bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standard patient training versus Vik-Asthme chatbot-guided training: ‘AsthmaTrain’ – a protocol for a randomised controlled trial for patients with asthma
Authors: Suehs Carey Meredith , Vachier Isabelle , Galeazzi David , Vaast François , Cardon Fanny , Molinari Nicolas , Bourdin Arnaud 
Published: February 2023

IntroductionTherapeutic education for patients with asthma has been shown to reduce asthma morbidity. The high availability of smart phones provides the opportunity to furnish patient training via specifically designed chatbot applications. The goal of this protocol is to perform a first pilot comparison of traditional face to face versus chatbot-guided patient therapeutic education programmes for patients with asthma.Methods and analysisEighty adult patients with a physician-confirmed diagnosis of asthma will be enrolled in a two-parallel-arm, randomised (1:1) controlled pilot trial. A single-Zelen consent procedure is deployed to first enrol all participants in the comparator arm, that is, the standard patient therapeutic education programme at the University Hospitals of Montpellier, France. This means of patient therapeutic education is based on reoccurring interviews and discussion with qualified nursing staff as per usual care. Following baseline data acquisition, randomisation will be performed. Those patients randomised to the comparator arm will not be informed of the second arm. Those patients randomised to the experimental arm will be proposed access to a specifically designed chatbot (Vik-Asthme) as the second tested means of patient training (refusals continue with standard training, though analysed as intention to treat). The primary outcome is change in the total Asthma Quality of Life Questionnaire score at the end of follow-up (6 months). Secondary outcomes cover asthma control, spirometry, general health status, programme adherence and burden for medical staff, exacerbations and medical resource use (medications, consults, emergency visits, hospitalisation and intensive care).Ethics and disseminationThis study (‘AsthmaTrain’ protocol version 4–20220330) has been approved by the Committee for the Protection of Persons Ile-de-France VII on 28 March 2022 (reference number 21.03617.000059). Enrolment began on 24 May 2022. Results will be published in international peer-reviewed journals.Trial registration numberNCT05248126.
Understanding barriers to using long-acting reversible contraceptives (LARCs) in primary care: a qualitative evidence synthesis
Authors: Linton Emma , Mawson Rebecca , Hodges Victoria , Mitchell Caroline Anne 
Published: February 2023

BackgroundLong-acting reversible contraceptives (LARCs) are highly effective. In primary care, LARCs are prescribed less frequently than user-dependent contraceptives despite higher efficacy rates. Unplanned pregnancies are rising in the UK, and LARCs may have a role in reducing these through and redressing inequitable contraceptive access. To provide contraceptive services that offer maximal choice and patient benefit, we must understand what contraception users and healthcare professionals (HCPs) think about LARCs and uncover barriers to their use.MethodsA systematic search using CINAHL, MEDLINE via Ovid, PsycINFO, Web of Science and EMBASE identified research about LARC use for pregnancy prevention in primary care. The approach adhered to the ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ methodology, critically appraised the literature, and used NVivo software to organise data and perform thematic analysis to determine key themes.ResultsSixteen studies met our inclusion criteria. Three themes were identified: (1) trustworthiness (where and from whom participants obtained information regarding LARCs), (2) control (whether LARCs detract from personal autonomy) and (3) systems (how HCPs influenced LARC access). Misgivings about LARCs frequently arose from social networks and fears of surrendering control over fertility were prominent. HCPs perceived access issues and lack of familiarity or training as the main barriers to prescribing LARCs.ConclusionsPrimary care plays a key role in improving access to LARC but barriers need to be addressed especially those involving misconception and misinformation. Access to LARC removal services are key to empower choice and prevent coercion. Facilitating trust within patient-centred contraceptive consult is essential.
What does the TIME study tell us about morning and evening dosing of antihypertensive medication?
Authors: Khong Teck K , Lin George S 
Published: February 2023

AbstractCommentary on:Mackenzie IS, Rogers A, Poulter NR,et al. Cardiovascular outcomes in adults with hypertension with evening vs morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial.Lancet. 2022;400:1417–25.
Does initial skeletal muscle size or sex affect the magnitude of muscle loss in response to 14 days immobilization?
Authors: Coffey Vernon G. , McGlory Chris , Phillips Stuart M. , Doering Thomas M. 
Published: February 2023

We aimed to determine whether there was a relationship between pre-immobilization skeletal muscle size and the magnitude of muscle atrophy following 14 days of unilateral lower limb immobilization. Our findings ( n = 30) show that pre-immobilization leg fat-free mass and quadriceps cross-sectional area (CSA) were unrelated to the magnitude of muscle atrophy. However, sex-based differences may be present, but confirmatory work is required. In women, pre-immobilization leg fat-free mass and CSA were associated with changes in quadriceps CSA after immobilization ( n = 9, r2 = 0.54–0.68; P < 0.05). The extent of muscle atrophy is not affected by initial muscle mass, but there is potential for sex-based differences.
Does the Functional Status of the Upper Limb Influence Limb Length Discrepancy in a Child with Birth Brachial Plexus Palsy?
Authors: BHARDWAJ Praveen , MALOKAR Dipak , SANKARAN Ajeesh , VARADHARAJAN Vigneswaran , VENKATRAMANI Hari , SABAPATHY S. Raja 
Published: February 2023

Background: Limb length discrepancy (LLD) is a frequent observation in children with birth brachial plexus palsy (BBPP) and a common concern among parents. A common assumption is that the LLD decreases if the child is using the involved limb more. However, there is no literature evidence for this assumption. The present study was conducted to assess the correlation between the functional status of the involved limb and the LLD in children with BBPP. Methods: One hundred consecutive patients (age > 5 years) with unilateral BBPP seen at our institute underwent measurements of limb lengths to assess the LLD. The arm, forearm and hand segments were measured separately. The functional status of the involved limb was assessed using modified House’s Scoring system (Scores 0–10). The correlation between limb length and functional status was assessed using the one-way Analysis of Variance (ANOVA) test. Post-hoc analyses were performed as required. Results: A length difference was observed in 98% of the limbs with brachial plexus lesions. The average absolute LLD was 4.6 cm with a standard deviation of 2.5 cm. We found a statistically significant difference in LLD among the patients with a House score of <7 (‘Poor function’) and 7 and above (‘Good function’; p < 0.001) with later indicative of independent use of the involved limb. We found no correlation between age and LLD. More extensive plexus involvement resulted in higher LLD. The maximal relative discrepancy was found in the hand segment of the upper extremity. Conclusions: LLD was seen in most of the patients with BBPP. The functional status of the involved upper limb in BBPP was found to be significantly associated with LLD. Though causation cannot be assumed. We found that children using the involved limb independently tend to have the least LLD. Level of Evidence: Level IV (Therapeutic)
Combined Inhibition of Smoothened and the DNA Damage Checkpoint WEE1 Exerts Antitumor Activity in Cholangiocarcinoma
Authors: Anichini Giulia , Raggi Chiara , Pastore Mirella , Carrassa Laura , Maresca Luisa , Crivaro Enrica , Lottini Tiziano , Duwe Lea , Andersen Jesper B. , Tofani Lorenzo , Di Tommaso Luca , Banales Jesus M. , Arcangeli Annarosa , Marra Fabio , Stecca Barbara 
Published: February 2023

AbstractCholangiocarcinoma (CCA) is characterized by resistance to chemotherapy and a poor prognosis. Therefore, treatments that can effectively suppress tumor growth are urgently needed. Aberrant activation of hedgehog (HH) signaling has been implicated in several cancers, including those of the hepatobiliary tract. However, the role of HH signaling in intrahepatic CCA (iCCA) has not been completely elucidated. In this study, we addressed the function of the main transducer Smoothened (SMO) and the transcription factors (TFs) GLI1 and GLI2 in iCCA. In addition, we evaluated the potential benefits of the combined inhibition of SMO and the DNA damage kinase WEE1. Transcriptomic analysis of 152 human iCCA samples showed increased expression of GLI1, GLI2, and Patched 1 (PTCH1) in tumor tissues compared with nontumor tissues. Genetic silencing of SMO, GLI1, and GLI2 inhibited the growth, survival, invasiveness, and self-renewal of iCCA cells. Pharmacologic inhibition of SMO reduced iCCA growth and viability in vitro, by inducing double-strand break DNA damage, leading to mitotic arrest and apoptotic cell death. Importantly, SMO inhibition resulted in the activation of the G2–M checkpoint and DNA damage kinase WEE1, increasing the vulnerability to WEE1 inhibition. Hence, the combination of MRT-92 with the WEE1 inhibitor AZD-1775 showed increased antitumor activity in vitro and in iCCA xenografts compared with single treatments. These data indicate that combined inhibition of SMO and WEE1 reduces tumor burden and may represent a strategy for the clinical development of novel therapeutic approaches in iCCA.
Coronary Artery Calcium Density and Cardiovascular Events by Volume Level: The MESA
Authors: Bhatia Harpreet S. , McClelland Robyn L. , Denenberg Julie , Budoff Matthew J. , Allison Matthew A. , Criqui Michael H. 
Published: February 2023

Background:
The Agatston coronary artery calcium (CAC) score provides robust cardiovascular disease risk prediction but upweights plaque area by a density factor. Density, however, has been shown to be inversely associated with events. Using CAC volume and density separately improves risk prediction, but it is unclear how to apply this method clinically. We aimed to evaluate the association between CAC density and cardiovascular disease across the spectrum of CAC volume to better understand how to incorporate these metrics into a single score.

Methods:
We performed an analysis of MESA (Multi-Ethnic Study of Atherosclerosis) participants with detectable CAC to evaluate the association between CAC density and events by level of CAC volume using multivariable Cox regression models.

Results:

In a cohort of 3316 participants, there was a significant interaction (
P
<0.001) between CAC volume and density for coronary heart disease (CHD) risk (myocardial infarction, CHD death, resuscitated cardiac arrest). Models using CAC volume and density resulted in improvement in the
C
-index (0.703, SE 0.012 versus 0.687, SE 0.013) and a significant net reclassification improvement (0.208 [95% CI, 0.102–0.306]) compared with the Agatston score for CHD risk prediction. Density was significantly associated with lower CHD risk at volumes ≤130 mm
3
(hazard ratio, 0.57 per unit of density [95% CI, 0.43–0.75]), but the inverse association at volumes >130 mm
3
was not significant (hazard ratio, 0.82 per unit of density [95% CI, 0.55–1.22]).

Conclusions:

The lower risk for CHD associated with higher CAC density varied by level of volume, and volume ≤130 mm
3
is a potentially clinically useful cut point. Further study is needed to integrate these findings into a unified CAC scoring method.
Contemporary Anatomic Criteria and Clinical Outcomes With Transcatheter Mitral Repair
Authors: Sorajja Paul , Sato Hirotomo , Bapat Vinayak N. , Cavalcante João L. , Bae Richard , Fukui Miho , Stanberry Larissa , Enriquez-Sarano Maurice 
Published: February 2023

Background:
Consensus-driven criteria have recently been proposed for prediction of mitral transcatheter edge-to-edge repair outcomes, yet validation for response to therapy is needed. We examined the relation between contemporary criteria and outcomes with mitral transcatheter edge-to-edge repair therapy.

Methods:
Mitral transcatheter edge-to-edge repair patients were classified according to anatomic and clinical criteria (1) Heart Valve Collaboratory criteria for nonsuitability; (2) commercial indications (suitable); and (3) neither (ie, intermediate). Analyses for Mitral Valve Academic Research Consortium–defined outcomes of reduction in mitral regurgitation and survival were performed.

Results:

Among 386 patients (median age, 82 years; 48% women), the most common classification was intermediate (46%), with 138 patients (36%) and 70 patients (18%) in the suitable and nonsuitable categories, respectively. Nonsuitable classification was related to prior valve surgery, smaller mitral valve area, type IIIa morphology, larger coaptation depth, and shorter posterior leaflet. Nonsuitable classification was associated with less technical success (
P
<0.001) and survival free of mortality, heart failure hospitalization, and mitral surgery (
P
<0.001). Among the nonsuitable patients, technical failure or any 30-day major adverse cardiac event occurred in 25.7%. Nevertheless, in these patients, acceptable mitral regurgitation reduction without adverse events still occurred in 69%, and their 1-year survival with mild or no symptoms was 52%.

Conclusions:
Contemporary classification criteria identify patients less suitable for mitral transcatheter edge-to-edge repair with respect to acute procedural success and survival, though patients most commonly fit an intermediate category. In experienced centers, sufficient mitral regurgitation reduction can be achieved safely in the selected patients even with challenging anatomy.
Influence of the Social Environment on Ideal Cardiovascular Health
Authors: Singh Sarah S. , Stranges Saverio , Wilk Piotr , Tang Anthony S. L. , Frisbee Stephanie J. 
Published: February 2023

Background
The environment plays a large role in the health of individuals; however, more research is needed to better understand aspects of the environment that most influence health. Specifically, our study examines how the social environment influences cardiovascular health (CVH).

Methods and Results
The social environment was characterized using measures of belonging and life and work stress in individuals, as well as nationally derived measures of marginalization, deprivation, economic status, and community well‐being in neighborhoods. CVH was defined by the American Heart Association's Cardiovascular Health Index—a summed score of 7 clinical and behavioral components known to have the greatest impact on CVH. Data were obtained from the Canadian Community Health Survey 2015 to 2016 and multiple national data sources. Multilevel regression models were used to analyze the associations between CVH and the social environment. Overall, 27% of Canadians reported ideal CVH (6–7 score points), 68% reported intermediate CVH (3–5 score points), and 5% reported poor CVH (0–2 score points). The neighborhood environment contributed up to 7% of the differences in CVH between individuals. Findings indicated that residing in a neighborhood with greater community well‐being (odds ratio [OR], 1.33 [95% CI, 1.26–1.41]) was associated with achieving higher odds of ideal CVH, while weaker community belonging (OR, 0.67 [95% CI, 0.62–0.72]) and residing in a neighborhood with greater marginalization (OR, 0.87 [95% CI, 0.82–0.91]) and deprivation (OR, 0.67 [95% CI, 0.64–0.69]) were associated with achieving lower odds of ideal CVH.

Conclusions
Aspects of individual‐level social environment and residing in a neighborhood with a more favorable social environment were both independently and significantly associated with achieving ideal CVH.
Racial, Ethnic, and Socioeconomic Inequities in Access to Left Atrial Appendage Occlusion
Authors: Reddy Kriyana P. , Eberly Lauren A. , Halaby Rim , Julien Howard , Khatana Sameed Ahmed M. , Dayoub Elias J. , Coylewright Megan , Alkhouli Mohamad , Fiorilli Paul N. , Kobayashi Taisei J. , Goldberg David M. , Santangeli Pasquale , Herrmann Howard C. , Giri Jay , Groeneveld Peter W. , Fanaroff Alexander C. , Nathan Ashwin S. 
Published: February 2023

Background
Inequitable access to high‐technology therapeutics may perpetuate inequities in care. We examined the characteristics of US hospitals that did and did not establish left atrial appendage occlusion (LAAO) programs, the patient populations those hospitals served, and the associations between zip code–level racial, ethnic, and socioeconomic composition and rates of LAAO among Medicare beneficiaries living within large metropolitan areas with LAAO programs.

Methods and Results

We conducted cross‐sectional analyses of Medicare fee‐for‐service claims for beneficiaries aged 66 years or older between 2016 and 2019. We identified hospitals establishing LAAO programs during the study period. We used generalized linear mixed models to measure the association between zip code–level racial, ethnic, and socioeconomic composition and age‐adjusted rates of LAAO in the most populous 25 metropolitan areas with LAAO sites. During the study period, 507 candidate hospitals started LAAO programs, and 745 candidate hospitals did not. Most new LAAO programs opened in metropolitan areas (97.4%). Compared with non‐LAAO centers, LAAO centers treated patients with higher median household incomes (difference of $913 [95% CI, $197–$1629],
P
=0.01). Zip code–level rates of LAAO procedures per 100 000 Medicare beneficiaries in large metropolitan areas were 0.34% (95% CI, 0.33%–0.35%) lower for each $1000 zip code–level decrease in median household income. After adjustment for socioeconomic markers, age, and clinical comorbidities, LAAO rates were lower in zip codes with higher proportions of Black or Hispanic patients.

Conclusions
Growth in LAAO programs in the United States had been concentrated in metropolitan areas. LAAO centers treated wealthier patient populations in hospitals without LAAO programs. Within major metropolitan areas with LAAO programs, zip codes with higher proportions of Black and Hispanic patients and more patients experiencing socioeconomic disadvantage had lower age‐adjusted rates of LAAO. Thus, geographic proximity alone may not ensure equitable access to LAAO. Unequal access to LAAO may reflect disparities in referral patterns, rates of diagnosis, and preferences for using novel therapies experienced by racial and ethnic minority groups and patients experiencing socioeconomic disadvantage.
Spatial Variations in Tropical Cyclone Rainfall over the Western North Pacific According to ENSO Phase
Authors: Kim Dasol , Park Doo-Sun R. , Matyas Corene J. 
Published: February 2023

Abstract
This study investigated spatial variations in rainfall accompanying tropical cyclones (TCs) over the western North Pacific (WNP) from June to October over 1998–2019 according to phases of El Niño–Southern Oscillation (ENSO). The rainfall characteristics of TCs include rainfall strength (RS) in the core region, total rainfall area (RA), and total rainfall volume (RV), all of which were calculated from satellite precipitation data. Spatial variation in mean RS presents a west–east dipole pattern (i.e., increases in the west of 125°E and decreases in the east during La Niña, and vice versa during El Niño) similar to that of maximum wind speed (Vmax), indicating a close relationship between them. On the other hand, both of mean RA and RV homogeneously increase during La Niña over the entire basin while they decrease during El Niño. The environmental conditions around TCs, including sea surface temperature, total column water, and divergence in the upper and lower troposphere during La Niña appear generally favorable for precipitation, while those during El Niño are unfavorable. Using multivariable regression models, we quantified the contributions of Vmax and environmental conditions to the variations in TC rainfall. Overall results suggest that the variation in RS according to ENSO are mainly related to Vmax, while those of RA and RV are strongly controlled by environmental conditions.
Prognostic factors for recurrence in patients with papillary thyroid carcinoma
Authors: Hakim Tawil José Antonio , Rojas María Fernanda , Santivañez Juan José , León Leonardo , González Devia Deyanira 
Published: February 2023

Background The prognostic factors for tumor recurrence and mortality of patients diagnosed with Papillary Thyroid Carcinoma (PTC) with immediate surgery in Colombia has not been reported. Objective To retrospectively evaluate the risk factors for recurrence and survival at 10 years in patients with the diagnosis of PTC treated at Fundación Santa Fe deBogota (FSFB). Methods A total of 486 patients with thyroid surgery accompanied by medical follow-up were recruited. Demographic, clinical, and pathological variables were followed-up for a median period of 10 years. Results The most significant variables for recurrence were tumors with > 4 cm of size (hazard ratio [HR] = 8.1; 95% confidence interval [CI] = 1.7–55) and extrathyroidal spread (HR = 26.7; 95% CI = 3.1–228). Conclusion PTC in our population has low rates of mortality (0.6%) and recurrence (9.6%), with an average time of recurrence of 3 years. Size of the lesion, positive surgical margins, extrathyroidal spread, and high postoperative serum thyroglobulin (Tg) level act as prognostic factors that determine the likelihood of recurrence. Unlike other studies, the influence of age and gender does not act as a prognostic factor.
Patient longevity and survival with custom-made endovascular solutions: The Fenestrated AnacondaTM approach
Authors: Jubouri Matti , Surkhi Abdelaziz O , Tan Sven Z C P , Bailey Damian M , Williams Ian M 
Published: February 2023

Background Endovascular aortic repair (EVAR) has become the mainstay treatment for abdominal aortic aneurysms and is associated with excellent clinical outcomes. However, there remains a risk of complications requiring reintervention. Several EVAR devices exist commercially, yet, the Terumo Aortic Fenestrated Anaconda™ has demonstrated outstanding results. The main scope of this study is to evaluate survival/longevity, target vessel patency (TVP), endograft migration and reintervention following Fenestrated Anaconda™ implantation and discuss relevant literature. Methods The current study represents a 9-year cross-sectional international analysis of custom-made Fenestrated Anaconda™ device. For the statistical analysis, SPSS 28 for Windows and R was utilised. Pearson Chi-Square analysis was used to assess differences in cumulative distribution frequencies between variables. Statistical significance for all two-tailed tests was set at p < 0.05. Results A total of 5058 patients received the Fenestrated Anaconda™ endograft. The Fenestrated Anaconda™ was indicated either due to complex anatomy for competitor devices ( n = 3891, 76.9%) or based on surgeon preference ( n = 1167, 23.1%). Both survival and TVP were 100% during the first 6 postoperative years but dropped to 77.1% and 81% thereafter. In the complex anatomy indication group, cumulative survival and TVP were both 100% until year 7 post-EVAR when they decreased to 82.8% and 75.7%. In the other indication group, survival and TVP were also 100% during the first 6 years but plateaued at 58.1% and 98.8% in years 7–9 of follow-up. No cases of endograft migration and reintervention were recorded. Conclusion The Fenestrated Anaconda™ has been proven across the literature to be a highly effective EVAR endograft, as it has demonstrated excellent survival/longevity and TVP as well as minimal endograft migration and reintervention.