bluuebunny/crossref_metadata_2025_split huggingface dataset:
A data-adaptive method for investigating effect heterogeneity with high-dimensional covariates in Mendelian randomization
Authors: Tian Haodong , Tom Brian D. M. , Burgess Stephen 
Published: February 2024

Abstract
Background
Mendelian randomization is a popular method for causal inference with observational data that uses genetic variants as instrumental variables. Similarly to a randomized trial, a standard Mendelian randomization analysis estimates the population-averaged effect of an exposure on an outcome. Dividing the population into subgroups can reveal effect heterogeneity to inform who would most benefit from intervention on the exposure. However, as covariates are measured post-“randomization”, naive stratification typically induces collider bias in stratum-specific estimates.

Method
We extend a previously proposed stratification method (the “doubly-ranked method”) to form strata based on a single covariate, and introduce a data-adaptive random forest method to calculate stratum-specific estimates that are robust to collider bias based on a high-dimensional covariate set. We also propose measures based on the Q statistic to assess heterogeneity between stratum-specific estimates (to understand whether estimates are more variable than expected due to chance alone) and variable importance (to identify the key drivers of effect heterogeneity).

Result
We show that the effect of body mass index (BMI) on lung function is heterogeneous, depending most strongly on hip circumference and weight. While for most individuals, the predicted effect of increasing BMI on lung function is negative, it is positive for some individuals and strongly negative for others.

Conclusion
Our data-adaptive approach allows for the exploration of effect heterogeneity in the relationship between an exposure and an outcome within a Mendelian randomization framework. This can yield valuable insights into disease aetiology and help identify specific groups of individuals who would derive the greatest benefit from targeted interventions on the exposure.
Model-based standardization using multiple imputation
Authors: Remiro-Azócar Antonio , Heath Anna , Baio Gianluca 
Published: February 2024

AbstractBackgroundWhen studying the association between treatment and a clinical outcome, a parametric multivariable model of the conditional outcome expectation is often used to adjust for covariates. The treatment coefficient of the outcome model targets a conditional treatment effect. Model-based standardization is typically applied to average the model predictions over the target covariate distribution, and generate a covariate-adjusted estimate of the marginal treatment effect.MethodsThe standard approach to model-based standardization involves maximum-likelihood estimation and use of the non-parametric bootstrap. We introduce a novel, general-purpose, model-based standardization method based on multiple imputation that is easily applicable when the outcome model is a generalized linear model. We term our proposed approach multiple imputation marginalization (MIM). MIM consists of two main stages: the generation of synthetic datasets and their analysis. MIM accommodates a Bayesian statistical framework, which naturally allows for the principled propagation of uncertainty, integrates the analysis into a probabilistic framework, and allows for the incorporation of prior evidence.ResultsWe conduct a simulation study to benchmark the finite-sample performance of MIM in conjunction with a parametric outcome model. The simulations provide proof-of-principle in scenarios with binary outcomes, continuous-valued covariates, a logistic outcome model and the marginal log odds ratio as the target effect measure. When parametric modeling assumptions hold, MIM yields unbiased estimation in the target covariate distribution, valid coverage rates, and similar precision and efficiency than the standard approach to model-based standardization.ConclusionWe demonstrate that multiple imputation can be used to marginalize over a target covariate distribution, providing appropriate inference with a correctly specified parametric outcome model and offering statistical performance comparable to that of the standard approach to model-based standardization.
Ethnoracial disparities in childhood growth trajectories in Brazil: a longitudinal nationwide study of four million children
Authors: Benes Matos da Silva Helena , Ribeiro-Silva Rita de Cássia , Freitas de Mello e Silva Juliana , Chis Ster Irina , Rebouças Poliana , Goes Emanuelle , Ichihara Maria Yury , Ferreira Andrêa , M. Pescarini Julia , Leovigildo Fiaccone Rosemeire , S. Paixão Enny , L. Barreto Maurício 
Published: February 2024

Abstract

Background
The literature contains scarce data on inequalities in growth trajectories among children born to mothers of diverse ethnoracial background in the first 5 years of life.

Objective
We aimed to investigate child growth according to maternal ethnoracial group using a nationwide Brazilian database.

Methods
A population-based retrospective cohort study employed linked data from the CIDACS Birth Cohort and the Brazilian Food and Nutrition Surveillance System (SISVAN). Children born at term, aged 5 years or younger who presented two or more measurements of length/height (cm) and weight (kg) were followed up between 2008 and 2017. Prevalence of stunting, underweight, wasting, and thinness were estimated. Nonlinear mixed effect models were used to estimate childhood growth trajectories, among different maternal ethnoracial groups (White, Asian descent, Black, Pardo, and Indigenous), using the raw measures of weight (kg) and height (cm) and the length/height-for-age (L/HAZ) and weight-for-age z-scores (WAZ). The analyses were also adjusted for mother’s age, educational level, and marital status.

Results
A total of 4,090,271 children were included in the study. Children of Indigenous mothers exhibited higher rates of stunting (26.74%) and underweight (5.90%). Wasting and thinness were more prevalent among children of Pardo, Asian, Black, and Indigenous mothers than those of White mothers. Regarding children’s weight (kg) and length/height (cm), those of Indigenous, Pardo, Black, and Asian descent mothers were on average shorter and weighted less than White ones. Regarding WAZ and L/HAZ growth trajectories, a sharp decline in average z-scores was evidenced in the first weeks of life, followed by a period of recovery. Over time, z-scores for most of the subgroups analyzed trended below zero. Children of mother in greater social vulnerability showed less favorable growth.

Conclusion
We observed racial disparities in nutritional status and childhood growth trajectories, with children of Indigenous mothers presenting less favorable outcomes compared to their White counterparts. The strengthening of policies aimed at protecting Indigenous children should be urgently undertaken to address systematic ethnoracial health inequalities.
Efficient administration of a combination of
nifedipine and sildenafil citrate versus only nifedipine on clinical outcomes in women
with threatened preterm labor: a systematic review and meta-analysis
Authors: Manouchehri Elham , Makvandi Somayeh , Razi Mahdieh , Sahebari Maryam , Larki Mona 
Published: February 2024

Abstract
Background
Preterm labor (PTL) is a common and serious pregnancy disorder that
can cause long-term neurological issues in the infant. There are conflicting
studies concerning whether sildenafil citrate (SC) reduces preterm labor
complications. Therefore, the meta-analysis aimed to examine the clinical
outcomes in women with threatened PTL who received nifedipine plus SC therapy
versus only nifedipine.

Methods
For the original articles, six databases were searched using
relevant keywords without restriction on time or language until January 13,
2024. The Cochrane risk-of-bias tool for randomized trials (RoB) and the Risk of
Bias Assessment Tool for Nonrandomized Studies (RoBANS) were both used to assess
the risk of bias in randomized and non-randomized studies, and GRADE determined
the quality of our evidence. Meta-analysis of all data was carried out using
Review Manager (RevMan) version 5.1.

Results
Seven studies with mixed quality were included in the meta-analysis.
The study found that combining nifedipine and SC resulted in more prolongation
of pregnancy (MD = 6.99, 95% CI: 5.32, 8.65, p < 0.00001), a lower rate of delivery in the 1st to 3rd days
after hospitalization (RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001), a higher birth weight (252.48 g vs. nifedipine
alone, p = 0.02), and the risk ratio of
admission to the neonatal intensive care unit (NICU) was significantly lower
(RR = 0.62, 95% CI: 0.50, 0.76, p < 0.00001) compared to nifidepine alone. The evidence was high
for prolongation of pregnancy, delivery rate 24–72 h after admission, and NICU
admission, but low for newborn birth weight.

Conclusions
Given the effectiveness of SC plus nifedipine in increased
prolongation of pregnancy and birth weight, lower delivery in the 1st to 3rd
days after hospitalization, and NICU admission, Gynecologists and obstetricians
are suggested to consider this strategy for PTL management, although additional
article rigor is required to improve the quality of the evidence.
Exposure to di-2-ethylhexyl phthalate (DEHP) increases the risk of cancer
Authors: Yang Luchen , Liu Xiaoyang , Peng Zhufeng , Liu Zhenghuan , Song Pan , Zhou Jing , Ma Kai , Yu Yunfei , Dong Qiang 
Published: February 2024

AbstractCancer is a major socioeconomic burden that seriously affects the life and spirit of patients. However, little is known about the role of environmental toxicant exposure in diseases, especially ubiquitous di-(2-ethylhexyl) phthalate (DEHP) which is one of the most widely used plasticizers. Hence, the objective of this study was to assess the potential association between cancer and DEHP. The data were collected using the 2011–2018 National Health and Nutrition Examination Survey (NHANES) data (n = 6147), and multiple logistic regression was conducted to evaluate the association. The concentrations of DEHP were calculated by each metabolite and split into quartiles for analysis. After adjusting for confounding factors, DEHP was significantly associated with an increased risk of cancer prevalence, and the metabolites of DEHP showed similar results (OR > 1.0, p < 0.05). Simultaneously, the association remained when the analyses were stratified by age and sex, and the risk of cancer appeared to be higher in male patients. In addition, further analysis suggested that DEHP exposure obviously increased the risk of female reproductive system cancer, male reproductive system cancer, and other cancers (OR > 1.0, p < 0.05) but not skin and soft tissue cancer. DEHP exposure is associated with the risk of cancer, especially female reproductive system cancer, male reproductive system cancer and other cancers.
Cost of illness due to respiratory syncytial virus acute lower respiratory tract infection among infants hospitalized in Argentina
Authors: Dvorkin Julia , Sosa Emiliano , Vodicka Elizabeth , Baral Ranju , Sancilio Andrea , Dueñas Karina , Rodriguez Andrea , Rojas-Roque Carlos , Carruitero Patricia B. , Polack Fernando P. , Pecenka Clint , Libster Romina , Caballero Mauricio T. 
Published: February 2024

Abstract
Background
Information is scarce regarding the economic burden of respiratory syncytial virus (RSV) disease in low-resource settings. This study aimed to estimate the cost per episode of hospital admissions due to RSV severe disease in Argentina.

Methods
This is a prospective cohort study that collected information regarding 256 infants under 12 months of age with acute lower respiratory tract infection (ALRTI) due to RSV in two public hospitals of Buenos Aires between 2014 and 2016. Information on healthcare resource use was collected from the patient’s report and its associated costs were estimated based on the financial database and account records of the hospitals. We estimated the total cost per hospitalization due to RSV using the health system perspective. The costs were estimated in US dollars as of December 2022 (1 US dollar = 170 Argentine pesos).

Results
The mean costs per RSV hospitalization in infants was US$587.79 (95% confidence interval [CI] $535.24 – $640.33). The mean costs associated with pediatric intensive care unit (PICU) admission more than doubled from those at regular pediatric wards ($1,556.81 [95% CI $512.21 – $2,601.40] versus $556.53 [95% CI $514.59 – $598.48]).

Conclusions
This study shows the direct economic impact of acute severe RSV infection on the public health system in Argentina. The estimates obtained from this study could be used to inform cost-effectiveness analyses of new preventive RSV interventions being developed.
Deep learning in oral cancer- a systematic review
Authors: Warin Kritsasith , Suebnukarn Siriwan 
Published: February 2024

Abstract
Background
Oral cancer is a life-threatening malignancy, which affects the survival rate and quality of life of patients. The aim of this systematic review was to review deep learning (DL) studies in the diagnosis and prognostic prediction of oral cancer.

Methods
This systematic review was conducted following the PRISMA guidelines. Databases (Medline via PubMed, Google Scholar, Scopus) were searched for relevant studies, from January 2000 to June 2023.

Results
Fifty-four qualified for inclusion, including diagnostic (n = 51), and prognostic prediction (n = 3). Thirteen studies showed a low risk of biases in all domains, and 40 studies low risk for concerns regarding applicability. The performance of DL models was reported of the accuracy of 85.0–100%, F1-score of 79.31 - 89.0%, Dice coefficient index of 76.0 - 96.3% and Concordance index of 0.78–0.95 for classification, object detection, segmentation, and prognostic prediction, respectively. The pooled diagnostic odds ratios were 2549.08 (95% CI 410.77–4687.39) for classification studies.

Conclusions
The number of DL studies in oral cancer is increasing, with a diverse type of architectures. The reported accuracy showed promising DL performance in studies of oral cancer and appeared to have potential utility in improving informed clinical decision-making of oral cancer.
Reduction of prevalence of patients meeting the criteria for metabolic syndrome with tirzepatide: a post hoc analysis from the SURPASS Clinical Trial Program
Authors: Nicholls Stephen J. , Tofé Santiago , le Roux Carel W. , D’Alessio David A. , Wiese Russell J. , Pavo Imre , Brown Katelyn , Weerakkody Govinda J. , Zeytinoglu Meltem , Romera Irene C. 
Published: February 2024

Abstract
Background
Metabolic syndrome is characterized as the co-occurrence of interrelated cardiovascular risk factors, including insulin resistance, hyperinsulinemia, abdominal obesity, dyslipidemia and hypertension. Once weekly tirzepatide is approved in the US and EU for the treatment of type 2 diabetes (T2D) and obesity. In the SURPASS clinical trial program for T2D, tirzepatide demonstrated greater improvements in glycemic control, body weight reduction and other cardiometabolic risk factors versus placebo, subcutaneous semaglutide 1 mg, insulin degludec, and insulin glargine. This post hoc analysis assessed the effect of tirzepatide use on the prevalence of patients meeting the criteria for metabolic syndrome across SURPASS 1–5.

Methods
Metabolic syndrome was defined as having ≥ 3 of 5 criteria according to the US National Cholesterol Education Program: Adult Treatment Panel III. Analyses were based on on-treatment data at the primary endpoint from patients adherent to treatment (taking ≥ 75% study drug). A logistic regression model with metabolic syndrome status as the response variable, metabolic syndrome status at the baseline visit as an adjustment, and randomized treatment as fixed explanatory effect was used. The effect of tirzepatide use on the prevalence of patients meeting the criteria for metabolic syndrome by categorical weight loss, background medication and gender were assessed.

Results
In SURPASS, the prevalence of patients meeting the criteria for metabolic syndrome at baseline was 67–88% across treatment groups with reductions at the primary endpoint to 38–64% with tirzepatide versus 64–82% with comparators. Reductions in the prevalence of patients meeting the criteria for metabolic syndrome was significantly greater with all tirzepatide doses versus placebo, semaglutide 1 mg, insulin glargine, and insulin degludec (p < 0.001). Individual components of metabolic syndrome were also reduced to a greater extent with tirzepatide vs comparators. Greater reductions in body weight were associated with greater reductions in the prevalence of patients meeting the criteria for metabolic syndrome and its individual components. Background SGLT2i or sulfonylurea use or gender did not impact the change in prevalence of patients meeting the criteria for metabolic syndrome.

Conclusions
In this post hoc analysis, tirzepatide at all doses studied was associated with a greater reduction in the prevalence of patients meeting the criteria for metabolic syndrome compared to placebo, semaglutide 1 mg, insulin degludec, and insulin glargine. Although more evidence is needed, these data would support greater potential improvement in cardiovascular risk factor profile with tirzepatide treatment in people across the continuum of T2D.
Presurgical computed tomography-guided localization of lung ground glass nodules: comparing hook-wire and indocyanine green
Authors: Han Rui , Wang Long-Fei , Teng Fei , Lin Jia , Xian Yu-Tao , Lu Yun , Wu An-Le 
Published: February 2024

Abstract
Background
Presurgical computed tomography (CT)-guided localization is frequently employed to reduce the thoracotomy conversion rate, while increasing the rate of successful sublobar resection of ground glass nodules (GGNs) via video-assisted thoracoscopic surgery (VATS). In this study, we compared the clinical efficacies of presurgical CT-guided hook-wire and indocyanine green (IG)-based localization of GGNs.

Methods
Between January 2018 and December 2021, we recruited 86 patients who underwent CT-guided hook-wire or IG-based GGN localization before VATS resection in our hospital, and compared the clinical efficiency and safety of both techniques.

Results
A total of 38 patients with 39 GGNs were included in the hook-wire group, whereas 48 patients with 50 GGNs were included in the IG group. There were no significant disparities in the baseline data between the two groups of patients. According to our investigation, the technical success rates of CT-based hook-wire- and IG-based localization procedures were 97.4% and 100%, respectively (P = 1.000). Moreover, the significantly longer localization duration (15.3 ± 6.3 min vs. 11.2 ± 5.3 min, P = 0.002) and higher visual analog scale (4.5 ± 0.6 vs. 3.0 ± 0.5, P = 0.001) were observed in the hook-wire patients, than in the IG patients. Occurrence of pneumothorax was significantly higher in hook-wire patients (27.3% vs. 6.3%, P = 0.048). Lung hemorrhage seemed higher in hook-wire patients (28.9% vs. 12.5%, P = 0.057) but did not reach statistical significance. Lastly, the technical success rates of VATS sublobar resection were 97.4% and 100% in hook-wire and IG patients, respectively (P = 1.000).

Conclusions
Both hook-wire- and IG-based localization methods can effectively identified GGNs before VATS resection. Furthermore, IG-based localization resulted in fewer complications, lower pain scores, and a shorter duration of localization.
Hospital infections and health-related quality of life after cardiac surgery: a multicenter survey
Authors: Rijnhart-de Jong Hilda G. , Haenen Jo , Porta Fabiano , Timmermans Marijke , Boerma E. Christiaan , de Jong Kim ,   on behalf of the participating centers of the Cardiothoracic Surgery Registration Committee of the Netherlands Heart Registration, Bramer S. , Daeter E. J. , Hoohenkerk G. J. F. , Markou A. L. P. , Speekenbrink R. G. H. , Segers P. , Stooker W. , Li W. W. L. , Bekkers J. A. , Porta F. 
Published: February 2024

Abstract
Background
Recent research suggested that hospital infections are a predictive marker for physical non-recovery one year after cardiothoracic surgery. The purpose of this study was to explore whether this risk factor is etiologic. Additional, the influence of a potential effect modifying factor, diabetes mellitus, was investigated.

Methods
In this multicenter study, patients underwent elective or urgent cardiothoracic surgery between 01-01-2015 and 31-12-2019, and completed pre- and one year post-operative Short Form Health Survey 36/12 quality of life questionnaires. A binary logistic regression model, in which the inverse of the propensity score for infection risk was included as a weight variable, was used. Second, this analysis was stratified for diabetes mellitus status.

Results
8577 patients were included. After weighing for the propensity score, the standardized mean differences of all variables decreased and indicated sufficient balance between the infection and non-infection groups. Hospital infections were found to be a risk factor for non-recovery after cardiothoracic surgery in the original and imputed dataset before weighting. However, after propensity score weighing, hospital infections did not remain significantly associated with recovery (OR for recovery = 0.79; 95% CI [0.60–1.03]; p = 0.077). No significant interaction between diabetes mellitus and hospital infections on recovery was found (p = 0.845).

Conclusions
This study could not convincingly establish hospital infections as an etiologic risk factor for non-improvement of physical recovery in patients who underwent cardiothoracic surgery. In addition, there was no differential effect of hospital infections on non-improvement of physical recovery for patients with and without diabetes mellitus.
Trial registration International Clinical Trials Registry Platform ID NL9818; date of registration, 22-10-2021 (https://trialsearch.who.int/).