bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adductor Canal Block versus Femoral Nerve Block in Total Knee Arthroplasty
Authors: Berikashvili Levan B. , Yadgarov Mikhail Ya. , Kuzovlev Artem N. , Smirnova Anastasia V. , Kadantseva Kristina K. , Kuznetsov Ivan V. , Polyakov Petr A. , Likhvantsev Valery V. 
Published: April 2024

Objectives:The quality of postoperative analgesia in total knee arthroplasty is crucial for patient recovery, rehabilitation and hospital stay duration. In line with the above, а single-shot adductor canal block has been considered as surpassing method over continuous femoral nerve block. However, continuous adductor canal block and single-shot femoral nerve block ‘kept overboard’ the discussion. This study aims to compare the effectiveness of various types of adductor and femoral nerve blocks on clinically relevant outcomes in patients following total knee arthroplasty.Methods:A systematic review and network meta-analysis were conducted following ‘PRISMA-NMA’ and Cochrane Handbook guidelines. Eligibility criteria included randomized trials and, where these were lacking for a comparison, non-randomized studies involving adults undergoing primary total knee arthroplasty, comparing single-shot adductor canal block, continuous adductor canal block, single-shot femoral nerve block, and continuous femoral nerve block.Results:A total of 36 studies involving 3308 patients were included. Single-shot adductor canal block showed higher pain scores and opioid consumption but better functional recovery at 24-h compared to continuous femoral nerve block. However, this trend vanishes by the 48-h assessment post-surgery. Continuous adductor canal block had higher opioid consumption but better functional recovery and shorter hospital stay compared to continuous femoral nerve block. Single-shot adductor canal block showed higher pain scores but comparable opioid consumption and functional recovery to continuous adductor canal block.Discussion:The shift from continuous femoral nerve block to single-shot adductor canal block as the preferred method for pain relief after total knee arthroplasty may be premature. While the latter improves mobility, it falls short in pain control and doesn’t shorten hospital stays. Continuous adductor canal block shows promise but is currently underappreciated, and single-shot femoral nerve block is often overshadowed by other techniques in regional anesthesia. Further high-quality, multicenter randomized controlled trials are needed to validate these findings.
Reduced macular thickness and vascular density in abnormal glucose metabolism patients: A meta-analysis of optical coherence tomography (OCT) and OCT angiography studies
Authors: Fu Xiangyu , Ren Xiang , Chen Wenyue , Chen Danian 
Published: April 2024

AbstractBackground:Alterations in macular thickness and vascular density before clinically visible diabetic retinopathy (DR) remain inconclusive. This study aimed to determine whether retinal manifestations in abnormal glucose metabolism (AGM) patients differ from those in the healthy individuals.Methods:PubMed, Embase, and Web of Science were searched between 2000 and 2021. The eligibility criteria were AGM patients without DR. Primary and secondary outcomes measured by optical coherence tomography (OCT) and OCT angiography (OCTA) were analyzed and expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). A random-effects model was used in the data synthesis. The potential publication bias for the variables was evaluated using Egger’s test.Results:A total of 86 observational studies involving 13,773 participants and 15,416 eyes were included. OCT revealed that compared to healthy controls, the total macular thickness of AGM patients was thinner, including the thickness of fovea (–0.24, 95% CI [–0.39, –0.08];P = 0.002,I2 = 87.7%), all regions of parafovea (–0.32, 95% CI [–0.54, –0.11];P = 0.003;I2 = 71.7%) and the four quadrants of perifovea; the thickness of peripapillary retinal nerve fiber layer (pRNFL), macular retinal nerve fiber layer (mRNFL), and ganglion cell layer (GCL) also decreased. OCTA indicated that the superficial and deep vascular density decreased, the foveal avascular zone (FAZ) area enlarged, and the acircularity index (AI) reduced in AGM individuals.Conclusions:Retinal thinning and microvascular lesions have occurred before the advent of clinically detectable DR; OCT and OCTA may have the potential to detect these preclinical changes.Registration:PROSPERO; http://www.crd.york.ac.uk/prospero/; No. CRD42021269885.
Role of Primary Care Clinician Concern During Screening for Early Identification of Autism
Authors: Wieckowski Andrea Trubanova , Ramsey Riane K. , Coulter Kirsty , Eldeeb Sherief Y. , Algur Yasemin , Ryan Victoria , Stahmer Aubyn C. , Robins Diana L. 
Published: April 2024

ABSTRACT:

Objective:
The aim of this study was to evaluate the added value of primary care clinician (PCC)-indicated concern during primary care universal standardized screening in early identification of autism.

Methods:
Toddlers were screened for autism during primary care checkups (n = 7,039, aged 14.24–22.43 months) in 2 studies. Parents completed the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up. For each participant, PCCs indicated whether they had autism concerns (optional in 1 study—before or after viewing screening results, required before viewing screen results in the other). Children at high likelihood for autism from screen result and/or PCC concern (n = 615) were invited for a diagnostic evaluation; 283 children attended the evaluation.

Results:
Rates of PCC-indicated autism concerns were similar whether PCCs were required or encouraged to indicate concerns. High likelihood of autism indication on both screen and PCC concern resulted in the highest positive predictive value for autism and positive predictive value for any developmental disorder, as well as the highest evaluation attendance, with no significant difference between the positive screen-only and PCC concern-only groups. Although the frequency of PCC-indicated autism concern did not differ significantly based on the child's cognitive level, PCCs were more likely to identify children with more obvious autism characteristics compared with more subtle autism characteristics as having autism.

Conclusion:
The findings support the recommendation of the American Academy of Pediatrics that both screening and surveillance for autism be incorporated into well-child visits. High likelihood of autism on either screen or PCC concern should trigger a referral for an evaluation.
Long-term outcomes of patients with autoimmune hepatitis induced cirrhosis after immunosuppressive treatment
Authors: Hatoum Sara , Rockey Don C. 
Published: March 2024

Introduction
Autoimmune hepatitis is an immune-mediated liver disease that results in hepatic inflammation and subsequent fibrosis. We aimed to assess the natural history of autoimmune hepatitis in patients who had cirrhosis at the time of diagnosis.

Methods
We examined consecutive patients with autoimmune hepatitis (based on the revised International Autoimmune Hepatitis Group criteria) and cirrhosis who had long-term follow-up between 2012 and 2018. Complete clinical data, including longitudinal data, was obtained for each patient to determine clinical and biochemical outcomes. Decompensating events were defined as complications of portal hypertension.

Results
Thirty-four patients presenting with autoimmune hepatitis induced cirrhosis (age 50, 17–81; 71% women) were followed for an average of 8 years post-diagnosis. Fourteen (41%) patients had a decompensating event at diagnosis. All patients were begun on treatment; index decompensating events resolved in all patients. Twenty-six (76%) patients had normalization of transaminases; in this group, 4 (15%) patients developed one or more new decompensating events and 1 patient (4%) died. Of the 8 (24%) patients who did not have transaminase normalization, 6 (75%) developed one or more new decompensating events and 5 (62%) died or underwent liver transplant. There was a significant association between achieving normalization of transaminases and protection from developing a decompensating event (P = 0.003) and liver transplant or death (P = 0.001).

Conclusion
Most patients with autoimmune hepatitis with cirrhosis at presentation achieved normalization of transaminases with treatment and rarely developed further decompensating events. We speculate that some of these patients had stabilization or reversal of portal hypertension.
NewVibrio choleraesequences from Eastern and Southern Africa alter our understanding of regional cholera transmission
Authors: Xiao Shaoming , Abade Ahmed , Boru Waqo , Kasambara Watipaso , Mwaba John , Ongole Francis , Mmanywa Mariam , Trovão Nídia Sequeira , Chilengi Roma , Kwenda Geoffrey , Orach Christopher Garimoi , Chibwe Innocent , Bwire Godfrey , Stine O. Colin , Milstone Aaron M. , Lessler Justin , Azman Andrew S. , Luo Wensheng , Murt Kelsey , Sack David A. , Debes Amanda K. , Wohl Shirlee 
Published: March 2024

ABSTRACTDespite ongoing containment and vaccination efforts, cholera remains prevalent in many countries in sub-Saharan Africa. Part of the difficulty in containing cholera comes from our lack of understanding of how it circulates throughout the region. To better characterize regional transmission, we generated and analyzed 118Vibrio choleraegenomes collected between 2007-2019 from five different countries in Southern and Eastern Africa. We showed thatV. choleraesequencing can be successful from a variety of sample types and filled in spatial and temporal gaps in our understanding of circulating lineages, including providing some of the first sequences from the 2018-2019 outbreaks in Uganda, Kenya, Tanzania, Zambia, and Malawi. Our results present a complex picture of cholera transmission in the region, with multiple lineages found to be co-circulating within several countries. We also find evidence that previously identified sporadic cases may be from larger, undersampled outbreaks, highlighting the need for careful examination of sampling biases and underscoring the need for continued and expanded cholera surveillance across the African continent.
WITHDRAWN: Association between neutrophil to-lymphocyte ratio (NLR) and outcome of septic patients with atrial fibrillation (AF): A retrospective observational study based on Medical Information Mart for Intensive Care IV
Authors: Tang Weiyi , Shi Weizhen , Li Liangyao , tang kui 
Published: March 2024

Withdrawal StatementThe authors have withdrawn this manuscript because due to the discovery that the original data requires reanalysis to ensure the accuracy and completeness of the results, we have decided to withdraw the submission. A revision will be submitted once these concerns have been adequately addressed. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
Improving prediction models of amyotrophic lateral sclerosis (ALS) using polygenic, pre-existing conditions, and survey-based risk scores in the UK Biobank
Authors: Jin Weijia , Boss Jonathan , Bakulski Kelly M. , Goutman Stephen A. , Feldman Eva L. , Fritsche Lars G. , Mukherjee Bhramar 
Published: March 2024

AbstractBackground and ObjectivesAmyotrophic lateral sclerosis (ALS) causes profound impairments in neurological function and a cure for this devastating disease remains elusive. Early detection and risk stratification are crucial for timely intervention and improving patient outcomes. This study aimed to identify predisposing genetic, phenotypic, and exposure-related factors for Amyotrophic lateral sclerosis using multi-modal data and assess their joint predictive potential.MethodsUtilizing data from the UK Biobank, we analyzed an unrelated set of 292 ALS cases and 408,831 controls of European descent. Two polygenic risk scores (PRS) are constructed: “GWAS Hits PRS” and “PRS-CS,” reflecting oligogenic and polygenic ALS risk profiles, respectively. Time-restricted phenome-wide association studies (PheWAS) were performed to identify pre-existing conditions increasing ALS risk, integrated into phenotypic risk scores (PheRS). A poly-exposure score (“PXS”) captures the influence of environmental exposures measured through survey questionnaires. We evaluate the performance of these scores for predicting ALS incidence and stratifying risk, adjusting for baseline demographic covariates.ResultsBoth PRSs modestly predicted ALS diagnosis, but with increased predictive power when combined (covariate-adjusted receiver operating characteristic [AAUC] = 0.584 [0.525, 0.639]). PheRS incorporated diagnoses 1 year before ALS onset (PheRS1) modestly discriminated cases from controls (AAUC = 0.515 [0.472, 0.564]). The “PXS” did not significantly predict ALS. However, a model incorporating PRSs and PheRS1 improved prediction of ALS (AAUC = 0.604 [0.547, 0.667]), outperforming a model combining all risk scores. This combined risk score identified the top 10% of risk score distribution with a 4-fold higher ALS risk (95% CI: [2.04, 7.73]) versus those in the 40%-60% range.DiscussionsBy leveraging UK Biobank data, our study uncovers predisposing ALS factors, highlighting the improved effectiveness of multi-factorial prediction models to identify individuals at highest risk for ALS.
Real-World Genetic Characteristics of Candidates for Implantable Cardioverter-Defibrillators with Dilated Cardiomyopathy
Authors: Kim In-Soo , Kim Yoonjung , Seo Jiwon , Chung Hyemoon , Son Jung-Woo , Ha Sang Jin , Shim Jaemin , Kim Jong-Youn , Rim Se-Joong , Lee Kyung-A , Choi Eui-Young 
Published: March 2024

AbstractBackgroundThe real-world prevalence of sudden cardiac death (SCD)–related gene mutations and their relationship with implantable cardioverter-defibrillator (ICD) implantation in dilated cardiomyopathy (DCM) has not been clearly investigated.MethodsThis study included patients with sporadic DCM with persistent left ventricular ejection fraction (LVEF) ≤ 35% even after 3 months of guideline-directed medical treatment or those with an ICD for secondary prevention and LVEF < 50%. Genetic tests targeting 444 pan-cardiomyopathy genes (including 36 core DCM genes) were performed, along with the collection of clinical and electrophysiological information.ResultsA total of 105 patients were enrolled (median age, 65.0 [57.5–75.0] years), and 33 (31%) were women. The average LVEF was 27.4 ± 5.9%, and 46 patients (44%) had ICD or cardiac resynchronization therapy with ICD (34 for primary prevention and 12 for secondary prevention purpose) at the time of enrollment. Fourteen patients (13%) had pathogenic (P) or likely pathogenic (LP) variants (comprising 6TTN, 4DSP, 2TNNT2, 1RBM20,1DSGand 1MYBPC3, one patients had bothDSPandRBM20), and 59 patients (56%) had P/LP/variant of uncertain significance (VUS) in the 36 core DCM genes. Twenty-eight patients (27%) harbored SCD-related gene variants (14DSP, 11FLNC, 9RBM20and 2TMEM43). The prevalence of SCD gene variants tended to be higher in the secondary prevention and non-ICD groups (33.3% for secondary purposes, 11.8% for primary purposes, and 33.8% for non-ICD; p = 0.058).ConclusionsIn patients with advanced heart failure and DCM, P/LP-validated DCM variants were not common in sporadic cases. However, when extended to VUS, approximately half of the patients had core DCM-related variants. The prevalence of SCD variants was not lower in the non-ICD group, thus suggesting a potential risk of fatal arrhythmia.(Trial registration: CRIS KCT0004913)
Interoperability of phenome-wide multimorbidity patterns: a comparative study of two large-scale EHR systems
Authors: Strayer Nick , Vessels Tess , Choi Karmel , Zhang Siwei , Li Yajing , Han Lide , Sharber Brian , Hsi Ryan S , Bejan Cosmin A , Bick Alexander G. , Balko Justin M , Johnson Douglas B , Wheless Lee E , Wells Quinn S , Philips Elizabeth J , Pulley Jill M , Self Wesley H , Chen Qingxia , Hartert Tina , Wilkins Consuelo H , Savona Michael R , Shyr Yu , Roden Dan M , Smoller Jordan W , Ruderfer Douglas M , Xu Yaomin 
Published: March 2024

AbstractBackgroundElectronic health records (EHR) are increasingly used for studying multimorbidities. However, concerns about accuracy, completeness, and EHRs being primarily designed for billing and administrative purposes raise questions about the consistency and reproducibility of EHR-based multimorbidity research.MethodsUtilizing phecodes to represent the disease phenome, we analyzed pairwise comorbidity strengths using a dual logistic regression approach and constructed multimorbidity as an undirected weighted graph. We assessed the consistency of the multimorbidity networks within and between two major EHR systems at local (nodes and edges), meso (neighboring patterns), and global (network statistics) scales. We present case studies to identify disease clusters and uncover clinically interpretable disease relationships. We provide an interactive web tool and a knowledge base combining data from multiple sources for online multimorbidity analysis.FindingsAnalyzing data from 500,000 patients across Vanderbilt University Medical Center and Mass General Brigham health systems, we observed a strong correlation in disease frequencies ( Kendall’sτ= 0.643) and comorbidity strengths (Pearsonρ= 0.79). Consistent network statistics across EHRs suggest similar structures of multimorbidity networks at various scales. Comorbidity strengths and similarities of multimorbidity connection patterns align with the disease genetic correlations. Graph-theoretic analyses revealed a consistent core-periphery structure, implying efficient network clustering through threshold graph construction. Using hydronephrosis as a case study, we demonstrated the network’s ability to uncover clinically relevant disease relationships and provide novel insights.InterpretationOur findings demonstrate the robustness of large-scale EHR data for studying phenome-wide multimorbidities. The alignment of multimorbidity patterns with genetic data suggests the potential utility for uncovering shared biology of diseases. The consistent core-periphery structure offers analytical insights to discover complex disease interactions. This work also sets the stage for advanced disease modeling, with implications for precision medicine.FundingVUMC Biostatistics Development Award, the National Institutes of Health, and the VA CSRD
Design of a Clinical Balance Tool for Fall Risk Assessments: A Development and Usability Study
Authors: Garvin Jennifer Hornung , Yazzie Virginia M. , Katsuyama Natalie A. , Rudloff Truman , Worthen-Chaudhari Lise C. , Chaudhari Ajit M.W. 
Published: March 2024

AbstractBackgroundFalls are a significant source of early morbidity and mortality in the aging population, yet clinical changes that lead to increased fall risks often escape early identification and intervention. A device to measure postural control would facilitate evidence-based fall risk assessment.ObjectivesOur objectives were to iteratively develop a prototype quantitative posture instrument (QuPI) to replace the weight scale and to assess barriers and facilitators of its implementation in a clinical setting.MethodsWe undertook a formative evaluation and usability study of two QuPI prototypes in primary care, medical oncology, sports medicine, cardiology, and endocrinology outpatient clinics. Clinicians evaluated an initial QuPI prototype and completed a semi-structured interview to determine critical functionality, inform design, and assess usability. The QuPI was modified according to the results, and a new prototype was tested and evaluated.ResultsEighteen clinicians participated in both rounds of interviews. Clinicians who participated (referred to as participants) reported willingness to use the QuPI with all patients during the first round of interviews and stated they would replace their current weight scale with the modified QuPI during the second round of interviews. Participants identified design elements that were both facilitators and barriers to use. Usability scores for both prototypes were excellent. Despite several national guidelines for fall risk assessments, lack of consistent use of guidelines by care teams was found to be a barrier to effective fall risk assessments.ConclusionThe QuPI provides a new method for quantifying fall risks with good user acceptance, usability, and clinical feasibility without disrupting workflow. The QuPI supplemented and facilitated the use of standard algorithms for fall risk assessment. Greater education of the entire care team regarding evidence-based fall risk assessment will promote adherence to guidelines and fall prevention.
Characteristics and antiviral treatment eligibility of newly diagnosed hepatitis B patients at a teaching hospital in Ghana: Implications for prevention and management
Authors: Daniels Joseph , Nartey Yvonne A. , Djankpa Francis , Simpore Jacques , Obiri-Yeboah Dorcas 
Published: March 2024

AbstractHepatitis B virus (HBV) infection poses a considerable public health challenge in limited-resource settings especially in the sub-Saharan African region. Even though HBV infection is incurable, timely treatment is effective in preventing disease progression to liver cirrhosis or hepatocellular carcinoma. However, not all infected patients require treatment. The aim of this study was to determine the clinical, immunological, and virological profiles of newly diagnosed adult HBV patients at a tertiary healthcare center in Ghana and to determine the antiviral treatment eligibility rate based on current guidelines of the World Health Organization (WHO). A hospital-based cross-sectional study involving total sampling of 220 treatment naïve HBV surface antigen positive clients was carried out. A structured questionnaire was used to collect data and detailed clinical and laboratory assessment (serological, biochemical and virological) was carried out. Data were entered and analyzed with STATA version 16. The median age at diagnosis was 34 years (IQR 26.0 – 41.5) with a male to female ratio of 1:1.5. A total of 138 participants (62.7%) were diagnosed with HBV infection following voluntary testing. There was a median delay of 8.5 months (IQR 3.0 – 22.5) between initial diagnosis and patients’ presentation for medical care. In all, 24 patients (10.9%) had abnormal clinical examination findings, 172 patients (78.2%) had HBV DNA levels ≤ 2000 IU/ml while 8 (3.6%) were seropositive for HBeAg. A small proportion of patients had concomitant human immunodeficiency virus (2.7%) and hepatitis C virus (1.4%) infections. Treatment eligibility rate was very low among newly diagnosed HBV infected patients seeking medical care (n=14, 6.4%) following the WHO guidelines for treatment eligibility. Thus, increasing screening rate among the general population, early linkage to clinical care of screen positives and vaccination of screen negatives will help reduce HBV related clinical conditions in resource limited countries.