and health beliefs were collected. Locally weighted scatterplot smoothing regression analysis was used to evaluate the trends in the acceptance of influenza vaccine. Logistic regression was applied to identify factors associated with vaccination acceptance.

Results
The total acceptance rate was 76.5% (95%CI: 74.8–78.1%) among 2568 pregnant women enrolled. Only 8.3% of the participants had a history of seasonal influenza vaccination. In the logistic regression model, factors associated with the acceptance of influenza vaccine were western region, history of influenza vaccination, high knowledge of influenza infection and vaccination, high level of perceived susceptibility, perceived benefit, cues to action and low level of perceived barriers. Among 23.5% of the participants who had vaccine hesitancy, 48.0% of them were worried about side effect, 35.6% of them lacked confidence of vaccine safety.

Conclusions
Our findings highlighted that tailored strategies and publicity for influenza vaccination in the context of COVID-19 pandemic are warranted to reduce pregnant women’s concerns, improve their knowledge, expand vaccine uptake and alleviate pressure for healthcare system.