bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of the diagnostic performance of twelve noninvasive scores of metabolic dysfunction-associated fatty liver disease
Authors: Zou Haoxuan , Ma Xiaopu , Zhang Fan , Xie Yan 
Published: September 2023

Abstract
Background
The absence of distinct symptoms in the majority of individuals with metabolic dysfunction-associated fatty liver disease (MAFLD) poses challenges in identifying those at high risk, so we need simple, efficient and cost-effective noninvasive scores to aid healthcare professionals in patient identification. While most noninvasive scores were developed for the diagnosis of nonalcoholic fatty liver disease (NAFLD), consequently, the objective of this study was to systematically assess the diagnostic ability of 12 noninvasive scores (METS-IR/TyG/TyG-WC/TyG-BMI/TyG-WtHR/VAI/HSI/FLI/ZJU/FSI/K-NAFLD) for MAFLD.

Methods
The study recruited eligible participants from two sources: the National Health and Nutrition Examination Survey (NHANES) 2017-2020.3 cycle and the database of the West China Hospital Health Management Center. The performance of the model was assessed using various metrics, including area under the receiver operating characteristic curve (AUC), net reclassification index (NRI), integrated discrimination improvement (IDI), decision curve analysis (DCA), and subgroup analysis.

Results
A total of 7398 participants from the NHANES cohort and 4880 patients from the Western China cohort were included. TyG-WC had the best predictive power for MAFLD risk in the NHANES cohort (AUC 0.863, 95% CI 0.855–0.871), while TyG-BMI had the best predictive ability in the Western China cohort (AUC 0.903, 95% CI 0.895–0.911), outperforming other models, and in terms of IDI, NRI, DCA, and subgroup analysis combined, TyG-WC remained superior in the NAHANES cohort and TyG-BMI in the Western China cohort.

Conclusions
TyG-BMI demonstrated satisfactory diagnostic efficacy in identifying individuals at a heightened risk of MAFLD in Western China. Conversely, TyG-WC exhibited the best diagnostic performance for MAFLD risk recognition in the United States population. These findings suggest the necessity of selecting the most suitable predictive models based on regional and ethnic variations.
A systematic review and meta‐analysis of randomised controlled trials of surgical treatments for ingrown toenails part II: healing time, post‐operative complications, pain, and participant satisfaction
Authors: Exley Victoria , Jones Katherine , O'Carroll Grace , Watson Judith , Backhouse Michael 
Published: September 2023

AbstractBackgroundWhen performing nail surgery, clinicians must choose from a multitude of procedures and variations within each procedure. Much has been published to guide this decision making, but there are a lack of up to date robust systematic reviews to assess the totality of this evidence.MethodsFive databases (MEDLINE, Embase, CINAHL, Web of Science and CENTRAL) and two registers (Clinicaltrials.gov and ISRCTN) were searched to January 2022 for randomised trials evaluating the effects of a surgical intervention(s) for ingrown toenails. Two independent reviewers screened records, extracted data, assessed risk of bias and certainty of evidence. Data on co‐primary outcomes of symptom relief and symptomatic regrowth were presented in our first paper. This paper presents data for the secondary outcomes and further discussion.ResultsOf 3,928 records identified, 36 randomised trials were included in the systematic review. Healing time appears to be reduced with shorter application of phenol. A reduced healing time was also apparent was with the addition of curettage, although this may also increase the risk of post‐operative bleeding and pain. Post operative bleeding was also reportedly lower in people who received local anaesthetic with epinephrine but no tourniquet. Use of phenol with nail bed excision may decrease the risk of infection. Lower pain scores were reported when using partial matrixectomy and surgical interventions with phenol. Shorter duration of pain was reported with phenolisation and wedge resection. Participant satisfaction was high overall.ConclusionThis second paper reports secondary outcomes from a robust systematic review of randomised trials on surgical treatment of ingrown toenails. Despite the large volume of clinical trials conducted on the topic, few clinical conclusions can be drawn due to the poor quality of these studies. Further high‐quality clinical trials are needed to answer fundamental questions in the surgical treatment of ingrown toenails.
Autistic adults benefit from and enjoy learning via social interaction as much as neurotypical adults do
Authors: De Felice S. , Hatilova A. , Trojan F. , Tsui I. , Hamilton Antonia F. de C. 
Published: September 2023

Abstract
Background
Autistic people show poor processing of social signals (i.e. about the social world). But how do they learn via social interaction?

Methods
68 neurotypical adults and 60 autistic adults learned about obscure items (e.g. exotic animals) over Zoom (i) in a live video-call with the teacher, (ii) from a recorded learner-teacher interaction video and (iii) from a recorded teacher-alone video. Data were analysed via analysis of variance and multi-level regression models.

Results
Live teaching provided the most optimal learning condition, with no difference between groups. Enjoyment was the strongest predictor of learning: both groups enjoyed the live interaction significantly more than other condition and reported similar anxiety levels across conditions.

Limitations
Some of the autistic participants were self-diagnosed—however, further analysis where these participants were excluded showed the same results. Recruiting participants over online platforms may have introduced bias in our sample. Future work should investigate learning in social contexts via diverse sources (e.g. schools).

Conclusions
These findings advocate for a distinction between learning about the social versus learning via the social: cognitive models of autism should be revisited to consider social interaction not just as a puzzle to decode but rather a medium through which people, including neuro-diverse groups, learn about the world around them.
Trial registration Part of this work has been pre-registered before data collection https://doi.org/10.17605/OSF.IO/5PGA3
The “real life” efficacy of dupilumab is independent of initial polyp size and concomitant steroids in CRSwNP
Authors: Campion Nicholas J. , Brugger Jonas , Tu Aldine , Stanek Victoria , Brkic Faris F. , Bartosik Tina J. , Liu David T. , Hoehl Bruna S. , Gangl Katharina , Eckl-Dorna Julia , Schneider Sven 
Published: September 2023

Background Dupilumab significantly improves symptom control in chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with large polyps at the initiation of treatment (total polyp score (TPS) ≥ 5) have been the focus in published studies. Patients with significant burden of disease but small polyps (TPS ≤ 4) have not yet been evaluated for clinical response. This study set out to evaluate the benefit of dupilumab treatment on cohorts of small (TPS ≤ 4) compared to large polyps (TPS ≥ 5). Furthermore, benefit of concomitant oral and/or nasal steroid therapy has been evaluated. Methods 97 patients with CRSwNP, who were begun on dupilumab between January 2020 and October 2021, were included. All patients were followed-up for 6 months. At each visit they underwent nasal endoscopy, smell identification tests and filled out validated patient questionnaires. Results Significant drops in TPS were seen in both patient groups after 6 months of therapy, dropping from a median score of 3 to 0 and from 6 to 2 in patients with small and large polyps respectively. Furthermore, a linear mixed model calculated a drop of 22% and 24% in TPS per month in patients with small and large polyps respectively with no significant difference in rate of decline. Finally the model showed that neither oral nor nasal steroids influenced the rate of response to dupilumab therapy. Conclusions Polyp size at the initiation of dupilumab therapy and whether patients continue to take steroid therapy does not appear to influence effectiveness of dupilumab treatment.
Assessing different measures of fire risk for Cultural World Heritage Sites
Authors: Falk Martin Thomas , Hagsten Eva 
Published: September 2023

Abstract
This study aims to assess whether two publicly available sources of fire threats to 346 Cultural World Heritage Sites across Europe substitute or complement each other. By doing so, a novel measure based on information from the UNESCO periodic report II is created and benchmarked against the European forest fire information system (EFFIS) index. The UNESCO periodic report shows that forest fires are perceived as an actual or foreseeable hazard by 40% of the management of Cultural World Heritage Sites in Europe. When the EFFIS index is linked to the UNESCO World Heritage database, it occurs that 48% of these sites are at high risk of fire, 31% at medium risk and 21% at low risk. Results based on Probit and Fractional Probit estimations reveal that the perceived fire risk relates to several site characteristics as well as location. The regressions using the EFFIS index as dependent variable show indifference to site characteristics even if location is of importance. Estimations give that the perceived fire risk is highest for sites in the East and the North of Europe, while the results for the EFFIS index lead to a dominant risk in the South. A 10° increase in latitude (corresponding to the distances between Vienna and Stockholm or Athens and Vienna) leads to a considerable decrease in the proportion of high fire risk by 28 percentage points (with a sample mean of 48%). Thus, the two measures of fire risks complement rather than substitute each other. Latitude is of no importance for the site managers, although the EFFIS gives this aspect a heavy weight, with low or zero risks in locations at higher latitudes (Iceland, Ireland, Latvia, and Norway) and larger risks in Southern Europe (Cyprus, Malta, Portugal, Albania, Spain, and Greece). In addition, the perception of (wild)-fire threat is significantly lower for cities.
Comparison of balanced and unbalanced crystalloids as resuscitation fluid in patients treated for cardiogenic shock
Authors: Gmeiner Jonas , Bulach Bernhardt , Lüsebrink Enzo , Binzenhöfer Leonhard , Kupka Danny , Stocker Thomas , Löw Kornelia , Weckbach Ludwig , Rudi Wolf-Stephan , Petzold Tobias , Kääb Stefan , Hausleiter Jörg , Hagl Christian , Massberg Steffen , Orban Martin , Scherer Clemens 
Published: September 2023

Abstract
Background
The efficacy and safety of saline versus balanced crystalloid solutions in ICU-patients remains complicated by exceptionally heterogenous study population in past comparative studies. This study sought to compare saline and balanced crystalloids for fluid resuscitation in patients with cardiogenic shock with or without out-of-hospital cardiac arrest (OHCA).

Methods
We retrospectively analyzed 1032 propensity score matched patients with cardiogenic shock from the Munich University Hospital from 2010 to 2022. In 2018, default resuscitation fluid was changed from 0.9% saline to balanced crystalloids. The primary endpoint was defined as 30-day mortality rate.

Results
Patients in the saline group (n = 516) had a similar 30-day mortality rate as patients treated with balanced crystalloids (n = 516) (43.1% vs. 43.0%, p = 0.833), but a higher incidence of new onset renal replacement therapy (30.2% vs 22.7%, p = 0.007) and significantly higher doses of catecholamines. However, OHCA-patients with a lactate level higher than 7.4 mmol/L had a significantly lower 30-day mortality rate when treated with saline (58.6% vs. 79.3%, p = 0.013). In addition, use of balanced crystalloids was independently associated with a higher mortality in the multivariate cox regression analysis after OHCA (hazard ratio 1.43, confidence interval: 1.05–1.96, p = 0.024).

Conclusions
In patients with cardiogenic shock, use of balanced crystalloids was associated with a similar all-cause mortality at 30 days but a lower rate of new onset of renal replacement therapy. In the subgroup of patients after OHCA with severe shock, use of balanced crystalloids was associated with a higher mortality than saline.
Trial registration: LMUshock registry (WHO International Clinical Trials Registry Platform Number DRKS00015860).
Impaired parasympathetic function in long-COVID postural orthostatic tachycardia syndrome – a case-control study
Authors: Rigo Stefano , Urechie Vasile , Diedrich Andrè , Okamoto Luis E. , Biaggioni Italo , Shibao Cyndya A. 
Published: September 2023

Abstract
Purpose
Eighty percent of patients infected by SARS-CoV-2 report persistence of one symptom beyond the 4-week convalescent period. Those with orthostatic tachycardia and orthostatic symptoms mimicking postural tachycardia syndrome, they are defined as Long-COVID POTS [LCP]. This case-control study investigated potential differences in autonomic cardiovascular regulation between LCP patients and healthy controls.

Methods
Thirteen LCP and 16 healthy controls, all female subjects, were studied without medications. Continuous blood pressure and ECG were recorded during orthostatic stress test, respiratory sinus arrhythmia, and Valsalva maneuver. Time domain and power spectral analysis of heart rate [HR] and systolic blood pressure [SBP] variability were computed characterizing cardiac autonomic control and sympathetic peripheral vasoconstriction.

Results
LCP had higher deltaHR (+ 40 ± 6 vs. + 21 ± 3 bpm, p = 0.004) and deltaSBP (+ 8 ± 4 vs. -1 ± 2 mmHg, p = 0.04) upon standing; 47% had impaired Valsalva maneuver ratio compared with 6.2% in controls (p = 0.01). Spectral analysis revealed that LCP had lower RMSSD (32.1 ± 4.6 vs. 48.9 ± 6.8 ms, p = 0.04) and HFRRI, both in absolute (349 ± 105 vs. 851 ± 253ms2, p = 0.03) and normalized units (32 ± 4 vs. 46 ± 4 n.u., p = 0.02). LFSBP was similar between groups.

Conclusions
LCP have reduced cardiovagal modulation, but normal sympathetic cardiac and vasoconstrictive functions. Impaired parasympathetic function may contribute to the pathogenesis of Long-COVID POTS syndrome.
A protocol for the development and validation of a virtual reality-based clinical test of social cognition
Authors: Matre M , Johansen T , Olsen A , Tornås S , Martinsen AC , Lund A , Becker F , Brunborg C , Spikman J , Ponsford J , Neumann D , McDonald S , Løvstad M 
Published: September 2023

Abstract
Background
Impairments in social cognition are common after traumatic brain injury (TBI) and may have severe negative consequences for patients and their families. Most tests of social cognition have limited ecological validity due to simplistic and contrived social stimuli with limited relevance to everyday social functioning. There is a need for measures of social cognition that reflect the dynamic, multimodal and contextualized nature of social situations and that predict real-world functioning. Three hundred sixty–degree (360°) Virtual Reality (VR) video can increase ecological validity through enhanced social presence, or a sense of “being there”. This paper describes the development and protocol design for validation of a Norwegian VR-version of The Awareness of Social Inference Test (TASIT), which is a widely used video-based test of social cognition.

Methods
Development of VR TASIT included filming 61 short videos depicting social interactions in both VR and desktop format, using a 360° camera. Software for standardized test administration and collection of performance data was developed in Unity, for administration on both VR and desktop interface. The validation study will test the reliability and validity of VR TASIT in participants with TBI (n = 100) and healthy controls (n = 100). Half of the participants will perform the desktop version, and the other half the VR version. Analyses will include known groups validity, convergent and divergent validity, as well as test–retest reliability of VR TASIT. A comparison of the ability of TASIT VR and desktop versions to predict real-world functioning (ecological validity) will be explored using the Social Skills Questionnaire for TBI and La Trobe Communication Questionnaire. Finally, the levels of perceived social presence of the stimulus materials and prevalence of cybersickness after exposure to the virtual environment will be documented.

Discussion
It is expected that VR TASIT will have comparable or better psychometric properties than the desktop version, and that the hypothesized increased level of social presence experienced in a virtual environment will result in improved ecological validity. More broadly, benefits and limitations of using VR video as stimulus material in assessment of social cognition and considerations for future development and clinical validation are discussed.

Trial registration
The study protocol was pre-registered in ClinicalTrials (April 4th 2022, NCT05309005). The study was retrospectively registered in Open Science Framework (December 15th 2022, osf.io/2vem8).
Does Anesthesia Quality Improvement Participation Lead to Incremental Savings in a Surgical Quality Collaborative Population? A Retrospective Observational Study
Authors: Janda Allison M. , Vaughn Michelle T. , Colquhoun Douglas A. , Mentz Graciela , Buehler Kathryn , Nathan Hari , Regenbogen Scott E. , Syrjamaki John , Kheterpal Sachin , Shah Nirav 
Published: September 2023

BACKGROUND:
The Anesthesiology Performance Improvement and Reporting Exchange (ASPIRE) Collaborative Quality Initiative (CQI) was launched as a partnership among hospitals to measure quality, review evidence-based practices, and improve anesthesia-related outcomes. Cost savings and improved patient outcomes have been associated with surgical CQI participation, but the impact of an anesthesia CQI on health care cost has not been thoroughly assessed. In this study, we evaluated whether participation in an anesthesia CQI led to health care savings. We hypothesized that ASPIRE participation is associated with reduced total episode payments for payers and major, high-volume procedures included in the Michigan Value Collaborative (MVC) registry.

METHODS:
In this retrospective observational study, we compared MVC episode payment data from Group 1 ASPIRE hospitals, the first cluster of 8 Michigan hospitals to join ASPIRE in January 2015, to non-ASPIRE matched control hospitals. MVC computes price-standardized, risk-adjusted payments for patients insured by Blue Cross Blue Shield of Michigan Preferred Provider Organization, Blue Care Network Health Maintenance Organization, and Medicare Fee-for-Service plans. Episodes from 2014 comprised the pre-ASPIRE time period, and episodes from June 2016 to July 2017 constituted the post-ASPIRE time period. We performed a difference-in-differences analysis to evaluate whether ASPIRE implementation was associated with greater reduction in total episode payments compared to the change in the control hospitals during the same time periods.

RESULTS:
We found a statistically significant reduction in total episode (−$719; 95% CI [−$1340 to −$97]; P = .023) payments at the 8 ASPIRE hospitals (N = 17,852 cases) compared to the change observed in 8 matched non-ASPIRE hospitals (N = 12,987 cases) for major, high-volume surgeries, including colectomy, colorectal cancer resection, gastrectomy, esophagectomy, pancreatectomy, hysterectomy, joint replacement (knee and hip), and hip fracture repair. In secondary analyses, 30-day postdischarge (−$354; 95% CI [−$582 to −$126]; P = .002) payments were also significantly reduced in ASPIRE hospitals compared to non-ASPIRE controls. Subgroup analyses revealed a significant reduction in total episode payments for joint replacements (−$860; 95% CI [−$1222 to −$499]; P < .001) at ASPIRE-participating hospitals. Sensitivity analyses including patient-level covariates also showed consistent results.

CONCLUSIONS:
Participation in an anesthesiology CQI, ASPIRE, is associated with lower total episode payments for selected major, high-volume procedures. This analysis supports that participation in an anesthesia CQI can lead to reduced health care payments.
Perioperative Anesthesia-Related Complications and Risk Factors in Children: A Cross-Sectional Observation Study in Rwanda
Authors: Nizeyimana Francoise , Skelton Teresa , Bould M. Dylan , Beach Michael , Twagirumugabe Theogene 
Published: September 2023

BACKGROUND:
Despite an increasing awareness of the unmet burden of surgical conditions, information on perioperative complications in children remains limited especially in low-income countries such as Rwanda. The objective of this study was to estimate the prevalence of perioperative anesthesia-related adverse events and to explore potential risk factors associated with them among pediatric surgical patients in public referral hospitals in Rwanda.

METHODS:
Data were collected for all patients under 5 years of age undergoing surgery in 3 public referral hospitals in Rwanda from June to December 2015. Patient and family history, type of surgery, comorbidities, anesthesia technique, intraoperative adverse events and postoperative events in the postanesthesia care unit (PACU) were recorded. The incidence of perioperative adverse events was assessed and associated risk factors analyzed with univariate logistic regression.

RESULTS:
Of 354 patients enrolled in this study 11 children had a cardiac arrest. Six (1.7%) suffered an intraoperative cardiac arrest, 2 of whom (0.6%) died intraoperatively. In the PACU, 6 (1.8%) suffered a postoperative cardiac arrest, 5 of whom (1.5%) died in the PACU. One child had both an intraoperative cardiac arrest and then a cardiac arrest in PACU but survived. Eighty-nine children (25.1%) had an intraoperative adverse event, whereas 67 (20.6%) had an adverse event in PACU. A review of the cases where cardiac arrest or death occurred indicated that there were significant lapses in the expected standard of care. Age <1 week was associated with cardiac arrest or death.

CONCLUSIONS:
The rate of perioperative complications, including death, for children undergoing surgery in tertiary care hospitals in Rwanda was high. Quality improvement measures are needed to decrease this rate among surgical pediatric patients in this low resource setting.
Expression and function of four AAV-based constructs for dystrophin restoration in the mdx mouse model of Duchenne muscular dystrophy
Authors: Potter Rachael A. , Griffin Danielle A. , Heller Kristin N. , Mendell Jerry R. , Rodino-Klapac Louise R. 
Published: September 2023

ABSTRACT
Robust expression of shortened, functional dystrophin provided impetus to develop adeno-associated virus (AAV)–based constructs for clinical application. Because several cassettes are being tested in clinical trials, this study compared the efficacies of four shortened dystrophin-promoter combinations with implications for outcomes in clinical trials: MHCK7 or MCK promoter with a shortened dystrophin transgene containing the N-terminus and spectrin repeats R1, R2, R3 and R24 (rAAVrh74.MHCK7.micro-dystrophin and rAAVrh74.MCK.micro-dystrophin, respectively); shortened dystrophin construct containing the neuronal nitric oxide (nNOS) binding site (rAAVrh74.MHCK7.DV.mini-dystrophin); and shortened dystrophin containing the C-terminus (rAAVrh74.MHCK7.micro-dystrophin.Cterm). Functional and histological benefit were examined at 4 weeks following intramuscular delivery in mdx mice. rAAVrh74.MHCK7.micro-dystrophin provided the most robust transgene expression and significantly increased specific force output in the tibialis anterior muscle. Muscle environment was normalized (i.e. reductions in central nucleation), indicating functional and histological advantages of rAAVrh74.MHCK7.micro-dystrophin. Thus, promoter choice and transgene design are critical for optimal dystrophin expression/distribution for maximal functional improvement.