bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploring the reliability of inpatient EMR algorithms for diabetes identification
Authors: Lee Seungwon , Martin Elliot A , Pan Jie , Eastwood Cathy A , Southern Danielle A , Campbell David J T , Shaheen Abdel Aziz , Quan Hude , Butalia Sonia 
Published: January 2024

IntroductionAccurate identification of medical conditions within a real-time inpatient setting is crucial for health systems. Current inpatient comorbidity algorithms rely on integrating various sources of administrative data, but at times, there is a considerable lag in obtaining and linking these data. Our study objective was to develop electronic medical records (EMR) data-based inpatient diabetes phenotyping algorithms.Materials and methodsA chart review on 3040 individuals was completed, and 583 had diabetes. We linked EMR data on these individuals to the International Classification of Disease (ICD) administrative databases. The following EMR-data-based diabetes algorithms were developed: (1) laboratory data, (2) medication data, (3) laboratory and medications data, (4) diabetes concept keywords and (5) diabetes free-text algorithm. Combined algorithms usedorstatements between the above algorithms. Algorithm performances were measured using chart review as a gold standard. We determined the best-performing algorithm as the one that showed the high performance of sensitivity (SN), and positive predictive value (PPV).ResultsThe algorithms tested generally performed well: ICD-coded data, SN 0.84, specificity (SP) 0.98, PPV 0.93 and negative predictive value (NPV) 0.96; medication and laboratory algorithm, SN 0.90, SP 0.95, PPV 0.80 and NPV 0.97; all document types algorithm, SN 0.95, SP 0.98, PPV 0.94 and NPV 0.99.DiscussionFree-text data-based diabetes algorithm can yield comparable or superior performance to a commonly used ICD-coded algorithm and could supplement existing methods. These types of inpatient EMR-based algorithms for case identification may become a key method for timely resource planning and care delivery.
Five-year follow-up of a phase 2 study of ibrutinib plus fludarabine, cyclophosphamide, and rituximab as initial therapy in CLL
Authors: Ahn Inhye E. , Brander Danielle M. , Ren Yue , Zhou Yinglu , Tyekucheva Svitlana , Walker Heather A. , Black Robert , Montegaard Josie , Alencar Alvaro , Shune Leyla , Omaira Mohammad , Jacobson Caron A. , Armand Philippe , Ng Samuel Y. , Crombie Jennifer , Fisher David C. , LaCasce Ann S. , Arnason Jon , Hochberg Ephraim P. , Takvorian Ronald W. , Abramson Jeremy S. , Brown Jennifer R. , Davids Matthew S. 
Published: January 2024

Abstract
We previously reported high rates of undetectable minimal residual disease &lt;10−4 (uMRD4) with ibrutinib plus fludarabine, cyclophosphamide, and rituximab (iFCR) followed by 2-year ibrutinib maintenance (I-M) in treatment-naïve chronic lymphocytic leukemia (CLL). Here, we report updated data from this phase 2 study with a median follow-up of 63 months. Of 85 patients enrolled, including 5 (6%) with deletion 17p or TP53 mutation, 91% completed iFCR and 2-year I-M. Five-year progression-free survival (PFS) and overall survival were 94% (95% confidence interval [CI], 89%-100%) and 99% (95% CI, 96%-100%), respectively. No additional deaths have occurred with this extended follow-up. No difference in PFS was observed by immunoglobulin heavy-chain variable region gene status or duration of I-M. High rates of peripheral blood (PB) uMRD4 were maintained (72% at the end of iFCR, 66% at the end of 2-year I-M, and 44% at 4.5 years from treatment initiation). Thirteen patients developed MRD conversion without clinical progression, mostly (77%) after stopping ibrutinib. None had Bruton tyrosine kinase (BTK) mutations. One patient had PLCG2 mutation. Six of these patients underwent ibrutinib retreatment per protocol. Median time on ibrutinib retreatment was 34 months. The cumulative incidence of atrial fibrillation was 8%. Second malignancy or nonmalignant hematologic disease occurred in 13%, mostly nonmelanoma skin cancer. Overall, iFCR with 2-year I-M achieved durably deep responses in patients with diverse CLL genetic markers. Re-emergent clones lacked BTK mutation and retained sensitivity to ibrutinib upon retreatment. This trial is registered at www.clinicaltrials.gov as #NCT02251548.
Effectiveness and safety of prophylactic anticoagulation among hospitalized patients with inflammatory bowel disease
Authors: Dawwas Ghadeer K. , Cuker Adam , Schaubel Douglas E. , Lewis James D. 
Published: January 2024

Abstract
Hospitalized patients with inflammatory bowel disease (IBD) are at increased risk of venous thromboembolism (VTE). We aimed to evaluate the effectiveness and safety of prophylactic anticoagulation compared with no anticoagulation in hospitalized patients with IBD. We conducted a retrospective cohort study using a hospital-based database. We included patients with IBD who had a length of hospital stay ≥2 days between 1 January 2016 and 31 December 2019. We excluded patients who had other indications for anticoagulation, users of direct oral anticoagulants, warfarin, therapeutic-intensity heparin, and patients admitted for surgery. We defined exposure to prophylactic anticoagulation using charge codes. The primary effectiveness outcome was VTE. The primary safety outcome was bleeding. We used propensity score matching to reduce potential differences between users and nonusers of anticoagulants and Cox proportional-hazards regression to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The analysis included 56 194 matched patients with IBD (users of anticoagulants, n = 28 097; nonusers, n = 28 097). In the matched sample, prophylactic use of anticoagulants (vs no use) was associated with a lower rate of VTE (HR, 0.62; 95% CI, 0.41-0.94) and with no difference in the rate of bleeding (HR, 1.05; 95% CI, 0.87-1.26). In this study of hospitalized patients with IBD, prophylactic use of heparin was associated with a lower rate of VTE without increasing bleeding risk compared with no anticoagulation. Our results suggest potential benefits of prophylactic anticoagulation to reduce the burden of VTE in hospitalized patients with IBD.
Development of an umbilical cord blood transplantation–specific nonrelapse mortality risk assessment score
Authors: Okada Yosuke , Usui Yoshiaki , Hayashi Hiromi , Nishikubo Masashi , Toubai Tomomi , Uchida Naoyuki , Tanaka Masatsugu , Onizuka Makoto , Takahashi Satoshi , Doki Noriko , Uehara Yasufumi , Maruyama Yumiko , Ishiwata Kazuya , Kawakita Toshiro , Sawa Masashi , Eto Tetsuya , Ishimaru Fumihiko , Kato Koji , Fukuda Takahiro , Atsuta Yoshiko , Kanda Junya , Yakushijin Kimikazu , Nakasone Hideki 
Published: January 2024

Abstract
Higher rate of nonrelapse mortality (NRM) remains yet to be resolved in umbilical cord blood transplantation (UCBT). Considering that UCBT has some unique features compared with allogeneic hematopoietic cell transplantation from other graft sources, a UCBT-specific NRM risk assessment system is required. Thus, in this study, we sought to develop a UCBT-specific NRM Risk Assessment (CoBRA) score. Using a nationwide registry database, we retrospectively analyzed 4437 recipients who had received their first single-unit UCBT. Using the backward elimination method, we constructed the CoBRA score in a training cohort (n = 2687), which consisted of recipients age ≥55 years (score 2), hematopoietic cell transplantation–specific comorbidity index ≥3 (score 2), male recipient, graft-versus-host disease prophylaxis other than tacrolimus in combination with methotrexate, performance status (PS) 2 to 4, HLA allele mismatch ≥ 2, refined Disease Risk Index high risk, myeloablative conditioning, and CD34+ cell doses &lt; 0.82 × 105/kg (score 1 in each). The recipients were categorized into 3 groups: low (0-4 points), intermediate (5-7 points), and high (8-11 points) groups according to the CoBRA score. In the validation cohort (n = 1750), the cumulative incidence of NRM at 2 years was 14.9%, 25.5%, and 47.1% (P &lt; .001), and 2-year overall survival (OS) was 74.2%, 52.7%, and 26.3% (P &lt; .001) in the low, intermediate, and high groups, respectively. In summary, the CoBRA score could predict the NRM risk as well as OS after UCBT. Further external validation will be needed to confirm the significance of the CoBRA score.
A thrombin-driven neural net diagnoses the antiphospholipid syndrome without the need for interruption of anticoagulation
Authors: de Laat-Kremers Romy M. W. , Wahl Denis , Zuily Stéphane , Ninivaggi Marisa , Regnault Véronique , Musial Jacek , de Groot Philip G. , Devreese Katrien M. J. , de Laat Bas 
Published: January 2024

Abstract
Thrombosis is an important manifestation of the antiphospholipid syndrome (APS). The thrombin generation (TG) test is a global hemostasis assay, and increased TG is associated with thrombosis. APS is currently diagnosed based on clinical and laboratory criteria, the latter defined as anti-cardiolipin, anti–β2-glycoprotein I antibodies, or lupus anticoagulant (LA). APS testing is often performed after a thrombotic episode and subsequent administration of anticoagulation, which might hamper the interpretation of clotting assays used for LA testing. We set out to develop an artificial neural network (NN) that can diagnose APS in patients who underwent vitamin K antagonist (VKA) treatment, based on TG test results. Five NNs were trained to diagnose APS in 48 VKA-treated patients with APS and 64 VKA-treated controls, using TG and thrombin dynamics parameters as inputs. The 2 best-performing NNs were selected (accuracy, 96%; sensitivity, 96%-98%; and specificity, 95%-97%) and further validated in an independent cohort of VKA-anticoagulated patients with APS (n = 33) and controls (n = 62). Independent clinical validation favored 1 of the 2 selected NNs, with a sensitivity of 88% and a specificity of 94% for the diagnosis of APS. In conclusion, the combined use of TG and NN methodology allowed for us to develop an NN that diagnoses APS with an accuracy of 92% in individuals with VKA anticoagulation (n = 95). After further clinical validation, the NN could serve as a screening and diagnostic tool for patients with thrombosis, especially because there is no need to interrupt anticoagulant therapy.
F3l: an automated and secure function-level low-overhead labeled encrypted traffic dataset construction method for IM in Android
Authors: Xu Keya , Cheng Guang 
Published: January 2024

AbstractFine-grained function-level encrypted traffic classification is an essential approach to maintaining network security. Machine learning and deep learning have become mainstream methods to analyze traffic, and labeled dataset construction is the basis. Android occupies a huge share of the mobile operating system market. Instant Messaging (IM) applications are important tools for people communication. But such applications have complex functions which frequently switched, so it is difficult to obtain function-level labels. The existing function-level public datasets in Android are rare and noisy, leading to research stagnation. Most labeled samples are collected with WLAN devices, which cannot exclude the operating system background traffic. At the same time, other datasets need to obtain root permission or use scripts to simulate user behavior. These collecting methods either destroy the security of the mobile device or ignore the real operation features of users with coarse-grained. Previous work (Chen et al. in Appl Sci 12(22):11731, 2022) proposed a one-stop automated encrypted traffic labeled sample collection, construction, and correlation system, A3C, running at the application-level in Android. This paper analyzes the display characteristics of IM and proposes a function-level low-overhead labeled encrypted traffic datasets construction method for Android, F3L. The supplementary method to A3C monitors UI controls and layouts of the Android system in the foreground. It selects the feature fields of attributes of them for different in-app functions to build an in-app function label matching library for target applications and in-app functions. The deviation of timestamp between function invocation and label identification completion is calibrated to cut traffic samples and map them to corresponding labels. Experiments show that the method can match the correct label within 3 s after the user operation.
Pre-existing knee osteoarthritis and severe joint depression are associated with the need for total knee arthroplasty after tibial plateau fracture in patients aged over 60 years
Authors: Gupta Shreya , Sadczuk Dominika , Riddoch Fraser I. , Oliver William M. , Davidson Ellie , White Tim O. , Keating John F. , Scott Chloe E. H. 
Published: January 2024

AimsThis study aims to determine the rate of and risk factors for total knee arthroplasty (TKA) after operative management of tibial plateau fractures (TPFs) in older adults.MethodsThis is a retrospective cohort study of 182 displaced TPFs in 180 patients aged ≥ 60 years, over a 12-year period with a minimum follow-up of one year. The mean age was 70.7 years (SD 7.7; 60 to 89), and 139/180 patients (77.2%) were female. Radiological assessment consisted of fracture classification; pre-existing knee osteoarthritis (OA); reduction quality; loss of reduction; and post-traumatic OA. Fracture depression was measured on CT, and the volume of defect estimated as half an oblate spheroid. Operative management, complications, reoperations, and mortality were recorded.ResultsNearly half of the fractures were Schatzker II AO B3.1 fractures (n = 85; 47%). Radiological knee OA was present at fracture in 59/182 TPFs (32.6%). Primary management was fixation in 174 (95.6%) and acute TKA in eight (4.4%). A total of 13 patients underwent late TKA (7.5%), most often within two years. By five years, 21/182 12% (95% confidence interval (CI) 6.0 to 16.7) had required TKA. Larger volume defects of greater depth on CT (median 15.9 mm vs 9.4 mm; p < 0.001) were significantly associated with TKA requirement. CT-measured joint depression of > 12.8 mm was associated with TKA requirement (area under the curve (AUC) 0.766; p = 0.001). Severe joint depression of > 15.5 mm (hazard ratio (HR) 6.15 (95% CI 2.60 to 14.55); p < 0.001) and pre-existing knee OA (HR 2.70 (95% CI 1.14 to 6.37); p = 0.024) were independently associated with TKA requirement. Where patients with severe joint depression of > 15.5 mm were managed with fixation, 11/25 ultimately required TKA.ConclusionOverall, 12% of patients aged ≥ 60 years underwent TKA within five years of TPF. Severe joint depression and pre-existing knee arthritis were independent risk factors for both post-traumatic OA and TKA. These features should be investigated as potential indications for acute TKA in older adults with TPFs.Cite this article: Bone Joint J 2024;106-B(1):28–37.
Cost-effectiveness analysis of a pragmatic randomized trial evaluating surgical reconstruction versus rehabilitation in patients with long-standing anterior cruciate ligament injury
Authors: Leal Jose , Mirza Burhan , Davies Loretta , Fletcher Heidi , Stokes Jamie , Cook Jonathan A. , Price Andrew , Beard David J. 
Published: January 2024

AimsThe aim of this study was to estimate the incremental use of resources, costs, and quality of life outcomes associated with surgical reconstruction compared to rehabilitation for long-standing anterior cruciate ligament (ACL) injury in the NHS, and to estimate its cost-effectiveness.MethodsA total of 316 patients were recruited and randomly assigned to either surgical reconstruction or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment). Healthcare resource use and health-related quality of life data (EuroQol five-dimension five-level health questionnaire) were collected in the trial at six, 12, and 18 months using self-reported questionnaires and medical records. Using intention-to-treat analysis, differences in costs, and quality-adjusted life years (QALYs) between treatment arms were estimated adjusting for baseline differences and following multiple imputation of missing data. The incremental cost-effectiveness ratio (ICER) was estimated as the difference in costs divided by the difference in QALYs between reconstruction and rehabilitation.ResultsAt 18 months, patients in the surgical reconstruction arm reported higher QALYs (0.052 (95% confidence interval (CI) -0.012 to 0.117); p = 0.177) and higher NHS costs (£1,017 (95% CI 557 to 1,476); p < 0.001) compared to rehabilitation. This resulted in an ICER of £19,346 per QALY with the probability of surgical reconstruction being cost-effective of 51% and 72% at a willingness-to-pay threshold of £20,000 and £30,000 per QALY, respectively.ConclusionSurgical reconstruction as a management strategy for patients with long-standing ACL injury is more effective, but more expensive, at 18 months compared to rehabilitation management. In the UK setting, surgical reconstruction is cost-effective.Cite this article: Bone Joint J 2024;106-B(1):38–45.
Wait-and-scan: an alternative for curettage in atypical cartilaginous tumours of the long bones
Authors: Scholte Claire H. J. , Dorleijn Desirée M. J. , Krijvenaar Duco T. , van de Sande Michiel A. J. , van Langevelde K. 
Published: January 2024

AimsDue to its indolent clinical behaviour, the treatment paradigm of atypical cartilaginous tumours (ACTs) in the long bones is slowly shifting from intralesional resection (curettage) and local adjuvants, towards active surveillance through wait-and-scan follow-up. In this retrospective cohort study performed in a tertiary referral centre, we studied the natural behaviour of ACT lesions by active surveillance with MRI. Clinical symptoms were not considered in the surveillance programme.MethodsThe aim of this study was to see whether active surveillance is safe regarding malignant degeneration and local progression. In total, 117 patients were evaluated with MRI assessing growth, cortical destruction, endosteal scalloping, periosteal reaction, relation to the cortex, and perilesional bone marrow oedema. Patients received up to six follow-up scans.ResultsAt the time of the first follow-up MRI, 8% of the lesions showed growth (n = 9), 86% remained stable (101), and 6% decreased in size (n = 7). During the third follow-up, with a mean follow-up time of 60 months (SD 23), 24 patients were scanned, of whom 13% had lesions that had grown and 13% lesions that had decreased in size. After 96 months (SD 37), at the sixth follow-up MRI, 100% of the lesions remained stable. None of the lesions showed malignant progression and although some lesions grew in size (mean 1 mm (SD 0.8)), no malignant progression occurred.ConclusionWe conclude that active surveillance with MRI is safe for ACTs in the long bones in the short- and mid-term follow-up.Cite this article: Bone Joint J 2024;106-B(1):86–92.
Evaluation of the trajectory of recovery following surgically treated acetabular fractures
Authors: Tucker Adam , Roffey Darren M. , Guy Pierre , Potter Jeffrey M. , Broekhuyse Henry M. , Lefaivre Kelly A. 
Published: January 2024

AimsAcetabular fractures are associated with long-term morbidity. Our prospective cohort study sought to understand the recovery trajectory of this injury over five years.MethodsEligible patients at a level I trauma centre were recruited into a longitudinal registry of surgical acetabular fractures between June 2004 and August 2019. Patient-reported outcome measures (PROMs), including the 36-Item Short Form Health Survey (SF-36) physical component summary (PCS), were recorded at baseline pre-injury recall and six months, one year, two years, and five years postoperatively. Comparative analyses were performed for elementary and associated fracture patterns. The proportion of patients achieving minimal clinically important difference (MCID) was determined. The rate of, and time to, conversion to total hip arthroplasty (THA) was also established.ResultsWe recruited 251 patients (253 fractures), with a 4:1 male to female ratio and mean age of 46.1 years (SD 16.4). Associated fracture patterns accounted for 56.5% of fractures (n = 143). Trajectory analysis showed all timepoints had significant disability versus baseline, including final follow-up (p < 0.001). Elementary fractures had higher SF-36 PCS at six months (p = 0.023) and one year (p = 0.007) compared to associated fractures, but not at two years (p = 0.135) or five years (p = 0.631). The MCID in SF-36 PCS was observed in 37.3% of patients (69/185) between six months and one year, 26.9% of patients (39/145) between one and two years, and 23.3% of patients (20/86) between two and five years, highlighting the long recovery potential of these injuries. A significant proportion of patients failed to attain the MCID after five years (38.1%; 40/105). Conversion to THA occurred in 13.1% of patients (11/110 elementary and 22/143 associated fractures). Approximately two-thirds of THAs (21/33 patients; 63.6%) were performed within two years of index surgery.ConclusionAcetabular fractures significantly impact physical function. Recovery trajectory is often elongated beyond one year, with two-thirds of our patients displaying persistent clinically relevant long-term disability.Cite this article: Bone Joint J 2024;106-B(1):69–76.
Reconstruction following oncological iliosacral resection
Authors: Broida Samuel E. , Tsoi Kim M. , Rose Peter S. , Ferguson Peter C. , Griffin Anthony M. , Wunder Jay S. , Houdek Matthew T. 
Published: January 2024

AimsThe sacroiliac joint (SIJ) is the only mechanical connection between the axial skeleton and lower limbs. Following iliosacral resection, there is debate on whether reconstruction of the joint is necessary. There is a paucity of data comparing the outcomes of patients undergoing reconstruction and those who are not formally reconstructed.MethodsA total of 60 patients (25 females, 35 males; mean age 39 years (SD 18)) undergoing iliosacral resection were reviewed. Most resections were performed for primary malignant tumours (n = 54; 90%). The mean follow-up for surviving patients was nine years (2 to 19).ResultsOverall, 27 patients (45%) were reconstructed, while 33 (55%) had no formal reconstruction. There was no difference in the use of chemotherapy (p = 1.000) or radiotherapy (p = 0.292) between the groups. Patients with no reconstruction had a mean larger tumour (11 cm (SD 5) vs 8 cm (SD 4); p = 0.014), mean shorter operating times (664 mins (SD 195) vs 1,324 mins (SD 381); p = 0.012), and required fewer blood units (8 (SD 7) vs 14 (SD 11); p = 0.012). Patients undergoing a reconstruction were more likely to have a deep infection (48% vs 12%; p = 0.003). Nine reconstructed patients had a hardware failure, with five requiring revision. Postoperatively 55 (92%) patients were ambulatory, with no difference in the proportion of ambulatory patients (89% vs 94%; p = 0.649) or mean Musculoskeletal Tumor Society Score (59% vs 65%; p = 0.349) score between patients who did or did not have a reconstruction. The ten-year disease-specific survival was 69%, with no difference between patients who were reconstructed and those who were not (78% vs 45%; p = 0.316). There was no difference in the rate of metastasis between the two groups (hazard ratio (HR) 2.78; p = 0.102).ConclusionOur results demonstrate that SIJ reconstruction is associated with longer operating times, greater need for blood transfusion, and more postoperative infections, without any improvement in functional outcomes when compared to patients who did not have formal SIJ reconstruction.Cite this article: Bone Joint J 2024;106-B(1):93–98.