bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Diabetes on Outcomes in Patients Hospitalized With Acute Myocardial Infarction: Insights From the Atherosclerosis Risk in Communities Study Community Surveillance
Authors: Jain Vardhmaan , Qamar Arman , Matsushita Kunihiro , Vaduganathan Muthiah , Ashley Kellan E. , Khan Muhammad Shahzeb , Bhatt Deepak L. , Arora Sameer , Caughey Melissa C. 
Published: May 2023

Background
Diabetes is associated with increased risk of acute myocardial infarction (AMI). The demographic trends, clinical presentation, management, and outcomes of patients with diabetes who are hospitalized with AMI have not been recently reported.

Methods and Results

The ARIC (Atherosclerosis Risk in Communities) study conducted hospital surveillance of AMI in 4 US communities. AMI was classified by physician review using a validated algorithm. Medications and procedures were abstracted from the medical record. From 2000 to 2014, 21 094 weighted hospitalizations for AMI were sampled. The prevalence of diabetes steadily increased, from 35% to 41% to 43% (
P
‐trend<0.0001) across 2000 to 2004, 2005 to 2009, and 2010 to 2014, respectively. Patients with diabetes were older (61 versus 59 years of age), more often Black (44% versus 31%), and more commonly women (42% versus 34%). The burden of cardiovascular comorbidities was higher with diabetes and increased temporally. Patients with diabetes less often presented with ST‐segment elevation (9% versus 17%) or acute chest pain (72% versus 80%), and had higher mean GRACE (Global Registry of Acute Coronary Syndrome) score (123 versus 109), Thrombolysis in Myocardial Ischemia (TIMI) score (4.3 versus 4.0), and Killip class (1.9 versus 1.5). Patients with diabetes had a lower adjusted probability of receiving aspirin (relative probability, 0.95 [95% CI, 0.91–0.99]), nonaspirin antiplatelets (0.93 [95% CI, 0.86–0.99]), coronary angiography (0.85 [95% CI, 0.78–0.92]), and coronary revascularization (0.85 [95% CI, 0.76–0.92]). Diabetes was associated with a 52% higher hazard of all‐cause 1‐year mortality (hazard ratio, 1.52 [95% CI, 1.23–1.89]).

Conclusions
Diabetes is associated with higher risk of death in patients hospitalized with AMI, highlighting the need for adherence to evidence‐based therapies in this high‐risk population.
Association of Normal Serum Uric Acid Level and Cardiovascular Disease in People Without Risk Factors for Cardiac Diseases in China
Authors: Tian Xue , Wang Penglian , Chen Shuohua , Zhang Yijun , Zhang Xiaoli , Xu Qin , Luo Yanxia , Wu Shouling , Wang Anxin 
Published: May 2023

Background
Healthy individuals with normal level of serum uric acid (SUA) may not be truly at the lowest risk of cardiovascular disease (CVD). This study aimed to assess the association of SUA levels with CVD and its subtypes in people without CVD risk factors and determine a suitable target of SUA to prevent CVD.

Methods and Results

We enrolled 25 284 participants who were free of CVD, absent of CVD risk factors, and with an SUA level between 180 and 359 μmol/L (3–6 mg/dL) at baseline from the Kailuan study. Cox proportional hazards models were applied to calculated adjusted hazard ratio (HR) and 95% CI for the risk of CVD and its subtypes. During a median follow‐up of 12.97 years (interquartile range, 12.68–13.16 years), we identified 1007 cases of CVD. There was an increase in the risk of incident CVD with increasing SUA levels (
P
trend
=0.0011). Compared with participants with SUA levels of 180 to 239 μmol/L (3–4 mg/dL), the HR of CVD was 1.12 (95% CI, 0.96–1.31) and 1.28 (95% CI, 1.08–1.52) for SUA levels of 240 to 299 μmol/L (4–5 mg/dL) and 300 to 359 μmol/L (5–6 mg/dL), respectively. A multivariable‐adjusted spline regression model showed a J‐shaped association between SUA and the risk of CVD. Similar results were observed for stroke and myocardial infarction.

Conclusions
The risk of incident CVD increased with elevating SUA levels among individuals without hyperuricemia or other traditional CVD risk factors. These findings highlighted the importance of primordial prevention for SUA level increase along with other traditional CVD risk factors.
The Effect of Self-Controlling Difficulty Levels in a Virtual Environment
Authors: Yuviler-Gavish Nirit , Ozery Ezra , Tarazi Ezri 
Published: May 2023

Abstract
In the current study we examine whether, in a virtual environment, self-controlling the difficulty level of a game will result in worse performance compared to a fixed difficulty level. Our hypothesis is evaluated using a novel VR game. Forty-five participants were randomly assigned to two between-participants groups: the Experimental group, in which the participant determined the desired level of difficulty in all five game sets by themselves, and the Controlled group, in which the level of difficulty was set to medium for all participants in all game sets. The results demonstrate that the mean difficulty level selected by the Experimental group was lower than medium in the first two sets, and higher than medium in the last three sets. In the last two sets, an earlier termination of the game and lower scores were demonstrated for the Experimental group compared to the Controlled group. The conclusions are that the participants in an unfamiliar virtual environment might not be able to select their difficulty levels to match the task at hand and might not optimize their learning zones.
Venous Thromboembolism Chemoprophylaxis Compliance in the Surgical Intensive Care Unit
Authors: Nichols Chance , Schellenberg Morgan , Lewis Meghan R. , Emigh Brent , Switzer Emily , Inaba Kenji 
Published: May 2023

Introduction Early initiation of venous thromboembolism chemoprophylaxis (VTEp) decreases VTE risk in trauma patients in the Surgical Intensive Care Unit (SICU). The frequency and variation of VTEp interruption by different surgical subspecialties in the SICU is incompletely described in the literature. The objective of this study was to examine VTEp compliance in the SICU in terms of uninterrupted VTEp following initiation, both by surgical service and time of year, to identify opportunities for improvement. Methods This single-center quality improvement (QI) study examined all SICU patients, which are almost exclusively trauma patients, at our institution (1/2021-04/2022). Exclusions were therapeutic anticoagulation. Type of VTEp, calendar month of SICU stay, perceived indications for interruption, and primary service were collected. Results Of 5 434 patient days (PD), VTEp was not administered in 1879 (35%). Common reasons for VTEp interruption were ongoing bleeding (n = 964 PD, 51%) and periprocedural status (n = 651 PD, 35%). Periprocedural interruption was highest in July. Acute Care Surgery (ACS) (n = 208 PD, 32%) and Orthopedics (n = 188 PD, 29%) interrupted VTEp most often. ACS most commonly withheld VTEp for second look laparotomies while Orthopedics withheld VTEp for intramedullary nailing or external fixator application. Conclusion Missed VTEp doses occurred most frequently at the beginning of the residency year, with a high percentage held for periprocedural status. Because the necessity of periprocedural VTEp holds is unclear, the appropriateness of these holds and any impact on VTE rates will be assessed as the next steps. In the interim, our findings provide targets for multidisciplinary QI endeavors.
Early Surgical Stabilization of Rib Fractures is Feasible in Patients With Non-Urgent Operative Pelvic Injuries
Authors: Ladhani Husayn A. , Harrell Kevin N. , Burlew Clay Cothren , van Wijck Suzanne F.M. , Smith Elizabeth F. , Coleman Julia R. , Horwood Chelsea , Werner Nicole L. , Lawless Ryan , Platnick Barry , Campion Eric , Moore Ernest E. , VanDerPloeg Daniel , Parry Joshua A. , Pieracci Fredric M. 
Published: May 2023

Introduction The feasibility of prioritizing surgical stabilization of rib fractures (SSRF) in patients with other injuries is unknown. The purpose of this study was to evaluate the timing and outcomes of SSRF between patients with and without non-urgent operative pelvic injuries. Patients and Methods In this retrospective observational study, all patients between 2010 and 2020 who underwent SSRF (SSRF group) and those who underwent SSRF and non-urgent operative management of pelvic fractures (SSRF + P group) were included. Demographics, injury characteristics, operative details, and outcomes were compared between the 2 groups. Results Over 11 years, 154 SSRF patients were identified, with 143 patients in the SSRF group (93%) and 11 patients in the SSRF + P group (7%). Median number of rib fractures (7 vs 9, P = .04), total number of fractures (11 vs 15, P < .01), and flail segment (54% vs 91%, P = .02) were higher in SSRF + P group. Median time to SSRF was similar (0 vs 1 day, P = .20) between the 2 groups. Median time to pelvic fixation was 3 days in SSRF + P group and 8 out of 11 patients (73%) underwent SSRF prior to pelvic fixation. Median operative time (137 vs 178 mins, P = .14) and median number of ribs plated (4 vs 5, P = .05) were higher in SSRF + P group. There was no difference in SSRF-related complications, pelvic fracture-related complications from operative positioning, rates of pneumonia, or mortality between the 2 groups. Conclusions SSRF can be performed early in patients with non-urgent operative pelvic injuries without a difference in pelvic fracture-related complications, SSRF-related complications, pneumonia, or mortality.
Prospective Study on Avoiding Seroma Formation by Flap Fixation After Modified Radical Mastectomy
Authors: Hakseven Musluh , Avşar Gökhan , Çetindağ Özhan , Deryol Rıza , Benk Mehmet Sah , Sırgancı Gözde , Culcu Serdar , Ünal Ali Ekrem , Bayar Sancar 
Published: May 2023

Introduction Seroma development after mastectomy is a common complication. Continued seroma causes increased outpatient visits, repeated aspirations, infection, delayed healing, delayed adjuvant therapy, and increased cost. Various treatments are being attempted to prevent and reduce seroma development. We examined the effects of flap fixation on seroma using absorbable sutures after modified radical mastectomy (MRM). Methods The prospectively recorded data of patients who underwent surgery for breast cancer were analyzed retrospectively. 72 consecutive patients who underwent MRM were included in the study. Patients who underwent MRM in the same way by the same surgeon were divided into two groups: the group whose wound was closed by fixing the flap to the chest wall with an absorbable suture (group A), and the group whose wound was closed with the classical method (group B). The groups were compared in terms of seroma development, clinicopathological data, and early complications. Results Drain removal time and the total amount of drained fluid in group A patients were significantly lower than drain removal time and the total amount of drained fluid in group B patients ( P < .001). Similarly, the amount of aspirated seroma in the control examinations of group A patients was significantly lower than that in group B ( P < .05). Group B needed re-aspiration significantly more than group A ( P < .05). Conclusions Flap fixation with suture after MRM is a method that reduces seroma formation and the amount of drained fluid, enables early removal of the drain, prevents delay in starting adjuvant treatment, is more comfortable for the patient and physician, and is also inexpensive.
Morphometric Analysis and Observer Perceptions Following Transvestibular Chondrolaryngoplasty
Authors: Ziltzer Ryan S. , Bellamkonda Nikhil , Smith Alden , Lee Justine C. , Mendelsohn Abie H. 
Published: May 2023

Objectives: To assess novel morphometric measurement strategies and observer perception ratings as potential metrics for evaluating gender-affirming transvestibular chondrolaryngoplasty in reducing contour protrusion of the neck. Methods: High-resolution preoperative and 3-month postoperative photographs of a pilot series of 10 patients (n = 10) who underwent endoscopic transvestibular chondrolaryngoplasty were collected. Morphometric measurements of “light reflex” and lateral view thyroid protrusion angles of the neck contours were analyzed. Pre- and postoperative photographs were presented in random order in a survey to 17 untrained judges and rated on perceived masculinity/femininity and thyroid notch protrusion on a 7-point scale. A pre- to postoperative change in morphometric angles and subjective ratings was assessed using paired t-tests and Wilcoxon signed-rank tests. Results: Mean light reflex angles were reduced after surgery from 78.6° to 40.5° in the anterior neutral view ( P = .0003), from 45.2° to 24.4° in the anterior extended view ( P = .003), and from 7.03° to 4.32° in the lateral view ( P = .006). Median survey ratings of neck photographs were improved after surgery, from 4 to 3 in gender perception toward more feminine perception ( P < .0001) and from 4 to 2 in thyroid protrusion toward less protrusive perception ( P < .0001). Conclusions: Morphometric analysis in anterior and lateral views as well as subjective gender perception and contour protrusion measures following feminization chondrolaryngoplasty by endoscopic transvestibular scarless approach demonstrate encouraging possibilities as outcome evaluation measures for chondrolaryngoplasty.
Task-sharing psychosocial interventions for the prevention of common mental disorders in the perinatal period in low- and middle-income countries: A systematic review and meta-analysis
Authors: Prina Eleonora , Ceccarelli Caterina , Abdulmalik Jibril O , Amaddeo Francesco , Cadorin Camilla , Papola Davide , Tol Wietse A , Lund Crick , Barbui Corrado , Purgato Marianna 
Published: May 2023

Aim: to assess the efficacy of psychosocial interventions delivered through task-sharing approaches for preventing perinatal common mental disorders among women in low- and middle-income countries. Methods: We conducted a systematic review of randomized controlled trials following a prespecified protocol registered in the Open Science Framework (osf.io/qt4y3). We searched MEDLINE, Web of Science, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) through June 2022. Two reviewers independently extracted the data and evaluated the risk of bias of included studies using the Cochrane risk of bias tool. We performed random-effects meta-analyses and rated the certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: We included 23 studies with 24,442 participants. At post-intervention, task-shared psychosocial interventions, were effective in preventing the development of mental disorders in general (RR 0.57, 95% CI [0.35, 0.91]), and specifically depression (RR 0.51, 95% CI [0.35, 0.75]), but not anxiety disorders (RR 0.46, 95% CI [0.06, 3.33]). Similarly, psychosocial interventions reduced psychological distress (SMD −1.32, 95% CI [−2.28, −0.35]), and depressive symptoms (SMD −0.50, 95% CI [−0.80, −0.16]), and increased parenting self-efficacy (SMD −0.76, 95% CI [−1.13, −0.38]) and social support (SMD −0.72, 95% CI [−1.22, −0.22]). No effect was detected for anxiety symptoms at post-intervention. At follow-up the beneficial effects of interventions progressively decreased. Conclusions: Psychosocial interventions delivered through the task-sharing modality are effective in preventing perinatal common mental disorders and fostering positive mental health among women in low- and middle-income countries. However, our findings are tentative, due to the low number of preventative intervention strategies considering outcomes as the incidence of mental disorders, especially in the long-term. This evidence supports calls to implement and scale up psychosocial prevention interventions for perinatal common mental disorders in low- and middle-income countries.
Determination of the minimal important difference for inspiratory muscle strength in people with severe and very severe COPD
Authors: Beaumont Marc , Couasnon Charles , Péran Loic , Berriet Anne Cécile , Ber Catherine Le , Pichon Romain 
Published: May 2023

Objective Inspiratory muscle training is recommended for people with chronic obstructive pulmonary disease (COPD) with inspiratory muscle weakness. Clinical interpretation of changes in inspiratory muscle strength could be helped by the determination of cut-off values. The aim of this study was to estimate the minimal important difference for inspiratory muscle strength assessed with maximal inspiratory pressure (MIP) in people with COPD. Design Post hoc analysis of a randomized controlled trial (EMI2 study) including people with severe to very severe COPD undergoing a pulmonary rehabilitation program was conducted. The determination of the minimal important difference was realized using both anchor-based and distribution-based methods. Setting The study includes patients admitted to the rehabilitation program unit of the Centre Hospitalier des Pays de Morlaix (Morlaix, France) between March 5, 2014 and September 8, 2016. Participants Seventy-three people with severe to very severe COPD (age 62.2  ±  8.0 years, forced expiratory volume in 1 s 36.4  ±  9.5% of theoretical) were analyzed. Intervention Patients followed a standardized pulmonary rehabilitation program 5 days a week for 4 weeks. The program included aerobic training, ground-based outdoor walking training, and strengthening of lower and upper limb muscles. Main measures At the end of the pulmonary rehabilitation program, MIP improved by 14.8  ±  14.9 cmH2O (p < 0.05). Regarding the anchor-based method, only the modified Medical Research Council was selected as an appropriate anchor. The receiver operating characteristic curve analysis reported a minimal important difference of 13.5 cmH2O (sensibility: 75% specificity: 67.5%). Using distribution-based methods, the estimate of minimal important difference was 7.9 cmH2O (standard error of measurement method) and 10.9 cmH2O (size effect method). Results The estimations proposed by this study ranged from 7.9 to 13.5 cmH2O. Conclusions The measurement of minimal important difference is a simple tool for assessing the changes of inspiratory muscle strength during a pulmonary rehabilitation program. We propose a minimal important difference of 13.5 cmH2O for the improvement of MIP. Further studies are needed to confirm this estimation. ClinicalTrials.gov identifier: NCT02074813
In Vitro Effects of Triamcinolone and Methylprednisolone on the Viability and Mechanics of Native Articular Cartilage
Authors: Fackler Nathan P. , Yareli-Salinas Evelia , Callan Kylie T. , Athanasiou Kyriacos A. , Wang Dean 
Published: May 2023

Background: The chondrotoxic effects of methylprednisolone acetate (MP) and triamcinolone acetonide (TA) have been well described. However, the mechanical effects of these commonly used steroids on native cartilage are largely unknown. Purpose: To investigate the in vitro effects of a single 1-hour MP or TA exposure on the viability, mechanics, and biochemical content of native articular cartilage explants. Study Design: Controlled laboratory study. Methods: Articular cartilage explants (n = 6 per group) were harvested from the femoral condyles of bovine stifles. Explants were exposed to chondrogenic medium containing a clinical dose of MP or TA for 1 hour, followed by fresh medium wash and exchange. Explants in the control group underwent the same treatment with chondrogenic medium alone. At 24 hours after treatment, samples were assessed for viability (live/dead), mechanical properties (creep indentation and Instron tensile testing), biochemical (collagen and glycosaminoglycan) content, and pyridinoline crosslinking via mass spectrometry. Results: Mean cell viability was significantly decreased in native explants exposed to MP (35.5%) compared with the control (49.8%; P < .001) and TA (45.7%; P = .01) specimens. Significant decreases were seen in the mechanical properties of steroid-treated native explants when compared with controls, with decreases in aggregate modulus (646.3 vs 312.8 kPa [MP] and 257.0 kPa [TA]; P < .001), shear modulus (370.1 vs 191.2 kPa [MP] and 157.4 kPa [TA]; P < .001), and ultimate tensile strength (9.650 vs 5.648 MPa [MP; P = .021] and 6.065 MPa [TA; P = .0403]). No significant differences in collagen and glycosaminoglycan content were found in the steroid-treated groups. Pyridinoline crosslinking was significantly decreased in explants exposed to TA compared with controls ( P = .027). Conclusion: Exposure of MP to articular cartilage explants was chondrotoxic, and exposure of articular cartilage explants to MP or TA resulted in significant decreases in mechanical properties of articular cartilage explants compared with controls. Clinicians should be judicious regarding use of intra-articular steroids, particularly in patients with intact healthy articular cartilage.
Lower Patellofemoral Joint Contact Force During Side-Step Cutting After Return-to-Sports Clearance Following Anterior Cruciate Ligament Reconstruction
Authors: San Jose Argell J. , Maniar Nirav , Whiteley Rodney , Opar David A. , Timmins Ryan G. , Kotsifaki Roula 
Published: May 2023

Background: Low patellofemoral joint (PFJ) contact force has been associated with PFJ osteoarthritis. Quadriceps force and knee flexion angles, which are typically altered after an anterior cruciate ligament reconstruction (ACLR), primarily influence PFJ contact forces. It is still inconclusive whether differences in PFJ contact forces are present during high knee flexion tasks such as side-step cutting after clearance to return to sports (RTS) after ACLR. Purpose: To explore PFJ contact forces in the ACLR limb and compare them with those of the contralateral and control limbs during side-step cutting tasks after clearance to RTS. Study Design: Controlled laboratory study. Methods: A total of 26 male athletes with ACLR who were previously cleared to RTS were matched with 23 healthy men serving as the control group. Three-dimensional motion capture and force plate data were collected while both groups performed anticipated side-step cutting tasks. Joint kinematics, kinetics, muscle forces, and PFJ contact forces were calculated using musculoskeletal modeling. Results: Peak PFJ force was lower in the ACLR limbs compared with the contralateral limbs (mean difference [MD], 5.89 body weight [BW]; 95% CI, 4.7-7.1 BW; P < .001) and the control limbs (MD, 4.44 BW; 95% CI, 2.1-6.8 BW; P < .001). During peak PFJ force, knee flexion angle was lower in ACLR limbs compared with the contralateral (MD, 4.88°; 95% CI, 3.0°-6.7°; P < .001) and control (MD, 6.01°; 95% CI, 2.0°-10.0°; P < .002) limbs. A lower quadriceps force compared with the contralateral (MD, 4.14 BW; 95% CI, 3.4-4.9 BW; P < .001) and control (MD, 2.83 BW; 95% CI, 1.4-4.3 BW; P < .001) limbs was also found. Conclusion: Lower PFJ contact forces and a combination of quadriceps force deficits and smaller knee flexion angle were found in the ACLR compared with the contralateral and control limbs even after clearance to RTS. Clinical Relevance: Despite rehabilitation and subsequent clearance to RTS, differences in PFJ contact forces are present after ACLR. Current rehabilitation and RTS battery may not be effective and sensitive enough to identify and address these differences.