bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impaired Exercise Tolerance in Repaired Tetralogy of Fallot Is Associated With Impaired Biventricular Contractile Reserve: An Exercise-Stress Real-Time Cardiovascular Magnetic Resonance Study
Authors: Steinmetz Michael , Stümpfig Thomas , Seehase Matthias , Schuster Andreas , Kowallick Johannes , Müller Matthias , Unterberg-Buchwald Christina , Kutty Shelby , Lotz Joachim , Uecker Martin , Paul Thomas 
Published: August 2021

Background:
Correction of tetralogy of Fallot (cTOF) often results in pulmonary valve pathology and right ventricular (RV) dysfunction. Reduced exercise capacity in cTOF patients cannot be explained by these findings alone. We aimed to explore why cTOF patients exhibit impaired exercise capacity with the aid of a comprehensive cardiopulmonary exercise testing (CPET) and real-time cardiovascular magnetic resonance exercise testing (CMR-ET) protocol.

Methods:

Thirty three cTOF patients and 35 matched healthy controls underwent CPET and CMR-ET in a prospective case-control study. Real-time steady-state free precession cine and phase-contrast sequences were obtained during incremental supine in-scanner cycling at 50, 70, and 90 W. RV and left ventricle (LV) volumes and pulmonary blood flow (Qp) were calculated. Differences of CPET and CMR-ET between cTOF versus controls and correlations between CPET and CMR-ET parameters in cTOF were evaluated statistically for all CMR exercise levels using Mann-Whitney
U
and Spearman rank-order correlation tests.

Results:

CPET capacity was significantly lower in cTOF than in controls. cTOF patients exhibited not only significantly reduced Qp and RV function but also lower LV function on CMR-ET. Higher CPET values in cTOF correlated with higher Qp (Qp 90 W versus carbon dioxide ventilatory equivalent %:
R
=−0.519,
P
<0.05), higher LV–end-diastolic volume indexed to body surface area (LV–end-diastolic volume indexed to body surface area at 50 W versus oxygen uptake in % at maximum exercise on CPET
R
=0.452,
P
<0.05), and change in LV ejection fraction (EF; LV-EF at 90 W versus Watt %:
r
=−0.463,
P
<0.05). No correlation was found with regard to RV-EF. Significant RV-LV interaction was observed during CMR-ET (RV-EF versus LV-EF at 50 W and 70 W:
r
=0.66,
P
<0.02 and
r
=0.52,
P
<0.05, respectively).

Conclusions:
Impaired exercise capacity in cTOF resulted from a reduction in not only RV, but also LV function. cTOF with good exercise capacity on CPET demonstrated higher LV reserve and pulmonary blood flow during incremental CMR-ET. Apart from RV parameters, CMR-ET–derived LV function could be a valuable tool to stratify cTOF patients for pulmonary valve replacement.
Clinical Significance of Partial Anomalous Pulmonary Venous Connections (Isolated and Atrial Septal Defect Associated) Determined by Cardiovascular Magnetic Resonance
Authors: Hatipoglu Suzan , Almogheer Batool , Mahon Ciara , Houshmand Golnaz , Uygur Begum , Giblin Gerard T. , Krupickova Sylvia , Baksi A. John , Alpendurada Francisco , Prasad Sanjay K. , Babu-Narayan Sonya V. , Gatzoulis Michael A. , Mohiaddin Raad H. , Pennell Dudley J. , Izgi Cemil 
Published: August 2021

Background:
Partial anomalous venous connections (PAPVC) are associated with left to right shunting and right heart dilatation. Identification of PAPVC has increased with widespread use of cross-sectional imaging modalities. However, management strategies are mostly based on expert opinion given the scarcity of data from large series. We aimed to define types and significance of isolated and atrial septal defect (ASD) associated PAPVC detected by cardiovascular magnetic resonance.

Methods:
We retrospectively reviewed our cardiovascular magnetic resonance database from 2002 to 2018 to identify isolated or ASD-associated PAPVC cases.

Results:

A total of 215 patients (median age 46 years; range, 6–83) with isolated or ASD-associated PAPVC were identified among 102 135 clinical cardiovascular magnetic resonance studies. Of these, 104 were isolated and 111 were associated with an ASD. Anomalous connection of right upper pulmonary vein was the most common single venous anomaly (99/215), but in the isolated PAPVC group there were more anomalous left than right upper pulmonary veins (39 versus 34). The Qp/Qs was significantly higher for isolated anomalous single right upper pulmonary vein than left upper pulmonary vein (1.6 versus 1.4 respectively;
P
=0.01) as were right ventricular end-diastolic volumes (113.7±30.9 versus 90 [57–157] mL/m
2
,
P
=0.004). In the PAPVC with an ASD group, sinus venosus ASDs (82%) were associated with right-sided PAPVCs while both right and left-sided venous anomalies were seen in secundum ASDs (18%). In a substantial number of patients (30 out of 91) with sinus venosus ASDs, PAPVCs were more complex and involved more than a single anomalous right upper pulmonary vein; and in 5 patients with ASD, PAPVC was identified only after the ASD closure.

Conclusions:
This large series provides descriptive and hemodynamic features for isolated and ASD-associated PAPVCs. Anomalous isolated right upper pulmonary vein may cause a significant shunt (Qp/Qs >1.5). PAPVC associated with sinus venosus and secundum ASDs might be more complex than a single anomalous pulmonary vein and missed before ASD correction.
Association of Mildly Reduced Kidney Function With Cardiovascular Disease: The Framingham Heart Study
Authors: Ataklte Feven , Song Rebecca J. , Upadhyay Ashish , Musa Yola Ibrahim , Vasan Ramachandran S. , Xanthakis Vanessa 
Published: August 2021

Background

Data are limited on the association of mildly reduced estimated glomerular filtration rate (eGFR 60–89 mL/min per 1.73 m
2
) with cardiovascular disease (CVD) in the community.

Methods and Results

We evaluated 3066 Framingham Offspring Study participants (55% women, mean age 58 years), without clinical CVD. Using multivariable regression, we related categories of mildly reduced eGFR (80–89, 70–79, or 60–69 versus ≥90 mL/min per 1.73 m
2
[referent]) to prevalent coronary artery calcium, carotid intima media thickness, and left ventricular hypertrophy, and to circulating concentrations of cardiac stress biomarkers. We related eGFR categories to CVD incidence and to progression to ≥Stage 3 chronic kidney disease (eGFR <60 mL/min per 1.73 m
2
) using Cox regression. Individuals with eGFR 60–69 mL/min per 1.73 m
2
(n=320) had higher coronary artery calcium score (odds ratio 1.69; 95% CI 1.02–2.80) compared with the referent group. Individuals with eGFR 60–69 and 70–79 mL/min per 1.73 m
2
had higher blood growth differentiating factor‐15 concentrations (β=0.131 and 0.058 per unit‐increase in log‐biomarker, respectively). Participants with eGFR 60–69 and 80–89 mL/min per 1.73 m
2
had higher blood B‐type natriuretic peptide concentrations (β=0.119 and 0.116, respectively). On follow‐up (median 16 years; 691 incident CVD and 252 chronic kidney disease events), individuals with eGFR 60–69 and 70–79 mL/min per 1.73 m
2
experienced higher CVD incidence (hazard ratio [HR], 1.40; 95% CI, 1.02–1.93 and 1.45, 95% CI, 1.05–2.00, respectively, versus referent). Participants with eGFR 60–69 mL/min per 1.73 m
2
experienced higher chronic kidney disease incidence (HR, 2.94; 95% CI, 1.80–4.78 versus referent).

Conclusions

Individuals with mildly reduced eGFR 60–69 mL/min per 1.73 m
2
have a higher burden of subclinical atherosclerosis cross‐sectionally, and a greater risk of CVD and chronic kidney disease progression prospectively. Additional studies are warranted to confirm our findings.
Circulating Growth Differentiation Factor 15 Is Increased Preceding Preeclampsia Diagnosis: Implications as a Disease Biomarker
Authors: Cruickshank Tess , MacDonald Teresa M. , Walker Susan P. , Keenan Emerson , Dane Kirsten , Middleton Anna , Kyritsis Valerie , Myers Jenny , Cluver Catherine , Hastie Roxanne , Bergman Lina , Garcha Damanpreet , Cannon Ping , Murray Elizabeth , Nguyen Tuong‐Vi , Hiscock Richard , Pritchard Natasha , Hannan Natalie J. , Tong Stephen , Kaitu’u‐Lino Tu’uhevaha J. 
Published: August 2021

BackgroundWe investigated the biomarker potential of growth differentiation factor 15 (GDF‐15), a stress response protein highly expressed in placenta, to predict preeclampsia.Methods and ResultsIn 2 prospective cohorts (cohort 1: 960 controls, 39 women who developed preeclampsia; cohort 2: 950 controls, 41 developed preeclampsia), plasma concentrations of GDF‐15 at 36 weeks' gestation were significantly increased among those who developed preeclampsia (P<0.001), area under the receiver operating characteristic curves (AUC) of 0.66 and 0.71, respectively. In cohort 2 a ratio of sFlt‐1/PlGF (a clinical biomarker for preeclampsia) had a sensitivity of 61.0% at 83.2% specificity to predict those who will develop preeclampsia (AUC of 0.79). A ratio of GDF‐15×sFlt‐1/PlGF yielded a sensitivity of 68.3% at 83.2% specificity (AUC of 0.82). GDF‐15 was consistently elevated across a number of international cohorts: levels were higher in placenta and blood from women delivering <34 weeks' gestation due to preterm preeclampsia in Melbourne, Australia; and in the blood at 26 to 32 weeks' gestation among 57 women attending the Manchester Antenatal Vascular Service (MAViS, UK) who developed preeclampsia (P=0.0002), compared with 176 controls. In the Preeclampsia Obstetric adVerse Events biobank (PROVE, South Africa), plasma GDF‐15 was significantly increased in women with preeclampsia with severe features (P=0.02; n=14) compared to controls (n=14).ConclusionsWe conclude circulating GDF‐15 is elevated among women more likely to develop preeclampsia or diagnosed with the condition. It may have value as a clinical biomarker, including the potential to improve the sensitivity of sFlt‐1/PlGF ratio.
Early Risk of Stroke in Patients Undergoing Acute Versus Elective Cardioversion for Atrial Fibrillation
Authors: Forslund Tomas , Braunschweig Frieder , Holzmann Martin J. , Siddiqui Anwar J. 
Published: August 2021

Background
Electrical cardioversion (ECV) is routinely used to restore sinus rhythm in patients with symptomatic atrial fibrillation. The European guidelines have been updated in recent years. Current information on differences in the risk for stroke after acute versus elective ECV is lacking.

Methods And Results

All patients with a first‐time acute or elective ECV in the Stockholm regional health care data warehouse from 2011 to 2018 were included. Cox regression analyses were performed evaluating ischemic or unspecified stroke within 30 days after ECV with adjustments for the CHA
2
DS
2
‐VASc score, medical treatment, and year of inclusion. The study included 9139 patients, 3094 after acute and 6045 after elective ECV. The mean age was 65.9±11.3 years, 69.5% were men, and the mean CHA
2
DS
2
‐VASc score was 2.4±1.7. Before the intervention, 49.6% of patients with an acute ECV and 96.4% of those with an elective ECV had claimed an oral anticoagulant prescription. Ischemic or unspecified stroke occurred in 26 (0.28%) patients within 30 days. The unadjusted risk was higher after acute compared with elective ECV (hazard ratio [HR], 2.29; 95% CI, 1.06–4.96), whereas there was no difference after multivariable adjustments (adjusted HR, 0.99; 95% CI, 0.36–2.72). Both non–vitamin K oral anticoagulants (adjusted HR, 0.28; 95% CI, 0.08–0.98) and warfarin (adjusted HR, 0.17; 95% CI, 0.05–0.53) were associated with a lower risk for stroke compared with no anticoagulation.

Conclusions
Acute ECV was associated with a higher unadjusted risk for stroke than elective ECV, but the risk was similar after adjustment for anticoagulant treatment. This study indicates the importance of anticoagulation before ECV according to recent European guidelines.
Soil Moisture Control of Precipitation Reevaporation over a Heterogeneous Land Surface
Authors: Cheng Yu , Chan Pak Wah , Wei Xin , Hu Zeyuan , Kuang Zhiming , McColl Kaighin A. 
Published: August 2021

AbstractSoil moisture heterogeneity can induce mesoscale circulations due to differential heating between dry and wet surfaces, which can, in turn, trigger precipitation. In this work, we conduct cloud-permitting simulations over a 100 km × 25 km idealized land surface, with the domain split equally between a wet region and a dry region, each with homogeneous soil moisture. In contrast to previous studies that prescribed initial atmospheric profiles, each simulation is run with fixed soil moisture for 100 days to allow the atmosphere to equilibrate to the given land surface rather than prescribing the initial atmospheric profile. It is then run for one additional day, allowing the soil moisture to freely vary. Soil moisture controls the resulting precipitation over the dry region through three different mechanisms: as the dry domain gets drier, (i) the mesoscale circulation strengthens, increasing water vapor convergence over the dry domain, (ii) surface evaporation declines over the dry domain, decreasing water vapor convergence over the dry domain, and (iii) precipitation efficiency declines due to increased reevaporation, meaning proportionally less water vapor over the dry domain becomes surface precipitation. We find that the third mechanism dominates when soil moisture is small in the dry domain: drier soils ultimately lead to less precipitation in the dry domain due to its impact on precipitation efficiency. This work highlights an important new mechanism by which soil moisture controls precipitation, through its impact on precipitation reevaporation and efficiency.
The Virtual Interview Experience for MATCH 2021: A Pilot Survey of General Surgery Residency Program Directors
Authors: Rajesh Aashish , Asaad Malke , Elmorsi Rami , Ferry Andrew M. , Maricevich Renata S. 
Published: August 2021

Background Virtual interviews (VIs) for the 2020 residency application season were mandated as a result of the COVID-19 pandemic. We aimed to determine the perspectives of general surgery (GS) program directors (PDs) on the benefits and drawbacks of VIs. Methods A 14-item survey was emailed to all GS PDs from programs identified on the American Council for Graduate Medical Education website. Program directors were asked about the cost-time benefit of VIs, its ability to assess candidates, and their thoughts on the future of VIs for evaluating residency applicants. Results 60 PDs responded corresponding to a response rate of 21%. While 93% agreed/strongly agreed that VIs were less expensive, only 35% found VIs to be less time-consuming. 75% and 67%, respectively, disagreed/strongly disagreed that VIs allowed for an easier assessment of an applicant’s fit, and personality and communication skills. Almost one-half of our survey respondents suggested that VIs made the selection committee rely more heavily on objective applicant data. Almost two-thirds of GS PDs suggested that they would adopt both VI and in-person interview formats for future application cycles. The median [interquartile range] cost saved through the implementation of VIs was US$ 4500 [1625 – 10 000]. Conclusion Remarkably, VIs have been swiftly imbibed by all residency programs and many aspects of the VI experience were positive. While MATCH 2021 has definitely proved to be one of its kind, the implementation of VIs has been met with overall broad success and a promising future awaits this novel modality of resident selection to GME programs in the United States.
Impact of Adjunctive Pharmacotherapy With Intragastric Balloons for the Treatment of Obesity
Authors: Mehta Amit , Shah Shawn , Dawod Enad , Hajifathalian Kaveh , Kumar Rekha , Igel Leon I. , Saunders Katherine H. , Kumbhari Vivek , Farha Jad , Badurdeen Dilhana , Itani Mohamad I. , Moore Rachel L. , Starpoli Anthony A. , Carr-Locke David L. , Shukla Alpana , Aronne Louis J. , Sharaiha Reem Z. 
Published: August 2021

Background We conducted this study to compare the weight loss outcome of intragastric balloons (IGBs) in conjunction with pharmacotherapy vs IGB and intensive lifestyle changes alone. Methods This was a multicenter, non-randomized, retrospective study involving 4 academic hospitals. Patients underwent IGB placement with or without concomitant anti-obesity pharmacotherapy. The primary outcome was percent total weight loss (TBWL) after IGB placement at 6 and 12 months. Results This study included 102 patients, with 23 patients (mean age 46.6 years, 82.6% female) treated with IGB/pharmacotherapy and 79 patients (mean age 46.0 years, 88.6% female) treated with IGB/lifestyle modifications. Patients had a 100% follow-up rate at 6 and 12 months. At 6 months following IGB placement, both groups achieved a similar %TBWL. At 12 months, %TBWL was greater in the IGB/pharmacotherapy group (12.6% ± 1.2 vs 9.7% ± 0.7, P = .04). 65.2% of patients achieved ≥10% TBWL at 12 months in the IGB/pharmacotherapy group, compared to 38.0% in the IGB/lifestyle group ( P < .05). The proportion of patients that achieved ≥15% weight loss at 12 months was also significantly different between the IGB/pharmacotherapy and IGB/lifestyle groups (30.4% vs 20.3%, P < .05). Discussion IGB with concomitant use of pharmacotherapy did not improve weight loss while the IGB was in place compared to IGB and lifestyle changes. However, patients receiving IGB with pharmacotherapy did have greater weight loss and diminished weight regain after balloon removal compared to those receiving just IGB and lifestyle changes.
Operative Confidence Among U.S General Surgery Residents
Authors: Elkbuli Adel , Ehrlich Haley , Gargano Toria , Newsome Kevin , Liu Huazhi , McKenney Mark , Ang Darwin 
Published: August 2021

Background General surgery residents (GSRs) must develop operative autonomy skills to practice independently after graduation. We aim to investigate perceived confidence and operative autonomy of GSR physicians in order to identify and address influential factors. Methods A 28-question anonymous online survey was distributed to 23 United States general surgery residency programs. Multivariable logistic regression was used for calculating the adjusted odds ratio (aOR) for binary outcomes. Significance was defined as P-values ≤ .05 or 95% confidence intervals (CIs) >1 or <1. Results There were 120/558 (21.5%) GSR respondents. General surgery residents with >200 overall operative case volume reported significantly higher confidence with minor cases (P = .05) and major cases (P = .02). General surgery residents that performed both minor and major surgeries reported higher confidence with minor cases at 85.7% compared to GSRs that performed mostly minor surgeries (64.7%) and mostly major surgeries (62.5%). General surgery residents who performed >50 minor surgeries during their PGY 1 and 2 were less confident with major cases than GSRs who performed <50 minor surgeries (aOR: 19.98, 95% CI: 1.26, 318). General surgery residents from community teaching hospitals reported higher confidence with major and minor cases than GSRs from university teaching hospitals and combined programs. Conclusion Increased case volume, predominant case type, early surgical experience during PGY 1 and 2 years, and training at community teaching hospitals were identified as the most important factors that positively influence perception of operative confidence and autonomy among GSRs. These may have important implications in the development of future surgeons.
Efficacy and safety of transcranial direct current stimulation for post-stroke spasticity: A meta-analysis of randomised controlled trials
Authors: Huang Jiapeng , Qu Yun , Liu Lini , Zhao Kehong , Zhao Ziqi 
Published: August 2021

Objectives: To evaluate the efficacy and safety of transcranial direct current stimulation for post-stroke spasticity and to assess its evidence using a meta-analysis. Methods: We searched the Cochrane Library, EMBASE, MEDLINE (via PubMed), PEDro, CBM, CNKI and Wan Fang Data from their inception to June 2021 for randomised clinical trials published in English or Chinese, which aimed to explore the effects of transcranial direct current stimulation on post-stroke spasticity. Two reviewers independently extracted the data and evaluated the methodological quality and overall evidence quality. Results: Thirteen randomised clinical trials comprising 924 patients were included, 12 of which were included in the meta-analysis. The results showed that anodal stimulation (standard mean difference = −0.91; [95% CI; −1.63 to −0.19]) combined with other therapies was more effective in improving upper limb spasticity. More than 20 minutes of stimulation were found to be effective in improving spasticity. Transcranial direct current stimulation was superior to the control treatments for subacute (standard mean difference = −1.16; −1.75 to −0.57) and chronic stroke (standard mean difference = −0.68; −1.13 to −0.22) patients aged under 60 (standard mean difference = −1.07; −1.54 to −0.60). No severe adverse events were reported in any of the included studies. Conclusions: Low-quality evidence demonstrates that anodal transcranial direct current stimulation as an adjunct is effective and safe in reducing upper limb post-stroke spasticity when applied for more than 20 minutes in subacute and chronic stroke survivors aged under 60. Further high-quality studies are needed to explore its long-term efficacy and safety.
Radiographic Outcomes of Proximal vs Distal Syndesmotic Low Tibial Osteotomy
Authors: Choi Jun Young , Cho Jin Ho , Song Tae Hun , Suh Jin Soo 
Published: August 2021

Background: We aimed to determine whether the location of tibial osteotomy affects the outcome during low tibial osteotomy (LTO) with fibular osteotomy for varus ankle arthritis by comparing proximal syndesmotic (PS) and distal syndesmotic (DS) tibial osteotomy. Methods: We retrospectively reviewed the radiographic findings of 50 cases (among 47 patients) who underwent LTO with fibular osteotomy for varus ankle arthritis. The enrolled patients were divided into 2 groups according to the location of the tibial osteotomy: the PS group (25 cases, 24 patients) and the DS group (25 cases, 23 patients). Radiographic parameters were compared between the 2 groups. Results: There were no significant differences in tibial anterior and lateral surface angles, tibiomedial malleolar angle, talar center migration, and intermalleolar distance correction between the 2 groups (all P > .05). However, the decreases in talar tilt (TT) and talocrural angle (TCA) were more pronounced in the DS group than in the PS group (both P < .05). Among patients with TT ≥8 degrees, a greater decrease in TT (+1.0 degrees vs –2.8 degrees) and TCA was observed in the DS group, whereas the PS group demonstrated greater increases in TCA and intermalleolar distance (all P < .01). Conclusion: In this series, DS tibial osteotomy combined with fibular osteotomy was a more effective operative option than PS tibial osteotomy to correct both extra- and intra-articular deformity for varus ankle arthritis. Level of Evidence: Level III, retrospective comparative study.