bluuebunny/crossref_metadata_2025_split huggingface dataset:
Steatosis grading consistency between controlled attenuation parameter and MRI-PDFF in monitoring metabolic associated fatty liver disease
Authors: Shao Cong xiang , Ye Junzhao , Dong Zhi , Li Fuxi , Lin Yansong , Liao Bing , Feng Shiting , Zhong Bihui 
Published: August 2021

Background: The consistency in steatosis grading between magnetic resonance imaging-based proton density fat fraction (MRI-PDFF) and controlled attenuation parameter (CAP) before and after treatment remains unclear. This study aimed to compare the diagnostic accuracy of steatosis grading between MRI-PDFF and CAP using liver biopsy as standard and to evaluate the value of monitoring changes in steatosis grading with CAP during follow-up utilizing MRI-PDFF as a reference. Methods: Consecutive patients from a biopsy cohort and a randomized controlled trial were included in this study and classified into 3 groups (the biopsy, orlistat treatment, and routine treatment subgroups). Hepatic steatosis was measured via MRI-PDFF and CAP at baseline and at the 6th month; the accuracy and cutoffs were assessed in the liver biopsy cohort at baseline. Results: A total of 209 consecutive patients were enrolled. MRI-PDFF and CAP showed comparable diagnostic accuracy for detecting pathological steatosis [⩾S1, area under the receiver operating characteristic curve (AUC) = 0.984 and 0.972, respectively]; in contrast, CAP presented significantly lower AUCs in grades S2–3 and S3 (0.820 and 0.815, respectively). The CAP values correlated well with the MRI-PDFF values at baseline and at the 6th month ( r = 0.809 and 0.762, respectively, both p < 0.001), whereas a moderate correlation in their changes ( r = 0.612 and 0.524 for moderate-severe and mild steatosis, respectively; both p < 0.001) was observed. The AUC of CAP change was obtained to predict MRI-PDFF changes of ⩾5% and ⩾10% (0.685 and 0.704, p < 0.001 and p = 0.001, respectively). The diagnostic agreement of steatosis grade changes between MRI-PDFF and CAP was weak (κ = 0.181, p = 0.001). Conclusions: CAP has decreased value for the initial screening of moderate-severe steatosis and is limited in monitoring changes in steatosis during treatment. The confirmation of steatosis grading with MRI-PDFF remains necessary.
Impact of exclusive e-cigarettes and heated tobacco products use on muco-ciliary clearance
Authors: Polosa R. , Emma R. , Cibella F. , Caruso M. , Conte G. , Benfatto F. , Ferlito S. , Gulino A. , Malerba M. , Caponnetto P. 
Published: August 2021

Background: Tobacco smoking impairs mucociliary clearance (MCC) efficiency as shown by prolonged saccharin test transit time (STTT). Avoiding exposure to tobacco smoke from combustible cigarettes may restore MCC function and former smokers have been shown to exhibit similar STTT as never smokers. The impact on STTT of switching from smoking to combustion-free tobacco products such as e-cigarettes (ECs) and heated tobacco products (HTPs) is not known. Methods: We report STTT of exclusive EC and HTP users. Test results were compared with those obtained in current, former, and never smokers. Results: STTT were obtained from 39 current, 40 former, 40 never smokers, and from 20 EC and 20 HTP users. Comparison of STTT values showed significant difference among the five study groups ( p < 0.00001) with current smokers having a median [interquartile range (IQR)] STTT of 13.15 min, which was significantly longer compared with that of all other study groups. In particular, compared with former (7.26 min) and never smokers (7.24 min), exclusive EC users and exclusive HTP users had similar STTT at 7.00 and 8.00 min, respectively. Conclusion: Former smokers who have switched to exclusive regular use of combustion-free nicotine delivery systems (i.e., ECs and HTPs) exhibit similar saccharin transit time as never and former smokers. This suggests that combustion-free nicotine delivery technologies are unlikely to have detrimental effects on MCC function.
Prevalence of Aspergillus fumigatus skin positivity in adults without an apparent/known atopic disease in Uganda
Authors: Kwizera Richard , Bongomin Felix , Olum Ronald , Worodria William , Bwanga Freddie , Meya David B. , Kirenga Bruce J. , Gore Robin , Fowler Stephen J. , Denning David W. 
Published: August 2021

Background: Skin prick testing (SPT) is an important investigation in the evaluation of allergy to fungal pathogens. However, the background sensitivity to fungal allergens among healthy people in Uganda is unknown. Our aim was to assess the background prevalence of Aspergillus fumigatus SPT positivity in apparently healthy adults without known atopic disease in Uganda. Methods: For this pilot study, we recruited 50 healthy volunteers using convenience sampling, 56% of whom were health workers. We performed the SPT for A. fumigatus according to manufacturer’s instructions. A wheal diameter of ⩾3 mm was considered positive. Results: The prevalence of A. fumigatus skin positivity was 60% (30/50). Participants with a positive A. fumigatus SPT were significantly younger than those with a negative result [median age (years): 28 versus 35; p = 0.005]. Conclusion: There is a high skin positivity against A. fumigatus among non-atopic healthy Ugandan adults. There is an urgent need to establish a normal wheal cut-off value for this population. SPT alone may be an unreliable test for the diagnosis of A. fumigatus associated allergic syndromes. More studies are needed to define the prevalence of A. fumigatus skin positivity among non-atopic healthy population in Africa.
Bilateral tubal incarceration into the broad ligaments caused by pelvic endometriosis: A case report
Authors: Massimello Francesca , Giannini Andrea , Tebache Linda , Nisolle Michelle , Simoncini Tommaso 
Published: August 2021

Introduction: Endometriosis is characterised by the presence of functional endometrial tissue outside the uterus. Salpinges are a common location of endometriotic implants. Endometriosis located into the broad ligament is a rare event. Case description: A 38-year-old infertile woman presented to our attention with moderate left iliac fossa pain after menses and intermenstrual bleeding. Transvaginal ultrasounds and pelvic magnetic resonance evidenced the presence of bilateral haematosalpinges. At the laparoscopic pelvic exploration, fallopian tubes were absent. Opening and dissecting the apical portion of the broad ligaments, we identified bilateral haematosalpinges incarcerated in the homolateral broad ligaments. We performed bilateral salpingectomy. Histological examination confirmed the presence of endometriosis. Conclusion: Care must be taken to the diagnostic assessment, counselling about the surgical programme before the intervention especially in patients during the reproductive period when the possibility of ablative surgery and subsequent need for an assisted reproductive technique exists.
Medial and Lateral Posterior Tibial Slope Are Independent Risk Factors for Noncontact ACL Injury in Both Men and Women
Authors: Hohmann Erik , Tetsworth Kevin , Glatt Vaida , Ngcelwane Mthunzi , Keough Natalie 
Published: August 2021

Background: Higher posterior tibial slope (PTS) is a risk factor for anterior cruciate ligament (ACL) injury in men and women. The individual contribution of the lateral (LPTS) and medial (MPTS) slope has not yet been investigated. Purpose: To determine whether either the LPTS or the MPTS is an independent risk factor for ACL injury, and to determine sex-specific differences between patients with ACL-deficient and ACL-intact knees. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed knee magnetic resonance (MR) images performed on ACL-deficient and ACL-intact knees between January 2018 and June 2020 at a single institution. Inclusion criteria were isolated ACL injury and noncontact mechanism (ACL-deficient group) and nonspecific knee pain and no history of injury (ACL-intact group). Exclusion criteria for both groups were the following: previous knee surgery; meniscal, collateral ligament, posterior cruciate ligament, or multiligamentous injuries; radiological evidence of osteoarthritis; and chondral damage on the tibia. The MR images were used to establish the posterior bony slope at 25%, 50%, and 75% from the medial and/or lateral border of the tibial plateau with respect to the proximal tibial anatomic axis. One-way analysis of variance (ANOVA) was used to determine differences in PTS at the 25%, 50%, and 75% distances for the medial and lateral tibial plateau between the groups and between the sexes. Results: Overall, 325 images were included (mean age, 36.1 ± 11.1 years; 142 ACL-deficient images [82 men and 60 women]; 183 ACL-intact images [112 men and 71 women]). MPTS and LPTS were significantly higher at 25%, 50%, and 75% in the ACL-deficient group (range, –2.7° to –5.7°) compared with the ACL-intact group (range, –2.1° to 1.5°; P = .00001). Similarly, MPTS and LPTS were significantly different in men versus women ( P = .00001). ANOVA revealed that there were no significant differences in PTS between men and women for all measures (MPTS, LPTS, ACL-deficient, ACL-intact; P = .68). Conclusion: The study results demonstrated that higher MPTS and LPTS is a potential risk factor for ACL injury in both men and women. However, despite being highly statistically significant, the differences between groups and sexes were small and may not be clinically relevant.
Arthroscopic Management for Bipartite Patella: A Systematic Review
Authors: Loewen Allison , Ge Susan M. , Marwan Yousef , Burman Mark , Martineau Paul A. 
Published: August 2021

Background: Bipartite patella is a rare congenital condition that becomes painful following direct trauma or an overuse injury. If it remains painful despite nonoperative treatment, surgery may be warranted. The current gold standard is open fragment excision or lateral release; however, arthroscopic management is also possible. Purpose: To investigate the safety and efficacy of arthroscopic treatment of painful bipartite patella. Study Design: Systematic review; Level of evidence, 4. Methods: Using Medline and Embase, we systematically reviewed the literature as of March 8, 2020, using the subject headings “bipartite patella” and “arthroscopy” and related key terms. All levels of evidence involving human studies in English were included. Articles were excluded if only the abstract was published or the study was related to nonsurgical treatment or nonrelated diagnoses. Data related to journal/article information, demographic/clinical data, arthroscopic technique, length of follow-up, treatment outcomes, and complications were extracted. Results: Eleven articles with 43 patients were included in the review. Most patients (n = 34; 79%) underwent arthroscopic lateral release, while 16% (n = 7) had arthroscopic excision of the accessory fragment and 5% (n = 2) had arthroscopic excision and release. All patients except for one, who experienced postoperative trauma, were pain-free after arthroscopic treatment and were able to return to sports after a mean 2.6 months. Conclusion: This review demonstrated that arthroscopic management of painful bipartite patella is a safe and effective alternative to open surgical excision or release. However, all articles were case studies or small case series, owing to the rarity of the condition. In the future, higher-level studies comparing arthroscopic techniques and postoperative rehabilitation programs should be performed.
Improving VTE prophylaxis adherence among hospitalized adolescents using Human-Centered Design
Authors: Kim Soobin , Klugman Jessie , Norell Sarah , Kenefake Alexandra , Komos Laurel , Jain Divya , Corcoran Moire , Montero Carlos , Kreppel Andrew , Sales Jocelyn , Porto Isabel , Wang Jenny , Hsu Lewis L. , Erwin Kim 
Published: August 2021

Background/problem statement Venous thromboembolism (VTE) is the leading cause of preventable hospital mortality in the United States; however, compliance with VTE prophylaxis is poor. Most materials for education about VTE prophylaxis are oriented toward adults rather than adolescents, for whom VTE risks are lower and prophylaxis indications differ. We hypothesized that educational materials for adolescents could improve compliance with VTE prophylaxis, reduce nurse burden for initiating and maintaining VTE prevention practices, and reduce practice variation by standardizing the conversation between clinicians and patients. Methods A multidisciplinary team including physicians, nurses, quality experts, communication designers, service designers, and medical students applied a human-centered design (HCD) process to define, iteratively prototype, and test education tools for nurses assigned to adolescents. We piloted a suite of six educational tools for adolescent VTE prophylaxis to fit into the existing hospital workflow. Results An in-room poster was selected after 85% of nurses responded favorably to this intervention. Adolescent adherence with Intermittent Pneumatic Compression Device increased from 69% to 79%, attaining the benchmark goal of 78%. Staff reported greater confidence in educating adolescent patients after the intervention: 62% of nurses and 72% of residents. Conclusion An HCD process helped nurses improve VTE prophylaxis for adolescents with an in-room poster and messaging strategy. Engaging staff in the design increased receptivity and adoption. The piloted materials also helped to create an environment of shared priority among the clinicians.
Obesity, tidal volume, and pulmonary deposition of fine particulate matter in children with asthma
Authors: Afshar-Mohajer Nima , Wu Tianshi David , Shade Rebecca , Brigham Emily , Woo Han , Wood Megan , Koehl Rachelle , Koehler Kirsten , Kirkness Jason , Hansel Nadia N. , Ramchandran Gurumurthy , McCormack Meredith C. 
Published: August 2021

BackgroundObese children with asthma are more vulnerable to air pollution, especially fine particulate matter (PM2.5), but reasons are poorly understood. We hypothesised that differences in breathing patterns (tidal volume, respiratory rate and minute ventilation) due to elevated body mass index (BMI) may contribute to this finding.ObjectiveTo investigate the association of BMI with breathing patterns and deposition of inhaled PM2.5.MethodsBaseline data from a prospective study of children with asthma were analysed (n=174). Tidal breathing was measured by a pitot-tube flowmeter, from which tidal volume, respiratory rate and minute ventilation were obtained. The association of BMI z-score with breathing patterns was estimated in a multivariable model adjusted for age, height, race, sex and asthma severity. A particle dosimetry model simulated PM2.5lung deposition based on BMI-associated changes in breathing patterns.ResultsHigher BMI was associated with higher tidal volume (adjusted mean difference (aMD) between obese and normal-range BMI of 25 mL, 95% CI 5–45 mL) and minute ventilation (aMD 453 mL·min−1, 95% CI 123–784 mL·min−1). Higher tidal volumes caused higher fractional deposition of PM2.5in the lung, driven by greater alveolar deposition. This translated into obese participants having greater per-breath retention of inhaled PM2.5(aMD in alveolar deposition fraction of 3.4%, 95% CI 1.3–5.5%), leading to worse PM2.5deposition rates.ConclusionsObese children with asthma breathe at higher tidal volumes that may increase the efficiency of PM2.5deposition in the lung. This finding may partially explain why obese children with asthma exhibit greater sensitivity to air pollution.
Efficacy and safety of inhaled ENaC inhibitor BI 1265162 in patients with cystic fibrosis: BALANCE-CF 1, a randomised, phase II study
Authors: Goss Christopher H. , Fajac Isabelle , Jain Raksha , Seibold Wolfgang , Gupta Abhya , Hsu Ming-Chi , Sutharsan Sivagurunathan , Davies Jane C. , Mall Marcus A. 
Published: August 2021

BackgroundInhibition of the epithelial sodium channel (ENaC) in cystic fibrosis (CF) airways provides a mutation-agnostic approach that could improve mucociliary clearance in all CF patients. BI 1265162 is an ENaC inhibitor with demonstrated pre-clinical efficacy and safety already demonstrated in humans.ObjectiveWe present results from BALANCE-CFTM1, a phase II, placebo-controlled, randomised, double-blind study of four dose levels of BI 1265162versusplacebo for 4 weeks on top of standard of care in adults and adolescents with CF.ResultsInitially, 28 randomised subjects (BI 1265162 200 µg twice daily n=14, placebo twice daily n=14) were assessed at an interim futility analysis. Compared with placebo, numerical changes of –0.8% (95% CI –6.6 to 4.9%) in percentage predicted forced expiratory volume in 1s (ppFEV1) and +2.1 units (95% CI –2.4 to 6.5 units) in lung clearance index (LCI) were observed in the active group, meeting a pre-defined stopping rule; accordingly, the study was terminated. Recruitment had continued during the interim analysis and pending results; 24 patients were added across three dose levels and placebo. The final results including these patients (+1.5% ppFEV1, 200 µg twice-daily doseversusplacebo) were not supportive of relevant clinical effect. Furthermore, LCI change was not supportive, although interpretation was limited due to insufficient traces meeting quality criteria. A 9.4-point improvement in the Cystic Fibrosis Questionnaire – Revised Respiratory Domain was observed in the 200 µg twice daily dose groupversusplacebo. BI 1265162 up to 200 µg twice daily was safe and well-tolerated. Pharmacokinetics were similar to those in healthy volunteers.ConclusionBI 1265162 was safe, but did not demonstrate a potential for clinical benefit. Development has been terminated.
Asthma and COVID-19 risk: a systematic review and meta-analysis
Authors: Sunjaya Anthony P. , Allida Sabine M. , Di Tanna Gian Luca , Jenkins Christine R. 
Published: August 2021

BackgroundIndividual case series and cohort studies have reported conflicting results in people with asthma on the vulnerability to and risk of mortality from coronavirus disease 2019 (COVID-19).Research questionAre people with asthma at a higher risk of being infected or hospitalised or poorer clinical outcomes from COVID-19?MethodsA systematic review and meta-analysis based on five main databases including the World Health Organization COVID-19 database between 1 December 2019 and 11 July 2021 on studies with a control (non-asthma) group was conducted. Prevalence and risk ratios were pooled using Sidik–Jonkman random-effects meta-analyses.Findings51 studies with an 8.08% (95% CI 6.87–9.30%) pooled prevalence of people with asthma among COVID-19 positive cases. The risk ratios were 0.83 (95% CI 0.73–0.95, p=0.01) for acquiring COVID-19; 1.18 (95% CI 0.98–1.42, p=0.08) for hospitalisation; 1.21 (95% CI 0.97–1.51, p=0.09) for intensive care unit (ICU) admission; 1.06 (95% CI 0.82–1.36, p=0.65) for ventilator use; and 0.94 (95% CI 0.76–1.17, p=0.58) for mortality for people with asthma. Subgroup analyses by continent revealed a significant difference in risk of acquiring COVID-19, ICU admission, ventilator use and death between the continents.InterpretationThe risk of being infected with severe acute respiratory syndrome coronavirus 2 was reduced compared to the non-asthma group. No statistically significant differences in hospitalisation, ICU admission and ventilator use were found between groups. Subgroup analyses showed significant differences in outcomes from COVID-19 between America, Europe and Asia. Additional studies are required to confirm this risk profile, particularly in Africa and South America, where few studies originate.
An updated approach to determine minimal clinically important differences in idiopathic pulmonary fibrosis
Authors: Kang Mohleen , Veeraraghavan Srihari , Martin Greg S. , Kempker Jordan A. 
Published: August 2021

IntroductionCurrent medications for idiopathic pulmonary fibrosis (IPF) have not been shown to impact patient-reported outcome measures (PROMs), highlighting the need for accurate minimal clinically important difference (MCID) values. Recently published consensus standards for MCID studies support using anchor-based over distribution-based methods. The aim of this study was to estimate MCID values for worsening in IPF using only an anchor-based approach.MethodsWe conducted secondary analyses of three randomised controlled trials with different inclusion criteria and follow-up intervals. The health transition question in the 36-Item Short-Form Health Survey (SF-36) questionnaire was used as the anchor. We used receiver operating curves to assess responsiveness between the anchor and 10 variables (four physiological measures and six PROMs). We used an anchor-based method to determine the MCID values of variables that met the responsiveness criteria (area under the curve ≥0.70).Results6-min walk distance (6MWD), the St George's Respiratory Questionnaire (SGRQ), physical component score (PCS) of SF-36 and University of California, San Diego, Shortness of Breath Questionnaire (UCSD SOBQ) met the responsiveness criteria. The MCID value for 6MWD was −75 m; the MCID value for SF-36 PCS was −7 points; the MCID value for SGRQ was 11 points; and the MCID value for the UCSD SOBQ was 11 points.ConclusionsThe MCID estimates of 6MWD, SGRQ, SF-36 and UCSD SOBQ using only anchor-based methods were considerably higher compared to previously proposed values. A single MCID value may not be applicable across all classes of disease severity or durations of follow-up time.
Epidemiology and economic burden of bronchiectasis requiring hospitalisation in Singapore
Authors: Phua Hwee Pin , Lim Wei-Yen , Ganesan Ganga , Yoong Joanne , Tan Kelvin Bryan , Abisheganaden John Arputhan , Lim Albert Yick Hou 
Published: August 2021

Background and objectiveLittle is known about the epidemiology and cost of bronchiectasis in Asia. This study describes the disease burden of bronchiectasis in Singapore.MethodsA nationwide administrative dataset was used to identify hospitalisations with bronchiectasis as a diagnosis. Population statistics and medical encounter data were used to estimate the incidence, mortality, prevalence and direct medical costs associated with bronchiectasis requiring hospitalisation.ResultsThere were 420 incident hospitalised bronchiectasis patients in 2017, giving an incidence rate of 10.6 per 100 000. Age-standardised incidence declined on average by 2.7% per year between 2007 and 2017. Incidence rates increased strongly with age in both men and women. Tuberculosis was a secondary diagnosis in 37.5% of incident hospitalisations in 2007, but has declined sharply since then. Patient survival was considerably lower in both men (5-year relative survival ratios (RSR) 0.63, 95% CI 0.59–0.66) and women (5-year RSR 0.75, 95% CI 0.72–0.78). The point prevalence of bronchiectasis was 147.1 per 100 000 in 2017, and increased sharply with age, with >1% of people aged ≥75 years having bronchiectasis. Total first-year costs among incident bronchiectasis patients in 2016 varied widely, with a mean±sdUSD 7331±8863. Approximately 10% of the patients admitted in 2016 had total first-year costs of more than USD 14 380.ConclusionBronchiectasis is common and imposes a substantial burden on healthcare costs and survival rates of patients in Singapore.