bluuebunny/crossref_metadata_2025_split huggingface dataset:
In-hospital outcomes of autologous stem cell transplantation in patients with multiple myeloma with versus without heart failure.
Authors: Garcia Gustavo , Rosario Manuel , Vasquez Moises , Hameed Maha , Vargas Ian , Wiese-Rometsch Wilhelmine , Smith Robert , Nair Jayan 
Published: June 2024

e19511 Background: Autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM) is known to improve progression-free survival. However, the outcomes in patients with heart failure (HF) are uncertain. This study aims to compare hospital outcomes in patients with MM undergoing ASCT with and without HF. Methods: The National Inpatient Sample database was used to identify patients with MM undergoing ASCT during hospitalizations between 2016 and 2020. Under IRB exemption, data was extracted using ICD-10 codes. Data were stratified between patient with and without HF. A multivariate regression model was used to estimate the association of HF with ASCT in hospital outcomes, adjusting for statistically significant comorbidities. Results: A total of 30,375 hospitalizations with a diagnosis of MM undergoing ASCT were included, of which 1,535 had HF. On multivariant analysis compared to hospitalization without HF, those with HF had significantly higher risk of in-hospital mortality (adjusted odds ratio [aOR]: 2.20, 95% confidence interval [CI]: 1.49-3.24), graft-versus-host disease (GvHD) (aOR: 4.02, 95% [CI]: 2.48-6.52), transplant complications (aOR: 2.03, 95% [CI]: 1.62-2.56), sepsis (aOR: 2.279, 95% [CI]: 1.95- 2.65), septic shock (aOR: 3.49, 95% [CI]: 2.71-4.48), cardiogenic shock (aOR: 5.33, 95% [CI]: 2.61- 10.9), cardiac arrest (aOR: 3.78, 95% [CI]: 2.24- 6.35) and ventricular arrhythmia (aOR: 2.81, 95% [CI]: 2.08- 3.78). All p-values were <0.001. Additionally, patients with HF had a longer average length of stay (20.48 vs 16.38 days, p< 0.001) and a higher total cost of hospital stay ($245,831 vs $198,732, p<0.001) compared to those without HF. Conclusions: Our findings demonstrated that patients with multiple myeloma undergoing autologous stem cell transplantation, while also having coexisting heart failure (HF), experienced worse outcomes compared to patients without HF. These patients had a higher risk of transplant complications, GvHD, sepsis, septic shock, cardiogenic shock, cardiac arrest, ventricular arrhythmias and mortality. Additionally, these patients experienced a longer hospital stay with higher healthcare costs. Further interventions and research are warranted to improve outcomes in this group of patients.
Multiple myeloma in the African American population: A 2010-2020 NCDB analysis.
Authors: Neupane Niraj , Singh Harkarandeep , Budhathoki Pravash , Joshi Utsav , Shrestha Asis , Shikhrakar Shreeja , Parajuli Aakriti , Prasad Apurwa , Dhakal Binod 
Published: June 2024

e19531 Background: Multiple myeloma (MM) exhibits a disproportionately higher prevalence among African American individuals. Various factors contribute to the disease's progression, severity, and prognosis. This analysis presents real-world data from the National Cancer Database (NCDB) from 2010 to 2020. Methods: Cohort of 241,446 MM patients between 2010 and 2020 were analyzed. Demographic variations, including age, gender, insurance status, educational attainment, and median household income, were examined. Multivariate Cox regression analysis was conducted to identify factors influencing survival outcomes. Results: Within the database, from 2010 to 2020, 51,668 cases of multiple myeloma were recorded among Black individuals. The age group most affected was 40 to 65 years (50.2%), followed by those over 65 (47.3%), with 2.5% falling between 18 to 40 years, and a mean age of 64.4 years. Most cases affected females (51.5%), with most households earning less than $40,227 annually. A significant portion of Black patients did not receive a transplant (83.8%) or immune based option (73.1%). The mean duration from diagnosis to therapy initiation was 37.5 days. Multivariate analysis revealed that patients over 65 had a worse prognosis (HR = 1.52, 95% CI: 1.47 – 1.57, P < 0.001) compared to those under 65, while females exhibited a better prognosis (HR = 0.88, 95% CI: 0.86 – 0.91, P < 0.001). Patients with private insurance had better outcomes (HR = 0.73, 95% CI: 0.68 – 0.78, P < 0.001), as did those treated in academic centers (HR = 0.89, 95% CI: 0.87 – 0.92, P < 0.001). Additionally, patients receiving any form of transplant had better outcomes (HR = 0.45, 95% CI: 0.42 - 0.49, P < 0.001), along with those undergoing chemotherapy (HR = 0.73, 95% CI: 0.68 – 0.78, P < 0.001) and immunotherapy (HR = 0.67, 95% CI: 0.64 – 0.69, P < 0.001). Conclusions: The analysis highlights significant demographic and treatment influences among African American patients with MM. Some identifiable factors associated with improved outcomes include younger age, female gender, private insurance, treatment in academic centers, and most importantly receipt of transplant and Immunotherapy. These findings underscore the importance of targeted interventions considering various factors and improving outcomes in this population. [Table: see text]
Risk of Adverse Events in Anticoagulated Patients With Atrial Fibrillation and Nonalcoholic Fatty Liver Disease
Authors: Bucci Tommaso , Nabrdalik Katarzyna , Baratta Francesco , Pastori Daniele , Pignatelli Pasquale , Hydes Theresa , Alam Uazman , Violi Francesco , Lip Gregory Y H 
Published: June 2024

Abstract

Background
The clinical impact of nonalcoholic fatty liver disease (NAFLD) in patients with atrial fibrillation (AF) is still controversial.

Aim
To evaluate the 1-year risk of all-cause death, thromboembolic events, and bleeding in patients with AF-NAFLD.

Methods
Retrospective study with a health research network (TriNetX). Patients with AF on oral anticoagulation (OAC) were categorized according to the presence of NAFLD into 2 groups. The primary outcomes were the 1-year risks of (1) a composite cardiovascular outcome (all-cause death, myocardial infarction, stroke, cardiac arrest, and pulmonary embolism) and (2) a composite hemorrhagic outcome (intracranial hemorrhage and gastrointestinal bleeding). Cox regression analysis before and after propensity score matching was used to estimate hazard ratio (HR) and 95% 95% CI,. Sensitivity analyses investigated the risk associated with cirrhosis, thrombocytopenia, and type of OAC (warfarin vs non-vitamin K antagonist oral anticoagulants (NOACs).

Results
We identified 22 636 patients with AF-NAFLD (69 ± 12 years, 46.7% females) and 391 014 patients with AF and without liver disease (72 ± 12 years, 42.7% females). NAFLD was associated with a higher risk of composite cardiovascular (HR, 1.54; 95% CI, 1.47-1.61) and hemorrhagic (HR, 1.56; 95% CI, 1.42-1.72) outcomes. This was consistent also for all the single outcomes. Cirrhotic and thrombocytopenic patients with AF-NAFLD showed the highest risks. Compared to patients with AF-NAFLD on NOACs, those on warfarin were associated with a higher risk of cardiovascular and hemorrhagic outcomes.

Conclusion
In patients with AF, NAFLD is associated with a higher 1-year risk of adverse events, with the risk of adverse events progressively increasing from noncirrhotic to cirrhotic and from nonthrombocytopenic to thrombocytopenic patients. NOACs were associated with a better effectiveness and safety profile compared to warfarin.
Cerebrospinal Fluid Neutrophil Gelatinase-Associated Lipocalin as a Novel Biomarker for Postneurosurgical Bacterial Meningitis: A Prospective Observational Cohort Study
Authors: Lin Qingwen , Huang Er , Fan Kengna , Zhang Zeqin , Shangguan Huangcheng , Zhang Weiqing , Fang Wenhua , Ou Qishui , Liu Xiaofeng 
Published: June 2024

BACKGROUND AND OBJECTIVES:
Postneurosurgical bacterial meningitis (PNBM) was a significant clinical challenge, as early identification remains difficult. This study aimed to explore the potential of neutrophil gelatinase-associated lipocalin (NGAL) as a novel biomarker for the early diagnosis of PNBM in patients who have undergone neurosurgery.

METHODS:
A total of 436 postneurosurgical adult patients were enrolled in this study. Clinical information, cerebrospinal fluid (CSF), and blood samples were collected. After the screening, the remaining 267 patients were divided into the PNBM and non-PNBM groups, and measured CSF and serum NGAL levels to determine the diagnostic utility of PNBM. Subsequently, patients with PNBM were categorized into gram-positive and gram-negative bacterial infection groups to assess the effectiveness of CSF NGAL in differentiating between these types of infections. We analyzed the changes in CSF NGAL expression before and after anti-infection treatment in PNBM. Finally, an additional 60 patients were included as an independent validation cohort to further validate the diagnostic performance of CSF NGAL.

RESULTS:
Compared with the non-PNBM group, CSF NGAL was significantly higher in the PNBM group (305.1 [151.6-596.5] vs 58.5 [30.7-105.8] ng/mL; P < .0001). The area under the curve of CSF NGAL for diagnosing PNBM was 0.928 (95% CI: 0.897-0.960), at a threshold of 119.7 ng/mL. However, there was no significant difference in serum NGAL between the 2 groups (142.5 [105.0-248.6] vs 161.9 [126.6-246.6] ng/mL, P = .201). Furthermore, CSF NGAL levels were significantly higher in patients with gram-negative bacterial infections than those with gram-positive bacteria (P = .023). In addition, CSF NGAL levels decrease after treatment compared with the initial stage of infection (P < .0001). Finally, in this validation cohort, the threshold of 119.7 ng/mL CSF NGAL shows good diagnostic performance with a sensitivity and specificity of 90% and 80%, respectively.

CONCLUSION:
CSF NGAL holds promise as a potential biomarker for the diagnosis, early drug selection, and efficacy monitoring of PNBM.
Mood, Cognitive Function, and Plasma Kynurenine Metabolites Responses Following Severe Changes in Physical Activity
Authors: KAMANDULIS SIGITAS , LUKONAITIENE INGA , SNIECKUS AUDRIUS , BRAZAITIS MARIUS , MICKEVICIUS MANTAS , CERNYCH MARGARITA , RUAS JORGE , SCHWIELER LILLY , LOUVROU VARVARA , ERHARDT SOPHIE , WESTERBLAD HAKAN , VENCKUNAS TOMAS 
Published: June 2024

ABSTRACT

Purpose
To monitor changes in mood, cognitive function, brain electrical activity, and circulating kynurenine pathway metabolites in response to a 3-wk severe physical activity (PA) restriction, followed by 3 wk of resumed activity adding resistance and high-intensity interval exercise training.

Methods
Twenty healthy participants (14 males, 6 females; 25.4 ± 5.2 yr) underwent 3 wk of limited PA using forearm crutches with one leg suspended (INACT) and then 3 wk of resumed activity plus supervised resistance and high-intensity interval training sessions (ACT, three to six sessions per week). At baseline, after INACT, and then after ACT, venous blood was sampled for analysis of major kynurenine pathway metabolites, a short version of the International Physical Activity Questionnaire, Hospital Anxiety and Depression Scale (HADS) and Profile of Mood States (POMS) questionnaires were completed, and cognitive tests with electroencephalography were performed.

Results
During INACT, the depression score on the HADS scale tended to increase (3.5 to 6.8; P = 0.065), whereas it was reduced with ACT compared with after INACT (2.8; P = 0.022). On the POMS scale, depression, fatigue, and confusion increased within INACT (P < 0.05). Notably, subjects exhibited considerable variability, and those experiencing depression symptoms recorded by the HADS scale (n = 4) displayed distinct mood disturbances on POMS. All HADS and POMS scores were fully restored to baseline with ACT. Neither INACT nor ACT induced significant changes in cognition, brain electrical activity, or kynurenine pathway metabolites (P > 0.05).

Conclusions
Although young healthy individuals with 3 wk of severely restricted PA do not undergo changes in circulating kynurenine pathway metabolites, cognitive performance, and brain electrical activity, their mood response is quite variable, and depression develops in some. Three weeks of resuming mobility plus exercise training reversed the mood profile.
Predicting Musculoskeletal Loading at Common Running Injury Locations Using Machine Learning and Instrumented Insoles
Authors: VAN HOOREN BAS , VAN RENGS LARS , MEIJER KENNETH 
Published: June 2024

ABSTRACT

Introduction
Wearables have the potential to provide accurate estimates of tissue loads at common running injury locations. Here we investigate the accuracy by which commercially available instrumented insoles (ARION; ATO-GEAR, Eindhoven, The Netherlands) can predict musculoskeletal loading at common running injury locations.

Methods
Nineteen runners (10 males) ran at five different speeds, four slopes, with different step frequencies, and forward trunk lean on an instrumented treadmill while wearing instrumented insoles. The insole data were used as input to an artificial neural network that was trained to predict the Achilles tendon strain, and tibia and patellofemoral stress impulses and weighted impulses (damage proxy) as determined with musculoskeletal modeling. Accuracy was investigated using leave-one-out cross-validation and correlations. The effect of different input metrics was also assessed.

Results
The neural network predicted tissue loading with overall relative percentage errors of 1.95 ± 8.40%, −7.37 ± 6.41%, and −12.8 ± 9.44% for the patellofemoral joint, tibia, and Achilles tendon impulse, respectively. The accuracy significantly changed with altered running speed, slope, or step frequency. Mean (95% confidence interval) within-individual correlations between modeled and predicted impulses across conditions were generally nearly perfect, being 0.92 (0.89 to 0.94), 0.95 (0.93 to 0.96), and 0.95 (0.94 to 0.96) for the patellofemoral, tibial, and Achilles tendon stress/strain impulses, respectively.

Conclusions
This study shows that commercially available instrumented insoles can predict loading at common running injury locations with variable absolute but (very) high relative accuracy. The absolute error was lower than the methods that measure only the step count or assume a constant load per speed or slope. This developed model may allow for quantification of in-field tissue loading and real-time tissue loading-based feedback to reduce injury risk.
Durability of Running Economy: Differences between Quantification Methods and Performance Status in Male Runners
Authors: ZANINI MICHELE , FOLLAND JONATHAN P. , BLAGROVE RICHARD C. 
Published: June 2024

ABSTRACT

Introduction
Running economy (RE) deteriorates during prolonged running, although the effect of measuring energy cost (EC) or oxygen cost (OC) on the magnitude of these changes has not been investigated. Similarly, it is unknown if runners’ performance level may influence the deterioration of RE during prolonged running. The aims of this study were to compare changes in EC and OC measurements of RE during a prolonged run in a large cohort of well-trained male runners, and to compare changes between runners of high- and low-performance standard.

Methods
Forty-four male runners (maximal oxygen uptake (V̇O2max) 62.4 mL·kg−1·min−1; 10-km time: 35:50 ± 4:40 mm:ss) completed an incremental test determining lactate threshold 1 (LT1) and V̇O2max, and on a separate occasion, a 90-min run at LT1. Respiratory gases were collected at 15-min intervals. Subsequently, subgroups of high- (HP; 10-km time: 31:20 ± 01:00 mm:ss) and low-performing (LP; 10-km time: 41:50 ± 01:20 mm:ss) runners were compared.

Results
RE deterioration was only fractionally larger when expressed as OC than EC (0.1% greater from 30–90 min; P < 0.001), perhaps due to the small change in respiratory exchange ratio (−0.01) in this study. For the HP group, increases were lower than LP after 90 min in both EC (+2.3% vs +4.3%; P < 0.01) and OC (+2.4% vs +4.5%; P < 0.01). Similarly, at standardized distances, changes were lower for HP versus LP, for example, at 16.7 km + 1.0 versus +3.2% for EC (P < 0.01), and +1.2 vs +3.4% for OC (P < 0.001).

Conclusions
The deterioration of RE was dependent on athlete’s performance level, with HP runners displaying superior RE durability. The use of EC or OC had only a fractional influence on RE durability, although this may gain importance with larger shifts in substrate metabolism.
Procuring Unverifiable Information
Authors: Sharma Salil , Tsakas Elias , Voorneveld Mark 
Published: June 2024

We study settings where information in the form of Bayesian signals is acquired by an expert on behalf of a principal. Information acquisition is costly for the expert and crucially not verifiable by the principal. The expert is compensated by the principal with a menu of state-contingent payments. We provide a full characterization of the set of all menus that implement (respectively, strictly implement) each signal. Moreover, we provide a closed-form characterization for the expected cost for the cheapest such menu, which we call proxy cost of the signal. Surprisingly, in general, the proxy cost is neither increasing in the Blackwell order nor posterior separable, even when the expert’s cost function is posterior separable itself. Subsequently, we study the full-agency problem (by introducing a downstream decision), thus endogenizing the signal. We show that there is always an optimal signal that can be strictly implemented, meaning that it is without loss of generality to exogenously restrict attention to strict implementation. As a result, similarly to Bayesian persuasion, the complexity of the principal’s optimal signal is bounded by the cardinality of the state space. Finally, we present some applications of interest. Funding: Financial support by the Wallander-Hedelius Foundation [Grants P2016-0072:1 and P20-0035 (to S. Sharma and M. Voorneveld)] is gratefully acknowledged.
Dual Value of Delayed Incentives: An Empirical Investigation of Gift Card Promotions
Authors: Kadiyala Bharadwaj , Özer Özalp , Şimşek A. Serdar 
Published: June 2024

Problem definition: Gift card promotions offer a tiered incentive (a gift card) to customers for purchasing regularly-priced products, with higher expenditure receiving a larger incentive. We empirically investigate the impact of gift card promotions on customer purchase behavior by collaborating with a major U.S.-based department store that targets gift card promotion emails on its online channel. Methodology/results: We use a collection of discontinuities in the retailer’s targeting policies and corresponding fuzzy regression discontinuity designs to estimate localized causal effects of the gift card promotion. We find that gift card promotion provided to customers whose most recent purchase was 4 and 13 months ago, respectively, increased their purchase probability by 11.24% and 26.64%, and their average expenditure by 9.53% and 1.9%, respectively. Overall, the gift card promotion generated, on average, $100K in incremental sales per promotion from these customers alone. Furthermore, the promotion induced customers to seek out products from niche categories and increased spending on high-end brands. Gift card promotion emails also had a dominant advertisement effect, that is, customers who received the gift card promotion email increased expenditure even if they did not participate in the promotion. Managerial implications: (i) Gift card promotions are a viable strategy to boost short-term sales and to alter the distribution of the types (brand, category) of purchased products. (ii) Retailers should optimize gift card promotion tiers based on the tradeoff between increased customer expenditure and promotion expenses and consider the advertisement effect when targeting the promotion emails. (iii) Contrary to popular belief, retailers benefit from customers’ redeeming gift cards because they spend more due to the gift card, validating the dual value of the delayed incentive. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0218 .
LATERAL COLUMN MIDFOOT INJURY: DO THEY ALL NEED FIXATION?
Authors: Airey G. , Aamir J. , Chapman J. , Tanaka H. , Elbannan M. , Singh A. , Mangwani J. , Kyaw H. , Jeyaseelan L. , Mason L. 
Published: June 2024

BackgroundResearch on midfoot injuries have primarily concentrated on the central column and the Lisfranc ligament without amassing evidence on lateral column injuries. Lateral column injuries have historically been treated with Kirschner wire fixation when encountered.ObjectiveOur aim in this study was to analyse lateral column injuries to the midfoot, their method of treatment and the radiological lateral column outcomes. Our nul hypothesis being that fixation is required to obtain and maintain lateral column alignment.MethodsData was retrospectively collected from four centres on surgically treated midfoot fracture dislocations between 2011 and 2021. Radiographs were analysed using departmental PACS. All statistics was performed using SPSS 26.ResultsA total of 235 cases were diagnosed as having a lateral column injury out of the 409 cases included. On cross tabulation, there was a significant association with having a central column injury (234/235, p<.001) and 70% of cases (166/235) also had an additional medial column injury. Of the 235 lateral column injuries, data was available regarding fixation radiographic alignment on 222 cases. There were 44 cases which underwent Kirschner wire fixation, 23 plate fixations and 3 screw fixations. Lateral column alignment loss was seen in 2.84% (4/141) of those which didn't undergo fixation, 13.64% (6/44) which underwent K wires, and 0 % in those fixed by screws or K wires.ConclusionLateral column injury occurs in over half of midfoot fractures in this study. It rarely occurs alone and is most commonly related to three column injuries. Nevertheless, following stabilisation of the central column, additional fixation of injuries to the lateral column do not appear beneficial. The use of a bridge plate to fix the central column appears protective and purely ligamentous injury was a higher risk than an injury that included the bone.
THE TEN-YEAR PATIENT-REPORTED AND CLINICAL OUTCOMES OF A SERIES OF 156 MOBILE-BEARING TOTAL ANKLE ARTHROPLASTIES AND THE EFFECTS OF PATIENT AGE
Authors: Porter A. , Nicolas A. Pujol , Hakeem S. , Abdul N. , Elamin D. , Douglas-Harris M. , Ramaskandhan J. , Siddique M. 
Published: June 2024

BackgroundTotal Ankle Replacement (TAR) is an established treatment option for end-stage ankle arthritis. We analysed at minimum, 10-year patient-reported and clinical outcomes of 156 TARs from a single centre. We specifically compared outcomes between patients under 60 and over 60 at time of surgery.MethodsData was collected retrospectively from our departmental patient database. It included all patients who underwent a TAR by a single surgeon between 2006 and 2010 and patients were divided into those under 60 and those over 60 at the time of surgery. Patient reported outcomes (PROMs), including WOMAC, SF-36 and patient satisfaction scores and complications were analysed preoperatively and at one, two, five and over 10 years postoperatively.ResultsThere were 156 patients included in this analysis, 61 were under 60 (mean age 50.29) and 95 were over 60 (mean age 69.12). A total of 12 patients had revision surgery, (nine in the under 60 group) and 52 patients were deceased at the time of analysis (10 in the under 60 group). At one year the over 60 group had less pain and better functional scores (p=0.02, p=0.017). At two, five and ten years there was no statistical difference in pain and function between groups. At two years the over 60s reported less stiffness and quicker return to activities of daily living (p=0.007, p=0.001). However, at five and 10 years there was no statistical difference in any domain.ConclusionsThis study demonstrates that age does not correlate with a significant difference in pain or functional outcomes in patients who have TAR, at over 10 years follow up. The higher revision rates in the younger group may correlate with higher functional demand and lower mortality rate.