bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rituximab retention rate in systemic sclerosis: a long term real-life multicentre study
Authors: De Luca Giacomo , De Lorenzis Enrico , Campochiaro Corrado , Cacciapaglia Fabio , Del Papa Nicoletta , Zanatta Elisabetta , Airò Paolo , Lazzaroni Maria Grazia , Giuggioli Dilia , De Santis Maria , Alonzi Gabriella , Stano Stefano , Binda Marco , Moccaldi Beatrice , Tonutti Antonio , Cavalli Silvia , Batani Veronica , Natalello Gerlando , Iannone Florenzo , D’Agostino Maria Antonietta , Dagna Lorenzo , Matucci-Cerinic Marco , Bosello Silvia Laura 
Published: May 2024

Abstract

Objectives
To report real-life data on rituximab retention rate as an indicator of safety and efficacy in a multicentric national cohort of systemic sclerosis patients.

Methods
SSc patients treated with rituximab and followed for at least 36 months were included, clinically characterized and longitudinally monitored. A competing risk analysis with sub-hazard ratio (sHR) definition was performed to explore the clinical variables linked to specific cause of rituximab discontinuation.

Results
One-hundred and fifty-two SSc-patients [mean age 47.3 (12.3) years; females 79.6%; diffuse disease 77.6%; anti-topoisomerase-I positivity 63.2%] were evaluated over a median (interquartile range) time of 3.3 (1.7–5.0) years. The primary indications for rituximab were interstitial lung disease (38.8%), worsening skin fibrosis (36.8%) and arthritis (13.8%); 138 patients (90.8%) received more than one rituximab course. The 5-year rituximab retention rate was 59.9% (44.6–64.7%). Clinical response was the most common reason for rituximab discontinuation [5.7; 95% CI: (3.7–8.4) per 100 patient-years] and was associated with a shorter disease duration (sHR 0.8; 95% CI: 0.7, 0.9), anti-topoisomerase-I negativity (sHR 0.4; 95% CI: 0.2, 0.9), previous digital ulcers (sHR 2.6; 95% CI: 1.1, 6.2) and no history of arthritis (sHR 0.3; 95% CI: 0.1, 0.8). Treatment failure was the second cause of rituximab discontinuation [3.7 (95% CI: 2.2, 6.0) per 100 patient-years] and was associated with anti-centromere antibody positivity (sHR 2.8; 95% CI: 1.1, 7.4) and anti-topoisomerase-I negativity (sHR 0.2; 95% CI: 0.1, 0.6). Adverse events (AEs) were the less common cause of discontinuation [3.1 (95% CI: 1.7, 5.2) per 100 patient-years], associated with limited cutaneous subset (sHR 3.4; 95% CI: 1.2, 9.7) and previous mycophenolate mofetil treatment (sHR 4.5; 95% CI: 1.2, 16.3).

Conclusion
Rituximab is a safe and effective treatment in SSc: clinical response emerged as the primary reason for rituximab discontinuation, and AEs had a limited impact on treatment persistence. The identification of specific disease features associated with a response to rituximab will be useful in the management of SSc-patients.
Brains, Breeding, and Knowingness: The Politics of Meritocracy in Mid-Twentieth-Century Britain
Authors: Hill Alex 
Published: May 2024

Abstract
This article re-studies fifty-seven interviews with working-class voters conducted between 1958 and 1960 for Robert McKenzie and Allan Silver’s Angels in Marble: Working Class Conservatives in Urban England (1968). It uses these interview transcripts as a window into aspects of the mid-twentieth-century vernacular, specifically vernacular understandings of the social order. It argues that a powerful meritocratic ideology runs through the interviewees’ responses, articulated through the concept of ‘brains’. This discourse revered academic and professionalized forms of knowledge, arguing that they should form the currency of social mobility and the criterion of good political leadership. Hierarchies premised on class, race, and gender could be reinforced if they were perceived to reward those with ‘brains’ and criticized if they did not. However, this vernacular ideology was circumscribed by two other vernacular concepts: ‘breeding’ and ‘knowingness’. ‘Breeding’ celebrated the knowledge that came from elite experiences associated with family and upbringing. ‘Knowingness’ celebrated the knowledge that came from the experience of working-class life. These two concepts set a limit on the appeal of a vernacular meritocracy that based itself around ‘brains’.
Ferrostatin-1 mitigates cellular damage in a ferroptosis-like environment in Caenorhabditis elegans
Authors: Ferreyra Melisa R , Romero Verónica L , Fernandez-Hubeid Lucia E , Gonzales-Moreno Candelaria , Aschner Michael , Virgolini Miriam B 
Published: May 2024

Abstract
Although iron (Fe) is the most biologically abundant transition metal, it is highly toxic when it accumulates as Fe2+, forming a labile Fe pool and favoring the Fenton reaction. This oxidative scenario leads to a type of caspase-independent programmed cell death, referred to as ferroptosis, where following processes take place: (i) Fe2+ overload, (ii) glutathione peroxidase 4 inactivation, (iii) lipid peroxidation, and (iv) glutathione depletion. The present study sought to evaluate the consequences of Fe2+ administration on ferroptosis induction in Caenorhabditis elegans. We demonstrated higher mortality, increased lipid peroxidation, reduced glutathione peroxidase activity, and morphological damage in dopaminergic neurons upon Fe2+ overload. Pharmacological intervention at the level of lipid peroxidation with ferrostatin-1 (250 μM) mitigated the damage and returned the biochemical parameters to basal levels, revealing the potential of this therapeutical approach. Finally, to assess the relationship between ferroptosis and dopamine in a Parkinsonian background, we evaluated the UA44 worm strain which overexpresses the alpha-synuclein protein in cherry-labeled dopaminergic neurons. We demonstrated that Fe2+ administration reduced lethality associated with similar alterations in biochemical and dopaminergic morphological parameters in wild-type animals. These experiments provide mechanistic-based evidence on the efficacy of a pharmacological approach to mitigate the physiological, biochemical, and morphological consequences of Fe2+ overload. At the same time, they encourage further research on the impact of the combined effects resulting from the genetic background and dopamine signaling in a Parkinsonian phenotype.
Preoperative N-terminal Pro–B-type Natriuretic Peptide and High-sensitivity Cardiac Troponin T and Outcomes after Major Noncardiac Surgery: A Prospective Cohort Study
Authors: Zhao Bing-Cheng , Lei Shao-Hui , Zhuang Pei-Pei , Yang Xiao , Feng Wei-Jie , Qiu Shi-Da , Yang Huan , Liu Ke-Xuan ,   for the PREVENGE-CB Collaborators
Published: May 2024

Background
Patients undergoing noncardiac surgery have varying risk of cardiovascular complications. This study evaluated preoperative N-terminal pro–B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T to enhance cardiovascular events prediction for major noncardiac surgery.

Methods
This prospective cohort study included adult patients with cardiovascular disease or risk factors undergoing elective major noncardiac surgery at four hospitals in China. Blood samples were collected within 30 days before surgery for NT-proBNP and high-sensitivity troponin T (hs-TnT) measurements. The primary outcome was a composite of any cardiovascular events within 30 days after surgery. Logistic regression models were used to assess associations, and the predictive performance was evaluated primarily using area under the receiver operating characteristics curve (AUC) and fraction of new predictive information.

Results
Between June 2019 and September 2021, a total of 2,833 patients were included, with 435 (15.4%) experiencing the primary outcome. In the logistic regression model that included clinical variables and both biomarkers, the odds ratio for the primary outcome was 1.68 (95% CI, 1.37 to 2.07) when comparing the 75th percentile to the 25th percentile of NT-proBNP distribution, and 1.91 (95% CI, 1.50 to 2.43) for hs-TnT. Each biomarker enhanced model discrimination beyond clinical predictors, with a change in AUC of 0.028 for NT-proBNP and 0.029 for high-sensitivity cardiac troponin T, and a fraction of new information of 0.164 and 0.149, respectively. The model combining both biomarkers demonstrated the best discrimination, with a change in AUC of 0.042 and a fraction of new information of 0.219.

Conclusions
Preoperative NT-proBNP and hs-TnT both improved the prediction for cardiovascular events after noncardiac surgery in addition to clinical evaluation, with their combination providing maximal predictive information.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Removals and Revisions of Cervical Total Disc Replacement Devices in a Consecutive Series of 1626 Patients Beginning With the First Case Experience in 2003
Authors: Blumenthal Scott L. , Griffin Cody , Courtois Emily C. , Guyer Richard D. , Zigler Jack E. , Shellock Jessica L. , Ohnmeiss Donna D. 
Published: May 2024

Study Design.Retrospective cohort study.Objective.The purpose of this study was to investigate the rate of cervical total disc replacement (TDR) device removal or revision.Background.Cervical TDR has gained acceptance as an alternative to anterior cervical discectomy and fusion in appropriately selected patients. There have been concerns over device safety, one measure of which is subsequent surgery related to device problems.Patients and Methods.A consecutive series of 1626 patients undergoing cervical TDR from 2003 to June 2021 were included, consisting of TDRs up to 3 levels and hybrids (TDR and fusion). TDR removal or revision surgeries and reasons for these surgeries, procedures performed, and duration from index procedure were recorded. Data were analyzed to determine the removal/revision rate and factors possibly related to these events.Results.There were 24 removals/revisions (1.48%) in the 1626 patients. Removal was performed in 23 cases (1.41%) and revision in 1 (0.06%). Among removal cases, anterior cervical discectomy and fusion was performed in 18 and TDR was replaced with another TDR in 5. Removals with fusion included 5 cases of osteolysis with/withoutCutibacterium acnes, 4 device displacement/migration, 4 posterior spinal pathology, and one for each of the following: metal allergy, approach-related complications, malpositioning, subsidence, and hypermobility. The revision involved TDR repositioning 3 days after index surgery. There were 66 patients for whom a minimum of 10-year follow-up was confirmed, and none had removal/revision surgery 10 or more years after index surgery. There was no relationship between the occurrence of removal/revision and age, sex, body mass index, or physician experience (learning curve). The removal/revision rate was significantly higher in FDA trialsversuspostapproval (4.1%vs. 1.3%,P< 0.05).Conclusion.In this large consecutive series of patients, 1.48% of cervical TDRs were removed/revised. The low rate of removals/revisions over a long period of time provides support for the devices’ safety.Level of Evidence.Level IV.
Negative Pressure Wound Therapy versus Conventional Dressing in Lower Limb Fractures: Systematic Review and Meta-analysis
Authors: Alves André S. , Martineau Jérôme , Scampa Matteo , Kalbermatten Daniel F. , Oranges Carlo M. 
Published: May 2024

Summary:
Gustilo 3 lower limb fractures represent a significant challenge because of high complication risk. Two management strategies are commonly used for wound coverage until final closure: negative pressure wound therapy (NPWT) and conventional wound dressing (CWD), also described as standard wound coverage without subatmospheric pressure. Understanding their relative effectiveness is essential to improve patient outcomes. The aim of this systematic review and meta-analysis was to compare the efficacy of NPWT and CWD in Gustilo 3 lower limb fracture management, with a focus on overall rates, superficial infection, and deep infection rates. A systematic review of medical research databases was conducted in accordance with PRISMA guidelines. Studies comparing NPWT with CWD for Gustilo 3 fractures were included. Data extraction and quality assessment were performed. Treatment with CWD was associated with significantly higher rates of overall infection [pooled risk ratio (RR): 0.33; 95% confidence interval (CI): 0.14–0.51] and pooled risk difference (RD: 0.27; 95% CI: 0.15–0.38), superficial infection (pooled RR: 0.35; 95% CI: 0.04–0.66), and deep infection (pooled RR: 0.20; 95% CI: 0.02–0.38) compared with NPWT treatment. Overall infection rate remained significantly higher in the CWD group after analyzing only open tibia fractures (pooled RR: 0.35; 95% CI: 0.21–0.48). Nonunion rate was significant higher in the CWD group (pooled RR: 0.30; 95% CI: 0.00–0.59). Flap failure rate was similar in both groups (pooled RR: 0.09; 95% CI: −0.05 to 0.23). NPWT appears to be a reasonable option for wound management in Gustilo 3 lower limb fractures in terms of infection rates.
Dextran-40 Reduces Partial Flap Failure: A Systematic Review and Meta-analysis for Antithrombotics after Free Flaps
Authors: Lin Yi-En , Chen Mei-Chun 
Published: May 2024

Background:
Antithrombotic agents are used after free-flap surgery to prevent thrombus formation and improve flap outcomes. However, the reports vary. Therefore, this meta-analysis aimed to elucidate the need for antithrombotic agents in this context.

Methods:
We searched for studies that compared the outcomes of patients undergoing free-flap surgery with or without postoperative antithrombotic agents in the PubMed, Cochrane, and ClinicalTrials.gov databases. The primary outcome was total flap failure, with secondary outcomes including partial flap failure, pedicle thrombosis, and bleeding/hematoma. The relative risks (RRs) of outcomes with or without antithrombotic use were evaluated.

Results:
Fifteen studies (n = 6755 cases) were included. Antithrombotic agents did not reduce flap failure or pedicle thrombosis risks but increased bleeding and hematoma risks (RR, 1.535). Subgroup analyses by antiplatelet and anticoagulant use demonstrated results similar to those of antithrombotic use. The RR of bleeding/hematoma was 1.761 and 2.740 in the antiplatelet and anticoagulant groups, respectively. Postoperative dextran-40 administration reduced the risk of partial flap failure, with an RR of 0.535.

Conclusions:
Postoperative antithrombotic, antiplatelet, or anticoagulant use did not change the risk of total/partial flap failure or pedicle thrombosis but increased the risk of hematoma/bleeding. Postoperative use of dextran-40 reduced the risk of partial flap failure. Increased intraflap blood flow may decrease the risk of partial flap failure. However, dextran-40 may cause severe pulmonary distress. Further prospective studies are required to evaluate the effects of these agents on thrombus formation, intraflap blood flow, and partial flap failure risk.
Free Flaps in Patients with Advanced Arteriosclerosis of the Tibial Vessels: Mini Vein Graft to the Peroneal Artery
Authors: Haumer Alexander , Speck Nicole E. , Kurlander David E. , Wolff Thomas , Mujagic Edin , Lunger Alexander , Haug Martin D. , Schaefer Dirk J. , Ismail Tarek 
Published: May 2024

Summary:
Lower extremity reconstruction with free flaps in patients with only peroneal artery runoff remains a challenge. Here, we present a novel technique for reconstruction of medial defects in the distal leg using a medial approach to the peroneal artery and a short interposition vein graft anastomosed end to side to the peroneal artery. A retrospective, single-center study was performed including all patients who underwent lower extremity reconstruction with free flaps anastomosed to the peroneal artery using a mini vein graft from November 2020 to March 2022. The primary outcome measure was limb salvage. Secondary endpoints were flap survival and postoperative complications. Seven patients received lower extremity free flap reconstruction with a mini vein graft to the peroneal artery. Flap loss rate was 0%. Limb salvage was achieved in five patients (71%). At 6-month follow-up, all patients were ambulatory. One patient died 1 month after surgery due to heart failure. Mini vein graft to the peroneal artery allows reliable and safe free flap reconstruction of distal leg defects in patients with only peroneal artery runoff.
Characteristics of Patients with Clinical Signs and Symptoms of Carpal Tunnel Syndrome but Negative Diagnostic Testing
Authors: Latario Luke D. , Fowler John R. 
Published: May 2024

Background:
Carpal tunnel syndrome (CTS) is a clinical diagnosis involving numerous confirmatory diagnostic tools, including patient questionnaires, ultrasound (US), and electrodiagnostic studies (EDX.) Patients may experience clinical symptoms of CTS with false negative diagnostic testing. The purpose of this study was to identify characteristics of patients with clinical symptoms of CTS with negative diagnostic testing.

Methods:
An existing database of 295 hands containing the six-item CTS-6, US of the median nerve, and EDX was queried. Patients with symptoms of carpal tunnel scoring 12.5 or higher on CTS-6 were sorted into those with all positive testing or negative testing.

Results:
In 60 patients, 103 hands had both positive US and EDX and a CTS-6 of 12.5 or higher. Twenty-nine hands in 25 patients had a CTS-6 of 12.5 or higher and both negative ultrasound and EDX. There was a significantly younger average age of 43 (P = 0.007) and lower average BMI of 28 (P < 0.0001) of patients in the negative diagnostic study group, compared with the average age of 53, and a body mass index (BMI) of 34 in the positive diagnostic study.

Conclusions:
In this series, patients with symptoms of carpal tunnel syndrome and negative diagnostic studies were on average younger and had a lower BMI. These patients may warrant more careful consideration of CTS clinical diagnosis and counseling regarding a higher risk of false-negative confirmatory testing. Further studies are needed to determine possible effects of age and BMI on electrodiagnostic studies and ultrasound testing in CTS.
A Qualitative Narrative Study of Rescue and Recovery Workers Responding to the Terrorist Bombing of Oklahoma City’s Murrah Building
Authors: Pollio E. Whitney , Wang Jennifer , Randle Edward , Pollio David E. , North Carol S. 
Published: May 2024

Objective
Much of disaster mental health research uses quantitative methods, focusing on numerical prevalence, services, and outcomes.

Methods
Qualitative methods can provide more detailed, rich, and spontaneous insights into personal disaster experiences, yielding important insights beyond deductive methods. This large-scale qualitative narrative study examined experiences of 181 Oklahoma City bombing rescue/recovery workers.

Results
Thematic narrative content of the bombing experience arose from personal accounts of the bomb blast by rescue/recovery workers proceeding chronologically from initial awareness and deployment to harrowing onsite search and rescue/recovery missions to the aftermath with reflections on the bombing.

Conclusions
Beyond disaster recovery/rescue worker stories published in popular media, little other substantive published knowledge on this topic is available, and therefore this research study provides a wealth of new in-depth information that can provide guidance for policy and practice for disaster response.
Establishment and validation of an artificial intelligence web application for predicting postoperative in-hospital mortality in patients with hip fracture: a national cohort study of 52 707 cases
Authors: Lei Mingxing , Feng Taojin , Chen Ming , Shen Junmin , Liu Jiang , Chang Feifan , Chen Junyu , Sun Xinyu , Mao Zhi , Li Yi , Yin Pengbin , Tang Peifu , Zhang Licheng 
Published: May 2024

Background:
In-hospital mortality following hip fractures is a significant concern, and accurate prediction of this outcome is crucial for appropriate clinical management. Nonetheless, there is a lack of effective prediction tools in clinical practice. By utilizing artificial intelligence (AI) and machine learning techniques, this study aims to develop a predictive model that can assist clinicians in identifying geriatric hip fracture patients at a higher risk of in-hospital mortality.

Methods:
A total of 52 707 geriatric hip fracture patients treated with surgery from 90 hospitals were included in this study. The primary outcome was postoperative in-hospital mortality. The patients were randomly divided into two groups, with a ratio of 7:3. The majority of patients, assigned to the training cohort, were used to develop the AI models. The remaining patients, assigned to the validation cohort, were used to validate the models. Various machine learning algorithms, including logistic regression (LR), decision tree (DT), naïve bayesian (NB), neural network (NN), eXGBoosting machine (eXGBM), and random forest (RF), were employed for model development. A comprehensive scoring system, incorporating 10 evaluation metrics, was developed to assess the prediction performance, with higher scores indicating superior predictive capability. Based on the best machine learning-based model, an AI application was developed on the Internet. In addition, a comparative testing of prediction performance between doctors and the AI application.

Findings:
The eXGBM model exhibited the best prediction performance, with an area under the curve (AUC) of 0.908 (95% CI: 0.881–0.932), as well as the highest accuracy (0.820), precision (0.817), specificity (0.814), and F1 score (0.822), and the lowest Brier score (0.120) and log loss (0.374). Additionally, the model showed favorable calibration, with a slope of 0.999 and an intercept of 0.028. According to the scoring system incorporating 10 evaluation metrics, the eXGBM model achieved the highest score (56), followed by the RF model (48) and NN model (41). The LR, DT, and NB models had total scores of 27, 30, and 13, respectively. The AI application has been deployed online at https://in-hospitaldeathinhipfracture-l9vhqo3l55fy8dkdvuskvu.streamlit.app/, based on the eXGBM model. The comparative testing revealed that the AI application’s predictive capabilities significantly outperformed those of the doctors in terms of AUC values (0.908 vs. 0.682, P<0.001).

Conclusions:
The eXGBM model demonstrates promising predictive performance in assessing the risk of postoperative in-hospital mortality among geriatric hip fracture patients. The developed AI model serves as a valuable tool to enhance clinical decision-making.
Difficult diagnosis: Disseminated gonorrheal infection manifesting as septic arthritis
Authors: Alleyne Dwayne , Mitchell Sheryl 
Published: May 2024

ABSTRACT
Disseminated gonococcal infection is the causative agent of approximately 0.6%–1.2% of septic arthritis cases in North America and Europe. Typical presentations of this disorder include tenosynovitis, dermatitis, polyarthralgia, or oligoarticular purulent arthritis affecting the distal joints. Diagnosis is contingent on clinical presentation, with urine nucleic acid amplification testing as the preferred diagnostic modality. Synovial fluid cultures, along with imaging, can confirm diagnosis. The recommended treatment is a third-generation cephalosporin, such as intravenous ceftriaxone for 7–14 days and a dose of oral azithromycin.