bluuebunny/crossref_metadata_2025_split huggingface dataset:
Disparate Cardiovascular Hospitalization Trends Among Young and Middle‐Aged Adults Within and Across Race and Ethnicity Groups in Four States in the United States
Authors: Akhabue Ehimare , Rua Melanie , Gandhi Poonam , Kim Jung Hyun , Cantor Joel C. , Setoguchi Soko 
Published: December 2022

Background
Inpatient hospitalizations for cardiovascular disease (CVD) decreased nationally in the past decade. However, data are lacking on whether national declines represent trends within and across race and ethnicity populations from different US regions.

Methods and Results

Using State Inpatient Databases, Census Bureau and Behavioral Risk Factor Surveillance System data for Florida, Kentucky, New Jersey, and North Carolina, we identified all CVD hospitalizations and population characteristics for adults aged 18 to 64 years between January 1, 2009 and December 31, 2018. We calculated yearly CVD hospitalization rates for each state for the overall population, by sex, race, and ethnicity. We modeled yearly trends in age‐adjusted CVD hospitalization rate in each state using negative binomial regression. State base populations were similar by age (mean age: 40–42 years) and sex (50%–51% female) throughout the study period. There were 314 973 and 288 843 total CVD hospitalizations among the 4 states in 2009 and 2018, respectively. Crude hospitalization rates declined in all states (age 18–44 years NJ: −33.4%; KY: −17.0%; FL: −11.9%; NC: −11.2%; age 45–64 years NJ: −29.8%; KY: −20.3%; FL: −12.2%; NC: −11.6%) over the study period. In age‐adjusted models, overall hospitalization rates declined significantly in NJ −2.5%/y (95% CI, −2.9 to −2.1) and in KY −1.6%/y (−1.9 to −1.2) with no significant declining trend in FL and NC. Similar findings were present by sex. Among non‐Hispanic White populations, mean yearly decline in hospitalization rate was significant in all states except FL, with the greatest declines in NJ (−3.8%/y [−4.4 to −3.2],
P
values for state−year interaction <0.0001). By contrast, a significant declining trend was present for non‐Hispanic Black and Hispanic populations only in NJ (
P
values for state−year interaction <0.001). We found similar differences in trend between states in sensitivity analyses incorporating additional demographic and comorbid characteristics.

Conclusions
Decreases in CVD hospitalization rates in the past decade among nonelderly adults varied considerably by state and appeared largely driven by declines among non‐Hispanic White populations. Overall declines did not represent divergent trends between states within non‐Hispanic Black and Hispanic populations. Recognition of differences not just between but also within race and ethnicity populations should inform national and local policy initiatives aimed at reducing disparities in CVD outcomes.
Association of Incidentally Discovered Covert Cerebrovascular Disease Identified Using Natural Language Processing and Future Dementia
Authors: Kent David M. , Leung Lester Y. , Zhou Yichen , Luetmer Patrick H. , Kallmes David F. , Nelson Jason , Fu Sunyang , Puttock Eric J. , Zheng Chengyi , Liu Hongfang , Chen Wansu 
Published: December 2022

Background
Covert cerebrovascular disease (CCD) has been shown to be associated with dementia in population‐based studies with magnetic resonance imaging (MRI) screening, but dementia risk associated with incidentally discovered CCD is not known.

Methods and Results

Individuals aged ≥50 years enrolled in the Kaiser Permanente Southern California health system receiving head computed tomography (CT) or MRI for nonstroke indications from 2009 to 2019, without prior ischemic stroke/transient ischemic attack, dementia/Alzheimer disease, or visit reason/scan indication suggestive of cognitive decline or stroke were included. Natural language processing identified incidentally discovered covert brain infarction (id‐CBI) and white matter disease (id‐WMD) on the neuroimage report;
white matter disease
was characterized as mild, moderate, severe, or undetermined. We estimated risk of dementia associated with id‐CBI and id‐WMD.

Among 241 050 qualified individuals,
natural language processing
identified 69 931 (29.0%) with id‐WMD and 11 328 (4.7%) with id‐CBI. Dementia incidence rates (per 1000 person‐years) were 23.5 (95% CI, 22.9–24.0) for patients with id‐WMD, 29.4 (95% CI, 27.9–31.0) with id‐CBI, and 6.0 (95% CI, 5.8–6.2) without id‐CCD. The association of id‐WMD with future dementia was stronger in younger (aged <70 years) versus older (aged ≥70 years) patients and for CT‐ versus MRI‐discovered lesions. For patients with versus without id‐WMD on CT, the adjusted HR was 2.87 (95% CI, 2.58–3.19) for younger and 1.87 (95% CI, 1.79–1.95) for older patients. For patients with versus without id‐WMD on MRI, the adjusted HR for dementia risk was 2.28 (95% CI, 1.99–2.62) for younger and 1.48 (95% CI, 1.32–1.66) for older patients. The adjusted HR for id‐CBI was 2.02 (95% CI, 1.70–2.41) for younger and 1.22 (95% CI, 1.15–1.30) for older patients for either modality. Dementia risk was strongly correlated with id‐WMD severity; adjusted HRs compared with patients who were negative for id‐WMD by MRI ranged from 1.41 (95% CI, 1.25–1.60) for those with mild disease on MRI to 4.11 (95% CI, 3.58–4.72) for those with severe disease on CT.

Conclusions
Incidentally discovered CCD is common and associated with a high risk of dementia, representing an opportunity for prevention. The association is strengthened when discovered at younger age, by increasing id‐WMD severity, and when id‐WMD is detected by CT scan rather than MRI.
Ross Procedure Versus Mechanical Versus Bioprosthetic Aortic Valve Replacement: A Network Meta‐Analysis
Authors: Yokoyama Yujiro , Kuno Toshiki , Toyoda Nana , Fujisaki Tomohiro , Takagi Hisato , Itagaki Shinobu , Ibrahim Michael , Ouzounian Maral , El‐Hamamsy Ismail , Fukuhara Shinichi 
Published: December 2022

Background
The Ross operation appears to restore normal survival in young and middle‐aged adults with aortic valve disease. However, there are limited data comparing it with conventional aortic valve replacement. Herein, we compared outcomes of the Ross procedure with mechanical and bioprosthetic aortic valve replacement (M‐AVR and B‐AVR, respectively).

Methods and Results

MEDLINE and EMBASE were searched through March 2022 to identify randomized controlled trials and propensity score–matched studies that investigated outcomes of patients aged ≥16 years undergoing the Ross procedure, M‐AVR, or B‐AVR. The systematic literature search identified 2 randomized controlled trials and 8 propensity score–matched studies involving a total of 4812 patients (Ross: n=1991; M‐AVR: n=2019; and B‐AVR: n=802). All‐cause mortality was significantly lower in the Ross procedure group compared with M‐AVR (hazard ratio [HR] [95% CI], 0.58 [0.35–0.97];
P
=0.035) and B‐AVR (HR [95% CI], 0.32 [0.18–0.59];
P
<0.001) groups. The reintervention rate was lower after the Ross procedure and M‐AVR compared with B‐AVR, whereas it was higher after the Ross procedure compared with M‐AVR. Major bleeding rate was lower after the Ross procedure compared with M‐AVR. Long‐term stroke rate was lower following the Ross procedure compared with M‐AVR and B‐AVR. The rate of endocarditis was also lower after the Ross procedure compared with B‐AVR.

Conclusions
Improved long‐term outcomes of the Ross procedure are demonstrated compared with conventional M‐AVR and B‐AVR options. These results highlight a need to enhance the recognition of the Ross procedure and revisit current guidelines on the optimal valve substitute for young and middle‐aged patients.
Shrunken Pore Syndrome: A New and More Powerful Phenotype of Renal Dysfunction Than Chronic Kidney Disease for Predicting Contrast‐Associated Acute Kidney Injury
Authors: Zhang Li‐Wei , Luo Man‐Qing , Xie Xian‐Wei , You Zhe‐Bin , Zeng Ji‐Lang , Lin Mao‐Qing , Chen Li‐Chuan , Lin Kai‐Yang , Guo Yan‐Song 
Published: December 2022

Background
Shrunken pore syndrome (SPS) as a novel phenotype of renal dysfunction is characterized by a difference in renal filtration between cystatin C and creatinine. The manifestation of SPS was defined as a cystatin C–based estimated glomerular filtration rate (eGFR) <60% of the creatinine‐based eGFR. SPS has been shown to be associated with the progression and adverse prognosis of various cardiovascular and renal diseases. However, the predictive value of SPS for contrast‐associated acute kidney injury (CA‐AKI) and long‐term outcomes in patients undergoing percutaneous coronary intervention remains unclear.

Methods and Results

We retrospectively observed 5050 consenting patients from January 2012 to December 2018. Serum cystatin C and creatinine were measured and applied to corresponding 2012 and 2021 Chronic Kidney Disease Epidemiology Collaboration equations, respectively, to calculate the eGFR. Chronic kidney disease (CKD) was defined as a creatinine‐based eGFR <60 mL/min per 1.73 m
2
without dialysis. CA‐AKI was defined as an increase in serum creatinine ≥50% or 0.3 mg/dL within 48 hours after contrast medium exposure. Overall, 649 (12.85%) patients had SPS, and 324 (6.42%) patients developed CA‐AKI. Multivariate logistic regression analysis indicated that SPS was significantly associated with CA‐AKI after adjusting for potential confounding factors (odds ratio [OR], 4.17 [95% CI, 3.17–5.46];
P
<0.001). Receiver operating characteristic analysis indicated that the cystatin C–based eGFR:creatinine‐based eGFR ratio had a better performance and stronger predictive power for CA‐AKI than creatinine‐based eGFR (area under the curve: 0.707 versus 0.562;
P
<0.001). Multivariate logistic analysis revealed that compared with those without CKD and SPS simultaneously, patients with CKD and non‐SPS (OR, 1.70 [95% CI, 1.11–2.55];
P
=0.012), non‐CKD and SPS (OR, 4.02 [95% CI, 2.98–5.39];
P
<0.001), and CKD and SPS (OR, 8.62 [95% CI, 4.67–15.7];
P
<0.001) had an increased risk of CA‐AKI. Patients with both SPS and CKD presented the highest risk of long‐term mortality compared with those without both (hazard ratio, 2.30 [95% CI, 1.38–3.86];
P
=0.002).

Conclusions
SPS is a new and more powerful phenotype of renal dysfunction for predicting CA‐AKI than CKD and will bring new insights for an accurate clinical assessment of the risk of CA‐AKI.
Lexical Glosses in Cambridge, University Library, Kk. 3.18
Authors: Afros Elena 
Published: December 2022

Abstract
Cambridge, University Library, Kk.3.18, the latest extant copy of the Old English Bede, is a remarkably reader-oriented manuscript. Consistently punctuated, rubricated, and furnished with the list of chapter headings, chapter numbers, and continuous running titles, it is easy to read and navigate. Complementing these signposts are lexical interlinear glosses. Many of them are dialectally unmarked variants of Anglian and obsolete/obsolescent vocabulary as well as nonce formations. Another subset consists of the alternatives to the words that were probably familiar to the late Anglo-Saxon audience. These additions enhance the translation similarly to the multiple psalter glosses. The third group corrects copying errors by supplying a reading found in other manuscripts. On the whole, these glosses offer an apparatus that facilitates a better understanding of Bede’s Latin composition and its Old English translation. In addition, they provide invaluable information about the development of the Early English lexicon and the scribes’ active repertoire and linguistic preferences.
Gregorius in Schweden
Authors: Quak Arend 
Published: December 2022

Abstract
The Linköping Legendary contains amongst other texts an Old Swedish translation of the well-known medieval German legend of Gregory on the Stone. This text was translated into Swedish around 1525 in the monastery of Vadstena. In this article the Swedish translation is compared with the Middle High and Middle Low German originals. This comparison makes it highly probable that the translation was based on the 1478 Low German edition of the ‘Der Heiligen Leben’, also known as the ‘Passional’, by Lucas Brandis. Some differences between the Swedish translation and its exemplar can be explained as mistakes in understanding the Low German original.
Gender and Race Demographics of Fellowships After General Surgery Training in the United States: A Five-Year Analysis in Applicant and Resident Trends
Authors: Mueller Lauren , Morenas Rohan , Loe Mallory , Toraih Eman , Turner Jacquelyn 
Published: December 2022

Introduction The gender and minority gap in general surgery residency is narrowing; however, literature lacks comprehensive data regarding the demographics of fellowship programs following general surgery training. Methods Data from 2017 to 2021 for gender, ethnicity, and surgical subspecialty are publicly available from the ERAS database and ACGME yearly data reports. Cochran-Armitage trend tests were used to determine statistical significance in trends for female and minority applicants and trainees. Results The overall trend of female applicants to surgical specialties remained stagnant. However, female applicants to vascular surgery increased significantly from 25% to 35% (P = .045). There was no significant increase in female trainees in any surgical specialties evaluated. Furthermore, the overall trend of minority applicants to surgical specialties also remained stagnant, except for pediatric surgery, which showed significantly fewer minority applicants. Despite pediatric surgery having fewer applicants, minority trainees in this specialty increased significantly from 8% to 19% (P = .008). Conclusion Several current initiatives, such as intentional mentorship, are being reported to promote diverse and equal representation among female and minority applicants and trainees. However, the current overall margin of increase in diversity among surgical specialty applicants and trainees is minimal, indicating that continued efforts are needed to diversify surgical specialty training programs.
Guillotine Transmetatarsal Amputations With Staged Closure Promote Early Ambulation and Limb Salvage in Patients With Advanced Chronic Limb-Threatening Ischemia
Authors: Lepow Brian D. , Zulbaran-Rojas Alejandro , Park Catherine , Chowdhary Saakshi , Najafi Bijan , Chung Jayer , Ross Jeffrey A. , Mills Joseph L. , Montero-Baker Miguel 
Published: December 2022

Purpose: Transmetatarsal amputation (TMA) with primary closure has long been an option for limb salvage in patients with advanced chronic limb-threatening ischemia (CLTI) with extensive tissue loss of the forefoot. However, TMA healing and closure techniques are challenging, specifically in high-risk patients. Guillotine transmetatarsal amputations (gTMA) with staged closure may provide an alternative treatment in this population. We report long-term outcomes of such technique. Materials and Methods: A single-center retrospective cohort study of CLTI patients undergoing gTMA between 2017 and 2020 was performed. Limb salvage, wound healing, and survival rates were quantified using Kaplan-Meier (KM) analysis. Multivariate regression was used to identify the effect of patient characteristics on the outcomes. Results: Forty-four gTMA procedures were reviewed. Median follow-up was 381 (interquartile range [IQR], 212–539.75) days. After gTMA, 87.8% (n=36) of the patients were able to ambulate after a median interval of 2 (IQR, 1–3) days. Eventual coverage was achieved in a personalized and staged approach by using a combination of skin substitutes (88.6%, n=39) ± split thickness skin grafts (STSG, 61.4%, n=27). KM estimates for limb salvage, wound healing, and survival were 84.1%, 54.5%, and 88.6% at 1 year and 81.8%, 63.8%, and 84.1% at 2 years. Wound healing was significantly associated with STSG application (p=0.002, OR=16.5, 95% CI 2.87–94.81). Conclusion: gTMA resulted in high limb salvage rates during long-term follow-up in CLTI patients. Adjunctive STSG placement may enhance wound healing at the gTMA site, thus leading to expedited wound closure. Surgeons may consider gTMA as an alternative to reduce limb loss in CLTI patients at high risk of major amputation. Clinical Impact Currently, the clinical presentation of CLTI is becoming more complex to deal with due to the increasing comorbidities as the society becomes older. The data shown in this article means for clinicians that when facing diffused forefoot gangrene and extensive tissue loss, limb preservation could still be considered instead of major amputation. Guillotine transmetatarsal amputations in the setting of an aggressive multidisciplinary group, can be healed by the responsibly utilization of dermal substitutes and skin grafts leading to the preservation of the extremity, allowing mobility, avoiding of sarcopenia, and decreasing frailty. This will equate to maintenance of independent living and preservation of lifespan.
Increasing Awareness of Complications of Nerve Injury Following Shoulder Surgery: Preventing Delays in Referral and Treatment
Authors: Patterson Brendan M. , Reed Evelyn R. , Hill Elspeth , Buckwalter V Joseph A. , Bozoghlian Maria F. , Mackinnon Susan E. 
Published: December 2022

Background: Nerve injuries remain a challenging complication after shoulder surgery. While most resolve spontaneously, some require surgical intervention. This study describes the characteristics of patients sustaining nerve injuries following shoulder surgery, evaluates referral patterns to nerve surgeons, and characterizes nerve surgeries performed and their outcomes. Increased awareness of these injuries allows patients and providers to be better informed regarding the appropriate management when these complications occur. Methods: A retrospective review of referrals with nerve injuries following shoulder surgery between 2007 and 2015 was performed. The final analysis included 65 patients. Data reviewed included demographics, procedure and anesthesia type, and diagnosis of nerve injury. Time to referral to nerve surgeon and proportional changes in the Disabilities of the Arm, Shoulder, and Hand (DASH) scores were determined. Outcomes were categorized as failed, partially successful, and successful based on final follow-up. Results: Patients were referred following arthroscopic shoulder surgeries (35.4%), shoulder arthroplasties (24.6%), open shoulder procedures (21.5%), and combined open and arthroscopic procedures (18.5%). The mean time to referral was 7.6 months. Nerve injuries involved brachial plexus (33) and individual and multiple peripheral nerve branches (23 and 7, respectively). Twenty-five (38%) nerve injuries demonstrated spontaneous recovery. Thirty-five patients underwent surgical intervention, of which 27 were successful, 3 were partially successful, and 3 failed. Conclusions: This is the largest series of patients with iatrogenic nerve injury following shoulder surgeries to date. Our data demonstrate a lack of timely referral to nerve surgeons, especially after arthroscopy. There continues to be a variable injury pattern even among similar surgeries. Despite this, timely surgical intervention, when indicated, can lead to favorable outcomes.
Therapeutic efficacy and complications of radial versus femoral access in endovascular treatment of unruptured intracranial aneurysms
Authors: Fuga Michiyasu , Tanaka Toshihide , Tachi Rintaro , Tomoto Kyoichi , Okawa Shun , Teshigawara Akihiko , Ishibashi Toshihiro , Hasegawa Yuzuru , Murayama Yuichi 
Published: December 2022

Purpose The transradial approach (TRA) in neuroendovascular treatment is known to have a lower risk of complications than the transfemoral approach (TFA). However, little research has focused on assessments of efficacy and risk of complications in the treatment of intracranial aneurysms. This study aimed to compare the efficacy and complications of TRA and TFA in coil embolization of unruptured intracranial aneurysms (UIAs) at our institution. Methods Consecutive patients who underwent endovascular surgery via TRA or TFA at a single institution from 1 April 2019, to 28 February 2022, were retrospectively analyzed. Patients were classified into TRA and TFA groups and assessed using propensity-adjusted analysis for outcomes including fluoroscopy time, volume embolization ratio (VER), and complications. Results A total of 163 consecutive UIAs were treated with coil embolization during the 35-months study period. The incidence of minor access site complications (ASCs) was significantly higher with TFA (20%, 25/126) than with TRA (2.7%, 1/37; p = 0.01). Propensity-adjusted analysis (matched for age, sex, aneurysm volume, embolization technique, and sheath size) revealed that TRA was associated with a lower risk of minor ASCs (odds ratio, 0.085; 95% confidence interval 0.0094–0.78; p = 0.029). However, TRA did not differ significantly from TFA with respect to fluoroscopy time, VER, major ASCs, and non-ASCs. Conclusions Coil embolization for UIAs via TRA can reduce risk of minor ASCs without increasing the risk of non-ASCs compared with conventional TFA, and can achieve comparable results in term of efficacy and fluoroscopy time.
Reasons for admission to a general medical hospital for patients taking clozapine
Authors: Gee Siobhan , Almeida Vasco , Hughes Adam , McMullen Isabel , Taylor David 
Published: December 2022

Background: Clozapine is associated with a diverse range of side effects. In addition, patients prescribed clozapine commonly suffer with medical comorbidities. Objectives: This study aimed to characterise patients prescribed clozapine who required medical admission, understand reasons for admission, identify areas for interventions to prevent future admission and describe clozapine management during the inpatient stay. Design: We conducted a retrospective analysis of patients prescribed clozapine who were admitted to a general medical hospital in a 12-month period. Method: Data were collected using electronic drug charts and notes. Results: In total, 114 clozapine patients were hospitalised. Twenty-eight patients (25%) were admitted because of infection, 12 (11%) were elective admissions and 12 (11%) had gastrointestinal problems. Most patients admitted were Black (54%) and half were female. Few changes were made to clozapine dosing on admission or during the inpatient stay. Most patients had been taking clozapine for many years at the point of admission, the majority were able to continue taking it for the duration of their medical treatment and were discharged on the same dose they were taking prior to admission. Clozapine plasma concentrations were not consistently measured with only 18 (16%) patients having one or more plasma concentrations determined during their admission. The median clozapine plasma concentration on admission was 0.48 mg/L (nor-clozapine 0.21 mg/L), with a range of 0.09 to 3.9 mg/L. Three patients were admitted to the intensive care unit during their admission; all were discharged on clozapine. Four patients died; one from lung adenocarcinoma, one bowel obstruction, one cardiac arrest and one chest sepsis. In total, 27 patients (23%) had their clozapine stopped on admission, 6 (22% of this group) unintentionally. Conclusions: Our study found that the most common reason for admission for patients taking clozapine was infection. Plasma concentrations were not measured routinely despite clozapine having a narrow therapeutic index and enhanced potential for toxicity in the medically unwell patient.